patho 370 - CYU week 3

Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body. a. False b. True

B Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body.

New-organ damage is a function of both the stage of hypertension and its duration. a. True b. False

B End-organ damage is a function of both the stage of hypertension and its duration.

An elderly patient's blood pressure is measured at 160/98. How would the patient's left ventricular function be affected by this level of blood pressure? a. Left ventricular workload is increased with high afterload. b. High blood pressure enhances left ventricular perfusion during systole. c. This is an expected blood pressure in the elderly and has little effect on left ventricular function. d. High-pressure workload leads to left ventricular atrophy.

A Activation of the sympathetic nervous system increases the heart rate, contractility, blood pressure, and fluid retention by the kidney. Unfortunately, these compensatory efforts impose a greater workload on the heart. A blood pressure of 160/90 mm Hg is a higher than expected blood pressure in an elderly patient. High blood pressure does not enhance ventricular perfusion. Greater workload on the heart may contribute to further ischemic damage.

An example of an acyanotic heart defect is a. ventricular septal defect. b. all right-to-left shunt defects. c. transposition of the great arteries. d. tetralogy of Fallot.

A An example of an acyanotic heart defect is a ventricular septal defect. In this condition, blood from the left ventricle leaks into the right ventricle because of a defect in the ventricular wall. This leakage causes extra pressure in the right ventricle resulting in pulmonary hypertension. Tetralogy of Fallot is a cyanotic congenital defect. Transposition of the great vessels is a cyanotic congenital defect. The category of cyanotic congenital defects refers to those that are right-to-left shunts.

Beta-blockers are advocated in the management of heart failure because they a. reduce cardiac output. b. increase cardiac output. c. reduce blood flow to the kidneys. d. enhance sodium absorption.

A Beta-blockers are advocated in the management of heart failure to inhibit the cardiac effects of sympathetic activation. These drugs are negative inotropes and have the potential to reduce cardiac output. The goal with the use of beta-blockers in heart failure is to reduce cardiac output. Beta-blockers do not affect sodium reabsorption. Angiotensin II and aldosterone enhance sodium and water reabsorption by the kidney, contributing to an elevated blood volume.

Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body. a. True b. False

A Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body.

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock? a. Anaphylactic b. Hypovolemic c. Cardiogenic d. Neurogenic

A Exposure to a specific antigen causes receptors on mast cells and basophils to cross-link and activate histamine. The release of histamine along with other vasoactive chemicals produces bronchoconstriction. Cardiogenic shock is not associated with histamine release. Hypovolemic shock is not associated with histamine release. Histamine release does not occur with neurogenic shock.

First-degree heart block is characterized by a. prolonged PR interval. b. widened QRS complex. c. variable PR interval. d. absent P waves.

A First-degree block is generally identified by a prolonged PR interval (more than 0.20 second) on ECG. P waves are not absent in first-degree heart block. A widened QRS complex is associated with a particular dysrhythmia, but not first-degree heart block. A variable PR interval is found in type I second-degree block.

While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding? a. Increased LDL levels are associated with increased risk of coronary artery disease. b. Elevated LDL levels are an expected finding in the elderly and therefore are not particularly significant. c. Increased LDL levels are indicative of moderate alcohol intake, and patients should be advised to abstain. d. Measures to decrease LDL levels in the elderly would be unlikely to affect the progression of this disease.

A High levels of low-density lipoproteins (LDLs), which are high in cholesterol, have been associated with the highest risk of coronary atherosclerosis. Even when lipid metabolism is normal, a high-fat diet can overwhelm the liver's ability to clear LDL cholesterol from the circulation and result in hyperlipidemia. Dietary fat restriction may be beneficial in reducing cholesterol in this case. Increased LDL levels are not indicative of alcohol intake. Elevated LDL levels are not an expected finding in the elderly and should be treated.

Hypertension is closely linked to a. obstructive sleep apnea. b. de Quervain syndrome. c. spinal stenosis. d. urinary tract infection.

A Hypertension is present in 45% to 60% of those diagnosed with obstructive sleep apnea. Urinary tract infection is not directly linked to hypertension. de Quervain syndrome is a type of tendonitis and is not linked to hypertension. Spinal stenosis is not closely associated with hypertension.

High blood pressure increases the workload of the left ventricle, because it increases a. afterload. b. blood volume. c. stroke volume. d. preload.

A Hypertension reflects an elevation in SVR; rising afterload increases myocardial oxygen demand and overall cardiac workload. The workload of the left ventricle does not increase the stroke volume, blood volume, or preload.

The progressive stage of hypovolemic shock is characterized by a. tachycardia. b. cardiac failure. c. lactic acidosis. d. hypertension.

A In the progressive stage of hypovolemic shock, the patient is anxious and confused, with decreased blood pressure and heart rate greater than 120 beats/minute. In this stage of shock, the blood pressure is decreased. Lactic acidosis does not occur in the progressive stage of hypovolemic shock. Cardiac failure is not likely to occur in the earlier stages of hemorrhagic shock.

A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock. a. septic b. cardiogenic c. hypovolemic d. obstructive

A In the progressive stage of septic shock, some patients deteriorate to a hypodynamic state. This is characterized by decreased cardiac output and cold, clammy skin as a result of narrowed pulse pressure. Profound hypotension generally occurs which is unresponsive to treatment. Cardiogenic shock is evidenced by decreased cardiac output, elevated left ventricular end-diastolic pressure, S 3 heart sounds, and pulmonary edema. Hypotension occurs with hypovolemic shock, but extremities are not likely to be cold and edematous. Cold edematous extremities along with low cardiac output and profound hypotension are not manifestations of obstructive shock.

The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is a. ST-segment elevation. b. severe, crushing chest pain. c. dysrhythmias. d. pain radiating to the lower legs.

A Injuries to cardiac tissue caused by myocardial ischemia and infarction are indicated on the ECG by ST-segment changes. ST-segment elevation on the ECG indicates that ischemic injury is ongoing and that efforts to improve perfusion or reduce oxygen demand may be effective in preserving myocardial muscle. In some instances, an MI is entirely asymptomatic. Dysrhythmias that accompany MI are attributed to injured and ischemic cells that have not yet become necrotic. Pain radiating to the jaw and neck, not the lower legs, is symptomatic of an MI.

Mitral stenosis is associated with a. a pressure gradient across the mitral valve. b. a muffled second heart sound (S2). c. a prominent S4 heart sound. d. left ventricular hypertrophy.

A Mitral stenosis is characterized by an abnormal left atrial-left ventricular pressure gradient during ventricular diastole. Mitral stenosis is not associated with an S 4 heart sound. Mitral stenosis is associated with left atrial hypertrophy, not left ventricular hypertrophy. Mitral stenosis does not have a symptom of a muffled second heart sound.

The effect of nitric oxide on systemic arterioles is a. vasodilation. b. opposed by nitrate drugs. c. not significant. d. vasoconstriction

A Nitric oxide causes vasodilation in the systemic arterioles. Vasoconstriction is not associated with nitric oxide. There is a significant effect on the systemic arterioles related to nitric oxide. The effects of nitric oxide are not known to be opposed by nitrate drugs.

Improvement in a patient with septic shock is indicated by an increase in a. systemic vascular resistance. b. serum lactate level. c. cardiac output. d. SvO2.

A Systemic vascular resistance results in intravascular pooling in the venous system. Some portions of tissue are overperfused, and some are underperfused. Improvement in systemic vascular resistance is an indication of improvement in septic shock. In septic shock, the heart rate and stroke volume increase, and cardiac output is higher than normal. In septic shock, SvO 2 levels may already be higher than normal. An increase in serum lactate levels may increase levels of acidosis and tissue hypoxia.

A loud pansystolic murmur that radiates to the axilla is most likely a result of a. mitral regurgitation. b. aortic regurgitation. c. mitral stenosis. d. aortic stenosis.

A The murmur of mitral regurgitation usually occurs throughout ventricular systole (pansystolic), radiates toward the left axilla, and has a high-pitched blowing character. Aortic insufficiency is characterized by a high-pitched blowing murmur during ventricular diastole. A characteristic murmur of aortic stenosis occurs during ventricular systole and varies in intensity, progressively getting louder and then diminishing (crescendo-decrescendo). The murmur of aortic stenosis generally radiates to the neck. Blood rushing through the narrowed mitral valve during ventricular diastole can sometimes be heard as a low-pitched, rumbling diastolic murmur at the heart's apex.

Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock? a. Septic b. Anaphylactic c. Hypovolemic d. Cardiogenic

A The overproduction of nitric oxide is seen in septic shock as a result of the release of immune cytokines. Nitric oxide is not seen in cardiogenic shock. Hypovolemic shock is not associated with the overproduction of nitric acid. The pathophysiologic process of anaphylactic shock is not associated with the overproduction of nitric oxide.

After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later. The patient reports "moderate" adherence to the recommended lifestyle changes and has experienced a decreased from 165/96 to 148/90 mm Hg in blood pressure. What is the most appropriate intervention for this patient at this time? a. Continue lifestyle modifications only. b. Continue lifestyle modifications plus b-blocker therapy. c. Continue lifestyle modifications plus diuretic therapy. d. Continue lifestyle modifications plus ACE inhibitor therapy.

A The patient should be encouraged to continue compliance with lifestyle changes since the patient has exhibited some positive response to his changes. Diuretics are not needed at this time. ACE inhibitors should not be added to the therapy yet. β-blockers are not required at this time.

A patient who was involved in a fall from a tree becomes short of breath. The lung sounds are absent on one side. This patient is experiencing ________ shock. a. obstructive b. cardiogenic c. distributive d. hypovolemic

A This type of obstructive shock is the result of a tension pneumothorax and is caused by shifting and compression of mediastinal structures including the heart, which compromise left ventricular filling. Accumulation of air in the pleural space may occur because of trauma. Prompt relief of the obstructive event is necessary to restore cardiac output and prevent cardiovascular collapse. Cardiogenic shock is not related to a traumatic event. Hypovolemic shock results when circulating blood volume is inadequate to perfuse tissues. Distributive shock is characterized by an abnormally expanded vascular space caused by excessive vasodilation.

A patient with a history of myocardial infarction continues to complain of intermittent chest pain brought on by exertion and relieved by rest. The likely cause of this pain is a. stable angina. b. myocardial infarction. c. unstable angina. d. coronary vasospasm.

A Stable angina is the most common form of chest pain and is characterized by pain that is caused under conditions of increased myocardial workload, such as physical exertion or emotional strain. Pain related to myocardial infarction is not relieved by rest. Coronary vasospasm is characterized by unpredictable attacks of angina pain. A patient with unstable angina presents with symptoms similar to myocardial infarction.

Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of a. congestive heart failure (CHF). b. cardiac tamponade. c. cardiomyopathy. d. myocardial infarction.

B The three classic symptoms of cardiac tamponade are hypotension, distended neck veins, and muffled heart sounds. There are many other manifestations as well. Myocardial infarction is not exhibited by the symptoms described. Classic symptoms of cardiac tamponade are hypotension, distended neck veins, and muffled heart sounds. Symptoms of CHF may include jugular venous distention. Cardiomyopathy is not exhibited by the symptoms described.

A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic. a. True b. False

B A type of shock that includes brain trauma that results in depression of the vasomotor center is neurogenic shock.

An example of an acyanotic heart defect is a. transposition of the great arteries. b. ventricular septal defect. c. tetralogy of Fallot. d. all right-to-left shunt defects.

B An example of an acyanotic heart defect is a ventricular septal defect. In this condition, blood from the left ventricle leaks into the right ventricle because of a defect in the ventricular wall. This leakage causes extra pressure in the right ventricle resulting in pulmonary hypertension. Tetralogy of Fallot is a cyanotic congenital defect. Transposition of the great vessels is a cyanotic congenital defect. The category of cyanotic congenital defects refers to those that are right-to-left shunts.

A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient's blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time? a. Begin lifestyle modifications. b. Begin antihypertensive drug therapy. c. Encourage smoking cessation. d. Recheck blood pressure in 4 to 6 weeks.

B Antihypertensive drug therapy is not the first intervention in a person with modifiable risk factors. Therefore, lifestyle alterations are attempted first. Lifestyle alterations include exercise, smoking cessation, and weight loss. Blood pressure should be rechecked in 4 to 6 weeks. Smoking cessation counseling is an appropriate lifestyle alteration.

Aortic regurgitation is associated with a. elevated left ventricular/aortic systolic pressure gradient. b. diastolic murmur. c. elevated systemic diastolic blood pressure. d. shortened ventricular ejection phase.

B Aortic regurgitation results from an incompetent aortic valve that allows blood to leak back from the aorta into the left ventricle during diastole. In aortic regurgitation, there is not an elevated left ventricular/aortic pressure gradient. Diastolic blood pressure is generally lower because of rapid runoff of blood into the ventricle. Aortic regurgitation is associated with a longer ventricular ejection phase.

Chronic elevation of myocardial wall tension results in atrophy. a. True b. False

B Chronic elevation of myocardial wall tension results in hypertrophy.

The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is a. afterload reduction. b. digitalis. c. β-antagonist agents. d. preload reduction.

B Digitalis may be used for symptom management of heart failure. Cardiac glycosides directly inhibit the sodium-potassium pump present in the cell membrane of all cells. The intracellular changes allow more calcium to remain in the cell, thus strengthening myocardial contraction. Contractility is not improved through afterload reduction. Beta-blockers inhibit the effects of sympathetic activation and have the potential to reduce cardiac output. Preload reduction is not the therapy of choice in improving cardiac contractility.

A laboratory test that should be routinely monitored in patients receiving digitalis therapy is a. serum calcium. b. serum potassium. c. albumin level. d. serum sodium.

B Digitalis slows the heart rate through parasympathetic system activation and promotes sodium and water excretion through improved cardiac output to the kidney. Depletion of serum potassium (hypokalemia) may potentiate digitalis toxicity. Sodium and water excretion is activated through the parasympathetic system because of improved cardiac output to the kidneys. Albumin level is not affected by digitalis. Digitalis allows more calcium to remain in the cell through a slowing of the sodium-dependent calcium pump.

The majority of cardiac cells that die after myocardial infarction do so because of a. thrombus. b. apoptosis. c. insufficient glucose. d. cell rupture.

B MI results when prolonged or total disruption of blood flow to the myocardium causes cellular death by necrosis or apoptosis. Cardiac cells do not die as a result of cellular rupture. Insufficient glucose is not associated with myocardial death. The initiating event of MI is believed to be related to thrombus, but the resulting disruption of flow to the myocardium is because of necrosis or apoptosis.

Cor pulmonale refers to a. right ventricular failure secondary to right ventricular infarction. b. right ventricular hypertrophy secondary to pulmonary hypertension. c. biventricular failure. d. left ventricular hypertrophy secondary to lung disease.

B Pulmonary disorders that result in increased pulmonary vascular resistance impose a high afterload on the right ventricle. The resultant right ventricular hypertrophy known as cor pulmonale may progress to right ventricular failure as the lung disease worsens. Biventricular failure is most often the result of primary left ventricular failure that progresses to the right. Cor pulmonale is not associated with left ventricular hypertrophy. Only 3% of MIs occur in the right ventricle.

After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence of a.peripheral vascular disease. b.right-sided heart failure. c.isolated left-sided heart failure. d.arterial obstruction

B The backward effects of right-sided heart failure are as a result of congestion in the systemic venous system and lead to lower extremity edema. Arterial obstruction is not associated with dependent edema of the lower extremities. Left-sided heart failure is associated with pulmonary symptoms. Edema may be associated with peripheral vascular disease, but dependent edema over a 1-hour period is related to right-sided heart failure.

Restriction of which electrolytes is recommended in the management of high blood pressure? a. Potassium b. Sodium c. Magnesium d. Calcium

B The balance of the intake of water and sodium with their excretion by the kidney remains the central feature of long-term blood pressure maintenance. Sodium is not rapidly eliminated by the kidney like water and adds to the body's fluid volume. It is not necessary to restrict the intake of calcium when managing high blood pressure. Potassium does not need to be restricted in the management of high blood pressure. Magnesium does not play a role in the management of high blood pressure.

Second-degree heart block type I (Wenckebach) is characterized by a. no correlation between P waves and QRS complexes. b. lengthening PR intervals and dropped P wave. c. absent P waves. d. constant PR interval and dropped QRS complexes.

B Type I second-degree block is associated with progressively lengthening PR intervals until one P wave is not conducted and becomes a dropped beat. Second-degree block is not characterized by an absence of P waves. Type II second-degree block is associated with a consistent PR interval and dropped beats. The ECG of third-degree block shows regularly occurring P waves that are independent of the ventricular rhythm.

Patent ductus arteriosus is accurately described as a(n) a. stricture of the aorta that impedes blood flow. b. opening between the atria. c. communication between the aorta and the pulmonary artery. d. cyanotic heart defect associated with right-to-left shunt.

C A patent ductus arteriosus is a normal channel between the pulmonary artery and the aorta that remains open during intrauterine life. A patent ductus arteriosus is not an opening or a stricture in the atria. Patent ductus arteriosus is an acyanotic congenital defect.

What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume? a. Hypotension b. Bradycardia c. Tachycardia d. Aortic regurgitation

C An individual with reduced stroke volume would exhibit compensatory increases in heart rate. Hypertension is associated with decreased ventricular stroke volume. An individual with reduced stroke volume would exhibit compensatory increases in heart rate; therefore, bradycardia would not be expected. Aortic regurgitation would not be an expected compensatory sign of limited stroke volume.

Cardiogenic shock is characterized by a. hypovolemia. b. elevated SvO2. c. reduced cardiac output. d. reduced systemic vascular resistance

C Cardiogenic shock occurs primarily as a result of severe dysfunction of the left or right ventricles, or both, that results in inadequate cardiac pumping. The low cardiac output state is associated with a high left ventricular diastolic filling pressure. Cardiogenic shock is not manifested by hypovolemia. Sympathetic activation leads to increases in heart rate, vasoconstriction, and a narrow pulse pressure. Low cardiac output leads to reduced SvO 2.

Constrictive pericarditis is associated with a. cardiac hypertrophy. b. increased cardiac preload. c. impaired cardiac filling. d. elevated myocardial oxygen consumption

C Constrictive pericarditis results in a fibrous scarred pericardium that restricts cardiac filling. Chronic pericarditis may be the result of a previous cardiac surgery. Pericarditis is associated with increased workload of the heart because contraction is opposed by the surrounding structures. The constrictive process includes symptoms of exercise intolerance, weakness, and fatigue.

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria? a. 118/78 b. 140/88 c. 128/82 d. 138/94

C In adults, a normal blood pressure is <120 mm Hg systolic and <80 mm Hg diastolic pressure. Stage 1 hypertension begins with a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg. Between these values, the individual is said to have prehypertension, and interventions related to lifestyle changes should be initiated for primary hypertension. 118/78 is considered normal. An individual with a reading of 140/88 or 138/94 may be considered to have stage 1 hypertension.

Pulse pressure is defined as a. two thirds of systolic pressure + diastolic pressure. b. systolic pressure + diastolic pressure. c. systolic pressure - diastolic pressure. d. systolic pressure × systemic resistance.

C Pulse pressure is defined as the difference between systolic and diastolic blood pressure. Pulse pressure is the difference between systolic and diastolic pressure. Pulse pressure is not the sum of the systolic and diastolic pressures. Systemic resistance is not involved in determining the pulse pressure.

The majority of tachydysrhythmias are believed to occur because of a. triggered activity. b. defective gap junctions. c. reentry mechanisms. d. enhanced automaticity.

C Reentry is thought to be the culprit in most tachydysrhythmias. Reentry is a complex process in which a cardiac impulse continues to depolarize in a part of the heart after the main impulse has finished its path. Triggered activity occurs when an impulse is generated during or just after repolarization. Alterations in automaticity create electrolyte imbalances. Defective gap junctions are not related to tachydysrhythmias.

Sepsis has been recently redefined as a. a systemic infection with viable organisms in the bloodstream. b. a systemic inflammatory response to ischemia. c. a systemic inflammatory response to infection. d. severe hypotension in an infected patient.

C Systemic inflammatory response syndrome is the body's response to infection or other insults, which result in systemic signs and symptoms of widespread inflammation. Sepsis results from the presence of microorganisms in the bloodstream (bacteremia). Sepsis occurs as a result of bacteremia and is defined as a systemic inflammatory response to infection. Severe hypotension may be the result of sepsis, but it is not the definition.

An abnormally wide (more than 0.10 second) QRS complex is characteristic of a. supraventricular tachycardia. b. paroxysmal atrial tachycardia. c. premature ventricular complexes. d. junctional escape rhythm.

C The QRS of the premature complex is prolonged (greater than 0.10 second) and bizarre in appearance. Paroxysmal atrial tachycardia does not display a QRS complex that is greater than 0.10 seconds. Supraventricular tachycardia does not display a wide QRS complex. Escape rhythms may have a P wave that is inverted and located before, during, or after the QRS.

The common denominator in all forms of heart failure is a. poor diastolic filling. b. tissue ischemia. c. reduced cardiac output. d. pulmonary edema.

C The common manifestation of all forms of heart failure is the failure of the heart to pump blood adequately. The clinical presentation may differ depending on which ventricle fails (left or right, or both). Poor diastolic filling is not seen in all forms of heart failure. Pulmonary edema is seen in left-sided failure. Tissue ischemia is directly related to myocardial infarction, which may induce heart failure.

A patient who reports dizziness and who has absent P waves, wide QRS complexes, and a heart rate of 38 beats/minute on an ECG is most likely in which rhythm? a. Junctional tachycardia b. Third-degree heart block c. Sinus bradycardia d. Ventricular escape rhythm

D A ventricular escape rhythm originates in the Purkinje fibers, has a rate of 15 to 40 beats/minute, and is characterized by a wide QRS complex. An important clue to identifying escape rhythms is the absence of normal P waves and PR intervals. The rhythm involved in third-degree heart block includes regularly occurring P waves. Junctional tachycardia has a heart rate between 70 and 140 beats/minute. P waves are preceding, following, or buried in the QRS complex. Sinus bradycardia has a normal pattern on the ECG, but with a rate of less than 60 beats/minute.

Myocarditis should be suspected in a patient who presents with a. murmur and abnormal valves on echocardiogram. b. family history of cardiomyopathy. c. chest pain and ST elevation. d. acute onset of left ventricular dysfunction.

D Acute myocarditis is commonly characterized by left ventricular dysfunction or general dilation of all four heart chambers. Chest pain and ST elevation is indicative of myocardial infarction. Myocarditis is associated with viral infections. Dilated cardiomyopathy runs in families and has a genetic basis.

An erroneously low blood pressure measurement may be caused by a. measuring blood pressure after exercise. b. using a cuff that is too small. c. positioning the arm at heart level. d. positioning the arm above the heart level.

D An erroneous blood pressure result could occur with the arm above the level of the heart. It is important to measure blood pressure with the appropriate size cuff. The arm should be positioned at the level of the heart for a more accurate reading. Measuring pressure after exercise yields a higher measurement.

The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with a. animal proteins or dander. b. incompatible blood products. c. perfumes. d. antibiotics.

D Anaphylactic shock is most frequently associated with antibiotic therapy. Contact with perfumes is not the most frequent cause of anaphylactic shock. Incompatible blood products do not lead to anaphylactic shock. Animal dander may lead to an anaphylactic reaction, but does so less commonly than antibiotics.

Angiotensin-converting enzyme (ACE) inhibitors block the a. conversion of angiotensinogen to angiotensin I. b. effect of aldosterone on the kidney. c. release of rennin. d. conversion of angiotensin I to angiotensin II.

D Angiotensin I is converted into angiotensin II while it is circulating through the pulmonary vessels, by the angiotensin-converting enzyme. ACE inhibitors block the conversion of angiotension I to angiotension II. Renin plays a role in the regulation of arterial blood pressure. ACE inhibitors do not block the conversion of angiotensinogen to angiotensin or the effect of aldosterone on the kidney.

Aortic regurgitation is associated with a. elevated left ventricular/aortic systolic pressure gradient. b. elevated systemic diastolic blood pressure. c. shortened ventricular ejection phase. d. diastolic murmur

D Aortic regurgitation results from an incompetent aortic valve that allows blood to leak back from the aorta into the left ventricle during diastole. In aortic regurgitation, there is not an elevated left ventricular/aortic pressure gradient. Diastolic blood pressure is generally lower because of rapid runoff of blood into the ventricle. Aortic regurgitation is associated with a longer ventricular ejection phase.

In which dysrhythmias should treatment be instituted immediately? a. Fever-induced tachycardia at 122 beats/minute b. Premature atrial complexes occurring every 20 seconds c. Asymptomatic sinus bradycardia at a heart rate of 50 beats/minute d. Atrial fibrillation with a ventricular rate of 220 beats/minute

D Atrial fibrillation is a completely disorganized and irregular atrial rhythm accompanied by an irregular ventricular rhythm of variable rate. Atrial fibrillation causes the atria to quiver rather than to contract forcefully. This allows blood to become stagnant in the atria and may lead to formation of thrombi. This condition requires resuscitation because of the reduction in cardiac output. The cause of the bradycardia should be investigated, but is not treated emergently when an individual is not exhibiting any symptoms. Fever-induced tachycardia will correct itself once the fever is lowered. Dysrhythmias are treated if they produce significant symptoms or are expected to progress to a more serious level.

Administration of which therapy is most appropriate for hypovolemic shock? a. 5% dextrose in water b. Vasoconstrictor agents c. Inotropic agents d. Crystalloids

D Crystalloids are solutions that contain electrolytes. Isotonic solutions, such as lactated Ringers, are commonly used crystalloid solutions. These solutions are preferred for volume resuscitation, because they remain in the extracellular space and are more effective in increasing blood volume. Vasoconstrictor agents are contraindicated in hypovolemic shock. Isotonic crystalloids are the most appropriate fluid for volume resuscitation. Isotonic fluids are preferred over glucose or hypotonic electrolyte solutions

A patient with heart failure who reports intermittent shortness of breath during the night is experiencing a. orthopnea. b. sleep apnea. c. paroxysmal atrial tachycardia. d. paroxysmal nocturnal dyspnea.

D Dyspnea that occurs at night is known as paroxysmal nocturnal dyspnea. Orthopnea is known as dyspnea when lying down. Intermittent shortness of breath at night is not known as paroxysmal atrial tachycardia. Sleep apnea is an absence of breathing during sleep.

A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to a. deep vein thrombosis. b. hypertension. c. angina. d. hypotension.

D Hypotension is low blood pressure characterized by dizziness, blurred vision, syncope, and injury from falls. Hypertension is high blood pressure characterized by headache, confusion, chest pain, and difficulty breathing. Deep vein thrombosis is evidenced by calf pain or tenderness. Angina is characterized by chest, shoulder, or jaw pain.

In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with a. low cardiac output. b. reduced contractility. c. high afterload. d. high cardiac output.

D In the hyperdynamic stage of septic shock, blood pressure falls because of the decreased systemic vascular resistance and decreased venous return. The heart rate and stroke volume increase and cardiac output is higher than normal. In the hyperdynamic phase of septic shock, afterload is not high. Cardiac output is high in the hyperdynamic stage of septic shock. The heart rate and stroke volume increase during the hyperdynamic stage of septic shock.

A patient with significant aortic stenosis is likely to experience a. peripheral edema. b. increased pulse pressure. c. hypertension. d. syncope

D In the patient with aortic stenosis, syncope and "greying out" episodes may occur when cerebral perfusion is inadequate. Low systolic blood pressure is a common sign of aortic stenosis. Faint pulses are a common sign of aortic stenosis. Peripheral edema is not associated with aortic stenosis.

Lusitropic impairment refers to a. altered automaticity. b. poor contractile force. c. altered action potential conduction rate. d. impaired diastolic relaxation.

D Lusitropic impairment refers to an energy-requiring process that removes free calcium ions from the cytoplasm by pumping them back into the sarcoplasmic reticulum and across the cell membrane into the extracellular fluid. Ischemia interferes with this process in the active phase of diastolic relaxation. Poor contractile force is not associated with lusitropic impairment. The conduction rate is not associated with the energy-requiring process known as lusitropy. Automaticity is not a factor in lusitropy.

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock? a. Anaphylactic b. Neurogenic c. Cardiogenic d. Septic

D Patients presenting with septic shock may have fever and hypotension. In addition, lactic acidosis may be present because of tissue hypoxemia. Presentation of cardiogenic shock is not inclusive of fever or lactic acidosis. Patients in anaphylactic shock do not have fever or lactic acidosis, and may have normal vital signs initially. Neurogenic shock may result from depression of the vasomotor center in the medulla.

Primary treatment for myocardial infarction (MI) is directed at a. activating the parasympathetic system. b. protecting the heart from further ischemia. c. reducing heart rate and blood pressure. d. decreasing myocardial oxygen demands.

D Reducing oxygen demand may be effective in preserving myocardial muscle. Decreasing demand increases myocardial oxygen supply. Once the cardiac muscle has been damaged, it is more important to preserve remaining muscle and prevent further loss of the myocardium. Reduction in the heart rate and blood pressure is not the primary treatment goal in MI care. Parasympathetic activation is not the primary treatment for myocardial infarction.

Which dysrhythmia is thought to be associated with reentrant mechanisms? a. Second-degree AV block b. Junctional escape c. Sinus bradycardia d. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

D Reentry is a complex process in which a cardiac impulse continues to depolarize in a part of the heart after the main impulse has finished its path and the majority of the fibers have repolarized. Wolff-Parkinson-White syndrome is caused by accessory pathways that originate in the atria, bypass the AV node, and enter a site in the ventricular myocardium. This causes the ventricles to contract prematurely, resulting in a reentrant tachycardia. Second-degree block is a conduction failure between the sinus impulse and its ventricular response. Sinus bradycardia is a slowed impulse generation by the sinus node. A junctional escape rhythm originates in the AV node.

Which finding is indicative of orthostatic hypotension in a person with a supine blood pressure (BP) of 110/70 and a heart rate (HR) of 100? a. Sitting BP 120/80, HR 100 b. Sitting BP 108/68, HR 102 c. Sitting BP 110/78, HR 98 d. Sitting BP 88/60, HR 118

D The definition of orthostatic hypotension is a decrease in systolic blood pressure greater than 20 mm Hg or a decrease in systolic pressure that is greater than 10 mm Hg within 3 minutes of moving to an upright position. The measurements of BP 108/68, HR 102 and BP 110/78, HR 98 are not indicative of orthostatic hypotension. An increase in blood pressure do not occur with orthostatic hypotension.