Quiz 3

This patient lost due trauma 30% to 40% of the blood. This represents which class of severity of blood loss?

Class III (30% to 40%)

Atherosclerosis puts a patient at risk for which of the following problems? (Select all that apply.)

Ischemic stroke Retinal injury Renal impairment

Which factors are considered intrinsic factors in blood pressure readings? (Select all that apply.)

Neural, hormonal regulation, external environmental factors , lifestyle, cognitive activity, and emotional state can affect BP

Restriction of which electrolytes is recommended in the management of high blood pressure?

Sodium

High blood pressure increases the risk of which conditions? (Select all that apply.)

Stroke Renal disease Ischemic heart disease

The Progressive stage of shock is marked by _________________

Tachycardia

What results when systemic blood pressure is increased?

Vasoconstriction

Mitral stenosis is associated with

a pressure gradient across the mitral valve.

Myocarditis should be suspected in a patient who presents with

acute onset of left ventricular dysfunction

High blood pressure increases the workload of the left ventricle because it increases

afterload.

Angiotensin-converting enzyme (ACE) inhibitors block the

conversion of angiotensin I to angiotensin II.

Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure.

mean arterial

A loud pansystolic murmur that radiates to the axilla is most likely a result of

mitral regurgitation.

Which is true about Premature ventricular complexes (PVCs)?

-Arise from the ventricular myocardium -Do not activate the atria or depolarize the sinus node. -Bizarre QRS ,Compensatory pause is common. -Bigeminy (every other beat) or trigeminy (every third beat) -With high frequency, CO may be compromised.

Which is true about Sinus Arrhythmia?

-Associated with fluctuations in autonomic influences and respiratory dynamics -May be particularly pronounced in children -Must be differentiated from sick sinus syndrome May need a pacemaker -Sinus arrhythmia is normal and needs no treatment.

The nurse understands that which is the correct description of a Korotkoff sound?

-Auscultation of Korotkoff sounds Systolic pressure: onset of Korotkoff sounds -Diastolic pressure: disappearance of Korotkoff sounds -Murmuring or swishing sounds

Left-Sided Heart Failure is most often associated with all of the following, except;

-Backward effects, which result in accumulation of blood within the pulmonary circulation, pulmonary congestion, and edema high left-atrial pressure, cyanosis -Forward effects, which result in insufficient CO with diminished delivery of oxygen and nutrients to peripheral tissues and organs

Regarding the Diastolic Dysfunction in heart failure, which is incorrect?

-Coronary artery disease and hypertension are two main causes. -More likely to develop in elderly, in women, and in those without history of MI -Disorder of myocardial relaxation such that the ventricle is excessively noncompliant and does not fill effectively -Low cardiac output, congestion, and edema formation with normal ejection fraction

Which is correct about the diagnostic features of Cardiogenic shock?

-Decreased CO -Elevated left ventricular end-diastolic pressure (preload) -S3 heart sounds -Pulmonary edema

The following are the major causes of abnormal automaticity Dysrhythmias:

-Failure to repolarize to normal resting membrane potential -Plasma membrane leakiness to sodium or calcium ions at rest -Hypokalemia

In regards to assessment and hemodynamic Monitoring which one is correct?

-Helpful for assessing CO, volume status, and oxygen delivery and consumption -Right atrial pressure, pulmonary artery pressure, and left atrial pressure monitored -Used to guide management of cardiac preload, afterload, and contractility to optimize CO and minimize workload

Which is true about the Pathogenesis of Shock?

-Imbalance between oxygen supply and oxygen requirements at the cellular level -Shock represents a diverse group of life-threatening conditions. -Common factor among all types of shock is hypoperfusion and impaired cellular oxygen utilization. -inadequate cellular oxygenation may result from decreased cardiac output. maldistribution of blood flow. reduced blood oxygen content.

Blood pressure is regulated on a short-term basis through which measures? (Select all that apply.)

-Interaction of carotid and aortic baroreceptors. -Vasomotor center in the brainstem. -Activation of SNS. -Inhibition of PSNS.

Which is true about Hypertensive emergency?

-Malignant hypertension (old term) -Hypertensive emergency: sudden increase in either or both systolic or diastolic blood pressure with evidence of end-organ damage -Rapid but controlled reduction of blood pressure using parenteral antihypertensive agents under close monitoring (typically in ICU setting)

What is true about Obstructive Shock?

-Manifests as right-sided heart failure -Results from mechanical obstructions that prevent effective cardiac filling and stroke volume -Common causes include pulmonary embolism, cardiac tamponade, and tension pneumothorax. -Rapid management of underlying obstruction is required to prevent cardiovascular collapse.

Which is true about Premature atrial complexes (PACs)?

-Originate in the atria but not the SA node -PACs occur earlier than normal, preceded by a P wave, and have a normal QRS complex configuration. -Frequent PACs may indicate underlying pathophysiologic process and be precursors to more serious dysrhythmias. -Paroxysmal focal atrial tachycardia: burst of atrial complexes resembling several PACs in a row

The following are the causes of lack of oxygen due to shock:

-Production of lactate -Failure of ion pumps leads to sodium and water accumulation in the cell (hydropic swelling). -Formation of oxygen radicals Induction of inflammatory cytokines

Which is true about Myocardial Hypertrophy and Remodeling?

-Results from a chronic elevation of myocardial wall tension (law of Laplace) -High systolic pressure in the ventricle needed to overcome a high afterload leading to hypertrophy -Neurohormonal factors have hypertrophic effect on the heart. -Angiotensin II involved in remodeling

Which is true about Neurogenic Shock?

-Results from loss of sympathetic activation of arteriolar smooth muscle -Causes include medullary depression (brain injury, drug overdose) or lesions of sympathetic nerve fibers (spinal cord injury) -Treatment includes vasopressors, fluids, elevation of the legs, slow position changes, and the use of pressure stockings on the legs.

Which is true about septic shock?

-Results from severe systemic inflammatory response to infection -Characterized by release of immune mediators resulting in widespread inflammation -Clotting cascade, complement system, and kinin system are activated -Even though CO is high, cellular hypoxia is present. -Reduced cellular oxygen utilization is manifested as high SvO2.

Which lifestyle modification has the greatest potential impact on lowering blood pressure?

-Weight loss -Exercise -DASH diet -Alcohol moderation -Decreased sodium intake

Which is true about Multiple Organ Dysfunction Syndrome (MODS)?

-When 2 or more systems are affected -Most common causes of secondary MODS: sepsis and septic shock -Initiated by immune mechanisms that are overactive and destructive -Cytokines affect endothelium, recruit neutrophils, and activate inflammation in vascular beds leading to tissue destruction and organ dysfunction.

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 lb. 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?

Begin antihypertensive drug therapy.

Which serum biomarker(s) are indicative of irreversible damage to myocardial cells?

Elevated CK-MB, troponin I, and troponin T

A patient presents to the emergency department with a diastolic blood pressure of 132 mm Hg, retinopathy, and symptoms of an ischemic stroke. This symptomology is likely the result of

hypertensive crisis.

The most common cause of heart failure is__________

myocardial ischemia and hypertension

The prevalence of high blood pressure is higher in

non-Hispanic black adults.

Hypertension is closely linked to

obstructive sleep apnea.

Hypertension with a specific, identifiable cause is known as _____ hypertension.

secondary

A patient with significant aortic stenosis is likely to experience

syncope