quiz 3 patho
Tachycardia is an early sign of low cardiac output that occurs because of
baroreceptor activity.
A laboratory test that should be routinely monitored in patients receiving digitalis therapy is a. serum sodium. b. albumin level. c. serum potassium. d. serum calcium.
c
An abnormally wide (more than 0.10 second) QRS complex is characteristic of a. paroxysmal atrial tachycardia. b. supraventricular tachycardia. c. junctional escape rhythm. d. premature ventricular complexes.
d
Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of
nitric oxide.
An erroneously low blood pressure measurement may be caused by
positioning the arm above the heart level.
What is the patient's recorded blood pressure from 3 weeks ago?
162/96 mm Hg.
Hypertension with a specific, identifiable cause is known as _____ hypertension.
2ndary
What is the heart rate in asymptomatic sinus bradycardia?
50 beats/minute.
How much overweight is the patient?
About 40 lbs.
What is sleep apnea?
Absence of breathing during sleep.
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?
Continue lifestyle modifications only.
What do ACE inhibitors block?
Conversion of angiotensin I to angiotensin II.
What happens to fever-induced tachycardia once the fever is lowered?
Corrects itself.
Administration of which therapy is most appropriate for hypovolemic shock?
Crystalloids
What is the patient's diet like?
High-fat, high-calorie.
What is orthostatic hypertension?
Positional changes that do not generally result in hypertension.
Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock? a. Anaphylactic b. Cardiogenic c. Hypovolemic d. Neurogenic
a
Myocarditis should be suspected in a patient who presents with a. acute onset of left ventricular dysfunction. b. chest pain and ST elevation. c. family history of cardiomyopathy. d. murmur and abnormal valves on echocardiogram.
a
mprovement in a patient with septic shock is indicated by an increase in a. SvO2. b. systemic vascular resistance. c. serum lactate level. d. cardiac output. 0.125 points
b
What is the cause of hypotension in neurogenic shock?
Depression of the vasomotor center in the medulla.
What is paroxysmal nocturnal dyspnea?
Dyspnea that occurs at night.
What is primary hypertension?
Hypertension without a clearly identifiable cause.
Is norepinephrine released from juxtaglomerular cells?
No.
What medications does the patient take?
None.
What is the role of second-degree AV block in dysrhythmias?
Not associated with reentrant mechanisms.
What is the role of sinus bradycardia in dysrhythmias?
Not associated with reentrant mechanisms.
Cor pulmonale refers to
right ventricular failure secondary to right ventricular infarction.
What is the treatment for variant angina?
Vasodilating agents.
Primary treatment for myocardial infarction (MI) is directed at a. decreasing myocardial oxygen demands. b. activating the parasympathetic system. c. protecting the heart from further ischemia. d. reducing heart rate and blood pressure
a
The progressive stage of hypovolemic shock is characterized by a. tachycardia. b. hypertension. c. cardiac failure. d. lactic acidosis.
a
Beta-blockers are advocated in the management of heart failure because they a. reduce blood flow to the kidneys. b. reduce cardiac output. c. increase cardiac output. d. enhance sodium absorption.
b
Hypertrophy of the right ventricle is a compensatory response to a. aortic stenosis. b. pulmonary stenosis. c. aortic regurgitation. d. tricuspid stenosis.
b
In which dysrhythmias should treatment be instituted immediately? a. Premature atrial complexes occurring every 20 seconds b. Atrial fibrillation with a ventricular rate of 220 beats/minute c. Asymptomatic sinus bradycardia at a heart rate of 50 beats/minute d. Fever-induced tachycardia at 122 beats/minute
b
Mitral stenosis is associated with a. a prominent S4 heart sound. b. a pressure gradient across the mitral valve. c. left ventricular hypertrophy. d. a muffled second heart sound (S2).
b
The common denominator in all forms of heart failure is a. tissue ischemia. b. reduced cardiac output. c. pulmonary edema. d. poor diastolic filling.
b
Administration of a vasodilator to a patient in shock would be expected to
decrease left ventricular afterload
Primary treatment for myocardial infarction (MI) is directed at
decreasing myocardial oxygen demands.
A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to
hypotension
Constrictive pericarditis is associated with
impaired cardiac filling.
Lusitropic impairment refers to
impaired diastolic relaxation.
What is the cause of hypotension in hypovolemic shock?
Hypovolemia.
Are defective gap junctions related to tachydysrhythmias?
No
What is the patient's past medical history?
No significant past medical history.
Are P waves absent in first-degree heart block?
No.
Are atherosclerotic plaques with large lipid cores prone to binding?
No.
Are large lipid cores of atherosclerotic plaques prone to attachment?
No.
Are β-blockers required for a patient with hypertension who has experienced a decrease in blood pressure after 6 weeks of moderate adherence to lifestyle changes?
No.
Is aldosterone released from juxtaglomerular cells?
No.
Is angiotensin involved in the process of cellular release within the kidneys?
No.
Is automaticity a factor in lusitropy?
No.
Is coronary vasospasm the likely cause of intermittent chest pain brought on by exertion and relieved by rest in a patient with a history of myocardial infarction?
No.
Is diuretic therapy needed for a patient with hypertension who has experienced a decrease in blood pressure after 6 weeks of moderate adherence to lifestyle changes?
No.
Is hypotension in neurogenic and anaphylactic shock related to high afterload?
No.
Is hypovolemia the cause of hypotension in neurogenic and anaphylactic shock?
No.
Is myocardial infarction the likely cause of intermittent chest pain brought on by exertion and relieved by rest in a patient with a history of myocardial infarction?
No.
Is poor contractile force associated with lusitropic impairment?
No.
Is the conduction rate associated with lusitropy?
No.
Is unstable angina the likely cause of intermittent chest pain brought on by exertion and relieved by rest in a patient with a history of myocardial infarction?
No.
Should ACE inhibitors be added to the therapy for a patient with hypertension who has experienced a decrease in blood pressure after 6 weeks of moderate adherence to lifestyle changes?
No.
What are the manifestations of anaphylactic shock?
Normal vital signs initially, without fever or lactic acidosis.
What is hepatomegaly?
Not a symptom of pure left-sided heart failure.
What is jugular vein distention?
Not a symptom of pure left-sided heart failure.
What is peripheral edema?
Not a symptom of pure left-sided heart failure.
What is the role of junctional escape in dysrhythmias?
Not associated with reentrant mechanisms.
What is paroxysmal atrial tachycardia?
Not related to intermittent shortness of breath at night.
What should be done when investigating the cause of bradycardia?
Not treated emergently if no symptoms.
What is the cause of hypotension in anaphylactic shock?
Peripheral pooling of blood.
What is the cause of hypotension in neurogenic and anaphylactic shock?
Peripheral pooling of blood.
Cardiogenic shock is characterized by a. reduced cardiac output. b. reduced systemic vascular resistance. c. elevated SvO2. d. hypovolemia.
a
Constrictive pericarditis is associated with a. impaired cardiac filling. b. increased cardiac preload. c. elevated myocardial oxygen consumption. d. cardiac hypertrophy.
a
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
What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume?
Tachycardia
What is a variable PR interval found in?
Type I second-degree block.
What is the characteristic of variant angina?
Unpredictable attacks of angina pain.
What results when systemic blood pressure is increased?
Vasoconstriction
Is a patient diagnosed with cardiogenic shock and hyperventilating at risk for respiratory acidosis?
False.
What are the manifestations of septic shock?
Fever, hypotension, and lactic acidosis.
What can stagnant blood in the atria lead to?
Formation of thrombi.
What are the manifestations of neurogenic shock?
Hypotension due to depression of the vasomotor center in the medulla.
What are the manifestations of hypovolemic shock?
Hypotension, but extremities are not likely to be cold and edematous.
Hypotension associated with neurogenic and anaphylactic shock is because of a. high afterload. b. peripheral pooling of blood. c. hypovolemia. d. poor cardiac contractility.
b
In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with a. reduced contractility. b. high cardiac output. c. high afterload. d. low cardiac output.
b
A patient with heart failure who reports intermittent shortness of breath during the night is experiencing a. paroxysmal atrial tachycardia. b. orthopnea. c. paroxysmal nocturnal dyspnea. d. sleep apnea.
c
Rheumatic heart disease is most often a consequence of a. cardiomyopathy. b. chronic intravenous drug abuse. c. β-hemolytic streptococcal infection. d. viral infection with herpesvirus.
c
Second-degree heart block type I (Wenckebach) is characterized by a. absent P waves. b. no correlation between P waves and QRS complexes. c. lengthening PR intervals and dropped P wave. d. constant PR interval and dropped QRS complexes.
c
What is malignant hypertension?
A hypertensive crisis.
When should the patient's blood pressure be rechecked?
In 4 to 6 weeks.
Administration of a vasodilator to a patient in shock would be expected to a. decrease left ventricular afterload. b. increase tissue perfusion. c. increase contractility. d. decrease vascular resistance.
a
In which dysrhythmias should treatment be instituted immediately? a. Premature atrial complexes occurring every 20 seconds b. Atrial fibrillation with a ventricular rate of 220 beats/minute c. Asymptomatic sinus bradycardia at a heart rate of 50 beats/minute d. Fever-induced tachycardia at 122 beats/minute dizz
b
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. isolated left-sided heart failure. c. right-sided heart failure. d. arterial obstruction.
c
Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure. a. pulse b. systolic c. mean arterial d. diastolic
c
Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of a. congestive heart failure (CHF). b. cardiomyopathy. c. cardiac tamponade. d. myocardial infarction.
c
Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells. a. norepinephrine b. aldosterone c. renin d. angiotensinogen
c
Patent ductus arteriosus is accurately described as a(n) a. stricture of the aorta that impedes blood flow. b. cyanotic heart defect associated with right-to-left shunt. c. communication between the aorta and the pulmonary artery. d. opening between the atria.
c
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
The prevalence of high blood pressure is higher in a. Mexican-American adults. b. Asian children. c. non-Hispanic black adults. d. non-Hispanic white adults.
c
The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is a. preload reduction. b. β-antagonist agents. c. digitalis. d. afterload reduction.
c
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 110/78, HR 98 c. Sitting BP 88/60, HR 118 d. Sitting BP 108/68, HR 102
c
Sepsis has been recently redefined as a. severe hypotension in an infected patient. b. a systemic inflammatory response to ischemia. c. a systemic infection with viable organisms in the bloodstream. d. a systemic inflammatory response to infection.
d
The effect of nitric oxide on systemic arterioles is a. not significant. b. vasoconstriction. c. opposed by nitrate drugs. d. vasodilation.
d
What is the patient's current blood pressure?
150/92 mm Hg.
First-degree heart block is characterized by
prolonged PR interval.
A patient with significant aortic stenosis is likely to experience
syncope
Increased preload of the cardiac chambers may lead to which patient symptom?
Edema
The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is
. ST-segment elevation.
Angiotensin-converting enzyme (ACE) inhibitors block the
. conversion of angiotensin I to angiotensin II.
How many packs of cigarettes does the patient smoke per day?
1 1/2 packs.
What is the heart rate in fever-induced tachycardia?
122 beats/minute.
What is unstable angina?
Similar symptoms to myocardial infarction.
An example of an acyanotic heart defect is
ventricular septal defect.
What does high blood pressure increase?
Afterload.
What is variant angina?
Angina caused by coronary artery spasm.
What is classic angina?
Angina often associated with physical exertion.
In which dysrhythmias should treatment be instituted immediately?
Atrial fibrillation with a ventricular rate of 220 beats/minute.
Is dislodgement an occurrence of atherosclerotic plaques with large lipid cores?
No.
What is the least appropriate intervention for this patient at this time?
Begin antihypertensive drug therapy.
What is the first intervention for a patient with modifiable risk factors for hypertension?
Begin lifestyle modifications.
What is atrial fibrillation?
Completely disorganized and irregular atrial rhythm.
What is right-sided heart failure characterized by?
Congestion in the systemic venous system that increases systemic vascular resistance.
What is the most appropriate intervention for a patient with hypertension who has experienced a decrease in blood pressure after 6 weeks of moderate adherence to lifestyle changes?
Continue lifestyle modifications only.
Which serum biomarker(s) are indicative of irreversible damage to myocardial cells?
Elevated CK-MB, troponin I, and troponin T
What serum biomarkers indicate irreversible damage to myocardial cells?
Elevated CK-MB, troponin I, and troponin T.
How often do premature atrial complexes occur?
Every 20 seconds.
What lifestyle alterations should be attempted first in a person with modifiable risk factors for hypertension?
Exercise, smoking cessation, and weight loss.
How often does the patient exercise?
Infrequently.
What can lead to secondary hypertension?
Ingestion of certain drugs, foods, or chemicals.
What is the function of renin?
Initiates the renin-angiotensin-aldosterone cascade leading to salt and water retention by the kidney.
What is the role of ischemia in lusitropic impairment?
Interferes with the removal of calcium ions during diastolic relaxation.
What is the effect of atrial fibrillation on the ventricular rhythm?
Irregular ventricular rhythm of variable rate.
What is a classic sign of right-sided heart failure?
Jugular vein distention.
How would the patient's left ventricular function be affected by a blood pressure of 160/98?
Left ventricular workload is increased with high afterload.
What is the expected effect of a blood pressure of 160/98 on left ventricular function in the elderly?
Little effect on left ventricular function.
What is stable angina?
Most common form of chest pain, caused by increased myocardial workload.
How do alterations in automaticity create electrolyte imbalances?
N/A
What is the cause of hypotension in obstructive shock?
Narrowed pulse pressure and low cardiac output.
Which dysrhythmia is associated with reentrant mechanisms?
Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome).
Why does atrial fibrillation require resuscitation?
Reduction in cardiac output.
How often does the patient drink alcohol?
Regularly.
What type of shock is the overproduction of nitric oxide an important aspect of?
Septic shock
What is cardiogenic shock?
Shock characterized by decreased cardiac output, elevated left ventricular end-diastolic pressure, S3 heart sounds, and pulmonary edema.
What is septic shock?
Shock characterized by fever, hypotension, and lactic acidosis.
What is obstructive shock?
Shock characterized by narrowed pulse pressure and cold, clammy skin.
Restriction of which electrolytes is recommended in the management of high blood pressure?
Sodium
What happens to the atria in atrial fibrillation?
They quiver instead of contracting forcefully.
What is the cause of hypotension in septic shock?
Tissue hypoxemia and lactic acidosis.
True or False: Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body.
True
What is triggered activity?
When an impulse is generated during or just after repolarization.
Is cardiac output generally adequate in neurogenic and anaphylactic shock?
Yes.
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. unstable angina. c. coronary vasospasm. d. myocardial infarction.
a
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. Measures to decrease LDL levels in the elderly would be unlikely to affect the progression of his disease. c. Increased LDL levels are indicative of moderate alcohol intake, and patients should be advised to abstain. d. Elevated LDL levels are an expected finding in the elderly and therefore not particularly significant.
a
Mitral stenosis is associated with
a pressure gradient across the mitral valve
Sepsis has been recently redefined as
a systemic inflammatory response to infection.
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.
The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with
antibiotics
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. cardiogenic b. hypovolemic c. obstructive d. distributive
c
Increased preload of the cardiac chambers may lead to which patient symptom? a. Decreased heart rate b. Decreased respiratory rate c. Edema d. Excitability
c
Low cardiac output in association with high preload is characteristic of ________ shock.
cardiogenic
A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock? a. Neurogenic b. Anaphylactic c. Cardiogenic d. Septic
d
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. High blood pressure enhances left ventricular perfusion during systole. b. High-pressure workload leads to left ventricular atrophy. c. This is an expected blood pressure in the elderly and has little effect on left ventricular function. d. Left ventricular workload is increased with high afterload.
d
Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock? a. Septic b. Hypovolemic c. Cardiogenic d. Anaphylactic
d
Aortic regurgitation is associated with
diastolic murmur.
The most commonly recognized outcome of hypertension is pulmonary disease. a. False b. True
f
Chronic elevation of myocardial wall tension results in atrophy. a. False b. True
false
A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis.
false alk.
New-organ damage is a function of both the stage of hypertension and its duration.
false end damage
A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic.
false neurogenic shock.
A loud pansystolic murmur that radiates to the axilla is most likely a result of
mitral regurgitation.
Hypertension is closely linked to
obstructive sleep apnea.
Left-sided heart failure is characterized by
pulmonary congestion.
Atherosclerotic plaques with large lipid cores are prone to
rupture.
A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock?
septic
Improvement in a patient with septic shock is indicated by an increase in
systemic vascular resistance.
Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes. a. True b. False
t
Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.
true
The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension. a. False b. True
true
What is reentry?
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.
What is a widened QRS complex associated with?
A particular dysrhythmia, not first-degree heart block.
What is disseminated intravascular coagulation?
A serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body.
What is the effect of decreased venous return to the heart?
Decreased cardiac output and hypotension.
What is the cause of hypotension in cardiogenic shock?
Decreased cardiac output and poor cardiac contractility.
What are the manifestations of cardiogenic shock?
Decreased cardiac output, elevated left ventricular end-diastolic pressure, S3 heart sounds, and pulmonary edema.
What is orthopnea?
Dyspnea when lying down.
When are dysrhythmias treated?
If they produce significant symptoms or are expected to progress.
What does lusitropic impairment refer to?
Impaired diastolic relaxation.
What is lusitropic impairment?
Impaired removal of calcium ions during diastolic relaxation.
What are the manifestations of obstructive shock?
Narrowed pulse pressure, cold, clammy skin, low cardiac output, and profound hypotension.
What is neurogenic and anaphylactic shock?
Profound peripheral vasodilation of both arterioles and veins leads to peripheral pooling of blood and hypotension.
What is first-degree heart block characterized by?
Prolonged PR interval.
What is left-sided heart failure characterized by?
Pulmonary congestion and edema.
What are the symptoms of left-sided heart failure?
Pulmonary congestion with dyspnea.
What is released from juxtaglomerular cells in response to low cardiac output?
Renin.
What is a patient diagnosed with cardiogenic shock and hyperventilating at risk for?
Respiratory alkalosis.
What is peripheral edema seen in?
Right-sided heart failure.
What initiates platelet aggregation and thrombus formation in atherosclerotic plaques?
Rupture of atherosclerotic plaques with large lipid cores.
What are atherosclerotic plaques with large lipid cores prone to?
Rupture.
What is the likely cause of intermittent chest pain brought on by exertion and relieved by rest in a patient with a history of myocardial infarction?
Stable angina.
Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria? a. 128/82 b. 118/78 c. 140/88 d. 138/94
a
A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n) a. young female athlete with cardiomegaly. b. elderly woman without a previous history of MI. c. middle-aged man with a previous history of MI. d. young sedentary male with a high-stress job.
b
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. Ventricular escape rhythm c. Third-degree heart block d. Sinus bradycardia
b
An example of an acyanotic heart defect is a. transposition of the great arteries. b. ventricular septal defect. c. all right-to-left shunt defects. d. tetralogy of Fallot.
b
Angina caused by coronary artery spasm is called _____ angina. a. unstable b. Prinzmetal variant c. classic d. stable
b
Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class? a. Class III b. Class II c. Class IV d. Class I
d
Tachycardia is an early sign of low cardiac output that occurs because of a. anxiety. b. acidosis. c. tissue hypoxia. d. baroreceptor activity.
d
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.
A patient with pure left-sided heart failure is likely to exhibit
pulmonary congestion with dyspnea.
Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?
Anaphylactic
What is hypertension with a specific, identifiable cause known as?
Secondary hypertension.