Cardio Student Questions 54B

A 58-year-old African American male came into the hospital with shortness of breath and lightheadedness. His pulse rate was 24 bpm and his blood pressure was 150/70. He said he got chest pains when he was hiking two days ago but it went away after he stopped hiking. What does these manifestations describe. A. Coronary artery disease B. Aneurysm C. Pericarditis D. Cardiogenic shock

ANS: A Answer A Rationale: Coronary artery disease is any vascular disorder that narrows the arteries. The narrowing causes cells to not get enough oxygen, so results in ischemia which causes the lightheadedness. And since the heart is pumping more blood than usual to try and get oxygen to the cells the pulse rate and bp are high. Angina is a common manifestation of CAD especially after physical or emotional distress.

Mr. Smith, a 67-year old patient who recently underwent Coronary Artery Bypass Grafting (CABG) surgery, was admitted into the Cardiac Intensive Care Unit. The nurse in charge of Mr. Smith reports that he is hypotensive and has developed warm, flushed skin. In addition, she notices that the patient is suddenly unable to speak coherently and is always agitated. These clinical manifestations describe: A. Sepsis Shock B. Neurogenic Shock C. Anaphylactic Shock D. Obstructive Shock

ANS: A Answer A Rationale: Early symptoms of sepsis shock include hypotension and warm, flushed skin. Unlike the other forms of shock, septic shock is presented with a decrease in systemic vascular resistance. Hypotension decreases blood flow, which encourages tissue hypoxia. When tissue hypoxia is present, anaerobic metabolism occurs to compensate for the decreased flow of oxygen to the tissue, causing Mr. Smith to develop warm, flushed skin. Changes to cognition and behavior are due to the decreased blood flow to the brain.

A patient is brought to the hospital by his wife because she thinks he is having a heart attack. She tells you, the ER nurse, that her husband is having difficulty breathing but his breaths are very rapid, he has severe chest pain, and before his breaths became labored, he would not stop muttering about how everything is wrong and that there is nothing he or anyone else can do to fix it. After examination of the patient's past medical history, you find that the patient has had myocardial ischemia for five years treated with medication. From this evidence, you are able to come to the conclusion that the patient is undergoing: A. Cardiogenic Shock B. Hypovolemic Shock C. Anaphylactic Shock D. Neurogneic Shock

ANS: A Rationale for Answer A: A person who is undergoing cardiogenic shock will show the clinical manifestations of chest pain, dyspnea, faintness, hypotension, tachycardia, tachypnea, low measured cardiac output, and a feeling of impending doom. Cardiogenic shock occurs when the heart is not able to pump enough blood to tissues and organs despite having an adequate supply. For most patients who suffer cariogenic shock, the damage to the heart is a result of myocardial infarction but it can also be a result of myocardial ischemia. This damage to the heart mostly effects the left ventricle, and the heart's ability to pump oxygenated blood to the rest of the body is impaired. This is the case for this patient.

Susie reports symptoms of shortness of breath, intolerance to exercise, and fatigue. She goes to her primary physician and the physician notes that she has a late stage of rheumatic heart disease, left atrial enlargement, and a diastolic murmur upon auscultation. These clinical manifestations describe: A. Mitral Stenosis B. Mitral Valve Regurgitation C. Aortic Stenosis D. Aortic Regurgitation

ANS: A Rationale for Answer A: Mitral Stenosis is when the blood has a hard time pumping blood from the left atrium to the left ventricle, causing blood to back up into the lungs. Rheumatic heart disease is one of the characteristic causes of mitral stenosis, in addition to endocarditis. Susie experiences fatigue, SOB, and intolerance of exercise because when the blood backs up, there is not as much output of blood. The body is not able to be perfused with oxygen. Left atrial enlargement is seen because blood is flowing back to the left atrium.

After conducting and analyzing the results of a patient's physical assessment, the nurse notices that the client is at high risk for developing atherosclerosis. What information from the client's physical assessment did the nurse observed to make such assumption? A. 67-year-old Latino male, weight: 235 lb, smokes 2 boxes of cigarettes daily, Blood pressure is 158/91. LDL count of 188 mg/dL. B. States that step mother has history of premature coronary artery disease C. Temperature: 97.8 °F, respiration rate: 20 bpm, heart rate: 98 bpm D. States not having a healthy diet and drinking at least 5 beers weekly.

ANS: A Rationale for Answer A: Risk factors for atherosclerosis: Non-modifiable risk factors: increasing age, male gender, genetic disorders of lipid metabolism, and family history of premature coronary artery disease. Modifiable risk factors: Cigarette smoking, obesity, hypertension, hyperlipidemia with elevated low-density lipoprotein and low-high density lipoprotein cholesterol. Diabetes mellitus.

A patient presents to the emergency room with shortness of breath and chest pain that radiates to the neck and jaw. These symptoms are not relieved by rest or nitroglycerin. The nurse obtains a 12-lead ECG and the screen shows an ST-elevation. Which of these is the patient experiencing? A. NSTEMI B. STEMI C. Stable angina D. Variant angina

ANS: B Rationale for Answer B: Acute ST elevation MI (STEMI), also known as heart attack, is characterized by the ischemic death of myocardial tissue associated with atherosclerotic disease of the coronary arteries. Symptoms include chest pain, shortness of breath, dizziness, and palpitations. Pain is usually substernal, radiating to the left arm, neck, or jaw. Pain is prolonged and not relieved by rest or nitroglycerin. Treatment includes percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

A 55-year-old patient Bob enters the emergency room with a severe burn to both his arms and his face from a fried turkey accident he had as the deep fryer oil spilled on him. Bob suffers from high blood pressure, high cholesterol, kidney failure so he currently undergoing dialysis, and an irregular heartbeat with a pace monitor. Bob vital signs as he enters the hospital at 180/100 BP and has a HR of 120 BPM. Bob also had an increased WBC of 12,000 per microliter of blood. The nurse has diagnosed Bob with fatigue and being very weak. Once Bob was placed into a room and had an IV bag placed, his symptoms are worsening. He is having greater renal failure and an elevated heart rate. What is Bob currently experiencing, A. MODS/Sepsis B. Primary MODS C. Secondary MODS D. Myocardial Infarction

ANS: A Rationale for Answer A: Septic shock causes MODS because it is common type of distributive shock, which is the systemic immune response to severe infection. So, with our patient, once he was severely burned, his body reacted by an extreme inflammatory response, which lead to tachycardia and increased white blood cell count. This inflammatory response lead to the already failing organs of the kidneys and heart which led him into septic shock.

Justine Rose arrives at a medical facility complaining of visual disturbances along with epigastric pain that has persisted for about 2 days. Upon having a complete physical assessment she is found to have an abnormal BP of 145/ 93. The patient is 24 weeks pregnant and a urine sample that was taken revealed that she has abnormal quantities of protein in her urine (proteinuria= 350mg). Past medical records reveal that patient has no history of high blood pressure. What is the most reasonable diagnosis given the following information? A. Preeclampsia-Eclampsia B. Gestational Hypertension C. Chronic Hypertension D. Preeclampsia superimposed on chronic

ANS: A Rationale for answer A: Preeclampsia-Eclampsia- Most reasonable option because patient has a systolic greater than 140 mm Hg/ diastolic greater than 90 mm Hg, and proteinuria greater than or equal to 300 mg (in 24 hours). Preeclampsia- Eclampsia is also developed after 20 weeks of gestation. Symptoms may include persistent headache, cerebral/ visual disturbances, and persistent epigastric pain. A major sign is seizures that cannot be related to any other cause. Woman at higher risk include those with multiple fetuses, diabetes mellitus, collagen vascular disease, or underlying kidney disease.

An 85-year-old man named Mr. Jones is complaining of recurring left calf pain during walking. He does not report pain while climbing stairs or swimming. He has diabetes mellitus but is considered very active for his age. Which of the following risk factors contributes the least to his diagnosis of PAD? A. Type II Diabetes B. Smoking Status C. Age D. Sex

ANS: B Answer B Rationale: Cigarette smoking is one of the main risk factors for PAD, with more than 80% of persons with the disorder being current or former smokers. However, this patient does not smoke and never has smoked, so this risk factor does not contribute to his diagnosis of PAD.

Mr. Blue, a 66 year old man has been in the intensive care unit for the past week after undergoing surgery. During the hourly vital check, his nurse notices that his vitals are as listed: blood pressure 94/44, respiratory rate 22 breaths per minute, temperature 101.5 °F, and pulse 114 beats per minute. The nurse also documents that the patient has warm flushed skin and a decreased level of consciousness, but is still able to communicate with the nurse. Concerned with the patient's vitals and observations, the nurse informs the doctor who orders tests to check the patient's serum lactate levels and leukocyte levels. The lab test results state that the patient's serum lactate levels are 2.5 mmol and the leukocyte levels are 12,000 ml. After reassessing the patient's vitals an hour later the nurse notices that his vitals have not changed. Which of the following is the patient most likely experiencing? A. Hypovolemic Shock B. Sepsis C. Multiple Organ Damage D. Septic Shock

ANS: B Answer B Rationale: Sepsis is condition that occurs due to a confirmed severe infection. It is characterized by two consecutive cases of SIRS (systemic inflammatory response syndrome). SIRS can be confirmed with the following vital signs, temperature of >100.4 °F or < 96.8 °F, a respiratory rate of >22, a heat rate of >90, a white blood cell count of >12,000 or <4, 000, and a PCO2 of < 32 mmHg. Additionally, sepsis can be confirmed with lactate levels greater 2 mmol but less than 4 mmol, indicating that the patient is experiencing a sepsis infection but may not yet be experiencing septic shock or multiple organ damage

Neurogenic shock is caused by a loss of signals from the vasomotor center (in brainstem) to control blood vessel tone. What signs make neurogenic shock different from the other types of shock? A. An alteration in cognition or consciousness B. Slow heart rate; warm and dry skin C. Fast heart; warm and dry skin D. Oliguria

ANS: B Answer B Rationale: The vasomotor center activates neurons along the spinal cord, which would then send information to the heart and to the blood vessels. This information instructs the vessels to constrict and informs the heart to increase heart rate and contractility. However, with the loss of these signals from the vasomotor center, such actions cannot take place. Thus, there is a non-opposing vagal nerve. With a non-opposing vagal tone, bradycardia results. The other cardinal sign of neurogenic shock is that the skin is warm and dry.

A 62-year-old Caucasian male comes into the hospital complaining of not being able to urinate. During the exam, the nurse notices an elevated blood pressure level, decreased urine formation, and retention of salt and water. What would the nurse interpret with these findings? A. Primary Hypertension B. Renal Hypertension C. Myocardial Infarction D. Atherosclerosis

ANS: B Answer B Rationale: When patients who come into the hospital because they have trouble urinating and there is a finding of elevated blood pressure it means there is a problem with renal function. The kidney plays a big role in the regulation of blood pressure. Kidney disorders are the leading cause of secondary hypertension.

A 73-year old female patient has severe aortic stenosis. After the nurse assesses the patient, which of the following findings should he/she expect? A. Diastolic murmur B. Narrowed pulse pressure C. Bounding pulse D. Hypertension

ANS: B Answer B: Rationale- A narrowed pulse pressure is a finding of aortic stenosis. A valve is stenotic when you hear a murmur of blood shooting through the narrow opening when the valve opens. In aortic stenosis the aortic valve narrows, causing a decrease in blood flow from the left ventricle to the aorta. This leads to a low/narrowed pulse pressure.

A father brings in his 18-month old son to the Emergency Department at Ronald Regan and states his child has had persistent diarrhea, vomiting, and profuse sweating for the past 48 hours. He states his child is not able to keep down any liquids he tries to give him. It is noted in the child's health history that he has no serious conditions or diseases, and no hospital admissions prior to this visit. The ER nurse examines the infant and notes he has pale cold skin, blue lips, rapid breathing, and is crying. Based on these clinical manifestations, the baby is at risk for: A. Cardiogenic Shock B. Hypovolemic Shock C. Septic Shock D. Obstructive Shock

ANS: B Rationale for Answer B: Hypovolemic shock is the most common type of shock in infants, and in children is most prominently characterized by irritability, a rapid respiratory rate, pallor, and dehydration. In the case study presented in this question, the patient is an infant, has had a great deal of fluid loss due to his diarrhea, vomiting, and constant sweating over two days. He also has signs of pale skin and blue lips which denote poor circulation, and an elevated heart rate due to his rapid breathing. The type of shock that best resembles all of these manifestations in the answer choices is hypovolemic shock.

Mrs. Jones arrives in the Emergency Department (ED) complaining of nausea, fatigue, difficulty concentrating and weight gain. Upon examination, you notice that she has hepatomegaly, swollen ankles, and jugular vein distension. Which diagnosis best explains Mrs. Jones symptoms? A. Left-sided heart failure B. Right-sided heart failure C. Myocardial infarction D. Hypertension

ANS: B Rationale for Answer B: In response to the increase in right ventricular end-diastolic, right atrial, and systemic venous pressure increases due to right-sided heart failure, peripheral edema occurs. This accounts for Mrs. Jones' weight gain and swollen ankles. The failing right ventricle also leads to the congestion of blood going back to the heart, leading to hepatomegaly, jugular vein distension, and nausea

A 74-year-old African-American male arrives at the ED complaining of chest pain, shortness of breath, fatigue, left arm weakness, and nausea. Given these clinical manifestations, which of the following is the patient most likely experiencing: A. Stroke B. Myocardial Infarction C. Panic Attack D. Asthma Attack

ANS: B Rationale for Answer B: Individuals who are experiencing a Myocardial Infarction (MI) often complain of chest pain. This chest pain is commonly described as being severe and may sometimes radiate to other body parts, most commonly the left arm, neck, or jaw. Pain associated with a myocardial infarction is often so severe that it requires the administration of morphine. Fatigue and weakness are also common, particularly in the arms and legs. Nausea and vomiting are also commonly reported among MI patients as a result of both pain and vagal stimulation. Given this information, the symptoms reported by the patient are highly indicative of a Myocardial Infarction.

A 19-year-old patient reports light headache during her sleep including cold sweat. After standing up, the patient then reports sudden loss of vision with severe dizziness. The nurse notes that the patient does not take sufficient water every day due to her habit, heart rate is 55 beats/minute, and her BP is 88/60. These findings lead the nurse to diagnosis: A. Primary Hypertension B. Orthostatic Hypotension C. Hypoxemia D. Hypovolemia

ANS: B Rationale for Answer B: People with orthostatic hypotension describe light-headed feeling, dizziness after standing up from seated or supine position, followed by nausea and if severe, sudden syncope. This occurs due to a decrease in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing. Reduced blood volume, drug-induced hypotension, bed rest and immobility are a common cause of orthostatic hypotension.

A 54-year-old male comes into the Emergency Room complaining of sharp chest pain on the left side of his chest and fatigue. Upon assessment by the nurse, he was found to have an oral temperature of 99.9F, shortness of breath when asked to lie down, and swelling in his lower left extremity. Based on the following symptoms, the nurse assumes that the patient is experiencing acute pericarditis. Which of the following is responsible for the inflammation of the pericardium? A. Decreased blood pressure and shock B. Serous exudate filling the pericardial cavity C. Increased venous pressure D. Increased blood pressure causing too much blood in the heart leading to expansion of the heart

ANS: B Rationale for Answer B: Pericarditis is associated with increased capillary permeability. The capillaries that are responsible for supplying the serous pericardium become permeable, allowing plasma proteins to enter the pericardial space. When fluid enters the pericardial space, there is no fluid separating the two-layered pericardial sac that surrounds the heart. Since there is no fluid, the two layers will rub against each other, which is responsible for the chest pain the patient is experiencing. The fluid in the pericardium will prevent efficient venous return.

A 47-year-old man named Jerry comes into the ER complaining "I feel so much pressure on my middle chest." As he describes the pain to the nurse, he is visibly short of breath and coughing. Health history interview reveals he is being currently being treated for a tuberculosis infection. Chest sounds indicate fluid in the pericardial cavity. The nurse suspects Jerry has what condition? A. Myocardial infarction B. Pericarditis has caused pericardial effusion. C. Pericarditis has cause constrictive pericarditis D. Bronchitis

ANS: B Rationale for Answer B: Pericarditis, with pericardial effusion Pressure like chest pain, shortness of breath and coughing are all symptoms of pericarditis. The recent infection and chest sounds indicating the presence of fluid suggest pericardial effusion.

A 42- year old man with a family history of heart disease is undergoing a routine physical check up. His blood pressure is measured to be at 150 mm hg/ 90 mm hg, and renal function is reported to be normal. Additionally, the patient reports this blood pressure has remained constant over time, and reports a diet high in sodium, alcohol intake, and smokes daily. The patient has no history of disease and is in overall good, physical shape. Which condition is the patient at risk of developing, which can result in heart disease and stroke? A. Orthostatic hypotension B. Primary Hypertension C. Secondary Hypertension D. General Adaptation Syndrome (GAS)

ANS: B Rationale for Answer B: Primary hypertension accounts for 90% of all cases of hypertension (P. 427). Lifestyle factors such as smoking and drinking (p. 429), alongside sodium retention, can lead to primary hypertension, and its associated heart disease/ stroke risks. This diagnosis results when no other cause for hypertension can be identified (p. 428). A diagnosis can be made when multiple readings have been reported over time (p. 428).

A 48-year-old woman presents at the ER complaining of numbness and tingling in her fingers. Upon inspection, you see the patient is experiencing changes in skin color that progress from pallor to cyanosis. The patient reports that she suffered frostbite three years ago while climbing Mount Everest. These findings cause you to suspect the patient is suffering from: A) Raynaud Disease B) Raynaud Phenomenon C) Thromboangiitis Obliterans D) Atherosclerotic Occlusive Disease

ANS: B Rationale for Answer B: Raynaud's phenomenon is associated with other disease states or known causes of vasospasm. The patient reports having had frostbite, a previous vessel injury. Other examples of previous vessel injuries are occupational trauma associated with the use of heavily vibrating tools, neurologic disorders, collagen diseases, and chronic arterial occlusive disorders

An 85-year-old African-American male has increased pulmonary pressure causing right heart failure. The nurse should monitor for complications because his heart can fail as a result of: a. Hypertension b. Left heart failure c. Pericarditis d. Acute pneumonia

ANS: B Rationale for Answer B: Right-sided failure often follows left-sided failure when pulmonary congestion forces back-flow of blood into the left ventricle.

A 55 year old male patient describes that he has substernal chest pain when he runs, plays soccer, or is stressed. He describes the pain as a steady, constricting, and suffocating sensation. He also states that the pain sometimes radiates to his jaw or arm. What do these characteristics describe? A. Cardiac tamponade B. Chronic stable angina C. Constrictive pericarditis D. Vasospastic angina

ANS: B Rationale for Answer B: These characteristics describe chronic stable angina. The typical symptoms include steady, constricting, suffocating pain in the chest that are precipitated by circumstances that increase the work demands of the heart and emotional stress. These situations might include things like exercise. The pain may radiate to the back, other areas of the chest, jaw, or arm.

Opal Lee, a 65 year old woman, comes into the ED and upon assessment presents with SOB, angina, left ventricular hypertrophy, and tachycardia. Patient has no pain or discoloration of the extremities and easily communicates aside from the SOB. Patient history includes obesity and mild atherosclerosis of the coronary arteries with a stable plaque. What could be the cause of Mrs. Lee's symptoms? A. Mrs. Lee is having a stroke. B. The stable plaque became unstable and ruptured, causing a thrombus in her coronary arteries. C. The stable plaque became unstable and broke off, causing an embolus that lodged in her peripheral arteries. D. Mrs. Lee is going into hypovolemic shock causing her increased heart rate.

ANS: B Rationale for B: It states in her history that she has had mild atherosclerosis in her coronary arteries and that the plaque was stable. If the plaque became unstable it could rupture causing a blood clot (thrombus). A thrombus blocking her coronary artery would cause the angina and SOB because the thrombus is inhibiting blood flow to the heart. A thrombus would also cause tachycardia and left ventricular hypertrophy as the body's way of trying to compensate for the blockage.

A condition that results from an inflammatory or infectious response and is due to the accumulation of fluid in the heart that increases intracardiac pressure and decreases venous return of blood back into the heart is known as what? a. Coronary Artery Disease b. Pericardial Effusion c. Myocardial Infarction d. Infective Endocarditis

ANS: B Answer B Rationale: Pericardial effusion is the accumulation of fluid in the pericardial cavity. It normally results from an inflammatory or infectious response. The signs and symptoms of pericardial effusion are dependent on the severity of the accumulation of fluid; how much fluid has accumulated and how quickly it accumulated. Pericardial effusion increases intracardiac pressure and decreases venous return of blood back into the heart because the heart is compressed

A patient was diagnosed with aortal valve regurgitation. When the nursing student interviews the patient, what is expected to be reported? A. Feet Swelling B. Difficulty Sleeping C. Frequent Dyspnea D. Cyanotic Fingers

ANS: C Rationale for answer C: In individuals with aortal valve regurgitation, a decrease in cardiac output leads to sympathetic stimulation and results in an increase in heart rate and peripheral resistance which causes the regurgitation to worsen. This disorder causes for blood pressure to fall and over time it will causes "exertional dyspnea".

A male patient comes into the hospital complaining of chest pain and pain to his peripheral extremities. Tests reveal a fatty plaque obstructing circulation to the extremities. Upon further testing, what genetic defect might be present in this man? A: His scavenger cells have underactive low-density lipoproteins receptors. B: His liver has the receptors to absorb and process low-density lipoproteins. C: Macrophages release free radicals that oxidize low-density lipoproteins. D: His high-density lipoproteins have overreactive cholesterol receptors.

ANS: C Answer C Rationale: Chest pain and pain in peripheral extremities such as the arms and legs are common symptoms of atherosclerosis. Likewise, the test results of a fatty plaque blocking circulation and preventing adequate supply of oxygen and other nutrients to extremities would explain chest pain as well as pain in the extremities. Atherosclerosis has multiple factors influencing its onset, but the main factor has to do with fatty plaque or foam cells preventing circulation. Answer C is the only option that increases the number of low-density lipoproteins in the body, the type of lipids that cause this plaque to form.

A patient of advanced age with history of alcohol abuse is admitted to an ICU demonstrating prolonged periods of hypotension, signs of an infarcted bowel due to insufficient blood flow, and hepatic dysfunction. His clinical manifestations show that homeostasis cannot be maintained without fast and proper interventions. What is he going through? A. Myocardial Infection (MI) B. Anaphylactic Shock C. MODS (Multiple Organ Dysfunction Syndrome) D. Obstructive Shock

ANS: C Answer C Rationale: Individuals that experience sepsis and continues leads to multiple organ dysfunction syndrome (MODS). These patients have altered organ functions where homeostasis cannot be maintained without interventions. MODS may affect the kidneys, brain, lungs, liver and heart. This is a life-threatening complication of shock. Individuals experiencing MODS need interventions focused on supporting the affected organs. This selection is the only option that describes the complication of shock.

A patient reports that after playing a game of rugby in the afternoon, he suffered from severe chest pain described as crushing with radiating pain to the left arm. Patient appears to have tachycardia and anxiety. These clinical manifestations describe: A. Acute Pericarditis B. Pericardial Effusion C. Myocardial Infarction D. Variant (Vasospastic) Angina

ANS: C Answer C Rationale: The Onset of STEMI includes abrupt and significant chest pain. The pain is characteristically severe, often described as being constricting, crushing, and suffocating. Pain can radiate to the left arm, jaw, or neck. Pain and elevated sympathetic activity cause tachycardia, restlessness, and anxiety, including emotional responses.

A patient suffered a myocardial infarction (MI) recently and wasn't treated at the hospital right away. It has been 3 days since his attack, what do you expect to see on his heart muscle tissue? A. Weak, fibrotic scar tissue with some revascularization B. Soft, hemorrhage in infarcted areas - highest risk for ruptures C. Visible necrosis D. Cyanosis, decreased temperature in tissue

ANS: C Rationale for Answer C: Myocardial cells that undergo necrosis are gradually replaced with scar tissue. An acute inflammatory response develops in the area of necrosis approximately 2 to 3 days after infarction. Thereafter, macrophages begin removing the necrotic tissue; the damaged area is gradually replaced with an ingrowth of highly vascularized granulation tissue, which gradually becomes less vascular and more fibrous in composition.

Mr. Smith was admitted to an emergency unit when his wife found him gasping for air while he was climbing the stairs. The patient was complaining that he could not breathe and was coughing up blood. Mr. smith also was complaining of abdominal pain and felt nauseated. The nurse sees that he had peripheral edema that was pink. The nurse also sees he has excessive weight gain with an increased abdominal girth. The clinical manifestations describe: A. Right sided heart failure B. Left sided heart failure C. Both Right and left sided heart failure D. Heart attack

ANS: C Rationale for answer C: Heart Failure is when the heart fails to meet the demands of the heart. It may be a result of an increased/Decreased Cardiac Output, Coronary Heart Disease where the artery is blocked or because of an increased pressure as in hypertension etc.. Failure of Specific Sides of the heart have different clinical manifestations. Failure of the left side heart failure will involve respiratory distress because the heart muscle is too weak, unable to empty the oxygenated blood from the left atrium to the left ventricle, causing a back flow to the lungs. Failure of the right side of the heart will lead to peripheral edema and weight gain because the heart is unable to empty blood from the right atrium to the right ventricle and the deoxygenated blood from the body backs out to the body through the superior and inferior vena cava instead of draining to the right ventricle, leading to build of fluid throughout the body (peripheral edema). So, a clinical manifestation of Mr. Smith' will be expected in both Right and Left sided heart failure.

A 47 y/o female came to the Emergency Department with an extreme case of vomiting and diarrhea × 5 days, which resulted with a large fluid volume deficit and weight loss of 5 pounds. The pt was pale, cool, and diaphoretic with a BP of 88/60, HR 118, RR 19, and Temp 99.9°F. What would you suspect is wrong with the pt? A. Septic Shock B. Anaphylactic Shock C. Hypovolemic Shock D. Obstructive Shock

ANS: C Rationale for answer C: Hypovolemic Shock is characterized by a decreased blood volume which is capable of filling the vascular compartment. It occurred when there is an acute loss of 15-20% of the circulation of blood volume. This decrease in blood volume can be attributed to an external loss of blood, plasma, or extracellular fluid, such as severe dehydration or loss of gastrointestinal fluid from vomiting and diarrhea. Hypovolemic Shock can also be caused from internal bleeding or from third space fluid loss when extracellular fluid is shifted from the vascular compartment to the interstitial space or compartment

A 75-year-old male patient presents with a sudden onset of pain, tingling, and numbness in their right leg. The provider has noted an absent dorsal pedal pulse from the patient's right foot, cyanosis to the affected foot, and a palpable "bump" on the femoral artery of the patient's right side. The primary cause for the patient's clinical manifestations is most likely: A) Peripheral artery disease B) Raynaud's phenomenon C) Angina Pectoris D) Atherosclerosis

ANS: D Answer D Rationale: Atherosclerosis usually doesn't present with any s/s until it entirely blocks or severely narrows an artery. Most individuals are unaware they have atherosclerosis until they experience a medical emergency secondary to it, such as a CVA, MI, or PAD. Atherosclerotic lesions narrow the vessels of arteries through plaque buildup, thrombosis can occur due to endothelium damage and aneurysm formation can result from the vessel walls weakening. Although atherosclerosis can affect any part of the body, it most commonly affects the arteries leading to the heart, kidneys, brain, small intestine, and lower extremities. This selection is the only option that describes the CAUSE for these clinical manifestations.

Two 45-year-old women go to their regular check-up at their community clinic. One woman has lower-body obesity while the other has abdominal obesity. They both have similar health histories with no known risk factors for hypertension except for being obese. Upon checking their blood pressure, one of the two women read 145 systolic over 90 diastolic, indicating hypertension. Which of the two women has hypertension? A. The woman with lower body obesity due to decreased insulin resistance related to fat deposited over the buttocks and legs. B. The woman with lower body obesity due to decreased amount of leptin in their blood, related to fat deposited over the buttocks and legs. C. The woman with abdominal obesity due to increased amount of adiponectin in their blood. D. The woman with abdominal obesity due to increased insulin resistance related to visceral fat.

ANS: D Answer D Rationale: Fat distribution may be a more determinative risk factor of hypertension than being overweight. Abdominal fat is more insulin resistant compared to fat deposited over the buttocks and legs. Insulin resistance causes the woman's blood sugar to increase. As the blood sugar level climbs this leads to type 2 diabetes, advancing to high risk for hypertension.

A premenopausal 50-year-old Asian Female has a family history of premature coronary artery disease (CAD) and smokes 1 pack of cigarettes a day. She is 5'4 and weighs 174 pounds (79 kg). Which of the following factors is NOT a risk factor for Atherosclerosis? A. 65-years-old B. Smoking Cigarettes C. Obesity D. Female Gender

ANS: D Rationale for Answer D: The male gender, not female gender, is at a higher risk for developing Atherosclerosis with all other factors being equal. This is likely because the hormone estrogen has protective factors against the development of coronary artery disease (CAD); however, after menopause, atherosclerosis incidence increases in women. The risk reaches equilibrium between males and females around 70 or 80 years of age.

Mrs. Kim had a surgery to replace her aortic valves. Her subsequent vital signs were: •Heart rate: 144 bpm •Blood pressure: 125/56 mmHg •Respiration rate: 36 breaths/min •Oxygen saturation: 87% of room air Additionally, heart murmurs were heard during the diastole phase. Upon auscultation of the lungs, audible crackles were heard. What valvular disorder do these findings describe and what complications should a health care provider expect to occur secondary to the valvular disorder? A. Aortic valve stenosis; pneumothorax B. Mitral valve stenosis; increased urine output C. Mitral valve regurgitation; orthopnea D. Aortic valve regurgitation; pulmonary edema

ANS: D Answer D Rationale: Mrs. Kim underwent an aortic valve replacement and heart murmurs were heard during the diastole phase, thus, she is encountering an aortic valve regurgitation due to a failure of prosthetic valve. The most common complication that follows is pulmonary edema because of the back flow of blood beginning from the left ventricle up to the left atrium and to the lungs. This causes a fluid built up in the lungs.

A 70-year-old male patient is brought into the emergency room with complaints of severe chest pain, which radiates to the left arm. Troponin assays have turned up positive for serum markers, and the emergency medical team administers nitroglycerin. However, patient's pain persists. What is the patient likely experiencing? A. Heart Burn B. Unstable angina C. ACS D. MI

ANS: D Rationale Answer D: Symptoms of MI include severe chest pain with radiation of pain to the left arm. This is a result of myocardial injury. Although chest pain may result from all listed answers, a positive cardiac panel would suggest MI. Furthermore, nitroglycerin is used to treat pain associated with MI. Additionally the inability of nitroglycerin to relieve patients pain simply points to the severity of the MI.

Maed is a 45 years old woman who is in the ED and wants to get checked because she recently experienced a squeezing and suffocating chest pain which increased in the beginning and at the end of the episode, but went away minutes after she rested. Maed told the nurse that she was recently doing an activity which required physical exertion in the cold weather because Maed was heartbroken. What medical finding did Maed's symptoms showed? A. NSTEMI B. Infective Endocarditis C. Mitral Valve Stenosis D. Chronic Stable Angina

ANS: D Rationale for Answer D: According to page 455 of the book, Chronic stable angina is a form of chest pain usually provoked when the work of the heart is increased but the coronary blood flow is insufficient. Chronic stable angina is triggered when one is participating in exertional activity, in emotional stress and cold weather. Also, this diagnosis of chest pain only lasts for a few minutes by rest or by nitroglycerin.

33. Landon Smith, a 17 y.o. African American male is admitted to the ICU after suffering a stab wound. He has lost a lot of blood and is diagnosed with hypovolemic shock. Nursing staff notices that he has not urinated since admission 2 days ago, is extremely thirsty, has a bluish color around his nail beds and lips, and is A&Ox4. Which of these symptoms is unusual considering his diagnosis? A. No urination in 2 days since admission B. Extreme thirst C. Bluish color around nail beds and lips D. Alert and oriented x4

ANS: D Rationale for Answer D: Hypovolemic shock usually results in altered consciousness or cognition because of reduced cardiac output and lack of cerebral perfusion due to the lowered blood volume. It would be unusual for a patient who has lost a lot of blood to be fully alert and oriented.

Mr. Smith had a myocardial infarction (MI) about 5 weeks ago. While he survived, he did not get to the hospital early enough to prevent tissue damage and scar tissue has begun forming. What zone of tissue damage is this? A. Ischemic zone B. Area of hypoxia C. Area of injury D. Area of necrosis

ANS: D Rationale for Answer D: Myocardial cells that undergo necrosis are gradually replaced with scar tissue because an acute inflammatory response develops in that area. Macrophages phagocytize the necrotic tissue and replace it with granulation tissue, which turns more fibrous in composition.

A patient experiences pain when walking but does not think much of it because he is not in athletic shape like he used to be. He is a cigarette smoker. He is admitted to the emergency room complaining of pain when he is laying down. What is the most likely cause of his pain: A. Hypercholesteremia B. Deep venous thrombosis C. Raynaud's disease D. Peripheral artery disease

ANS: D Rationale for Answer D: Peripheral artery disease. The strongest risk factors for PAD is cigarette smoking and diabetes mellitus. The primary symptom of PAD is intermittent claudication and pain with walking. When blood flow is reduced so much that it does not supply the minimal needs of resting muscles, there is ischemic pain when resting or laying down. These factors and symptoms match best with option D.

A patient with coronary artery disease is diagnosed with hypertension and an unstable plaque. The nurse is worried that it can turn into a thrombus. The nurse is concerned about his unstable plaque turning into a thrombus because it can lead to: A. Myocarditis B. Atherosclerosis C. Acute Pericarditits D. Myocardial Infarction

ANS: D Rationale for Answer D: Plaque disruption or unstable angina turns into a thrombus leading to an acute loss of blood supply to cardiac cells which can lead to myocardial ischemia (seconds) and if not reversed fast it can turn into a myocardial infarction (cells viable for 20 minutes with ischemia). Hence the unstable angina (unstable plaque) followed by thrombosis leads to myocardial ischemia that can lead to Myocardial infarction if not reversed fast enough.

A 68-year-old man went to the emergency room complaining of shortness of breath. He was soon admitted into the hospital for right heart failure. As a nurse, which statement most accurately describes right heart failure? (Pages 489-490) A. This type of heart failure usually leads to a persistent cough, dyspnea, weakness, and shortness of breath when lying down B. Most of the time, right heart failure leads to left sided heart failure C. This type of heart failure leads decreased cardiac output which delivers an adequate amount of oxygen D. There is a build up of pressure in the systemic veins which increases venous pressure, leading to peripheral edema

ANS: D Rationale for Answer D: Right sided heart failure is the failure of the right ventricle to move unoxygenated blood from the venous system into the pulmonary circulation. This leads to congestion of peripheral tissues. Pressure builds up in veins and causes congestion of fluids, which leads to edema. The increase of capillary pressures leads to edema in the lower extremities. There is usually weight gain associated with edema so patients must monitor weight.

While auscultating the heart of a patient complaining of new chest pain and fatigue, a localized low-pitch diastolic murmur is heard. Which of the follow valve disorders would the healthcare provider start to be concerned of? A. Mitral Valve Regurgitation B. Mitral Valve Prolapse C. Aortic Valve Regurgitation D. Mitral Valve Stenosis

ANS: D Rationale for Answer D: The symptoms of mitral valve stenosis are those of pulmonary congestion, including nocturnal paroxysmal dyspnea and orthopnea. Weakness, fatigue, and chest pain are common. An auscultatory characteristic of mitral valve stenosis is an opening snap following the second heart sound due to the stiff mitral valve, as the stenosis worsens; there is a localized low-pitched diastolic murmur that increases in duration with severity