WCU Pathophysiology Midterm

Secondary immune deficiency problems may be caused by (Select all that apply.) - surgery. - high blood sugar. - corticosteroids. - genetic disorders. - low protein level.

- surgery. - high blood sugar. - corticosteroids. - low protein level. Surgery leads to reduced B and T-cell counts. High blood sugar decreases WBC function. Corticosteroids are immunosuppressive. Antibodies are composed of proteins; low protein level impairs antibody synthesis. Genetic abnormalities of immune components lead to primary immune deficiency problems.

Right-sided heart failure is usually a consequence of (Select all that apply.)

-elevated right ventricular afterload. -right ventricular infarction.

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

-interaction of carotid and aortic baroreceptors. -vasomotor center in the brainstem. -activation of SNS. inhibition of PSNS.

End organ damage is

A function of both the stage of hypertension and its duration

Which involves bleeding associated with vascular or platelet defects? (Select all that apply.) a. Bleeding that occurs immediately after trauma b. Bleeding that involves skin or mucous membranes c. Bleeding that is brief in duration d. Bleeding that is delayed e. Bleeding into muscles or joints

A, B, C Bleeding associated with vascular or platelet defects usually occurs immediately after trauma (e.g., dental extraction), involves skin or mucous membranes, and is brief. Delayed bleeding or bleeding into muscles or joints is more typical of a coagulation defect

Regarding iron deficiency anemia, what laboratory features are typically decreased? (Select all that apply.) a. MCV b. MCH c. MCHC d. WBC e. Thrombocytes

A, B, C

A patient is diagnosed with aplastic anemia. The nurse expects to find what patient symptoms upon assessment? (Select all that apply.) a. Lethargy b. Heart palpitations c. Transient murmurs d. Bradycardia e. Orthopnea

A, B, C The symptoms of aplastic anemia are due to the gradual fall of red blood cells and include weakness, fatigue, lethargy, pallor, dyspnea, palpitations, onset of transient murmurs, and the tachycardia of anemia. Bradycardia is not a common symptom of aplastic anemia. Orthopnea is not a common symptom of aplastic anemia.

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

Afterload

In which dysrhythmias should treatment be instituted immediately?

Atrial fibrillation with a ventricular rate of 220 beats/min

In which dysrhythmias should treatment be instituted immediately?

Atrial fibrillation with a ventricular rate of 220 beats/minute

Most carbon dioxide is transported in the bloodstream as a. carboxyhemoglobin. b. bicarbonate ion. c. dissolved carbon dioxide. d. carbonic acid.

B Approximately 90% of the CO2 in the arterial blood and 60% of the CO2 in the venous blood are transported as bicarbonate. Carbon dioxide is not transported as carboxyhemoglobin. Some of the remaining carbon dioxide binds with protein to form carbaminohemoglobin for CO2 transport, but dissolved carbon dioxide is not the primary means of bloodstream transportation. Carbonic acid is disassociated into hydrogen and bicarbonate ions for elimination by the lungs and kidneys.

The person at highest risk for developing hypernatremia is a person who A. self-administers a daily tap water enema to manage a partial bowel ostruction B. receives tube feedings because he or she is comatose after a stroke C. has ectopic production of ADH from small cell carcinoma of the lung D. is receiving IV 0.9% NaCl at a fast rate

B

The person at highest risk for developing hypernatremia is a person who a. self-administers a daily tap water enema to manage a partial bowel obstruction. b. receives tube feedings because he or she is comatose after a stroke. c. has ectopic production of ADH from small cell carcinoma of the lung. d. is receiving IV 0.9% NaCl at a fast rate.

B

The process responsible for distribution of fluid between the interstitial and intracellular compartments is A. filtration B. osmosis C. active transport D. diffusion

B

Vomiting of stomach contents or continuous nasogastric suctioning may predispose to development of A. carbonic acid defecit B. metabolic acid deficit C. metabolic acidosis D. carbonic acid excess

B

Vomiting of stomach contents or continuous nasogastric suctioning may predispose to development of a. carbonic acid deficit. b. metabolic acid deficit. c. metabolic acidosis. d. carbonic acid excess.

B

Which acid are the kidneys unable to excrete? A. Metabolic B. Carbonic C. Bicarbonate D. Ammonia

B

Which acid are the kidneys unable to excrete? a. Metabolic b. Carbonic c. Bicarbonate d. Ammonia

B

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

B

A patient presents to the physician's office with pinpoint hemorrhages on the skin. The patient is most likely between the ages of _____ years. a. 6 months and 2 b. 4 and 7 c. 15 and 18 d. 25 and 45

B Allergic purpura is most often seen in children between the ages of 4 and 7 years. Allergic purpura is not often seen in infants, teenagers, or adults.

What is the correct definition of complete remission (CR) of leukemia?

CR is less than 5% blasts in marrow and normal CBC values

Which acid are the kidneys unable to excrete?

Carbonic

Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class?

Class 1

Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class?

Class I

In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing?

Class II, Compensated Stage

In which stage of shock is a patient who has lost 1200 ml of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing?

Class II, Compensated stage

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

C

Causes of metabolic acidosis include A. hyperventilation B. massive blood transfusion C. tissue anoxia D. hypoventilation

C

Causes of metabolic acidosis include a. hyperventilation. b. massive blood transfusion. c. tissue anoxia. d. hypoventilation.

C

Clinical manifestations of hyponatremia include A. weak pulse, low blood pressure, and increased heart rate B. thirst, dry mucous membranes, and diarrhea C. confusion, lethargy, coma, and perhaps seizures D. cardiac dysrhythmias, paresthesias, and muscle weakness

C

Clinical manifestations of hyponatremia include a. weak pulse, low blood pressure, and increased heart rate. b. thirst, dry mucous membranes, and diarrhea. c. confusion, lethargy, coma, and perhaps seizures. d. cardiac dysrhythmias, paresthesias, and muscle weakness.

C

Clinical manifestations of severe symptomatic hypophosphatemia are cause by A. excess proteins B. renal damage C. deficiency of ATP D. hypocalcemia

C

Diarrhea causes A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

C

Diarrhea causes a. respiratory acidosis. b. respiratory alkalosis. c. metabolic acidosis. d. metabolic alkalosis.

C

If an individual has a fully compensated metabolic acidosis, the blood pH is A. high B. low C. in the normal range D. either high or low, depending on the type of compensation

C

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

C

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

C

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

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

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

C

Sepsis is defined 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

Signs and symptoms of extracellular fluid volume excess include A. tachycardia B. increased serum sodium concentrate C. bounding pulse D. increased hematocrit

C

Signs and symptoms of extracellular fluid volume excess include a. tachycardia. b. increased serum sodium concentration. c. bounding pulse. d. increased hematocrit.

C

Tachycardia is an early sign of low cardiac output that occurs because of a. tissue hypoxia. b. anxiety. c. baroreceptor activity. d. acidosis.

C

The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3 = 24 mEq/L demonstrates A. metabolic acidosis B. respiratory acidosis C. respiratory alkalosis D. mixed alkalosis

C

The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3- = 24 mEq/L demonstrates a. metabolic acidosis. b. respiratory acidosis. c. respiratory alkalosis. d. mixed alkalosis.

C

The drug of choice for treating hypertensive diabetic patients is a. thiazide diuretics. b. β-blockers. c. ACE inhibitors. d. calcium channel blockers.

C

The inward-pulling force of particles in the vascular fluid is called ? pressure? A. capillary hydrostatic B. interstitial osmotic C. capillary osmotic D. interstitial hydrostatic

C

The major buffer in the extracellular fluid is A. hemoglobin B. albumin C. bicarbonate D. phosphate

C

The major buffer in the extracellular fluid is a. hemoglobin. b. albumin. c. bicarbonate. d. phosphate.

C

The nurse provides teaching regarding dietary intake of potassium to avoid an electrolyte imbalance when a patient A. takes very large doses of vitamin D to supplement during chemotherapy for breast cancer B. has fatty stools from taking an OTC weight loss product that decreases absorption of fat C. has chronic heart failure that is treated with diuretics D. experiences anorexia and chronic oliguric renal failure

C

The patient who requires the most careful monitoring for development of metabolic acidosis is a patient who A. is in the diuretic phase of acute renal failure B. has had hypokalemia for over a week C. has had diarrhea for over a week D. has newly diagnosed Cushing syndrome

C

The patient who requires the most careful monitoring for development of metabolic acidosis is a patient who a. is in the diuretic phase of acute renal failure. b. has had hypokalemia for over a week. c. has had diarrhea for over a week. d. has newly diagnosed Cushing syndrome.

C

Total body water in older adults is A. increased due to decreased adipose tissue and decreased bone mass B. increased due to decreased renal function and hormonal fluctuations C. decreased due to increased adipose tissue and decreased muscle mass D. decreased due to renal changes that cause diuresis with sodium execretion

C

Treatment for hemophilia A includes a. heparin administration. b. factor IX replacement. c. factor VIII replacement. d. platelet transfusion.

C

Tumor necrosis factor 〈 and interleukin-1 contribute to shock states because they induce production of a. catecholamines. b. clotting factors. c. nitric oxide. d. vasopressin.

C

What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding? A. Too much sodium in the feedings B. Excess of feedings C. Inadequate water intake D. Kidney failure

C

What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding? a. Too much sodium in the feedings b. Excess of feedings c. Inadequate water intake d. Kidney failure

C

Which alterations can lead to edeam? A. Decreased capillary hydrostatic pressure B. Increased capillary colloid osmotic pressure C. Decreased lymphatic flow D. Dcreased capillary membrane permeability

C

Which alterations can lead to edema? a. Decreased capillary hydrostatic pressure b. Increased capillary colloid osmotic pressure c. Decreased lymphatic flow d. Decreased capillary membrane permeability

C

Which electrolyte imbalances cause increased neuromuscular excitability? A. Hypokalemia and hyperphosphatemia B. Hyperkalemia and hypophosphatemia C. Hypocalcemia and hypomagnesemia D. Hypercalcemia and hypermagnesemia

C

Which electrolyte imbalances cause increased neuromuscular excitability? a. Hypokalemia and hyperphosphatemia b. Hyperkalemia and hypophosphatemia c. Hypocalcemia and hypomagnesemia d. Hypercalcemia and hypermagnesemia

C

Which of the following would result in an increase in systemic blood pressure? a. Hypovolemia b. Decreased cardiac output c. Vasoconstriction d. Decreased vascular resistance

C

A cause of thrombocytopenia includes a. hypoxemia. b. reduced erythropoietin. c. chemotherapy. d. secondary polycythemia.

C Bone marrow suppression from chemotherapy, recent immunizations, and alcohol ingestion are common causes of platelet production. Underlying systemic diseases may be present related to bleeding problems

When antigen-antibody complexes are formed in the blood, which of the following processes can occur? - Precipitation of the antigen-antibody complex - Phagocytosis of the antigen-antibody complex - Neutralization of the antigen - All of the above

All of the above

In addition to antibodies, which of the following molecules act as opsonins? - Histamine - Complement proteins - Fibrin - Antigens

Complement proteins

Obstruction

Arteriosclerosis/atherosclerosis Inflammation Vasospasm Thrombi/emboli Acute occlusion

Mechanical alterations

Arteriovenous fistulas Aneurysms

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

After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later and reports "moderate" adherence to the recommended lifestyle changes. His blood pressure is 148/90. What is the most appropriate intervention at this time?

Continue lifestyle modifications only.

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.

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.

After being diagnosed with hypertension a patient returns to the clinic six weeks later. The patient reports moderate adherence to the recommended lifestyle changes and has experienced a decreased from 165/96 to 148/90 mmHg in blood pressure. What is the most appropriate intervention for this patient at this time?

Continue lifestyle modifications only. Don't start ACE inhibitors, diuretics, or beta blockers because progress is happening without medication.

Angiotensin converting enzyme (ACE) inhibitors block the

Conversion of angiotensin 1 to angiotensin 2

Which change in a patient's assessment has the greatest urgency? A. Serum potassium concentration is decreasing; abdominal distension, but denies any difficulty breathing B. Serum calcium concentration is decreasing; reports constipation; is alert and denies any discomfort C. Serum calcium concentration is increasing; reports constipation; is alert and denies any discomfort D. Serum potassium concentration is increasing; has developed cardiac dysrhythmias, but denies any difficulty breathing

D

Which change in a patient's assessment has the greatest urgency? a. Serum potassium concentration is decreasing; abdominal distention, but denies any difficulty breathing b. Serum calcium concentration is decreasing; reports constipation; is alert and denies any discomfort c. Serum calcium concentration is increasing; reports constipation; is alert and denies any discomfort d. Serum potassium concentration is increasing; has developed cardiac dysrhythmias, but denies any difficulty breathing

D

The final step in clot formation is a. conversion of prothrombin to thrombin. b. platelet degranulation and adhesion. c. conversion of fibrinogen to fibrin. d. clot retraction.

D Clot retraction, the final stage of clot formation, occurs when the components of the fibrin clot are compressed or contracted to form a firm clot. Platelets serve as a catalyst in accelerating the conversion of prothrombin to thrombin. Platelet degranulation is not involved in clot formation. The formation of a fibrin clot occurs when fibrinogen is converted to fibrin, usually at the site of an injury.

Patients who experience anemic episodes when exposed to certain drugs most likely have a. thalassemia. b. spherocytosis. c. sickle cell anemia. d. glucose-6-phosphate dehydrogenase deficiency

D Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a RBC intracellular defect. Usually this anemia is first recognized during or after an infectious illness or exposure to certain drugs. Thalassemia does not carry a manifestation associated with pharmacologic agents. Spherocytosis is a hereditary anemia with manifestations of jaundice. Episodes of sickle cell anemia are associated with recurrent painful episodes related to organ dysfunction.

What is the effect on resistance if the radius of a vessel is halved

Doubling the radius of a vessel on the flow of blood results in a 16 times greater blood flow that increases the vessel's resistance by a factor of 16

Dynamics in the Microcirculation: Capillaries and Lymphatics

Exchange of gases and nutrients Dependent on pressure gradient between the capillary and the interstitium through balance of: -Capillary hydrostatic pressure -Interstitial fluid colloid osmotic pressure -Plasma colloid osmotic pressure -Interstitial fluid pressure Changes in capillary permeability that allows plasma proteins to leak out can result in edema Impairment of lymphatic flow allowing fluid to collect in the interstitium is referred to as lymphedema

Raynaud Syndrome

Extreme vasoconstriction producing cessation of flow to fingers and toes Intrinsic structural factors, extrinsic neuroregulation, and locally produced mediators are involved Treatment directed toward enhancing circulation through biofeedback, relaxation, calcium-channel blockers, sympatholytic drugs, and prostaglandins

A patient with a blood pressure consistently measured at 109/92 is correctly diagnosed as having stage 1 hypertension. True/False

F

Blood pressure in the legs of a supine individual normally is lower than that in the arms. True/False

F

Cardiogenic shock is characterized by low cardiac output, low blood pressure, and low cardiac preload. True/False

F

If stroke volume is 70 ml and heart rate is 100 beats/min, the cardiac output is 700 ml/min. True/False

F

In cardiogenic shock, an increase in oxygen extraction (lower SvO2) indicates an increase in cardiac output. True/False

F

Pulmonary edema is likely to occur when the left atrial or pulmonary capillary occlusion pressure reaches 12 mm Hg. True/False

F

The mean pulmonary artery pressure is about 30 mm Hg. True/False

F

Vasopressin, angiotensin II, and atrial natriuretic peptide all increase blood volume and pressure. True/False

F

Vasopressor drugs to restore blood pressure are the primary therapy for hypovolemic shock. True/False

F

Which end of an antibody binds to an antigen? - Fc - Fab - TH1 - TH2

Fab The Fab end of an antibody binds to antigen.

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

False

Chronic elevation of myocardial wall tension results in atrophy. True or false?

False

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

False

The most commonly recognized outcome of hypertension is pulmonary disease.

False

Seasonal allergic rhinitis is most involved in type II hypersensitivity reactions. T/F

False Seasonal allergic rhinitis is most involved in type I hypersensitivity reactions.

A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis.

False A patient diagnosed with cardiogenic shock who is hyperventilating is at risk for respiratory alkalosis.

Chronic elevation of myocardial wall tension results in atrophy.

False Chronic elevation of myocardial wall tension results in hypertrophy.

Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle cell anemia.

False (before 2 years of age and booster given at 3 to 5 years of age)

The most commonly recognized outcome of hypertension is pulmonary disease.

False (cardiovascular disease)

New-organ damage is a function of both the stage of hypertension and its duration. True or false?

False, end organ damage is a function of both the stage of hypertension and its duration.

A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic

False, neurogenic shock

A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic. True or false?

False, neurogenic shock

A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis

False, respiratory alkalosis

The most commonly recognized outcome of hypertension is pulmonary disease. True or false?

False, the most commonly recognized outcome of hypertension is cardiovascular disease

The characteristic x-ray findings in tuberculosis include

Ghons tubercules

Blood flow is slow through capillaries because capillaries

Have the largest total cross sectional area

Allergic (extrinsic) asthma is associated with

IgE-mediated airway inflammation

A 3-year old boy who exhibits prolonged bleeding after minor trauma and a prolonged aPTT, bu a normal platelet count, is likely to be diagnosed with

Hemophilia

An elderly patient's blood pressure is measured at 160/98 (Combined Hypertension Stage II). How would the patient's left ventricular function be affected by this level of blood pressure?

Left ventricular workload is increased with high afterload.

An elderly patient's blood pressure is measured at 160/98. How would his left ventricular function be affected by this level of blood pressure?

Left ventricular workload is increased with high afterload.

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?

Left ventricular workload is increased with high afterload.

Lymphatic flow is controlled by

Increasing fluid colloid osmotic pressure and by stimulation of the contractile fibers (often called lymphatic pumps) as they are stretched

Lymphatic flow controlled by:

Increasing interstitial fluid colloid osmotic pressure Stimulation of contractile fibers (lymphatic pumps)

What is necessary for red blood cell production?

Iron

Quervain syndrome

Is a type of tendonitis

MAP

Is the calculated average pressure within the circulatory system throughout the the cardiac cycle

Atherosclerosis put a pt at risk for

Ischemic stroke Retinal injury Renal impairment

Venous obstruction leads to edema because

It increases capillary hydrostatic pressure

Your patient is scheduled for a staging procedure. She wants to know what that means. The correct response is which of the following?

It is a procedure for determining the extent of tumor spread

What is the normal HCO3 levels in the blood?

Normal 22 - 26 mEq/L

What is the normal PaCO2 in the blood?

Normal 35 - 45 mmHg

What is the normal pH in the blood? What pH would cause death?

Normal 7.35 - 7.45; Death < 6.9 or > 7.8; Danger of Cardiac arrhythmias when low

Which assessment would support a diagnosis of type A COPD rather than type B COPD

Normal PaCO2, scant sputum, accessory muscle use, barrel chest

Administration of which of the following therapies would be most appropriate for hypovolemic shock?

Normal saline

Blood Vessels

Obstructions -May involve arterial or venous system -Obstruction results in reduced flow beyond the obstruction (downstream) and increased pressure before the obstruction (upstream) -In the arterial system obstruction manifests as distal ischemia, in the venous system obstruction manifests as edema

A patient who was involved in a fall from a tree becomes short of breath. The lung sounds are absent on one side. The patient is experiencing what kind of shock?

Obstructive shock

Hypertension is closely linked to

Obstructive sleep apnea

Chronic Venous Insufficiency

Results when valvular incompetence involves the deep veins Venous stasis ulcers are typically present Venous ulcers treated with compression therapy and infection control

Clinical Assessment

Personal/family history of bleeding disorder Systemic diseases that may be involved (liver disease not enough cogulative) Medication history (aspirin , antibotics ) Physical findings such as petechiae (flat bruise/coloration), purpura(patches or cluster), ecchymosis, hematoma(raised bruise/epi elevated fluid build up), hemarthrosis(blood in joint/ common hemathelia/ fracture), telangiectasia (bleeding under skin), and occult or frank bleeding

Obstructive sleep apnea would most likely be found in a patient diagnosed with

Pickwickian syndrome

A 3 year old is diagnosed with starvation ketoacidosis. What signs and symptoms should you anticipate in your assessment?

Rapid, deep breathing, LETHARGY, abdominal pain

Thromboangiitis Obliterans (Buerger Disease)

Rare inflammatory condition affecting small and medium-size arteries and veins of upper and lower extremities resulting in varying degrees of obstruction Treatment entails smoking cessation (if applicable) and use of prostaglandins

Anatomy of Capillaries

Single thickness of endothelial cells attached to a basement membrane Spaces between endothelial cells determine the capillary permeability -Blood-brain barrier -Kidney capillary beds

Lymphatic circulation

Specialized system of channels and tissues Reabsorbs fluid that leaks from vascular network into the interstitium and returns it to the general circulation

Which vessel normally demonstrates the most rapid blood flow

The vena cava

Blood Vessels: Structural Alterations

Types of structural alterations Valvular incompetence Arteriosclerosis/atherosclerosis Aneurysms Arteriovenous fistulas

The most reliable indicator that a person is experiencing an acute myocardial infarction is

ST-segment elevation

Hypertension reflects an elevation in

SVR

A patient diagnosed with chronic compensated heart failure reports that, "My feet swell if I eat salt but I don't understand why" The nurse's best response is

Salt holds water in your blood + makes more pressure against blood vessels, so fluid leaks out into your tissues + makes them swell

What form of oral rehydration, bottled water or salty broth, is best suited for a patient who is demonstrating signs of clinical dehydration?

Salty soup, because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid

The ingestion of certain drugs, food or chemicals can lead to

Secondary hypertension

What is the major function of T helper cells? - Triggering degranulation of mast cells - Producing antibodies against autoantigens - Killing virus-infected and potentially malignant cells - Secreting cytokines that regulate immune response

Secreting cytokines that regulate immune response

A patient presenting with fever, hypotension and lactic acidosis is most likely to be experiencing what type of shock?

Septic

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock?

Septic

A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ______ shock.

Septic

Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock?

Septic

A patient is presenting with fever, hypotension, and lactic acidosis is most likely experiencing what type of shock?

Septic shock

Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock?

Septic shock. The overproduction of nitric oxide is seen in septic shock as a result of the release of immune cytokines.

Peripheral edema is a result of

Venous thrombosis

A patient who reports dizziness and who has absent P waves, wide QRS complexes, and a heart rate of 38 beats/min on an ECG is most likely in which rhythm?

Ventricular escape rhythm

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?

Ventricular escape rhythm

A patient who reports dizziness who has absent P waves, wide QRS complexes, and a heart rate of 38 beats per minute on an EKG is most likely in which rhythm?

Ventricular escape rhythm

The person at highest risk for developing hypernatremia is a person who a. receives tube feedings because he or she is comatose after a stroke. b. self-administers a daily tap water enema to manage a partial bowel obstruction. c. is receiving IV 0.9% NaCl at a fast rate. d. has ectopic production of ADH from small cell carcinoma of the lung.

a

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

a

Total body water in older adults is a. decreased because of increased adipose tissue and decreased muscle mass. b. increased because of decreased renal function and hormonal fluctuations. c. increased because of decreased adipose tissue and decreased bone mass. d. decreased because of renal changes that cause diuresis with sodium excretion.

a

Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock?

a. Septic 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.

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

a. True

Viral pneumonia is characterized by a. a dry cough. b. exudative consolidation. c. a productive cough. d. significant ventilation-perfusion imbalance.

a. a dry cough. No exudative fluids are produced. Viral pneumonia does not produce exudates, so the cough is non-productive. Ventilation-perfusion imbalance does not usually occur in viral pneumonia.

Lack of α-antitrypsin in emphysema causes a. destruction of alveolar tissue. b. chronic mucous secretion and airway fibrosis. c. bronchoconstriction and airway edema. d. pulmonary edema and increased alveolar compliance.

a. destruction of alveolar tissue. Lack of α1-antitrypsin in emphysema causes destruction of alveolar tissue, as it is a protective enzyme that prohibits proteolytic breakdown of alveolar tissue. Lack of alpha1-antitrypsin does not cause chronic mucous secretion and airway fibrosis, pulmonary edema and increased alveolar compliance, or bronchoconstriction and airway edema.

Renal compensation for respiratory acidosis is evidenced by a. elevated bicarbonate ion concentration. b. elevated carbon dioxide. c. decreased bicarbonate ion concentration. d. decreased carbon dioxide.

a. elevated bicarbonate ion concentration. Elevated bicarbonate ion concentration is evidence of compensation for a respiratory acidosis. The lungs manage the carbon dioxide concentration. Elevated carbon dioxide is evidence of respiratory acidosis, not of compensation for it. Decreased bicarbonate ion concentration would make acidosis worse.

0. Respiratory alkalosis is caused by

a. hyperventilation

The body compensates for metabolic alkalosis by

a. hypoventilation.

Respiratory acidois is associated with

a. increased carbonic acid.

Uncompensated metabolic alkalosis would result in

a. increased pH, increased HCO3 -.

Chronic bronchitis often leads to cor pulmonale because of a. increased pulmonary vascular resistance. b. left ventricular strain. c. ventricular hypoxia. d. hypervolemia.

a. increased pulmonary vascular resistance. Chronic bronchitis often leads to cor pulmonale as a result of increased pulmonary vascular resistance when right ventricular end-diastolic pressure increases. Ventricular hypoxia, left ventricular strain, and hypervolemia do not lead to cor pulmonale.

A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for a. pneumothorax. b. pneumonia. c. pulmonary edema. d. pulmonary embolus.

a. pneumothorax. Pneumothorax leads to a tracheal shift to the side opposite the pneumothorax. Pneumonia, pulmonary edema, and pulmonary embolus do not lead to tracheal shift.

The person at highest risk for developing hypernatremia is a person who a. receives tube feedings because he or she is comatose after a stroke. b. has ectopic production of ADH from small cell carcinoma of the lung. c. is receiving IV 0.9% NaCl at a fast rate. d. self-administers a daily tap water enema to manage a partial bowel obstruction.

a. receives tube feedings because he or she is comatose after a stroke. Tube feedings are associated with hypernatremia as a result of intake of highly concentrated solution that causes the kidneys to excrete extra water to remove the solute load. Absorption of excessive water from daily tap water enemas would cause hyponatremia. Uncontrolled secretion of ADH causes renal retention of water that leads to hyponatremia. An IV solution of 0.9% NaCl (normal saline) is isotonic.

Emphysema results from destruction of alveolar walls and capillaries, which is because of a. release of proteolytic enzymes from immune cells. b. autoantibodies against pulmonary basement membrane. c. air trapping with resultant excessive alveolar pressure. d. excessive α1-antitrypsin.

a. release of proteolytic enzymes from immune cells. The pathologic changes leading to alveolar destruction are associated with the release of proteolytic enzymes from inflammatory cells such as neutrophils and macrophages. While air trapping occurs in emphysema, the destruction of alveolar walls and capillaries is because of release of proteolytic enzymes. Lack of α1-antitrypsin can result in emphysema. Autoantibodies are not involved in destruction of alveolar walls and capillaries in emphysema.

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

a. syncope. 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.

The fraction of total body water (TBW) volume contained in the intracellular space in adults is a. two thirds. b. one half. c. three fourths. d. one third.

a. two thirds. Approximately two thirds of TBW is contained inside the cells. Two thirds, not three fourths, of TBW is contained inside the cells. Two thirds, not one-half, of TBW is contained inside the cells. One-third of the TBW is extracellular in adults.

Neutropenia

absolute neutrophil count <500 cells/μl (neutrophil 1st one there of defense being immunocompromised ) Evaluation of peripheral blood sample key aspect of diagnosis Definitive diagnosis is usually made after bone marrow aspiration or lymph node biopsy

Bacterial pneumonia leads to hypoxemia caused by

accumulation of alveolar exudates

A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum (mixture of saliva and mucus, phlegm). The patient is most likely experiencing

acute cardiogenic pulmonary edema

A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum. This patient is most likely experiencing

acute cardiogenic pulmonary edema.

A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum. This patient is most likely experiencing

acute cariogenic pulmonary edema

Acute myocardial infarction and unstable angina are both?

acute coronary syndromes.

Myocarditis should be suspected in a patient who presents with

acute onset of left ventricular dysfunction

Myocarditis should be suspected in a patient who presents with

acute onset of left ventricular dysfunction.

Widespread atelectasis, non-cardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates on chest radiograph are characteristic of

acute respiratory distress syndrome

Anemia

administer erythropoietin growth factor rbc transfusion therapy Prevent bleeding episode

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

afterload

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

afterload

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

afterload.

COPD leads to a barrel chest, because it causes

air trapping

A commonly ingested substance associated with prolongation of the bleeding time is

aspirin

After evaluation, a child's asthma is characterized as "extrinsic". This means that the asthma is

associated with specific allergic triggers

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

In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing? a. Class III, Progressive Stage b. Class II, Compensated Stage c. Class I, Initial Stage d. Class IV, Refractory Stage

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

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 II b. Class I c. Class IV d. Class III

b

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

b

The arterial blood gas pH = 7.52, PaCO 2 = 30 mm Hg, HCO 3 - = 24 mEq/L demonstrates a. respiratory acidosis. b. respiratory alkalosis. c. metabolic acidosis. d. mixed alkalosis.

b

The assessment findings of a 5-year-old with a history of asthma include extreme shortness of breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles. There is no wheezing and the chest is silent in many areas. How should you interpret your assessment? a. The signs and symptoms are consistent with asthma; start oxygen and then check to see that your stethoscope is working properly. b. The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the doctor immediately. c. Since there is not wheezing, asthma is the problem, but oxygen should be started immediately anyway. d. The child probably has consolidated pneumonia; oxygen should be started immediately.

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

The process responsible for distribution of fluid between the interstitial and intracellular compartments is a. active transport. b. osmosis. c. filtration. d. diffusion.

b

What results when systemic blood pressure is increased? a. Decreased cardiac output b. Vasoconstriction c. Hypovolemia d. Decreased vascular resistance

b

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

b

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

All of the following stress-induced hormones increase blood glucose except

aldosterone

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?

b. Anaphylactic 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.

A person with acute hypoxemia may hyperventilate and develop

b. respiratory alkalosis.

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

c

A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n) a. young sedentary male with a high-stress job. b. middle-aged man with a previous history of MI. c. elderly woman without a previous history of MI. d. young female athlete with cardiomegaly.

c

A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum. This patient is most likely experiencing a. right-sided heart failure. b. cardiomyopathy. c. acute cardiogenic pulmonary edema. d. a medication reaction.

c

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

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

Abnormalities in intracellular regulation of ensyme activity and cellular production of ATP are associated with A. hyponatremia B. hypocalcemia C. hypophosphatemia D. hypokalemia

c

After evaluation, a child's asthma is characterized as "extrinsic." This means that the asthma is a. associated with respiratory infections. b. induced by psychological factors (stress). c. associated with specific allergic triggers. d. of unknown pathogenesis.

c

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

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

c

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

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

Decreased neuromuscular excitability is often the result of a. hypomagnesemia and hyperkalemia. b. hypocalcemia and hypokalemia. c. hypercalcemia and hypermagnesemia. d. hypernatremia and hypomagnesemia.

c

Hypertrophy of the right ventricle is a compensatory response to a. aortic regurgitation. b. aortic stenosis. c. pulmonary stenosis. d. tricuspid stenosis.

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

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 to the kidneys stimulates the release of _____ from juxtaglomerular cells. a. norepinephrine b. aldosterone c. renin d. angiotensinogen

c

Manifestations from sodium imbalances occur primarily as a result of a. vascular collapse. b. hyperosmolarity. c. cellular fluid shifts. d. hypervolemia.

c

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

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. systolic pressure + diastolic pressure. b. systolic pressure × systemic resistance. c. systolic pressure - diastolic pressure. d. two thirds of systolic pressure + diastolic pressure.

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

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

Signs and symptoms of clinical dehydration include a. increased skin turgor. b. increased blood pressure. c. decreased urine output. d. decreased heart rate.

c

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

c

The finding of ketones in the blood suggests that a person may have a. metabolic alkalosis. b. respiratory alkalosis. c. metabolic acidosis. d. respiratory acidosis.

c

The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by a. increased pulmonary blood flow. b. decreased chest wall compliance. c. increased residual lung volumes. d. increased expiratory flow rates.

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 primary cause of infant respiratory distress syndrome is a. umbilical cord compression. b. prematurity. c. lack of surfactant. d. maternal illegal drug use during pregnancy.

c

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

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

What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding? a. Too much sodium in the feedings b. Excess of feedings c. Inadequate water intake d. Kidney failure

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

The major buffer in the extracellular fluid is

c. bicarbonate.

Effects of hypernatremia on the central nervous system typically include a. insomnia. b. hallucinations. c. confusion. d. excitation.

c. confusion. Hypernatremia causes osmotic shrinking of brain cells, which manifests as confusion or coma. Hypernatremia does not usually cause central nervous system excitation, insomnia, or hallucinations.

Aortic regurgitation is associated with

c. diastolic murmur. 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.

A known cause of hypokalemia is a. pancreatitis. b. oliguric renal failure. c. insulin overdose. d. hyperparathyroidism.

c. insulin overdose. Insulin overdose causes hypokalemia by shifting potassium into cells. Oliguric renal failure decreases electrolyte excretion. Pancreatitis causes fat malabsorption, which binds calcium and magnesium, but not potassium, in the gastrointestinal tract. Hyperparathyroidism regulates calcium, not potassium.

Vomiting of stomach contents or continuous nasogastric suctioning may predispose to development of a. metabolic acidosis. b. carbonic acid excess. c. metabolic acid deficit. d. carbonic acid deficit.

c. metabolic acid deficit. Gastric contents are rich in hydrochloric acid; loss of this through suctioning or vomiting leads to a metabolic acid deficit and alkalosis. Carbonic acid is related to the respiratory system. Vomiting produces metabolic alkalosis as a result of loss of acid-rich gastric contents, it does not increase carbonic acid.

Diarrhea causes

c. metabolic acidosis.

Cancer grading is based on

cell differentiation

Manifestations from sodium imbalances occur primarily as a result of

cellular fluid shifts

A patient, who is 8 months pregnant, has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures. To determine if her infusion rate is too high, you should regularly

check the patellar reflex; if it becomes weak or absent, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest.

A cause of thrombocytopenia includes

chemotherapy

Causes of hypomagnesemia include

chronic alcoholism

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?

anaphylactic

Antiogensin converting enzyme (ACE) inhibitors block the conversion of

angiontensin I to angiontensin II

The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with

antibiotics

Patients presenting with symptoms of unstable angina and no ST segment elevation are treated with

antiplatelet drugs

The majority of cardiac cells that die after myocardial infarction do so because of

apoptosis

Coagulopathies

are defects of the normal clotting mechanism Results can include: Bleeding from a problem with the formation, stabilization or lysis of the fibrin clot Excessive clot formation due to inappropriate activation of the coagulation cascade

Adventitia

collagenous connective tissue (thickest section in veins)

Leukemia, lymphoma, and plasma cell myeloma (multiple myeloma)

common neoplastic disorders of the bone marrow and lymphoid tissues

Clinical manifestations of hyponatremia include

confusion, lethargy, coma, and perhaps seizure (CNS dysfunction)

Clinical manifestations of hyponatremia include

confusion, lethargy, coma, and perhaps seizures

Venules

connective tissue predominates

Angiotensin-converting enzyme (ACE) inhibitors block the

conversion of angiotensin I to angiotensin II

Angiotensin-converting enzyme (ACE) inhibitors block the

conversion of angiotensin I to angiotensin II.

Angiotensin-converting enzyme (ACE) inhibitors block the?

conversion of angiotensin I to angiotensin II.

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

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 a. myocardial infarction. b. angina. c. arthrosclerosis. d. hypertensive crisis.

d

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

d

Accumulation of fluid in the pleural space is called a. pleurisy. b. flail chest. c. an abscess. d. pleural effusion.

d

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

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

Asthma is categorized as a(n) a. infective pulmonary disorder. b. type of acute tracheobronchial obstruction. c. restrictive pulmonary disorder. d. obstructive pulmonary disorder.

d

Clinical manifestations of extracellular fluid volume deficit include a. thirst, dry mucous membranes, and diarrhea. b. cardiac dysrhythmias, paresthesias, and muscle weakness. c. confusion, lethargy, coma, and perhaps seizures. d. weak pulse, low blood pressure, and increased heart rate.

d

Copious amounts of foul-smelling sputum are generally associated with a. pulmonary edema. b. epiglottitis. c. emphysema. d. bronchiectasis.

d

Croup is characterized by a. a productive cough. b. drooling, sore throat, and difficulty swallowing. c. an inability to cough. d. a barking cough.

d

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

d

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

d

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells. a. aldosterone b. angiotensinogen c. norepinephrine d. renin

d

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

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

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

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

d

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

Tachycardia is an early sign of low cardiac output that occurs because of a. anxiety. b. acidosis. c. tissue hypoxia. d. baroreceptor activity.

d

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

d

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

d

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

d

Uncompensated metabolic alkalosis would result in a. increased pH, decreased HCO3-. b. decreased pH, decreased HCO3-. c. decreased pH, increased HCO3-. d. increased pH, increased HCO3-.

d

What is likely to lead to hyponatremia? a. Excess aldosterone secretion b. Insufficient ADH secretion c. Administration of intravenous normal saline d. Frequent nasogastric tube irrigation with water

d

Which complication of asthma is life threatening? a. Exercise-induced asthma b. Late phase response c. Mast cell degranulation d. Status asthmaticus

d

Widespread atelectasis, non-cardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates on chest radiograph are characteristic of a. asthma. b. chronic obstructive pulmonary disease. c. cor pulmonale. d. acute respiratory distress syndrome.

d

Tissues are able to autoregulate their rate of blood flow by controlling

Vascular resistance

Norepinephrine causes

Vasoconstriction

What happens when systemic blood pressure is increased

Vasoconstriction

What results when systemic blood pressure is increased?

Vasoconstriction

Which of the following would result in an increase in systemic blood pressure?

Vasoconstriction

Administration of a vasodilator to a patient in shock would be expected to

decrease left ventricular afterload

Administration of a vasodilator to a patient in shock would be expected to

decrease left ventricular afterload. Vasodilators are used to decrease the workload of the heart by decreasing left ventricular afterload. Nitroprusside and nitroglycerin are examples of vasodilators. Dobutamine is used to decrease vascular resistance. Positive inotropic drugs are used to increase contractility. Positive inotropes include β-adrenergic agonists, which have the ability to increase tissue perfusion.

Repiratory Acidosis

excess CO2 - cause of excess acid

Metabolic Alkalosis

excess HCO3- cause of excess base

The conversion of plasminogen to plasmin results in

fibrinolysis

Patients who experience anemic episodes when exposed to certain drugs most likely have

glucose-6-phosphate dehydrogenase deficiency

The nurse provides teaching regarding dietary intake of potassium to avoid an electrolyte imbalance when a patient

has chronic heart failure that is treated with diuretics

The patient who requires the most careful monitoring for development of metabolic acidosis is a patient who

has had diarrhea for over a week

The patient who requires the most careful monitoring for development of metabolic acidosis is a patient who

has had diarrhea for over a week.

A naive B cell is a B lymphocyte that: - is dysfunctional and marked for apoptosis. - has not left the thymus. - has not been presented with an antigen. - produces antibodies.

has not been presented with an antigen.

Blood flow is slow through capillaries because capillaries

have the largest total cross-sectional area

Renal compensation for respiratory acidosis is evidenced by

d. elevated bicarbonate ion concentration.

A 3-year-old is diagnosed with starvation ketoacidosis. What signs and symptoms should you anticipate in your assessment?

rapid, deep breathing, lethargy, abdominal pain

Type IV hypersensitivity

reactions are T-cell mediated and do not require antibody production, in contrast to type I, II, and III reactions. Sensitized T cells react with altered or foreign cells and initiate inflammation. Contact dermatitis, tuberculin reactions, transplant rejection, and graft-versus-host disease are examples. 24-48 hours INFLAMATION REACTION 24-48 HRS DELAYED IN THE DERMIS TB TEST DELAY HEYPERSENSITIVITY

Type III hypersensitivity

reactions occur when antigen-antibody complexes are deposited in tissues and result in the activation of complement and subsequent tissue inflammation and destruction. Antigen-antibody complexes activate the complement cascade and subsequently attract phagocytic cells to the tissue. History of persistent low-grade infections, inhalation of antigens into alveoli, and autoimmune production of antibodies may result in chronic production of antigen-antibody complexes. Examples include glomerulonephritis and SLE. Autoimmune igg Antigent antibot Attract nutrophil 6 hrs Infection Allergic Body attack cell itself and look at nonself cell Artemis diease attack own cell Lupus Farmers lung Arthritis and vasculitis 6 hours

The person at highest risk for developing hypernatremia is a person who

receives tube feedings because he or she is comatose after a stroke

Transfusion reactions involve RBC destruction caused by - donor antigens. - recipient antibodies. - donor T cells. - recipient T cells.

recipient antibodies. The recipient of the blood transfusion has antibodies to the donor's red blood cell (RBC) antigens; the antibodies destroy large numbers of RBC. Donor antigens, donor T, and recipient T cells do not cause transfusion reactions.

Artherosclerotic plaques with large lipid cores are prone to

rupture

Atherosclerotic plaques with large lipid cores are prone to

rupture.

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

secondary

Hypertension with a specific, identifiable cause is known as

secondary hypertension

Myasthenia gravis is a type II hypersensitivity disorder that involves - impaired muscle function. - symptoms of hyperthyroidism. - symptoms of arthritis or polyarthralgia. - symptoms of glomerular disease.

impaired muscle function. Myasthenia gravis involves muscle weakness caused by loss of acetylcholine stimulation at the motor end-plate. Symptoms of hyperthyroidism occur in Graves disease. Symptoms of arthritis or polyarthralgia occur in systemic lupus erythematosus, a type II hypersensitivity disorder. Glomerular disease can occur in type III hypersensitivity disorders.

To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke

impairs alpha1-antitrypsin, allowing elastase to predominate

To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke

impairs α1-antitrypsin, allowing elastase to predominate.

The major cause of death from leukemic disease is

infection

The patient is a 12-year-old boy diagnosed with acute lymphoid leukemia (ALL). As part of treatment, the patient must undergo several weeks of chemotherapy. The most serious complication of chemotherapy is

infection

empydema

infection in the pleural space

Pernicious anemia is caused by a lack o

intrinsic factor

Necrotic death of brain tissue usually produces _________ necrosis

liquefactive

The ________ is responsible for the synthesis of coagulation factors, with the exception of part of factor VIII.

liver

Type II hypersensitivity

occurs when antibodies are formed against antigens on cell surfaces, usually resulting in lysis of target cells.Cell lysis may be mediated by activated complement fragments (membrane attack complex) or by phagocytic cells that are attracted to target cells by the attached antibodies.Examples include transfusion reactions, erythroblastosis fetalis, myasthenia gravis, and hyperacute graft rejection. Igg igm Soon body contact with other cell if foreign immediately will kill the cell Foeign tissue Cell immediately attach Ex Organ transplant 15-30mins

How does the body compensate for metabolic acidosis?

lungs 'save' CO2 (make CO2 higher to lower pH) to offset increased base - breath slower

How does the body compensate for metabolic acidosis?

lungs, will try to raise pH to blow of CO2, compensate by faster respiratory rate to decrease CO2

Leukopenia

lymphadenopathy, joint swelling and pain, weight loss, anorexia, hepatomegaly, splenomegal (decrease in WBC )

Malignant Disorders of White Blood Cells - Plasma cell myeloma

malignant transformation of B-cell plasma cells; likes to form localized tumors in bony structures -Malignancy of B-cells chronic leukemia can be aggressive . Antibodies secreting B-cell can be cancerous.

The precursor cell to the macrophage is the: - neutrophil. - eosinophil. - plasma cell. - monocyte.

monocyte Monocytes produced by the bone marrow circulate in the blood, from which they enter tissue and mature into macrophages.

The process of covering bacteria with antibodies to promote phagocytosis of the microorganisms is called: - neutralization. - precipitation. - margination. - opsonization

opsonization The Fc portions of the antibodies that cover an opsonized microorganism attract phagocytes.

The process responsible for distribution of fluid between the interstitial and intracellular compartments is

osmosis

All these cellular responses are potentially reversible except

necrosis

The strength of the bond between oxygen and hemoglobin is known as the

oxygen-hemoglobin affinity

Fully compensated respiratory acidosis is demonstrated by

pH 7.36, PaCO2 55, HCO3- 36

A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician?

pH in high part of normal range, PaO 2 normal, PaCO 2 high, bicarbonate high

A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician?

pH in high part of normal range, PaO2 normal, PaCO2 high, bicarbonate high

Asthma is categorize as an

obstructive pulmonary disorder

Hypertension is closely linked to

obstructive sleep apnea

Hypertension is closely linked to

obstructive sleep apnea.

An abnormally wide (more than 0.10 secod) QRS complex is characteristic of

premature ventricular complexes

An abnormally wide (more than 0.10 second) QRS complex is a characteristic of

premature ventricular complexes

An abnormally wide (more than 0.10 second) QRS complex is characteristic of

premature ventricular complexes.

Legionnaires disease is characterized by

presence of systemic illness

A major risk factor for the development of active pulmonary tuberculosis (TB) disease is

immunosuppression

Constrictive pericarditis is associated with

impaired cardiac filling

Constrictive pericarditis is associated with

impaired cardiac filling.

Restrictive pericarditis is associated with?

impaired cardiac filling.

Lusitropic impairment refers to

impaired diastolic relaxation

Lusitropic impairment refers to

impaired diastolic relaxation.

The most common primary immune deficiency that affects only B cells is - DiGeorge. - Bruton agammaglobulinemia. - Wiskott-Aldrich. - selective IgA

selective IgA The most common B-cell primary immunodeficiency disorder is selective IgA deficiency. This disorder affects 1:2000 persons. DiGeorge is a T-cell primary immune deficiency. Bruton agammaglobulinemia is not the most common primary immune deficiency affecting B cells; frequency of disease is 1:250,000 males. Females are carriers. Wiskott-Aldrich affects both T cells and B cells.

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock?

septic

A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock.

septic

A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock.

septic

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock?

septic shock

Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock?

septic shock

Which change in a patient's assessment has the greatest urgency?

serum potassium concentration is increasing; has developed cardiac dysrhythmias, but denies any difficulty breathing

A laboratory test that should be routinely monitored in patients receiving digitalis therapy is

serum potassium.

A laboratory test that should be routinely monitored in patients receiving digitalis therapy is

serum potassium. Digitalis is used to slow the heart rate through activation of the PNS and may lead to hypokalema (low potassium), which can further lead to digitalis toxicity.

Capillaries

single layer of endothelial cells Changes occur with aging Thickening of the basement membrane in microvasculature: -Narrowed vessel lumen -Impaired exchange of oxygen, nutrients and metabolic wastes Decreased elastin and increased collagen: -Decreased elasticity of arteries -Increased fibrosis in media and thickening of intima Increased systolic blood pressure and arterial insufficiency

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

stable angina

Orthostatic hypotension is a risk factor for (Select all that apply.)

stroke, cognitive impairment, death.

It can be explained to a patient that high blood pressure increases the risk of (Select all that apply.) a. stroke.

stroke, renal disease, ischemic heart disease

Airway obstruction in chronic bronchitis is because of

thick mucus, fibrosis, and smooth muscle hypertrophy

Most myocardial infarctions occur when an atherosclerotic plaque stimulates?

thrombus formation at the site.

Causes of metabolic acidosis include

tissue anorexia

Causes of metabolic acidosis include

tissue anoxia

Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes. a. True b. False

t

The progressive stage of hypovolemic shock is characterized by

tachycardia

Malignant Disorders of White Blood Cells - Lymphoma

tends to localize in lymph tissues; is often disseminated to other sites at diagnosis (malignancy WBC in lymphatic tissue ) -maligancy WBC in lymphatic tissue

Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called

tension pneumothorax

After suffering a heart attack, a middle-aged man is counseled to take a cholesterol-lowering medication. This is an example of

tertiary prevention

Allostasis is best defined as

the overall process of adaptive change necessary to maintain survival and well-being.

Blood pressure equals?

the product of cardiac output (CO) and systemic vascular resistance. (SVR)

Metaplasia is

the replacement of one differentiated cell type with another

Ohm's law represents

the variables of driving pressure and resistance and their effect on blood flow

Graft vs leukemia

transplanted cells in the allograft that detect and kill leukemic cells (immuno type of graft)

What results when systemic blood pressure is increased?

vasoconstriction

The effect of nitric oxide on systemic arterioles is

vasodilation

Osmoreceptors located in the hypothalamus control the release of

vasopressin (ADH)

An example of an acyanotic heart defect is

ventricular septal defect

An example of an acyanotic heart defect is

ventricular septal defect.

An example of an acyanotic heart defect is?

ventricular septal defect.

Rheumatic heart disease is most often a consequence of

β-hemolytic streptococcal infection.

Rheumatic heart disease is most often a consequence of?

β-hemolytic streptococcal infection.

The majority of tachydysrhythmias are believed to occur because of

reentry mechanisms.

Obstructive disorders are associated with

Low expiratory flow rates

The cellular response indicative of injury because of faulty metabolism is

intracellular accumulations

Which characteristic is indicative of hemolytic anemia?

jaundice

Clinical manifestations of moderate to severe hypokalemia include

muscle weakness and cardiac dysrhythmias

Cor pulmonale refers to

right ventricular failure secondary to right ventricular infarction.

Cor pulmonale refers to

right ventricular hypertrophy secondary to pulmonary hypertension

Cor pulmonale refers to

right ventricular hypertrophy secondary to pulmonary hypertension.

The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is

digitalis.

A patient with heart failure who reports intermittent shortness of breath during the night is experiencing

paroxysmal nocturnal dyspnea.

First degree heart block is characterized by

prolonged PR interval

First-degree heart block is characterized by

prolonged PR interval

A patient diagnosed with chronic compensated heart failure reports that, "My feet swell if I eat salt but I don't understand why" The nurse's best response is

"Salt holds water in your blood and makes more pressure against your blood vessels, so fluid leaks out into your tissues and makes them swell."

First-degree heart block is characterized by

prolonged PR interval.

Tachycardia is an early sign of low cardiac output that occurs because of a. baroreceptor activity. b. anxiety. c. tissue hypoxia. d. acidosis.

a

Vaccination for pneumococcal pneumonia should be performed before ____ years of age in patients with sickle cell anemia.

2 before 2 years of age in patients with sickle cell anemia and booster vaccinations given 3 to 5 years later.

The electrolyte that has a higher concentration in the extracellular fluid than in the intracellular fluid is _____ ions. a. sodium b. phosphate c. potassium d. magnesium

a

The relationship between the variables of pressure and resistance is expressed by Ohm's law

(Blood flow) Q = P/R P is the pressure difference R is the resistance

Sepsis has been recently redefined as

a systemic inflammatory response to infection.

Sepsis is defined as

a systemic inflammatory response to infection.

Chronic Lymphoid Leukemia

- 30% of all case of leukemia -95% malignant B-cell= asymptomatic -5% malignant T-cell= aggressive Clinical Signs -increased infection susceptibility -defective apoptosis REDUCED: -RBC -platelet Symptoms: -fatigue -weight loss -ANOREXIA -LYMPHADENOPATHY -splenomegaly -Malignant lymphocytes invade lymphoid tissues and bone marrow; disrupts function Enlarged, painless lymph nodes (lymphadenopathy) Enlarged spleen Treatment: -depend on transformation -rapid growth (chemo) -no response: stem cell transplantation Shared symptoms: CML: -splenomegaly -fatigue -weight loss CLL cell characteristed by defective apoptosis and longer lifespan Derived from mature peripheral B cells

Acute Myeloid Leukemia (Acute granulocytic Leukemia )

- 80% all cases are adults average age 64 Clinical signs: -malignant immature WBC> 20% -Cells: large segmented nucleus & fine chromatin -abrupt onset of symptoms -increased infection susceptibly COMMON INFECTIONS SITES: -skin -GI -GU -Respiratory tract ex UTI Symptoms: -bone pain -anemia -thrombocytopenia Treatment: incorporating cytogenic profile of leukemia cells to indivualize theraphy and monitor response TWO PHASE: 1. chemotherapy: attempt CR 2.Post remission: attempt elimination of residual malignant cells Agent used: -ICE protocol -DAT protocol CHEMO Shared symptoms: ALL: bone pain HAIRY CELL: anemia Cells have large segmented nucleus and fine chromatin (its there has to condense to attach chromosome/ immaturity) Abrupt onset of symptoms Prognosis worse for AML than ALL: <50% children and 30% adults survive long term Acute promyelocytic leukemia (APL) most curable (accounts for 10%-15% of AML) of all subtypes

Acute Lymphoblastic Leukemia/Lymphoma

- 80% malignant B-cell -20% malignant T-cell -peak incidence: between 3 and 7 years -2nd peak: middle age Clinical signs: -primarily a children's disease: 2nd leading cause - children may refuse to walk -3% may present with signs of CNA -increased infection susceptibility Symptoms: -fatigue -bone pain -BRUISING -fever -LOSS OF APPETITE -splenomegaly -lymphadenopathy -enlarged liver Treatment: -chemo for induction and post-remission -pre B-cell: 90% cure rate -mature B-cell & T-cell: poor prognosis prognosis: -5 year survival rate ----80% children -----30%-50% adults Chemo CML & CLL: -splenomegaly -fatigue -weight loss CLL only: -lymphadenopathy AML: -bone pain

non-Hodgkin Disease

- 95% older adults males>females -incidence increasing, eps. AIDS population -EPSTEIN_BARR VIRUS withot Reed-sternberg cells 2 types: -indolent (chronic) -agressive (acute) complication: -surperior vena cava obstruction -spinal cord compression Symptoms: -night sweats -LYMPHADENOPATHY -FEVER -pruritus -weight loss -malaise Treatment: -radiation therapy on localized tumors (common) -if disease is disseminated then chemotherapy PROGNOSIS: -stage 1-2= favorable outcomes -stage 3 -4 = less favorable Depends

Anaphylaxis may occur in certain hypersensitivity reactions, including type (Select all that apply.) - I. - II. - III. - IV.

- I. - II.

How does the body compensate for respiratory acidosis?

- kidney compensates by saving (reabsorbs) HCO3 to compensate for the acidic environment, buffer the CO2

Autoimmune diseases result from (Select all that apply.) - overactive immune function. - increase in self-tolerance. - failure of the immune system to differentiate self and nonself molecules. - communicable infections.

- overactive immune function. - failure of the immune system to differentiate self and nonself molecules. Autoimmunity results from a functional increase in the activity of the immune system. Breakdown of self-tolerance occurs. Genetic and environmental factors are thought to contribute to autoimmunity. Autoimmune disease results from failure of the immune system to differentiate self and nonself molecules; this results in immune reactions that attack normal tissue.

Hairy cell Leukemia

-2% adult leukemia -average age 55 (males 5:1) Rare chronic B-cell phenotype Clinical signs: -90% all cases associated splenomegaly -hair-like projection Reduced: -granulocytes -platelets -RBCs INCREASE injection susceptibility Symptoms: -splenomegaly -anemia -bleeding disorder treatment: -chemo 80% CR rates CML & CLL: splenomegaly AML: anemia

Which statement is true about the incidence of heart failure? (Select all that apply.)

-Heart failure is the fastest-growing cardiac disorder. -The increasing incidence and hospitalization rates of heart failure reflect the aging population in the United States. -The incidence of heart failure is 10 per 1000 population after age 65.

A patient with forward effects of heart failure may present with which symptoms? (Select all that apply.)

-Impaired memory -Mental fatigue -Confusion

A patient's ECG lacks recognizable waveforms and is deemed to be in sinus arrest. The patient's sinus arrest may be a result of (Select all that apply.)

-MI. -electrical shock. -electrolyte disturbance. -acidosis.

A patient has heart failure with a normal ejection fraction. Which findings are most likely found in this patient? (Select all that apply.)

-Pulmonary congestion -Edema -Ejection fraction less than 45%

Extrinsic Mechanisms

-Release of norepinephrine results in vasoconstriction via α1 receptors -Release of epinephrine results in vasodilation via β2-adrenergic receptors -Venous system flow controlled by pressure gradient from veins and venous and thoracic pumps -SNS -smooth muscle

Lymphatic Structure

-Thin walled and resemble veins -Range in size from capillaries to vessels of increased diameter -Intermittent valves that extend into lumen -Capillary walls contain contractile fibers that propel lymph along the vessel

Dysrhythmias are significant since they (Select all that apply.)

-can indicate an underlying disorder -can impair cardiac output

Plasma Cell Myeloma (Multiple Myeloma)

-invade bone and form multiple tumor sites; may also target other tissues, including lymph nodes, liver, spleen, and kidneys - occurs in adults >40 years -avg 65 years old (male>female) -Renal insufficiency; 50 % cases -signal clone Clinical signs: -magligant plasma cell invade tissue and form multiple tumor sites TUMOR INVADED: -bone (most) -lymph nodes -liver -spleen -kidneys -abnormalities in chromose structure and number -LARGE AMOUNTs of one type of anti-body creating characteristic spike -presence of BENCE Jones protein Bence Jones protein: malignant plasma cells produce light-chain antibody fragments that accumulate in blood and urine -bone destruction -protein in urine -high serum Calcium lvl -honey comb appearance -end stage renal disease -increased infection Symptoms: -bone pain -anemia -bleeding disorder TREATment: -autologous stem cell transplant is the initial therapy if patient is strong enough -antineoplastic agents -high dose chem then allogenic BMT BONE PAIN: -narcotic/nonnarcotic pain relievers -localized radiation ALL & AML: bone pain AML& hairy cell: anemia Haircell: bleeding disorder CHEMO

The most common causes of heart failure are (Select all that apply.)

-myocardial ischemia -hypertension

Hodgkin Disease

-slow , insidious -30% malignant lymphoma -half cases between age 20 & 40 males> females Clinical sign: -REED_STERNBERG CELLS found in EPSTEIN-BARR VRIUS -cliassical text book spreading 2 types: -rare lymphocyte predominance (5%) -classical (cHD) Lymphnode Enlargement (above Diaphragm): -cervical nodes (common) lymphnode Enlargement (below Diaphragm): -inguinal nodes (common) Symptom: -night sweats -LYMPHADENOPATHY -FEVER -pruritus -weight loss -malaise TREATMENT: -radiation therapy on localized tumor (common) -is dieases is disseminated then chemotherapy DEPENDS

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.

The prevalence of high blood pressure is higher in

. non-Hispanic black adults.

Burkitt lymphoma is most closely associated with

Epstein-Barr virus

Prehypertension

128/82

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria?

128/82

A 3-year-old boy who exhibits prolonged bleeding after minor trauma and a prolonged aPTT, but a normal platelet count, is likely to be diagnosed with a. hemophilia. b. liver dysfunction. c. disseminated intravascular coagulation. d. thrombocytopenia.

A

The areterial oxygen content (CaO2) for a patient with PaO2 100 mmHg, SaO2 95%, and hemoglobin 15 g/dL is _____ mL oxygen/dL

19.4

The fraction of total body water (TBW) volume contained in the intracellular space in adults is

2/3

A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n)

elderly woman without a previous history of MI.

A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n)

elderly woman without previous history of MI

Which serum biomarkers are indicative of irreversible damage of myocardial cells?

elevated CK-MB, troponin ! and troponin T

Respiratory acidosis is associated with a. increased carbonic acid. b. hypokalemia. c. increased neuromuscular excitability. d. increased pH.

A

Respiratory alkalosis is caused by a. hyperventilation. b. pneumonia. c. chest muscle weakness. d. pulmonary edema.

A

Respiratory alkalosis is caused by A. hyperventilation B. pneumonia C. chest muscle weakness D. pulmonary edema

A

Signs and symptoms of clinical dehydration include A. decreased urine output B. increased skin turgor C. increased blood pressure D. decreased heart rate

A

Signs and symptoms of clinical dehydration include a. decreased urine output. b. increased skin turgor. c. increased blood pressure. d. decreased heart rate.

A

The body compensates for metabolic alkalosis by A. hypoventilation B. decreasing arterial carbon dioxide C. increasing bicarbonate ion excretion D. hyperventilation

A

Renal compensation for respiratory acidosis is evidenced by

elevated bicarbonate ion concentration

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

2ndary

The body compensates for metabolic alkalosis by a. hypoventilation. b. decreasing arterial carbon dioxide. c. increasing bicarbonate ion excretion. d. hyperventilation.

A

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

A

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

A

The electrolyte that has a higher concentration in the extracellular fluid than in the intracellular fluid is _____ ions. a. sodium b. phosphate c. magnesium d. potassium

A

The electrolyte that has a higher concentration in the extracellular fluid that in the intracellular fluid is ? ions? A. sodium B. phosphate C. magnesium D. potassium

A

The finding of ketones in the blood suggests that a person may have A. metabolic acidosis B. metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis

A

The finding of ketones in the blood suggests that a person may have a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

A

Uncompensated metabolic alkalosis would result in a. increased pH, increased HCO3-. b. increased pH, decreased HCO3-. c. decreased pH, increased HCO3-. d. decreased pH, decreased HCO3-.

A

Uncompensated metabolic alkalosis would result in A. increased pH, increased HCO3 B. increased pH, decreased HCO3 C. decreased pH, increased HCO3 D. decreased pH, decreased HCO3

A

What age group has a larger volume of extracellular fluid than intracellular fluid? A. Infants B. Adolescents C. Young Adults D. Older Adults

A

Which of the following causes of shock is not considered to be obstructive? a. Ventricular rupture b. Pulmonary embolus c. Cardiac tamponade d. Tension pneumothorax

A

A patient presents to the physician's office with pinpoint hemorrhages on the skin. The patient is most likely between the ages of _____ years.

4 and 7

Which of the following findings 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 110/72, HR 118 b. Sitting BP 108/68, HR 102 c. Sitting BP 110/78, HR 98 d. Sitting BP 120/80, HR 100

A

Which of the following cells are strong phagocytes? - Macrophages - T lymphocytes - Plasma cells - Natural killer cells

Macrophages

Which of the following is an accurate description of patent ductus arteriosus?

A communication between the aorta and the pulmonary artery.

A laboratory test finding helpful in confirming the diagnosis of iron-deficiency anemia is a. elevated total iron-binding capacity. b. elevated MCHC and MCV. c. elevated total and indirect bilirubin. d. positive direct or indirect Coombs test

A In iron-deficiency anemia, the total iron-binding capacity is elevated. The red cell indices of MCHC and MCV are decreased in iron-deficiency anemia. Total and indirect bilirubin levels are not utilized in diagnosing iron-deficiency anemia. Coombs testing is not utilized in obtaining a diagnosis of iron-deficiency anemia.

Hypertensive crisis is characterized by

A diastolic blood pressure of greater than 120mm Hg and symptoms of end organ damage such as retinopathy and ischemic stroke

Aortic regurgitation is associated with?

A diastolic murmur.

Movement of lymph is enhanced by

: Lymphatic pumps Compression of lymphatic channels (ambulation) Intrathoracic pressure changes (deep breathing) Lymphatic contractions (increased BP)

Sympathetic nervous system (SNS)—medulla-vasomotor center

: responds to direct stimulation and to excitatory/inhibitory afferent stimuli

Parabolic profile of laminar flow

: velocity of the layers of blood flow within the vessel vary, with blood in the center moving faster than blood in outer layers

A patient diagnosed with chronic compensated heart failure reports that, "My feet swell if I eat salt, but I don't understand why" The nurse's best response is A. "Salt holds water in your blood and makes more pressure against your blood vessels, so fluid leaks out into your tissues and makes them swell" B. "Gravity makes more pressure down by your feet than up at the top of your body, so more fluid leaks into your tissues at your feet and they swell." C. "Salt makes your blood vessels relax and the blood does not flow as fast, so some of it leaks into your tissues and makes swelling." D. "Salt binds to the proteins in your blood and changes the osmotic pressure so more fluid can leak out and stay in the tissues, causing swelling."

A

Administration of which of the following therapies would be most appropriate for hypovolemic shock? a. Normal saline b. Vasoconstrictor agents c. Inotropic agents d. 5% dextrose in water

A

After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later and reports "moderate" adherence to the recommended lifestyle changes. His blood pressure is 148/90. What is the most appropriate intervention at this time? a. Continue lifestyle modifications only. b. Continue lifestyle modifications plus diuretic. c. Continue lifestyle modifications plus ACE inhibitor. d. Continue lifestyle modifications plus β-blocker.

A

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

A

An increase in the resting membrane potential (hyperpolarized) is associated with a. hypokalemia. b. hyperkalemia. c. hypocalcemia. d. hypercalcemia.

A

Because of his high blood pressure, smoking history, obesity, and sedentary lifestyle, a patient is at significant risk for developing atherosclerosis. What laboratory evaluation would be most helpful in further assessing risk for atherosclerosis? a. Serum lipid profile b. Serum sodium level c. Thyroid hormone panel d. Urinalysis

A

Clinical manifestations of extracellular fluid volume deficit include A. weak pulse, low blood pressure, and increased heart rate B. thirst, dry mucous membranes, and diarrhea C. confusion, lethargy, coma, and perhaps seizures D. cardiac dysrhythmias, paresthesias, and muscle weakness

A

Decreased neuromuscular excitability is often the result of A. hypercalcemia and hypermagnesemia B. hypomagnesemia and hyperkalemia C. hypocalcemia and hypokalemia D. hypernatremia and hypomagnesemia

A

Decreased neuromuscular excitability is often the result of a. hypercalcemia and hypermagnesemia b. hypomagnesemia and hyperkalemia. c. hypocalcemia and hypokalemia. d. hypernatremia and hypomagnesemia.

A

Dysfunction of which organ would lead to clotting factor deficiency? a. Liver b. Kidney c. Spleen d. Pancreas

A

Effects of hypernatremia on the central nervous system typically include A. confusion B. excitation C. insomnia D. hallucinations

A

Effects of hypernatremia on the central nervous system typically include a. confusion. b. excitation. c. insomnia. d. hallucinations.

A

Fully compensated respiratory acidosis is demonstrated by A. pH 7.36, PaCO2 55, HCO3 36 B. pH 7.45, PaCO2 40, HCO3 28 C. pH 7.26, PaCO2 60, HCO3 26 D. pH 7.40, PaCO2 40, HCO3 24

A

Manifestations from sodium imbalances occur primarily due to A. cellular fluid shifts B. vascular collapse C. hyperosmolarity D. hypervolemia

A

Manifestations from sodium imbalances occur primarily due to a. cellular fluid shifts. b. vascular collapse. c. hyperosmolarity. d. hypervolemia.

A

Red blood cells obtain nearly all their energy from metabolism of a. glucose. b. fats. c. proteins. d. acetyl coenzyme A

A

Respiratory acidosis is associated with A. increased carbonic acid B. hypokalemia C. increased neuromuscular excitability D. increased pH

A

A newborn has melena, bleeding from the umbilicus, and hematuria. The newborn most likely experiencing a. vitamin K deficiency bleeding. b. acquired vitamin K deficiency. c. von Willebrand disease. d. disseminated intravascular coagulation.

A Vitamin K deficiency bleeding is found in newborns and includes melena, bleeding from the umbilicus, and hematuria. Acquired vitamin K deficiency may include gastrointestinal bleeding, ecchymoses, menorrhagia, and hematuria. von Willebrand disease presents as epistaxis, mucosal bleeding, ecchymoses, gastrointestinal bleeding, and menorrhagia. Disseminated intravascular coagulation includes bleeding from orifices, petechiae, and ecchymoses on skin and mucous membranes.

A normal bleeding time in association with normal platelet count, and increased prothrombin time (PT) and INR, is indicative of a. vitamin K deficiency. b. hemophilia B. c. hemophilia A. d. idiopathic thrombocytopenia.

A Vitamin K deficiency should be considered as the cause for bleeding when the PT and INR are increased but other coagulation studies are normal. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Hemophilia A results from factor deficiency or the abnormal function of factor VIII. In idiopathic thrombocytopenia, a decreased platelet count is seen in prolonged bleeding times.

A male patient involved in a motor vehicle accident is brought to the emergency department with acute flank pain. What additional signs of bleeding may the patient exhibit? (Select all that apply.) a. Hematuria b. Melena c. Hematemesis d. Menorrhagia e. Hemoptysis

A, B, C, E Blood in the urine is indicative of a bleeding disorder. Blood in the feces could indicate internal bleeding. Blood in vomit may signify a bleeding disorder. Menorrhea is excessive menstrual bleeding, which would not be seen in the male patient. Bloody sputum is a common symptom of a bleeding disorder.

The nurse is educating a patient diagnosed with anemia of chronic renal failure about the disease. Which statements made by the nurse are correct regarding the patient's treatment? (Select all that apply.) a. "Since your glomerular filtration is 13 mL/min, you'll be started on dialysis." b. "Your hematocrit is 29%, so you're going to start on erythropoietin therapy." c. "Your hemoglobin is 9 g/dl, so you'll need erythropoietin therapy." d. "We need to get your hemoglobin up to at least 15 g/dl" e. "You're going to need iron, folate, and B12 therapy to help improve your blood counts."

A, B, C, E Therapy for anemia of chronic renal failure consists of dialysis when the glomerular filtration rate is less than 15 ml/min, and erythropoietin is administered to achieve the target hematocrit of 33% to 36% and hemoglobin of 11 to 12 g/dl. Patient replacement of iron, folate, and B12 to adequate levels is also recommended. Using erythropoiesis-stimulating agents to increase hemoglobin values to greater than 12 g/dl is not routinely recommended.

When a patient is struck in the eye by a baseball, the result is redness and swelling. This increase in blod flow to a localized area is called

hyperemia

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

A. BP 88/60, HR 118. Orthostatic hypotension is a decrease in systolic pressure greater than 20 mmHG or greater than 10 mmHg within 3 minutes of moving to an upright position.

The body compensates for metabolic alkalosis by

hypoventilation

An erroneously low blood pressure measurement may be caused by: A. Positioning the arm above heart level B. Position the arm at heart level C. Measuring blood pressure after exercise D. Using a cuff that is too small

A. Positioning the arm above heart level

A newborn patient is diagnosed with hemolytic disease. The nurse may expect to find what signs and symptoms? (Select all that apply.) a. Petechial hemorrhages b. Hepatomegaly c. Splenomegaly d. Kernicterus e. Erythema

ABCD

One of the cardinal features of sickle cell anemia includes acute and chronic dysfunction of which organs? (Select all that apply.) a. Spleen b. Bones c. Brain d. Lungs e. Stomach

ABCD

The drug of choice for treating hypertensive diabetic patients is?

ACE inhibitors

A 5-year-old patient's parents report loss of appetite and fatigue in their child. The parents also state that the child refuses to walk as a result of pain. The child's most likely diagnosis is

ALL (acute lymphoid leukemia)

In general, the best prognosis for long-term disease-free survival occurs with

ALL (acute lymphoid leukemia)

The principle Ig mediator of type I hypersensitivity reactions is a. IgA. b. IgG. c. IgM. d. IgE.

ANS: D Immunoglobulin E (IgE) is the principal antibody mediating type I hypersensitivity reactions. IgA is not the primary Ig mediator of type I hypersensitivity reactions. IgG is involved in type II hypersensitivity reactions. IgM is involved in type II hypersensitivity reactions.

Which disorder is considered a primary immunodeficiency disease? a. HIV/AIDS b. Malnutrition immunodeficiency c. Cancer immunodeficiency d. Radiation immunodeficiency

ANS: A HIV/AIDS is a primary immunodeficiency disease involving destruction of T helper cells. Malnutrition immunodeficiency is a secondary immunodeficiency disorder and leads to T-cell destruction and dysfunction. Cancer immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from chemotherapeutic agents. Radiation immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from the effects of radiation.

Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because a. massive histamine release from mast cells leads to vasodilation. b. toxins released into the blood interfere with cardiac function. c. anaphylaxis results in large volume losses secondary to sweating. d. hypoxia resulting from bronchoconstriction impairs cardiac function.

ANS: A Hypotension can occur in type I hypersensitivity resulting from massive histamine release leading to vasodilation. Toxins are not released during type I hypersensitivity reactions. Sweating occurs as a reaction to shock from severe hypotension; the hypotension occurs first and is because of histamine release. Hypoxia occurs in anaphylaxis as a result of shock from severe hypotension; the hypotension occurs first and is because of histamine release.

Myasthenia gravis is a type II hypersensitivity disorder that involves a. impaired muscle function. b. symptoms of hyperthyroidism. c. symptoms of arthritis or polyarthralgia. d. symptoms of glomerular disease.

ANS: A Myasthenia gravis involves muscle weakness caused by loss of acetylcholine stimulation at the motor end-plate. Symptoms of hyperthyroidism occur in Graves disease. Symptoms of arthritis or polyarthralgia occur in systemic lupus erythematosus, a type II hypersensitivity disorder. Glomerular disease can occur in type III hypersensitivity disorders.

Severe combined immunodeficiency (SCID) syndrome is an example of a(n) a. deficient immune response. b. excessive immune response. c. primary acquired immunodeficiency. d. hypersensitivity reaction.

ANS: A SCID syndrome is an example of a deficient immune response in which the immune response is ineffective because of disease-causing genotypes or secondary/acquired dysfunction. An excessive immune response includes disorders in which the immune system is overfunctioning or hyperfunctioning. HIV/AIDS is an example of a primary acquired immunodeficiency disorder. Hypersensitivity reactions are an excessive immune response.

Which disorder is associated with a type III hypersensitivity mechanism of injury? a. Systemic lupus erythematosus b. Graves disease c. Erythroblastosis fetalis d. Seasonal allergic rhinitis

ANS: A Systemic lupus erythematosus is a type III hypersensitivity disorder. Type III hypersensitivity is characterized by antigen-antibody complex deposition into tissues, with consequent activation of complement and a subsequent self-sustaining inflammatory reaction. Graves disease and erythroblastosis fetalis are type II hypersensitivity reactions. Seasonal allergic rhinitis is a type I hypersensitivity reaction.

A primary effector cell of the type I hypersensitivity response is a. monocytes. b. mast cells. c. neutrophils. d. cytotoxic cells.

ANS: B Mast cells are a primary effector cell of the type I hypersensitivity response. Monocytes, neutrophils, and cytotoxic cells are not primary effectors of the type I hypersensitivity response.

Transfusion reactions involve RBC destruction caused by a. donor antigens. b. recipient antibodies. c. donor T cells. d. recipient T cells.

ANS: B The recipient of the blood transfusion has antibodies to the donor's red blood cell (RBC) antigens; the antibodies destroy large numbers of RBC. Donor antigens, donor T, and recipient T cells do not cause transfusion reactions.

The effects of histamine release include a. vasoconstriction. b. bronchodilation. c. increased vascular permeability. d. decreased gut permeability.

ANS: C Histamine release leads to increased vascular permeability, which fosters fluid movement out of capillaries and into tissues leading to the edema common in type I hypersensitivity. Histamine leads to bronchoconstriction, increased gut permeability, and vasodilation (not vasoconstriction).

Certain autoimmune diseases are associated with the presence of specific proteins on a person's cells. These proteins are called ________ proteins. a. complement b. antibody receptor c. HLA or MHC d. TCR or BCR

ANS: C Human major histocompatibility complex (MHC) genes located on chromosome 6p21 (also called human leukocyte antigen (HLA) genes) are frequently associated with certain autoimmune disorders. Complement, antibody receptors, and TCR or BCR are not factors in development of autoimmune disease.

RhoGAM (an Rh antibody) would be appropriate in an Rh-_____ woman with an _____ Rh-_____ antibody titer carrying an Rh-_____ fetus. a. negative; positive; positive b. positive; negative; negative c. negative; negative; positive d. negative; negative; negative

ANS: C If a woman is Rh-negative, RhoGAM is administered for prevention of Rh-positive antibodies. Erythroblastosis fetalis develops during pregnancy when an Rh-negative mother is sensitized to her fetus's Rh-positive red cell group antigens because of exposure during her current or a previous pregnancy. RhoGAM contains antibodies against Rh antigens on fetal blood cells and is given to the mother to destroy fetal cells that may be present in her circulation before her immune system becomes activated and begins to produce anti-Rh antibodies. RhoGAM is not effective if the mother already has a positive antibody titer for fetal Rh antigens. An Rh-positive woman with negative Rh antibody titer carrying Rh-negative fetus does not require RhoGAM because the mother is Rh-positive and the fetus is Rh-negative.

A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type _____ hypersensitivity reaction. a. I b. II c. III d. IV

ANS: C Immune complex glomerulonephritis (an inflammatory renal disorder) is an example of a type III hypersensitivity reaction. The circulating immune complex is then deposited in the glomerular capillary wall and mesangium. Glomerulonephritis secondary to strep throat is not a type I, II, or IV sensitivity reaction.

An important mediator of a type I hypersensitivity reaction is a. complement. b. antigen-antibody immune complexes. c. T cells. d. histamine.

ANS: D Histamine mediates type I hypersensitivity reactions. Complement mediates type II hypersensitivity reactions. Antigen-antibody immune complexes mediate type III hypersensitivity reactions. T cells mediate type IV hypersensitivity reactions.

Patients with immunodeficiency disorders are usually first identified because they a. run high fevers. b. have unusually high WBC counts. c. develop brain infections. d. develop recurrent infections.

ANS: D The first clinical indicators of immunodeficiency disorders are the signs and symptoms of infection, and the disorders are often first suspected when an individual has severe recurrent, unusual, or unmanageable infections. High fevers can occur in patients who have an intact immune system. Because of the immune deficiency, patients with immunodeficiency disorders may not demonstrate expected WBC counts with infection. Infections in patients with immunodeficiency disorders can occur anywhere in the body.

The most common primary immune deficiency that affects only B cells is a. DiGeorge. b. Bruton agammaglobulinemia. c. Wiskott-Aldrich. d. selective IgA.

ANS: D The most common B-cell primary immunodeficiency disorder is selective IgA deficiency. This disorder affects 1:2000 persons. DiGeorge is a T-cell primary immune deficiency. Bruton agammaglobulinemia is not the most common primary immune deficiency affecting B cells; frequency of disease is 1:250,000 males. Females are carriers. Wiskott-Aldrich affects both T cells and B cells.

The hypersensitivity reaction that does not involve antibody production is type a. I. b. II. c. III. d. IV.

ANS: D Type IV hypersensitivity reactions do not involve antibody production. The principal mediators are lymphocytes, including T helper cells (Th) that mediate the reaction by releasing lymphokines (cytokines) and/or antigen-sensitized cytotoxic T cells (Tc) that can directly kill cells. The other types involve antibody production. Type I involves IgE; type II involves IgM or IgG; type III involves IgG.

Seasonal allergic rhinitis is most involved in type II hypersensitivity reactions.

ANS: F Seasonal allergic rhinitis is most involved in type I hypersensitivity reactions.

Circulatory circuit

Absorption and delivery of nutrients Oxygen uptake and delivery Removal of waste products

Qualitative Platelet Disorders (nonfunctional platelets)

Ability of platelets to function in the hemostatic process is abnormal Inherited disorders include Bernard-Soulier syndrome, von Willebrand disease, and thrombasthenia Acquired disorders more common (drug-induced, renal failure, hematologic disease) Treatment based on underlying disorder and may require platelet transfusion

Vascular purpura

Abnormality of the vessels or tissues Purpura (patches of petechiae) are present Diagnosis is one of exclusion after platelet and coagulation disorders are ruled out Tourniquet (Rumpel-Leede) test may be used (pump hold 5 mins/ vessels constricted / blood filled/ if weak its going to break) Treatment is geared toward removing and avoiding the causative agent (whatever category it falls in) Allergic purpura: autoimmune process(body can attck vessels and break down making it thin= bleed) Ehlers-Danlos syndrome: deficient collagen and elastin (inherited disorder/ not enough collagen[skin bloodvessel, liagment tendon] or elastic ) Vitamin C deficiency: defective collagen synthesis (aquired/ nutrition/ Vitamin C=make collagen) Aging: loss of subcutaneous fat and changes in connective tissue

Acute Arterial Occlusion

Absence of arterial circulation—emergency May result from thrombi/emboli or mechanical compression Classic signs and symptoms (6 Ps) Pallor Paresthesia Paralysis Pain Polar Pulseless Incompetent valves (obesity, pregnancy, right heart failure, prolonged standing) producing varicose veins, chronic venous insufficiency, and obstruction by deep vein thrombosis Accompanied by edema, venous stasis ulcers, and pain Deep vein thrombosis can be life threatening

The pain characteristics of chronic venous insufficiency include

Aching and cramping in the affected area Relief with elevation to the area Relief with ambulation if pain is in the legs

Disseminated Intravascular Coagulation (DIC)

Acquired hemorrhagic syndrome in which clotting and bleeding occur simultaneously Fibrinogen level and platelet count decreased Increased bleeding time Elevated PT/INR/aPTT/D-dimer (lead towards hemorrhage) Treatment: removal/correction of underlying cause Acute excusive climb Bleeding eyes nose same time

What is the function of H1 receptors for histamine on white blood cells? - Activating neutrophils and macrophages - Reducing phagocytosis - Inhibiting degranulation - Increasing vascular permeability

Activating neutrophils and macrophages

In which stage of shock is a patient who has lost 1200 ml of blood, has normal blood pressure when supine, but experiences orthostatic hypotension upon standing? a. Compensated b. Mild c. Moderate d. Severe

B

Low cardiac output in association with high preload is characteristic of _____ shock. a. hypovolemic b. cardiogenic c. anaphylactic d. septic

B

A patient with long-standing hypertension is at risk for hypertensive heart disease. Which of the following clinical findings is indicative of this complication?

An S4 heart sound

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?

Anaphylactic

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?

Anaphylactic shock

Thalassemia may be confused with iron-deficiency anemia, because they are both a. hyperchromic. b. microcytic. c. genetic. d. responsive to iron therapy.

B

Blood flow controlled by central mechanisms mediated by:

Autonomic nervous system Venous and thoracic pumps Intrinsic autoregulatory mechanisms

Von Willebrand Disease

Autosomal dominant disorder of factor VIII carrier protein and platelet dysfunction Causes excessive bleeding (Hallmarkexcessive bleeding during and after surgery ) Treatment with desmopressin, which releases von Willebrand factor and factor VII from vascular endothelial cells; cryoprecipitate and humate-P used to manage severe bleeding Deficency in factor * Hallmarkexcessive bleeding during and after surgery

Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease)

Autosomal dominant trait Vessel wall composed of single layer of endothelium Multiple telangiectases, repeated episodes of bleeding, or a family history in both sexes (lip palate tongue face and trunk of body, plams hand and sole of feet) (treat)Supportive tx with topical hemostatic agents, cauterization(nose bleed), iron replacement, laser therapy Nose bleeds hallmark bleeding

A 48-year-old man was noted to have elevated blood pressure at a health fair and is in the office for follow-up. He states that 3 weeks ago his blood pressure was recorded at 162/96. He has no significant past medical history and takes no medications. He smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. He is about 40 pounds overweight and admits to a high-fat, high-calorie diet. At his visit today, his blood pressure is 150/92. What is the least appropriate intervention at this time? a. Begin lifestyle modifications. b. Begin antihypertensive drug therapy. c. Recheck blood pressure in 4 to 6 weeks. d. Encourage smoking cessation.

B

A known cause of hypokalemia is A. oliguric renal failure B. pancreatitis C. insulin overdose D. hyperparathyroidism

B

A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician? A. pH in high part of normal range, PaO2 normal, PaCO2 normal, bicarbonate normal B. pH in high part of normal range, PaO2 normal, PaCO2 high bicarbonate high C. pH in low part of normal range, PaO2 normal, PaCO2 low, bicarbonate low D. pH in low part of normal range, PaO2 normal, PaCO2 normal, bicarbonate normal

B

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

B

The fraction of total body water (TBW) volume contained in the intracellular space in adults is A. three-fourths B. two-thirds C. one-half D. one-third

B

The imbalance that occurs with oliguric renal failure is A. metabolic alkalosis B. hyperkalemia C. hypokalemia D. hypophosphatemia

B

A patient, who is 8 months pregnant, has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures. To determine in her infusion rate is too high, you should regularly A. check the patellar reflex, if it becomes more and more hyperactive, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest B. check the patellar reflex, if it becomes weak or absent, her infusion rate probably is too high and she is at risk for respiratory depression and cardiac arrest C. check the patellar reflex, if it stays the same, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest D. check for seizure activity; if no seizures occur, her infusion rate is correct

B

A person with acute hypoxemia may have hyperventilation and develop A. respiratory acidosis B. respiratory alkalosis C. metabolic alkalosis D. metabolic acidosis

B

A person with acute hypoxemia may hyperventilate and develop a. respiratory acidosis. b. respiratory alkalosis. c. metabolic alkalosis. d. metabolic acidosis.

B

After surgery for a cardiac valve replacement, a patient becomes hypotensive and tachycardic. The heart sounds are muffled, and the central venous pressure and left atrial pressure are elevated and equal. This patient is experiencing _____ shock. a. cardiogenic b. obstructive c. hypovolemic d. distributive

B

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

B

Causes of hypomagnesemia include A. hyperphosphatemia B. chronic alcoholism C. oliguric renal failure D. clinical dehydration

B

Causes of hypomagnesemia include a. hyperphosphatemia. b. chronic alcoholism. c. oliguric renal failure. d. clinical dehydration.

B

Clinical manifestations of moderate to severe hypokalemia include A. muscle spasms and rapid respirations B. muscle weakness and cardiac dysrhythmias C. confusion and irritability D. vomiting and diarrhea

B

Clinical manifestations of moderate to severe hypokalemia include a. muscle spasms and rapid respirations. b. muscle weakness and cardiac dysrhythmias. c. confusion and irritability. d. vomiting and diarrhea.

B

Diabetic patients with hypertension have a blood pressure goal of less than a. 120/80. b. 130/80. c. 130/90. d. 140/90.

B

Diarrhea and other lower intestinal fluid losses will contribute to A. metabolic alkalosis B. metabolic acidosis C. respiratory acidosis D. mixed acid-base disorders

B

Diarrhea and other lower intestinal fluid losses will contribute to a. metabolic alkalosis. b. metabolic acidosis. c. respiratory acidosis. d. mixed acid-base disorders.

B

Disseminated intravascular coagulation may be treated with heparin therapy to a. enhance fibrinolysis. b. inhibit clotting factor consumption. c. activate platelets. d. enhance liver synthesis of clotting factors.

B

Early manifestations of a developing metabolic acidosis include A. coma B. headache C. muscle cramps D. short and shallow respirations

B

Excessive antidiuretic hormone (ADH) secretion can cause ? concentration? A. increased serum sodium B. decreased serum sodium C. increased serum potassium D. decreased serum potassium

B

Excessive antidiuretic hormone (ADH) secretion can cause _____ concentration. a. increased serum sodium b. decreased serum sodium c. increased serum potassium d. decreased serum potassium

B

How is a patient hospitalized with a malignant tumor that secretes parathyroid hormone-related peptide monitored for the resulting electrolyte imbalance? A. Serum calcium, Chvostek and Trousseau signs B. Serum calcium, bowel function, level of conciousness C. Serum potassium, Chvostek and Trousseau signs D. Serum potassium, bowel function, level of consciousness

B

Hyperaldosteronism causes A. ECV deficit and hyperkalemia B. ECV excess and hypokalemia C. hyponatremia and hyperkalemia D. excessive water reabsorption without affecting sodium concentration

B

Hypernatremia may be cause by A. decreased aldosterone secretion B. decreased antidiuretic hormone secretion C. compulsive water drinking D. excessive dietary potassium

B

Hypernatremia may be caused by a. decreased aldosterone secretion. b. decreased antidiuretic hormone secretion. c. compulsive water drinking. d. excessive dietary potassium.

B

Hypotension associated with neurogenic and anaphylactic shock is due to a. hypovolemia. b. peripheral pooling of blood. c. poor cardiac contractility. d. high afterload.

B

The conversion of plasminogen to plasmin results in a. clot retraction. b. fibrinolysis. c. platelet aggregation. d. activation of thrombin.

B Fibrinolysis is the process of clot dissolution and occurs when plasminogen activators cleave plasminogen to plasmin. Clot retraction occurs when the components of the fibrin clot are compressed or contracted to form a clot. Factors released from platelets contribute to hemostasis by enhancing vasoconstriction, platelet aggregation, and vessel repair. Platelet aggregation is not the result of plasmin conversion. Thrombin cleaves fibrinogen to form a fibrin clot

The most appropriate treatment for secondary polycythemia is a. volume expansion with saline. b. measures to improve oxygenation. c. phlebotomy. d. chemotherapy.

B Secondary polycythemia is due to chronic hypoxemia with a resultant increase in erythropoietin production. The goal of treatment is aimed at measures to reduce hypoxemia and improve oxygenation by implementing oxygen therapy. IV fluids may be used to treat relative polycythemia, because it is related to dehydration. Phlebotomy or increases in laboratory studies do not have an effect on secondary polycythemia. Polycythemia is not treated with chemotherapeutic agents.

The prothrombin time (PT) and INR (International Normalized Ratio) measure the integrity of a. platelet function. b. extrinsic pathway. c. intrinsic pathway. d. fibrinolysis.

B The PT and INR assess the extrinsic pathway of coagulation. Platelet function is measured through a CBC. The aPTT assesses the intrinsic pathway of coagulation. The D-dimer assay reflects fibrinolysis.

The activated partial thromboplastin time (aPTT) is a measure of the integrity of a. the extrinsic pathway. b. the intrinsic pathway. c. factor VIII synthesis. d. plasminogen

B The intrinsic pathway is assessed through the aPTT. The extrinsic pathway is assessed through measurements of the PT and INR. An abnormal factor VIII function results in hemophilia A. The deficiency is verified by factor assay. The aPTT is not utilized to assess the integrity of plasminogen.

Widespread activation of the clotting cascade secondary to massive trauma is called a. hemophilia B. b. disseminated intravascular coagulation (DIC). c. Hageman disease. d. idiopathic thrombocytopenia purpura

B Widespread clotting in small vessels leads to consumption of the clotting factors and platelets, which in turn leads to bleeding. DIC is either acute or chronic and occurs secondary to malignancy, sepsis, snake bites, trauma, shock, burns, and many other factors. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Massive trauma is unrelated to the development of Hageman disease. Immune thrombocytopenia, formerly called idiopathic thrombocytopenia purpura, is an acquired immune-mediated disorder.

Lymphoid lineage (hematologic neoplasms)

B cells, T cells, and natural killer (NK) cells -NK ell leukemia/lymphoma ; B cell leukemia/lymphoma/myeloma; T cell leukemia/lymphoma A L L : A - ACUTE (ATTCK IMMATURE STAGE) L- LYMPHOID L- LEUKEMIA/ LYMPHOMA

What is involved in the release of plasminogen activators? (Select all that apply.) a. Factor X b. Factor XII c. HMWK d. Kallikrein e. Thrombin

B, C, D, E Factor XII, HMWK, kallikrein, and thrombin are involved in the release of plasminogen activators. Factor X initiates the common final pathway of coagulation.

Which diseases may be associated with a bleeding problem? (Select all that apply.) a. Urinary retention b. Renal failure c. Cirrhosis d. Systemic lupus erythematosus e. Ovarian cancer

B, C, D, E Renal failure may be associated with a bleeding problem. Liver disease, such as cirrhosis, may be associated with a bleeding problem. Systemic lupus erythematosus may be associated with a bleeding problem. Malignancies, such as ovarian cancer, may be associated with a bleeding problem. Urinary retention is not a disease.

Anemia related to vitamin B12 or folate deficiency is characterized by what laboratory features? (Select all that apply.) a. RBC counts of 775,000 to 900,000 cells/mm3 b. RBC counts of 500,000 to 750,000 cells/mm3 c. WBC counts of 3000 to 4000 cells/mm3 d. WBC counts of 4000 to 5000 cells/mm3 e. Platelet counts of 60,000 cells/mm

B, D Anemia related to vitamin B12 or folate deficiency is characterized by low RBC counts of 500,000 to 750,000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is characterized by low WBC counts of 4000 to 5000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is characterized by low RBC counts of 500,000 to 750,000, not 775,000 to 900,000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is characterized by low WBC counts of 4000 to 5000 cells/mm3, not 3000 to 4000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is characterized by low platelet counts of 50,000 cells/mm3.

A patient has a positive Chvostek sign. The nurse interprets this as a sign of A. hypercalcemia B. hypermagnesemia C. decreased neuromuscular excitability D. increased neuromuscular excitability

D

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria? A. 118/78 B. 128/82 C. 140/80 D. 138/94

B. 128/82

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 medication., but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 pounds 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

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?

Begin antihypertensive drug therapy

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?

Begin antihypertensive drug therapy.

A diagnostic laboratory finding in myeloma is

Bence Jones proteins in the urine

Rheumatic heart disease is most often a consequence of

Beta-hemolytic streptococcal infection

Copious amounts of foul-smelling sputum are generally associated with

Bronchiectasis

Retroviruses are associated with human cancers, including

Burkitt lymphoma

How do clinical conditions that increase vascular permeability cause edema?

By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure

How does a cytotoxic T lymphocyte kill another cell? - By secreting cytokines that attract phagocytes - By producing antibodies that opsonize it - By phagocytizing it directly - By secreting perforins and granzymes

By secreting perforins and granzymes Cytotoxic T lymphocytes secrete perforins and granzymes that cause cell death.

A 3 year old is diagnosed with starvation ketoacidosis. What signs and symptoms should you anticipate in your assessment? A. Slow, shallow breathing, belligerence, hyperexcitability B. Slow, shallow breathing, numbness and tingling around his mouth C. Rapid, deep breathing, lethargy, abdominal pain D. Rapid, deep breathing, tremors, elevated blood pressure

C

A deficiency of von Willebrand factor impairs a. activation of the coagulation cascade. b. platelet aggregation. c. platelet adhesion to injured tissue. d. platelet production.

C

A hypertensive patient is reluctant to adhere to the prescribed plan because he feels fine and doesn't like his new diet. It can be explained to him that high blood pressure increases the risk of all of the following except a. stroke. b. renal disease. c. diabetes. d. ischemic heart disease.

C

A patient is diagnosed with a tortuous blood vessel of the right hand that bleeds spontaneously. This patient presents with a. petechiae. b. purpura. c. telangiectasia. d. thrombocytosis.

C

A patient who reports an intestinal fistula also reports feeling "weak and dizzy" when she stands. While taking her blood pressure she becomes temporarily unresponsive but quickly regains consciousness when put into a supine position. What nursing interventions will the nurse implement before calling the physician? A. Sit her up again, with proper support, so you can have an accurate upright blood pressure and heart rate to record B. Give her a drink of water or juice, talk with her to calm her down, and ask if she slept well last night C. Give her water or juice and some salty crackers and ask if she has had any diarrhea or vomiting D. Assess small vein filling time, look for ankle edema, and ask if she had any fluid to drink yet today

C

A patient with long-standing hypertension is at risk for hypertensive heart disease. Which of the following clinical findings is indicative of this complication? a. Low voltage on electrocardiogram b. Bounding peripheral pulses c. An S4 heart sound d. Tachycardia

C

A person who experiences a panic attack and develops hyperventilation symptoms may experience A. neuromuscular depression B. anxiety acidosis C. numbness and tingling in the extremities D. acute compensatory metabolic acidosis

C

A person who experiences a panic attack and develops hyperventilation symptoms may experience a. neuromuscular depression. b. anxiety acidosis. c. numbness and tingling in the extremities. d. acute compensatory metabolic acidosis.

C

A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop A. hypokalemia B. hyperkalemia C. hypophosphatemia D. hyperphosphatemia

C

A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop a. hypokalemia. b. hyperkalemia. c. hypophosphatemia. d. hyperphosphatemia.

C

Administration of a pure 〈1-adrenergic agonist medication to a patient in shock would be expected to increase a. cardiac output. b. heart rate. c. blood pressure. d. stroke volume.

C

Activation of the extrinsic pathway of coagulation is initiated by a. platelet factors. b. collagen exposure. c. tissue thromboplastin. d. factor VII.

C The extrinsic pathway of coagulation begins when the vascular wall is traumatized. Tissue factor from injured tissue activates factors which in turn activate and convert into thrombin for clotting. Platelets play a major role in primary hemostasis as well as secondary hemostasis and clot retraction. Platelets accelerate the conversion of prothrombin to thrombin. Platelets adhere to collagen exposed by trauma and initiate degranulation. Factor VII is involved in the extrinsic pathway of coagulation when it is activated by tissue factor following a traumatic injury.

The most effective therapy for anemia associated with kidney failure is a. iron administration. b. high-protein diet. c. erythropoietin administration. d. vitamin B12 and folate administration.

C Therapy in anemia of chronic renal failure consists of dialysis and erythropoietin administration. The use of erythropoietin stimulating agents is to increase hemoglobin values to ensure adequate oxygen-carrying capacity. Iron, folate, and vitamin B12 replacement is initiated if necessary. Iron administration is utilized in iron deficiency anemia. A high-protein diet is not the treatment of choice in the patient with renal failure, and a high-protein diet may be contraindicated. Vitamin B12 and folate are prone to nutritional anemias and receive replacement to adequate levels if necessary. However, dialysis and erythropoietin are more effective.

A patient has a positive Chvostek sign. The nurse interprets this as a sign of: a. hypercalcemia. b. hypermagnesemia. c. decreased neuromuscular excitability. d. increased neuromuscular excitability.

D

Hapten mechanisms are found in which medications? (Select all that apply.) a. Ibuprofen b. Narcotics c. Penicillin d. Cephalosporins e. Tetracycline

C, D, E In the hapten mechanism, which is seen with penicillin, cephalosporins, and tetracycline, the drug combines with a component of the RBC membrane and an antibody is developed against the drug. Hapten mechanism is not seen in ibuprofen or narcotics.

Second-degree heart block type I (Wenckebach) is characterized by

lengthening PR intervals and dropped P wave.

Chronic Myeloid Leukemia

CML represents approximately 15% of all cases of leukemia in the United States Average age of onset: - 40-50 years - Occurs only occasionally in childhood/adolescence Clinical signs: - Presence of Philadelphia chromosomes (Ph+) -High granulocyte count -Translocation of chromosomes 9 and 22 causes two genes to be juxtaposed and creates a new fusion gene: bcr/abl (convert over = new gene some left over make new gene) Protein product of bcr/abl spurs cell proliferation and reduces apoptotic cell death -CML cells have greater degree of segmentation than AML cells Symptoms: -fatigue -weight lost -SWEATS -BLEEDING DISORDER -splenomegaly Treatment: -Allogenic BMT (blood marrow transfusion) -Anti-BRC/ABI therapy (imatinib) UNTREATED PROGNOSIS: -2 year survival SHARED SYMPTS: -Splenomegaly -Fatigue -Weight loss

Evaluation of primary and secondary hemostasis

CBC to identify anemia (bleeding can or cannot see) Platelet count to identify number of platelets (uniform look) Peripheral smear indicates the number and gross morphologic characteristics of platelet function Bleeding time evaluates vascular status and platelet function (normal bleeding time 3-10min) PT/INR assesses the extrinsic pathway of coagulation (prothrombin time)(international normalize ratio) aPTT assesses the intrinsic pathway (activated partial thromboblastin time) Blood cogulation assesment

Inflammation

Can increase risk of thrombotic process Vasculitis—inflammation of the intima of an artery Phlebitis—inflammation of the lining of a vein Arteritis—inflammatory process of autoimmune origin in arteries

The most commonly recognized outcome of hypertension is

Cardiovascular disease

Velocity of blood flow is measured in

Centimeters per sec

Lymphatic Vessels

Changes in capillary or interstitial oncotic pressure increase filtration into tissues resulting in edema Lymphedema results from impairment in the circulation of lymph

A patient, who is 8 months pregnant, has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures. To determine if her infusion rate is too high, you should regularly

Check the patellar reflex; if it becomes weak or absent, her infusion rate probably is too high + she at risk for respiratory depression or cardiac arrest

Hepatic Disease (liver diease)

Coagulopathies result from: -Impaired absorption of vitamin K -Decreased synthesis of fibrinogen, factors V and XI -Inability to remove activated coagulation factors and fibrinolytic proteins from circulation -Altered production of inhibitors of coagulation Treatment includes vitamin K administration; transfusion of platelets, fresh frozen plasma, or whole blood

Venules are composed of

Connective tissue

Administration of which therapy is most appropriate for hypovolemic shock?

Crystalloids

Administration of which therapy is most appropriate for hypovolemic shock (shock due to low plasma)?

Crystalloids, solutions that contain electrolytes to increase blood volume.

A commonly ingested substance associated with prolongation of the bleeding time is a. acetaminophen. b. tobacco. c. caffeine. d. aspirin

D

A patient with cold extremities and low cardiac output is not likely to be experiencing _____ shock. a. cardiogenic b. hypovolemic c. obstructive d. septic

D

A person who has hyperparathyroidism is likely to develop A. hypokalemia B. hyperkalemia C. hypocalcemia D. hypercalcemia

D

Emesis causes A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

D

Emesis causes a. respiratory acidosis. b. respiratory alkalosis. c. metabolic acidosis. d. metabolic alkalosis

D

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

D

How do clinical conditions hat increase vascular permeability cause edema? A. Through altering the negative change on the capillary basement membrane, which enables excessive fluid to accumulate in the interstitial compartment B. By causing movement of fluid from the vascular compartment into the intracellular compartment, which leads to cell swelling C. Through leakage of vascular fluid into the interstitial fluid, which increases interstitial fluid hydrostatic pressure D. By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure

D

Metabolic alkalosis is often accompanied by A. hypernatremia B. hyponatremia C. hyperkalemia D. hypokalemia

D

Metabolic alkalosis is often accompanied by a. hypernatremia. b. hyponatremia. c. hyperkalemia. d. hypokalemia.

D

Osmoreceptors located in the hypothalamus control the release of: A. Angiotensin B. Atrial Natriuretic Peptide C. Aldosterone D. Vasopressin (ADH)

D

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

D

Renal compensation for respiratory acidosis is evidenced by A. decreased carbon dioxide B. elevated carbon dioxide C. decreased bicarbonate ion concentration D. elevated bicarbonate ion concentration.

D

Renal compensation for respiratory acidosis is evidenced by a. decreased carbon dioxide. b. elevated carbon dioxide. c. decreased bicarbonate ion concentration. d. elevated bicarbonate ion concentration.

D

Respiratory acidosis may be caused by A. hyperventilation B. massive blood transfusion C. tissue hypoxia D. hypoventilation

D

Respiratory acidosis may be caused by a. hyperventilation. b. massive blood transfusion. c. tissue hypoxia. d. hypoventilation.

D

The ? system compensates for metabolic acidosis and alkalosis? A. gastrointestinal B. renal C. cardiac D. respiratory

D

The ________ system compensates for metabolic acidosis and alkalosis. a. gastrointestinal b. renal c. cardiovascular d. respiratory

D

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

D

Two primary acid-base disorders that are present independently are referred to as A. metabolic acidosis B. metabolic alkalosis C. respiratory alkalosis D. mixed acid-base imbalance

D

What form of oral rehydration, bottled water or salty broth, is best suited for a patient who is demonstrating signs of clinical dehydration? A. Bottled water, because he is so weak that he might choke on the fluid when he swallows, and water would be less damaging to the lungs than salty soup B. Bottled water, because it will rehydrate his cells C. Salty soup, because he needs nutrition as well as fluid D. Salty soup, because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid

D

What is likely to lead to hyponatremia? A. Insufficient ADH secretion B. Excess aldosterone secretion C. Administration of intravenous normal saline D. Frequent nasogastric tube irrigation with water

D

What is likely to lead to hyponatremia? a. Insufficient ADH secretion b. Excess aldosterone secretion c. Administration of intravenous normal saline d. Frequent nasogastric tube irrigation with water

D

Circulatory system changes in the older adult

Increased systemic vascular resistance Decreased elasticity of vessel walls Increased afterload Decreased baroreceptor function Decreased response to hypertensive stimuli

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

D. Atrial fibrillation with a ventricular rate of 220 beats/min

The cellular component that is most susceptible to radiation injury is the

DNA

Total body water in older adults is

Decreased b/c of increased adipose tissue + decreased muscle mass

When systemic vascular resistance is decreased, blood flow

Decreases

Vitamin K Deficiency Bleeding in Infancy

Deficiency of vitamin K-dependent coagulation factors (II, VII, IX, and X) Evidence of bleeding occurs early in life (melena (dark stool), hematuria, intracranial hemorrhage, hypovolemic shock) Prophylactic administration of vitamin K to the newborn largely eliminates this coagulation disorder Vitamin K Syntheses coagulation factors Infant and adults Infants if baby are breast feed Formula has all the vitamin May occur with malnutrition, malabsorption, chronic hepatic disease, antibiotic therapy (deplete vitamin ), oral anticoagulation therapy (coumanin?) Results in excessive bleeding Parenteral administration of vitamin K is used for treatment

Poiseuille's law represents resistance

Determinants of resistance -Vessel length -Vessel radius -Blood viscosity

Hyperaldosteronism causes

ECV excess and hypokalemia

Increased preload of the cardiac chambers may lead to which patient symptom?

Edema

Venous obstruction are manifested by

Edema

Increased preload of the cardiac chambers may lead to which patient symptom?

Edema (swelling)

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

Elevated CK-MB, troponin I, and troponin T

After sitting in a chair for an hour, an elderly patient develops moderate low extremity edema. His edema is most likely a consequence of

right-sided heart failure

Thrombocytopenia (can produce platelets or bonemarrow)

General mechanisms: -Decreased platelet production -Decreased platelet survival -Splenic sequestration (useful pulling in spleen) -Intravascular dilution of circulating platelets (platelet die off short lifespan) Low platelet count, prolonged bleeding time, abnormal peripheral smear Treatment based on identified cause

A patient who reports an intestinal fistula also reports feeling "weak and dizzy" when she stands. While taking her blood pressure she becomes temporarily unresponsive but quickly regains consciousness when put into a supine position. What nursing interventions will the nurse implement before calling the physician?

Give her water or juice and some salty crackers and ask if she has had any diarrhea or vomiting

Which disorder is considered a primary immunodeficiency disease? - HIV/AIDS - Malnutrition immunodeficiency - Cancer immunodeficiency - Radiation immunodeficiency

HIV/AIDS HIV/AIDS is a primary immunodeficiency disease involving destruction of T helper cells. Malnutrition immunodeficiency is a secondary immunodeficiency disorder and leads to T-cell destruction and dysfunction. Cancer immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from chemotherapeutic agents. Radiation immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from the effects of radiation.

Certain autoimmune diseases are associated with the presence of specific proteins on a person's cells. These proteins are called ________ proteins. - complement - antibody receptor - HLA or MHC - TCR or BCR

HLA or MHC Human major histocompatibility complex (MHC) genes located on chromosome 6p21 (also called human leukocyte antigen (HLA) genes) are frequently associated with certain autoimmune disorders. Complement, antibody receptors, and TCR or BCR are not factors in development of autoimmune disease.

What would the blood levels be when the body is compensating for metabolic alkalosis?

High HCO3, high PaCO2, pH started high, can be totally compensated or partially compensated.

What would the blood draw show during the compensation of repiratory acidosis? How do you know when it is partially or fully compensated?

High PaCO2, high HCO3 (trying to compensate), pH started low, can be totally compensated (by reapsorption of HCO3) or partially compensated. We see abnormal CO2 and we see abnormal HCO3, if totally compensate pH will be between 7.35-7.45. If it is partially compensated it will almost be at 7.35.

Decreased neuromuscular excitability is often the result of

Hypercalcemia and hypermagnesemia

The imbalance that occurs with oliguric renal failure is

Hyperkalemia

Risk factors for atherosclerosis include

Hyperlipidemia

Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with

Hypophosphotemia

A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to

Hypotension

Reduction in flow impairs ability to transport gases and nutrients to body tissues resulting in:

Hypoxia Ischemia Venous engorgement Venous obstruction

The principle Ig mediator of type I hypersensitivity reactions is - IgA. - IgG. - IgM. - IgE.

IgE Immunoglobulin E (IgE) is the principal antibody mediating type I hypersensitivity reactions. IgA is not the primary Ig mediator of type I hypersensitivity reactions. IgG is involved in type II hypersensitivity reactions. IgM is involved in type II hypersensitivity reactions.

A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type _____ hypersensitivity reaction. - I. - II. - III. - IV.

III Immune complex glomerulonephritis (an inflammatory renal disorder) is an example of a type III hypersensitivity reaction. The circulating immune complex is then deposited in the glomerular capillary wall and mesangium. Glomerulonephritis secondary to strep throat is not a type I, II, or IV sensitivity reaction.

The hypersensitivity reaction that does not involve antibody production is type

IV

The hypersensitivity reaction that does not involve antibody production is type - I. - II. - III. - IV.

IV Type IV hypersensitivity reactions do not involve antibody production. The principal mediators are lymphocytes, including T helper cells (Th) that mediate the reaction by releasing lymphokines (cytokines) and/or antigen-sensitized cytotoxic T cells (Tc) that can directly kill cells. The other types involve antibody production. Type I involves IgE; type II involves IgM or IgG; type III involves IgG.

When exposed to inhaled allergens, a patient with asthma produces large quantities of

IgE

The predominant antibody of a typical allergic response is: - IgG. - IgM. - IgE. - IgA.

IgE (IgA is the predominant antibody in mucosal membrane secretions.)

A major risk factor for the development of active pulmonary tuberculosis (TB) disease is

Immunosuppression

Varicose Veins

Impaired venous return results in increased capillary pressure causing edema, and superficial, darkened, raised, and tortuous veins Greater saphenous vein most commonly affected Treatment directed toward increasing venous flow and reducing venous pressure; sclerotherapy and surgical interventions may be used for severe cases

Arteriosclerosis/Atherosclerosis

Includes three pathologic processes: Mönckeberg sclerosis Arteriolar sclerosis Atherosclerosis Underlying pathologic condition leading to hypertension, cardiac and renal disease, peripheral arterial disease, and stroke Identification and interventions directed toward modifiable risk factor reduction

While hospitalized, an elderly patient with a history of MI was noted to have high levels of low-density lipoproteins (LDL). What is the significance of this finding?

Increased LDL levels are associated with increased risk of coronary artery disease.

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?

Increased LDL levels are associated with increased risk of coronary artery disease.

Hyperemia is

Increased blood flow to a localized area

A patient receives an ACE-inhibiting agent to manage his cardiovascular disease. Which of the following is not an expected result of ACE inhibitor therapy?

Increased cardiac preload

Uncompensated metabolic alkalosis would result in

Increased pH, increased HCO3-

In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiologic event?

Inflammation, mucosal edema, + bronchoconstriction

In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiologic event?

Inflammation, mucosal edema, and bronchoconstriction

Blood pressure is regulated on short term basis through

Interaction of carotid and aortic baroreceptors Vasomotor center in the brain stem Activation of SNS Inhibition of PSNS

Clinical manifestations of chronic arterial obstruction include

Intermittent claudication

Arterial thrombosis is usually manifestated by

Intermittent claudication (pain with activity) in which the affected limb improves with rest

Autoregulation

Intrinsic Mechanisms is the ability of blood vessels within organs to maintain a relatively constant blood flow regardless of changes in arterial pressure -High BP leads to stretch that results in constriction of arterioles and precapillary sphincters -Low BP results in vessel dilation

The relationship between blood flow and resistance is an

Inverse one

Malignant Disorders of White Blood Cells - Leukemias

Leukemias—circulating tumors that are disseminated from the beginning of the disease process; primarily involve blood and bone marrow -location Maligancy Of WBC in blood and bone marrow

Aneurysms

Localized arterial dilations Classified as true or false aneurysms Frequently found in cerebral circulation and thoracic and abdominal aorta Dissecting aortic aneurysms are a medical emergency and treated medically and/or surgically

When a client diagnosed with COPD type A asks, "Why is my chest so big and round?", the nurse responds that

Loss of elastic tissue in your lungs allows your airways to close + trap air, which makes your chest round

What would the blood draw show during the compensation of metabolic acidosis?

Low HCO3, low PaCO2, pH started low, can be totally compensated or partially compensated

What would the blood levels be when the body is compensating for respiratory alkalosis?

Low PaCO2, low HCO3, pH started high, can be totally compensated or partially compensated; look at initial cause: many causes are short lived (anxiety, sobbing - may not have time to compensate)

The mean arterial pressure is used to

Make incremental adjustments to vasoactive drugs

Embolus

Material that forms a clot within the bloodstream Embolus leaving L ventricle = ischemic stroke Embolus leaving R ventricle = pulmonary embolus Treatment may involve anticoagulant therapy, embolectomy (for thromboemboli) or a filter in the inferior vena cava (Greenfield filter)

Elevator

Metabolic HCO3 and pH - elevator

The smallest vessels of the vascular system and lymphatic vessels are commonly referred to as the

Microcirculation

Deep Vein Thrombosis

Most frequently due to thrombus in a deep vein of the lower extremity May be asymptomatic Treated aggressively with anticoagulation therapy Previous DVT is a risk factor for further hypercoagulation

Familial retinoblastoma involves the transmission of what from parent to offspring?

Mutant tumor-suppressor gene

The organism that causes pulmonary tuberculosis is

Mycobacterium tuberculosis

The organism that causes pulmonary tuberculosis is

Myobacterium tuberculosis

Resistance

Opposing forces that deter blood flow; as resistance increases, blood flow decreases

After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence o

right-sided heart failure.

Lymphedema

Occurs when normal flow is obstructed or altered in some fashion Primary lymphedema due to congenital anomaly or dysfunction of the lymphatic system Secondary lymphedema associated with a disease process or iatrogenic Typically affects extremities Interventions are medical (external compression therapy and exercise) and surgical (resection of subcutaneous fatty tissue)

Valvular Incompetence

Overstretching of the valves owing to excessive venous pressures resulting in backflow of blood Results in: Venous insufficiency Varicose veins Treatment is directed toward smoking cessation and regular exercise

First-degree block is identified by a prolonged ________.

PR interval

After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence of?

right-sided heart failure.

Which of the following cells produce antibodies? - T cells - Mast cells - Plasma cells - Macrophages

Plasma cells Plasma cells are mature B lymphocytes that have developed the capacity to produce antibodies during an immune response.

Thrombocytosis (increase in platelets / blood clot)

Platelet count greater than 400,000/mm3 Transitory—due to stress/physical exercise Primary—polycythemia vera(condition where person bonemarrow make too many blood cells) or chronic granulocytic leukemia (CML transitory) Secondary—response to hemorrhage, disease process, or splenectomy (aquired ones) Treatment reserved for primary etiologies with cytotoxic agents and antiplatelet therapy (kill platelets )

An erroneous low BP measurement may be caused by

Positioning the arm above the heart level

Which dysrhythmia is thought to be associated with reentrant mechanisms?

Preexcitation syndrome tachycardia (Wolf-Parkinson-White Syndrome)

Which dysrhythmia is thought to be associated with reentrant mechanisms?

Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

Legionnaires disease is characterized by

Presence of systemic illness

The goal of heparin for the management of DVT is to

Prevent further clot formation

Teeter Todder

Respiratory CO2 and pH

Angina caused by coronary artery spasm is called _____ angina.

Prinzmetal Variant

Angina caused by coronary artery spasm is called _____ angina.

Prinzmetal variant

Angina due to coronary artery spasm is called _____ angina.

Prinzmetal variant

Individuals who have chronic bronchitis most often have

Productive cough

Hypertrophy of the right ventricle is a compensatory response to

Pulmonary Stenosis

A serious complication of deep vein thrombosis is

Pulmonary embolus

The person at highest risk for developing hypernatremia is a person who

Receives tube feedings b/c he/she is comatose after stroke

Which pulmonary function test result is consistent with a diagnosis of asthma?

Reduced forced expiratory volume in 1 second (FEV 1)

Which pulmonary function test result is consistent with a diagnosis of asthma?

Reduced forced expiratory volume in 1 second (FEV1)

The movement of blood through the vascular system is opposed by the force of

Resistance

The most reliable indicator that a person is experiencing acute myocardial ischemia is?

S.T-segment elevation.

The most common primary immune deficiency that affects only B cells is

Selective IgA

How is a patient hospitalized with a malignant tumor that secretes parathyroid hormone-related peptide monitored for the resulting electrolyte imbalance?

Serum calcium, bowel function, level of consciousness

Which change in a patient's assessment has the greatest urgency?

Serum potassium concentration is increasing; has developed cardiac dysrhythmias, but denies any difficulty breathing

Which finding is indicative of orthostatic hypotension in a person with a supine BP of 110/70 and a HR of 100?

Sitting BP 88/60, HR 118

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?

Sitting BP 88/60, HR 118

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

Sodium

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

Sodum, the balance of intake of water and sodium and their excretion by the kidney remains the central feature of long-term blood pressure maintenance

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?

Stable angina

A thrombus is a

Stationary blood clot formed within a vessel or a chamber of the heart

Orthostatic hypotension is associated with cardiovascular disease and is a risk factor for

Stroke Cognitive impairment Death

High blood pressure increases the risk of

Stroke Renal disease Ischemic heart disease

Vasospasm

Sudden constriction of arterial smooth muscles resulting in obstruction of flow May be mediated by hormonal changes, food additives, or environmental factors Manifestations include: Prinzmetal angina Hemorrhagic stroke Migraine headaches

Which disorder is associated with a type III hypersensitivity mechanism of injury?

Systemic Lupus erythematosus

Which disorder is associated with a type III hypersensitivity mechanism of injury? - Systemic lupus erythematosus - Graves disease - Erythroblastosis fetalis - Seasonal allergic rhinitis

Systemic lupus erythematosus Systemic lupus erythematosus is a type III hypersensitivity disorder. Type III hypersensitivity is characterized by antigen-antibody complex deposition into tissues, with consequent activation of complement and a subsequent self-sustaining inflammatory reaction. Graves disease and erythroblastosis fetalis are type II hypersensitivity reactions. Seasonal allergic rhinitis is a type I hypersensitivity reaction.

Pulse pressure is defined as

Systolic pressure minus the diastolic pressure

All forms of shock are associated with inadequate tissue perfusion. True/False

T

Blood pressure equals the product of cardiac output and systemic vascular resistance. True/False

T

Cardiogenic and hypovolemic shock can be differentiated based on differences in cardiac preload. True/False

T

Excessive production of nitric oxide is a contributor to abnormal vasodilation seen in septic shock. True/False

T

If blood pressure drops, the baroreceptors stimulate the sympathetic nervous system and inhibit the parasympathetic nervous system. True/False

T

In septic shock, a decrease in venous oxygen saturation (SvO2) may indicate an improvement in distribution of blood flow. True/False

T

In the early stages of circulatory shock, the blood pressure may not accurately reflect the impairment in cardiac output. True/False

T

Lack of elasticity in the aorta as occurs with age contributes to higher systolic and lower diastolic blood pressures. True/False

T

Severe hypovolemic shock occurs when more than 40% of the total blood volume is lost. True/False

T

Stimulation of arterioles by α1-adrenergic receptors produces vasoconstriction and is likely to increase blood pressure. True/False

T

Systolic blood pressure is defined as the highest pressure detected in the arteries. True/False

T

What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume?

Tachycardia

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

a

Blood flow throughout the periphery is regulated by

The autonomic nervous system The venous and thoracic pumps Intrinsic autoregulatory mechanisms

The assessment findings of a 5-year-old with a history of asthma include extreme shortness of breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles. There is no wheezing and the chest is silent in many areas. How should you interpret your assessment?

The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the doctor immediately

The assessment findings of a 5-year-old with a history of asthma include extreme shortness of breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles. There is no wheezing and the chest is silent in many areas. How should you interpret your assessment?

The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the doctor immediately.

Which is indicative of a left tension pneumothorax?

absent breath sounds on the left

A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n)

an elderly woman without a previous history of MI

Systemic vascular resistance is used to determine

The resistance of vessels, diseases, or drug therapies that affect vessels

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. pain radiating to the lower legs. d. dysrhythmias.

a

(Coagulation disorder) Hemophilia

The most common inherited coagulation disorder resulting in excessive bleeding Hemophilia A—factor VIII (8)deficiency Hemophilia B—factor IX (9)deficiency Treatment includes patient/family education Hemophilia A: cryoprecipitate or factor VIII concentrate (take plasma and freeze it contain coagulation ) Hemophilia B: fresh frozen plasma or cryoprecipitate

The primary functions of the circulatory system are

Transport oxygen Transport nutrients Remove metabolic waste

Mechanical Compression External forces to the vascular system may result in partial or complete obstruction May be caused by:

Trauma Tight casts, dressings, or stockings Compartment syndrome

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

True

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

True

Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.

True

The anemia resulting from a deficiency of either vitamin B 12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts.

True

The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.

True

The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension. True or false?

True

The liver is responsible for the synthesis of coagulation factors, with the exception of part of VIII

True

Two of the most serious oncology emergencies associated with non-Hodgkin lymphoma are obstruction of the superior vena cava and compression of the spinal cord.

True

Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.

True Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.

After degranulation, mast cells release prostaglandins and leukotrienes that perform which of the following functions? - Vasodilation and increased vascular permeability - Attract neutrophils and eosinophils - Activate the complement cascade - Opsonization of bacteria

Vasodilation and increased vascular permeability Inflammatory chemicals such as prostaglandins and leukotrienes cause vasodilation and increased vascular permeability.

Three determinants of resistance are

Vessel length Vessel radius Blood viscosity

A newborn has melena, bleeding from the umbilicus, and hematuria. The newborn most likely experiencing

Vitamin K deficiency bleeding

When a parent asks how they will know if their 2-month-old baby, who is throwing up and has frequent diarrhea, is dehydrated, the nurse's best response is A. "Clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, so those are the diagnostic criteria." B. "If he doesn't wet his diaper all afternoon and his neck veins look flat when he is lying down, then he is probably dehydrated." C. "If he sleeps more than usual and acts tired when he is awake, then he is probably dehydrated." D. "If the soft spot on the top of his head feels sunken in and his mouth is dry between his cheek and his gums, then he is probably dehydrated."

We didn't go over this one

Clinical manifestations of extracellular fluid volume deficit include

Weak pulse, low blood pressure, + increased heart rate

An increase in blood flow causes hyperemia

Which is located in the area proximal to the obstruction

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

Respiratory alkalosis is caused by a. hyperventilation. b. pulmonary edema. c. pneumonia. d. chest muscle weakness.

a

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

a

A major cause of treatment failure in tuberculosis is a. noncompliance. b. allergy to drugs used. c. immunosuppression. d. resistant organism.

a

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 antihypertensive drug therapy. b. Recheck blood pressure in 4 to 6 weeks. c. Encourage smoking cessation. d. Begin lifestyle modifications.

a

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

a

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

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

A person who experiences a panic attack and develops hyperventilation symptoms may experience a. numbness and tingling in the extremities. b. acute compensatory metabolic acidosis. c. neuromuscular depression. d. anxiety acidosis.

a

A person who has hyperparathyroidism is likely to develop a. hypercalcemia. b. hypocalcemia. c. hyperkalemia. d. hypokalemia.

a

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

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

a

Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called a. tension pneumothorax. b. pleural effusion. c. empyema. d. open pneumothorax.

a

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

a

Atherosclerotic plaques with large lipid cores are prone to a. rupture. b. dislodgement. c. attachment. d. binding.

a

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

Cystic fibrosis is associated with a. bronchiectasis. b. asthma. c. emphysema. d. chronic bronchitis.

a

Diarrhea causes a. metabolic acidosis. b. respiratory alkalosis. c. metabolic alkalosis. d. respiratory acidosis.

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

Hypotension associated with neurogenic and anaphylactic shock is because of a. peripheral pooling of blood. b. poor cardiac contractility. c. high afterload. d. hypovolemia.

a

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

Neuromuscular disorders impair lung function primarily because of a. weak muscles of respiration. b. inflammatory events in the lung. c. secondary pneumonia. d. inactivity secondary to the disorder.

a

Patients presenting with symptoms of unstable angina and no ST segment elevation are treated with a. antiplatelet drugs. b. cardiac catheterization. c. acute reperfusion therapy. d. cardiac biomarkers only.

a

When a parent asks how they will know if their 2-month-old baby, who is throwing up and has frequent diarrhea, is dehydrated, the nurse's best response is a. "If the soft spot on the top of his head feels sunken in and his mouth is dry between his cheek and his gums, then he is probably dehydrated." b. "Clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, so those are the diagnostic criteria." c. "If he sleeps more than usual and acts tired when he is awake, then he is probably dehydrated." d. "If he doesn't wet his diaper all afternoon and his neck veins look flat when he is lying down, then he is probably dehydrated."

a

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

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 88/60, HR 118 b. Sitting BP 108/68, HR 102 c. Sitting BP 120/80, HR 100 d. Sitting BP 110/78, HR 98

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

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

a (end-organ)

Croup is characterized by

a barking cough

Viral pneumonia is characterize by

a dry cough

Velocity:

a measure of the distance traveled in a given interval of time (centimeters/second)

Thrombocytopenia

a platelet count below 20,000 cells/μl, petechiae, easy bruising, bleeding gums, occult hematuria (blood in urine), retinal hemorrhages (decrease in platelet count possible bleeding issue)

Mitral stenosis is associated with

a pressure gradient across the mitral valve

Mitral stenosis is associated with

a pressure gradient across the mitral valve.

Individuals who have chronic bronchitis most often have

a productive cough

A patient diagnosed with chronic compensated heart failure reports that, "My feet swell if I eat salt but I don't understand why" The nurse's best response is a. "Salt holds water in your blood and makes more pressure against your blood vessels, so fluid leaks out into your tissues and makes them swell." b. "Salt binds to the proteins in your blood and changes the osmotic pressure so more fluid can leak out and stay in the tissues, causing swelling." c. "Salt makes your blood vessels relax and the blood does not flow as fast, so some of it leaks into your tissues and makes swelling." d. "Gravity makes more pressure down by your feet than up at the top of your body, so more fluid leaks into your tissues at your feet and they swell."

a. "Salt holds water in your blood and makes more pressure against your blood vessels, so fluid leaks out into your tissues and makes them swell." Salt holds water in the ECV, thus increasing capillary hydrostatic pressure. Gravity leads to feet swelling, but it does not explain what the patient is asking. Salt does not cause vasodilation, nor does it bind to blood proteins and change osmotic pressure.

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria?

a. 128/82 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.

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 antihypertensive drug therapy. 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.

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. 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.

Which electrolyte imbalances cause increased neuromuscular excitability? a. Hypocalcemia and hypomagnesemia b. Hyperkalemia and hypophosphatemia c. Hypercalcemia and hypermagnesemia d. Hypokalemia and hyperphosphatemia

a. Hypocalcemia and hypomagnesemia Hypocalcemia and hypomagnesemia both cause increased neuromuscular excitability. Hypokalemia, hyperkalemia, hypophosphatemia, hypercalcemia, and hypermagnesemia do not cause increased neuromuscular excitability.

When exposed to inhaled allergens, a patient with asthma produces large quantities of a. IgE. b. IgG. c. IgM. d. IgA.

a. IgE. During an allergic response, plasma cells produce large quantities of IgE. IgG, IgA, and IgM are not part of the pathophysiology of asthma.

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 indicative of moderate alcohol intake, and patients should be advised to abstain. b. Measures to decrease LDL levels in the elderly would be unlikely to affect the progression of this disease. c. Elevated LDL levels are an expected finding in the elderly and therefore are not particularly significant. d. Increased LDL levels are associated with increased risk of coronary artery disease.

a. Increased LDL levels are associated with increased risk of coronary artery disease. 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.

What age group has a larger volume of extracellular fluid than intracellular fluid? a. Infants b. Young adults c. Older adults d. Adolescents

a. Infants Infants have a larger volume of extracellular fluid than intracellular fluid. Adolescents, young adults, and older adults have a larger volume of intracellular fluid than extracellular fluid.

The finding of ketones in the blood suggests that a person may have

a. metabolic acidosis.

Asthma is categorized as a(n) a. obstructive pulmonary disorder. b. type of acute tracheobronchial obstruction. c. restrictive pulmonary disorder. d. infective pulmonary disorder.

a. obstructive pulmonary disorder. Asthma is an obstructive pulmonary disorder. Asthma is not a restrictive pulmonary disorder or a type of tracheobronchial obstruction. Although asthma can be associated with infection, it is not an infective pulmonary disorder.

Fully compensated respiratory acidosis is demonstrated by

a. pH 7.36, PaCO2 55, HCO3 - 36.

Fully compensated respiratory acidosis is demonstrated by a. pH 7.36, PaCO2 55, HCO3- 36. b. pH 7.40, PaCO2 40, HCO3- 24. c. pH 7.45, PaCO2 40, HCO3- 28. d. pH 7.26, PaCO2 60, HCO3- 26.

a. pH 7.36, PaCO2 55, HCO3- 36. Compensation for respiratory acidosis involves conservation of HCO 3 - in the body; an HCO 3 - of 36 is a key finding; the normal pH (7.36) indicates compensation. Low HCO 3 - is not indicative of compensated respiratory acidosis. Low pH indicates no compensation or only partial compensation. Values of pH 7.40, PaCO 2 40, and HCO 3 - 24 are all normal.

Hypotension associated with neurogenic and anaphylactic shock is because of

a. peripheral pooling of blood. Profound peripheral vasodilation of both arterioles and veins leads to peripheral pooling of blood and hypotension. Decreased venous return to the heart results in decreased cardiac output and hypotension. Hypovolemia is not the source of the hypotension involved in neurogenic and anaphylactic shock. Cardiac output is generally adequate in neurogenic and anaphylactic shock. Hypotension in neurogenic and anaphylactic shock is not related to high afterload.

An example of an acyanotic heart defect is

a. ventricular septal defect. 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.

Diastolic heart murmurs are?

always pathologic.

A major risk factor for the development of active pulmonary tuberculosis (TB) disease is a. contaminated water. b. immunosuppression. c. being a male. d. overuse of antibiotics.

b

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

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. coronary vasospasm. b. stable angina. c. myocardial infarction. d. unstable angina.

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

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

Causes of metabolic acidosis include a. hypoventilation. b. tissue anoxia. c. hyperventilation. d. massive blood transfusion.

b

Clinical manifestations of severe symptomatic hypophosphatemia are caused by a. excess proteins. b. deficiency of ATP. c. hypocalcemia. d. renal damage.

b

Empyema is defined as an a. infection localized in the lung. b. infection in the pleural space. c. infection in the blood. d. exudative bronchitis.

b

How is a patient hospitalized with a malignant tumor that secretes parathyroid hormone-related peptide monitored for the resulting electrolyte imbalance? a. Serum potassium, bowel function, level of consciousness b. Serum calcium, bowel function, level of consciousness c. Serum calcium, Chvostek and Trousseau signs d. Serum potassium, Chvostek and Trousseau signs

b

Hypertrophy of the right ventricle is a compensatory response to a. aortic stenosis. b. pulmonary stenosis. c. aortic regurgitation. d. tricuspid stenosis.

b

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

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

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

In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiologic event? a. Mast cell degranulation that causes decreased surfactant b. Inflammation, mucosal edema, and bronchoconstriction c. Loss of alveolar elastin and premature closure of airways d. Pulmonary edema and decreased alveolar compliance

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

In which dysrhythmias should treatment be instituted immediately?

b. Atrial fibrillation with a ventricular rate of 220 beats/minute 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.

Which acid are the kidneys unable to excrete?

b. Carbonic

Administration of which therapy is most appropriate for hypovolemic shock?

b. Crystalloids 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.

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

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

A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician?

b. pH in high part of normal range, PaO2 normal, PaCO2 high, bicarbonate high

Pressure

blood moves from areas of higher pressure (arteries) to an area of lower pressure (veins); the greater the pressure difference, the greater the blood flow

Which dysrhythmia is thought to be associated with reentrant mechanisms?

b. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome) 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.

What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume?

b. Tachycardia 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.

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?

b. Ventricular escape rhythm 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

b. acute onset of left ventricular dysfunction. 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.

The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with

b. antibiotics. 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.

Tachycardia is an early sign of low cardiac output that occurs because of

b. baroreceptor activity. A number of compensatory responses are set in motion to restore tissue perfusion and oxygenation in the early stage of shock. Baroreceptors located in the aorta and carotid arteries quickly sense the decrease in pressure and transmit signals to the vasomotor center in the brainstem medulla. The sympathetic nervous system stimulates β1 receptors, which respond by increasing the heart rate in an attempt to increase cardiac output. Tachycardia is not caused initially by tissue hypoxia. An early sign of low cardiac output is not anxiety. Tachycardia does not occur because of acidosis.

Cystic fibrosis is associated with a. chronic bronchitis. b. bronchiectasis. c. asthma. d. emphysema.

b. bronchiectasis. Fifty percent of cases of bronchiectasis are associated with cystic fibrosis. Cystic fibrosis is not associated with asthma, chronic bronchitis, or emphysema.

The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is

b. digitalis. 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.

In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with

b. high cardiac output. 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 has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to

b. hypotension. 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.

If an individual has a fully compensated metabolic acidosis, the blood pH is a. high. b. in the normal range. c. low. d. either high or low, depending on the type of compensation.

b. in the normal range. The blood pH is in the normal range if an individual has fully compensated for an acid-base imbalance. High blood pH indicates alkalosis. Low blood pH indicates uncompensated or partially compensated acidosis.

Respiratory acidosis is associated with a. increased pH. b. increased carbonic acid. c. hypokalemia. d. increased neuromuscular excitability.

b. increased carbonic acid. Respiratory acidosis causes an excess of carbonic acid that may be because of impaired gas exchange, inadequate neuromuscular function, and impairment of respiratory control of the brainstem. Hypokalemia is associated with alkalosis. Acidosis is associated with decreased neuromuscular excitability. Increased pH is associated with alkalosis; in acidosis the pH is low.

Vomiting of stomach contents or continuous nasogastric suctioning may predispose to development of

b. metabolic acid deficit.

Diarrhea and other lower intestnal fluid losses will contribute to

b. metabolic acidosis.

Emesis causes a. respiratory acidosis. b. metabolic alkalosis. c. respiratory alkalosis. d. metabolic acidosis.

b. metabolic alkalosis. Emesis causes metabolic alkalosis as the stomach is a major reservoir for acids. Emesis causes a metabolic acid-base imbalance as it is not related to the respiratory system. Emesis involves loss of gastric acid and fluid and causes an alkalotic disruption.

Cor pulmonale refers to

b. right ventricular hypertrophy secondary to pulmonary hypertension. 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.

A laboratory test that should be routinely monitored in patients receiving digitalis therapy is

b. serum potassium. 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.

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

b. stable angina. 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.

Bacterial pneumonia leads to hypoxemia caused by a. upper airway obstruction. b. accumulation of alveolar exudates. c. cardiogenic pulmonary edema. d. interstitial edema.

b?

Croup is characterized by

barking cough

Tachycardia is an early sign of low cardiac output that occurs because of

baroreceptor activity

Tachycardia is an early sign of low cardiac output that occurs because of

baroreceptor activity.

Tachycardia is an early sign of low cardiac output that occurs because of?

baroreceptor activity.

Administration of a pure 〈1-adrenergic agonist medication to a patient in shock would be expected to increase?

blood pressure

A diagnostic laboratory finding in myeloma is

bence jones proteins in the urine

The major buffer in the extracellular fluid is

bicarbonate

Most carbon dioxide is transported in the bloodstream as

bicarbonate ion

Excessive red cell lysis can be detected by measuring the serum

bilirubin

Primary cause of (Vascular)

bleeding is a problem with the vascular component of primary hemostasis May be acquired or inherited

Platelet Disorders Primary cause

bleeding is an abnormality in the quantity or quality of platelets May be acquired or inherited

Sings and symptoms of extracellular fluid volume excess include

bounding pulse

Copious amounts of foul-smelling sputum are generally associated with

bronchiectasis

Cystic fibrosis is associated with

bronchiectasis

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

What results when systemic blood pressure is increased?

c. Vasoconstriction At the smooth muscle of the arterial system, neurotransmitters bind to receptors to initiate vasoconstriction and increase systemic vascular resistance. An increase in vascular resistance causes the heart to work harder and thus increases blood pressure. Hypovolemia does not result in an increase in blood pressure. Cardiac output is not decreased when systemic blood pressure is increased. Vascular resistance is actually increased when the systemic blood pressure is increased.

Which clinical manifestation is not likely the result of a tuberculosis infection? a. Night sweats b. Productive cough c. Cyanosis d. Low-grade fever

c. Cyanosis Cyanosis is not a typical manifestation of tuberculosis infection. A productive cough, low-grade fever, and night sweats are the typical manifestations of tuberculosis infection.

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?

c. Left ventricular workload is increased with high afterload. 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.

A 3-year-old is diagnosed with starvation ketoacidosis. What signs and symptoms should you anticipate in your assessment? a. Rapid, deep breathing, tremors, elevated blood pressure b. Slow, shallow breathing, belligerence, hyperexcitability c. Rapid, deep breathing, lethargy, abdominal pain d. Slow, shallow breathing, numbness and tingling around his mouth

c. Rapid, deep breathing, lethargy, abdominal pain Rapid, deep breathing, lethargy, and abdominal pain are clinical manifestations of metabolic acidosis and its respiratory compensation. The other answer options are not clinical manifestations of metabolic acidosis and its respiratory compensation.

Croup is characterized by a. an inability to cough. b. drooling, sore throat, and difficulty swallowing. c. a barking cough. d. a productive cough.

c. a barking cough. Croup is characterized by a barking cough with stridor. A productive cough is not characteristic of croup. Croup is associated with coughing. Drooling, sore throat, and difficulty swallowing are not characteristics of croup.

A person who experiences a panic attack and develops

c. numbness and tingling in the extremities.

The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3 - = 24 mEq/L demonstrates

c. respiratory alkalosis.

Causes of metabolic acidosis include

c. tissue anoxia.

Pneumocystitis is a term that refers to a a. viral pneumonia found in transplant recipients. b. pneumonia secondary to bladder infection. c. fungal pneumonia secondary to HIV. d. non-infectious inflammation in the lung.

c?

The inward-pulling force of particles in the vascular fluid is called _____ pressure.

capillary osmotic

Malignant neoplasms of epithelial origin are known as

carcinomas

Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of

cardiac tamponade

Decreased cardiac output, muffled heart sounds, and equalized intracardiac pressures are manifestations of?

cardiac tamponade.

Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of

cardiac tamponade.

Low cardiac output in association with high preload is characteristic of ________ shock.

cardiogenic

Low cardiac output in associated with high preload is a characteristic of

cardiogenic shock

The final step in clot formation is

clot retraction

Patent ductus arteriosus is accurately described as a(n)

communication between the aorta and pulmonary artery

Patent ductus arteriosus is accurately described as a(n)

communication between the aorta and the pulmonary artery.

Which acid are the kidneys unable to excrete? a. Ammonia b. Metabolic c. Bicarbonate d. Carbonic

d. Carbonic The kidneys can excrete any acid except carbonic acid. The kidneys are able to excrete metabolic acids and ammonia. The kidneys are able to excrete bicarbonate, but bicarbonate is a base, not an acid.

In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing?

d. Class II, Compensated Stage In compensated stage hemorrhage (Class II), the blood loss is between 750 and 1500 mL. Blood pressure remains normal when the patient is supine but decreases upon standing. In initial stage hemorrhage (Class I) blood loss is up to 750 mL, and the patient's vital signs remain normal. Class III hemorrhage (progressive stage) is blood loss of 1500 and 2000 mL. Vital signs are changing. Severe Class IV hemorrhage (refractory stage) occurs when more than 2000 mL is lost. The patient is lethargic, with severe hypotension.

What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding? a. Kidney failure b. Excess of feedings c. Too much sodium in the feedings d. Inadequate water intake

d. Inadequate water intake Failure to provide adequate water when a patient is receiving tube feedings could result in hypernatremia. The feedings may have too much sodium, or the patient may be receiving too much feeding solution, but most likely the patient is not receiving enough water. Kidney failure is most likely not the cause of hypernatremia in this patient.

In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiologic event? a. Pulmonary edema and decreased alveolar compliance b. Mast cell degranulation that causes decreased surfactant c. Loss of alveolar elastin and premature closure of airways d. Inflammation, mucosal edema, and bronchoconstriction

d. Inflammation, mucosal edema, and bronchoconstriction In asthma, exposure to an allergen causes mast cell degranulation and release of inflammatory mediators that trigger airway inflammation, mucosal edema, and bronchoconstriction. In asthma, exposure to an allergen does not cause loss of alveolar elastin, pulmonary edema and decreased alveolar compliance, or decreased surfactant.

Obstructive sleep apnea would most likely be found in a patient diagnosed with a. poliomyelitis. b. myasthenia gravis. c. pneumonia. d. Pickwickian syndrome.

d. Pickwickian syndrome. Pickwickian syndrome is hypoventilation caused by obesity. Sleep apnea is often a problem in obese individuals. Obstructive sleep apnea is not likely to be found in a patient with myasthenia gravis, poliomyelitis, or pneumonia.

Angina caused by coronary artery spasm is called

d. Prinzmetal variant Variant, or Prinzmetal, angina is the term applied to vasospasm-initiated anginal symptoms caused by significant atherosclerotic plaques. These spasms usually respond promptly to vasodilating agents. Coronary artery spasm does not produce stable angina. Classic or typical angina is often associated with physical exertion. Unstable angina presents a similar clinical picture as myocardial infarction.

Sepsis has been recently redefined as

d. a systemic inflammatory response to infection. 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.

A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum. This patient is most likely experiencing

d. acute cardiogenic pulmonary edema. Acute cardiogenic pulmonary edema is a life-threatening condition requiring immediate treatment. It is associated with left ventricular failure that severely impairs gas exchange, and produces dramatic signs and symptoms including anxiety, severe dyspnea, an upright posture to breathe effectively, and pink frothy sputum. Right-sided heart failure produces systemic venous congestion. Cardiomyopathy is not associated with bubbly crackles and pink frothy sputum. A medication reaction is not the reason for the patient to exhibit severe dyspnea, anxiety, bubbly crackles, and frothy sputum.

Widespread atelectasis, non-cardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates on chest radiograph are characteristic of a. asthma. b. chronic obstructive pulmonary disease. c. cor pulmonale. d. acute respiratory distress syndrome.

d. acute respiratory distress syndrome. Acute respiratory distress syndrome is characterized by widespread atelectasis, non-cardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates. These findings are not characteristics of chronic obstructive pulmonary disease, asthma, or cor pulmonale.

COPD leads to a barrel chest, because it causes a. muscle atrophy. b. prolonged inspiration. c. pulmonary edema. d. air trapping.

d. air trapping. Destruction of alveolar walls reduces lung elastic recoil, which allows airway collapse during exhalation. Air enters the alveoli during inhalation, but has difficulty escaping during exhalation. When air is trapped in the alveoli, residual volume increases, causing a barrel chest. Destruction of alveolar walls does not cause pulmonary edema, muscle atrophy, or prolonged inspiration.

Causes of hypomagnesemia include a. hyperphosphatemia. b. clinical dehydration. c. oliguric renal failure. d. chronic alcoholism.

d. chronic alcoholism. Hypomagnesemia is common with chronic alcoholism. Hyperphosphatemia causes hypocalcemia. Oliguric renal failure and clinical dehydration reduce magnesium excretion.

Clinical manifestations of severe symptomatic hypophosphatemia are caused by a. excess proteins. b. hypocalcemia. c. renal damage. d. deficiency of ATP.

d. deficiency of ATP. Clinical manifestations of severe symptomatic hypophosphatemia are caused by a deficiency of ATP. Phosphate is an important component of ATP, which is the major source of energy for many cellular substances. Severe symptomatic hypophosphatemia does not cause excess protein accumulation, damage the kidneys, or cause hypocalcemia.

The patient who requires the most careful monitoring for development of metabolic acidosis is a patient who a. is in the diuretic phase of acute renal failure. b. has newly diagnosed Cushing syndrome. c. has had hypokalemia for over a week. d. has had diarrhea for over a week.

d. has had diarrhea for over a week. Diarrhea causes increased excretion of the base bicarbonate, which can lead to metabolic acidosis. Although the oliguric phase of acute renal failure causes metabolic acidosis, the diuretic phase does not, because the kidneys can still excrete metabolic acids. Hypokalemia is associated with metabolic alkalosis. Cushing syndrome is cortisol excess, which can cause metabolic alkalosis from increased renal excretion of hydrogen ions.

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

d. hypertensive crisis. Hypertensive crisis is characterized by a diastolic blood pressure of greater than 120 mm Hg, and symptoms of end-organ damage such as retinopathy and ischemic stroke. Blood pressure is not an indication of arthrosclerosis. Angina may accompany hypertensive crisis, but the question stem relates directly to hypertensive crisis. The patient may be having a myocardial infarction, but the addition of end-organ damage symptoms points to hypertensive crisis.

Respiratory acidosis may be caused by

d. hypoventilation.

Respiratory acidosis may be caused by a. hyperventilation. b. tissue hypoxia. c. massive blood transfusion. d. hypoventilation.

d. hypoventilation. Hypoventilation causes carbonic acid retention and respiratory acidosis. Hyperventilation causes excretion of too much carbonic acid and respiratory alkalosis. The liver metabolizes the citrate in transfused blood into bicarbonate. Tissue hypoxia causes lactic acid production during anaerobic metabolism and metabolic acidosis.

The body compensates for metabolic alkalosis by a. increasing bicarbonate ion excretion. b. decreasing arterial carbon dioxide. c. hyperventilation. d. hypoventilation.

d. hypoventilation. In metabolic alkalosis, the lungs compensate by hypoventilation to conserve CO 2 in the body. Decreasing arterial carbon dioxide would worsen metabolic alkalosis. The respiratory system compensates for metabolic acid and base disturbances; the lungs do not increase bicarbonate ion excretion. Hyperventilation would blow off CO 2 and cause respiratory alkalosis.

Lusitropic impairment refers to

d. impaired diastolic relaxation. 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.

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

d. mean arterial The mean arterial pressure is used to make incremental adjustments to vasoactive drugs. The MAP is the calculated average pressure within the circulatory system throughout the cardiac cycle. The systolic pressure is a part of the calculation but is not the data element used in adjustment of vasoactive medications. The diastolic reading is involved in calculating the MAP, but is not the number used in titration of vasoactive medications. The pulse pressure is the difference between the systolic and diastolic pressure.

The finding of ketones in the blood suggests that a person may have a. respiratory alkalosis. b. respiratory acidosis. c. metabolic alkalosis. d. metabolic acidosis.

d. metabolic acidosis. Ketones are produced from breakdown of fat in the body as a result of starvation or lack of ability to utilize glucose in diabetes mellitus. Ketoacids in the blood indicate a very high ketone level in the body, which leads to metabolic acidosis. Ketonuria from high ketones in the blood would not indicate metabolic alkalosis. The respiratory system does not influence ketone level.

Emesis causes

d. metabolic alkalosis.

Two primary acid-base disorders that are present independently are referred to as

d. mixed acid-base imbalance.

Two primary acid-base disorders that are present independently are referred to as a. metabolic acidosis. b. metabolic alkalosis. c. respiratory alkalosis. d. mixed acid-base imbalance.

d. mixed acid-base imbalance. Mixed acid-base disorders occur when two primary acid-base disorders are present independently. They may arise from simultaneous dysfunction of the respiratory system and kidneys. Metabolic acidosis is an acid disorder. Metabolic alkalosis and respiratory alkalosis are base disorders.

Hypertension is closely linked to

d. obstructive sleep apnea. 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.

The process responsible for distribution of fluid between the interstitial and intracellular compartments is a. active transport. b. filtration. c. diffusion. d. osmosis.

d. osmosis. Distribution of fluid between the interstitial and intracellular compartments occurs by the process of osmosis. Filtration is responsible for the distribution of fluid between the vascular and interstitial compartments. Active transport moves ions across membranes, but does not move water. Diffusion involves movement of particles, not movement of water.

Accumulation of fluid in the pleural space is called a. an abscess. b. flail chest. c. pleurisy. d. pleural effusion.

d. pleural effusion. Pleural effusion is accumulation of fluid in the pleural space. A lung abscess is a circumscribed area of suppuration and lung tissue destruction. Pleurisy is inflammation of the pleura that often manifests with pain on inspiration, fever, and chills. Flail chest is the fracture of several consecutive ribs.

An abnormally wide (more than 0.10 second) QRS complex is characteristic of

d. premature ventricular complexes. 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.

Left-sided heart failure is characterized by

d. pulmonary congestion. Left-sided heart failure is characterized by pulmonary congestion and edema. Right-sided heart failure is characterized by congestion in the systemic venous system that increases systemic vascular resistance. Jugular vein distention is a classic sign of right-sided heart failure. Peripheral edema is seen in right-sided failure.

The hypersecretion of mucus resulting for chronic bronchitis is the result of a. reduced inflammation. b. destruction of alveolar septa. c. barrel chest. d. recurrent infection.

d. recurrent infection. Mucus provides a hospitable environment for bacterial colonization and recurrent infection. Destruction of alveolar septa and reduced inflammation are not complications of chronic bronchitis. Hypersecretion of mucus does not contribute to barrel chest.

Beta-blockers are advocated in the management of heart failure because they

d. reduce cardiac output. 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.

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells.

d. renin When cardiac output is reduced, juxtaglomerular cells in the kidney release renin and initiate the renin-angiotensin-aldosterone cascade leading to salt and water retention by the kidney. Aldosterone is not released from juxtaglomerular cells. Norepinephrine is not released by cells within the kidney. Angiotensin is not involved in the process of cellular release within the kidneys.

. The ________ system compensates for metabolic acidosis and alkalosis.

d. respiratory

Apoptosis is a process that results in cellular

death

somatic death

death of the entire organism

In general, with aging, organ size and function

decrease

The primary effect of aging on all body systems is

decrease functional reserve

Hypernatremia may be caused by

decreased antidiuretic hormone secretion

Primary treatment for myocardial infarction is directed at

decreased myocardial oxygen demands

A restrictive respiratory disorder is characterized by

decreased residual volume

Signs and symptoms of clinical dehydration include

decreased urine output

When systemic vascular resistance is decreased, blood flow

decreases

Primary treatment for myocardial infarction is directed at

decreasing myocardial oxygen demands

Primary treatment for myocardial infarction (MI) is directed at

decreasing myocardial oxygen demands.

Clinical manifestations of severe symptomatic hypophosphatemia are caused by

deficiency of ATP

Severe combined immunodeficiency (SCID) syndrome is an example of a(n) - deficient immune response. - excessive immune response. - primary acquired immunodeficiency. - hypersensitivity reaction.

deficient immune response. SCID syndrome is an example of a deficient immune response in which the immune response is ineffective because of disease-causing genotypes or secondary/acquired dysfunction. An excessive immune response includes disorders in which the immune system is overfunctioning or hyperfunctioning. HIV/AIDS is an example of a primary acquired immunodeficiency disorder. Hypersensitivity reactions are an excessive immune response.

Patients with immunodeficiency disorders are usually first identified because they - run high fevers. - have unusually high WBC counts. - develop brain infections. - develop recurrent infections.

develop recurrent infections The first clinical indicators of immunodeficiency disorders are the signs and symptoms of infection, and the disorders are often first suspected when an individual has severe recurrent, unusual, or unmanageable infections. High fevers can occur in patients who have an intact immune system. Because of the immune deficiency, patients with immunodeficiency disorders may not demonstrate expected WBC counts with infection. Infections in patients with immunodeficiency disorders can occur anywhere in the body.

What are the symptoms of respiratory alkalosis?

diaphoresis, neuromuscular irritability (jumpy)

Aortic regurgitation is associated with

diastolic murmur

Aortic regurgitation is associated with

diastolic murmur.

The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is

digitalis

The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is?

digitalis

What causes respiratory acidosis?

disease process that precludes breathing at a rate or depth that will get rid of CO2 as fast as it is made (Can not get rid of CO2 as fast as we are making it) - COPD, drug overdose (barbiturate that depresses resp system, won't expel CO2) , head injury, neuromuscular disturbance

Widespread activation of the clotting cascade secondary to massive trauma is called

disseminated intravascular coagulation DIC

A common characteristic of viral pneumonia is

dry cough

The cellular change that is considered preneoplastic is

dysplasia

Increased preload of the cardiac chambers may lead to which patient symptom?

edema

A disease that is native to a particular region is called

endemic

Intima

endothelial cells in direct contact with the blood as it flows through the vessel

The most effective therapy for anemia associated with kidney failure is

erythropoietin administration

The prothrombin time (PT) and international nomalized ratio (INR) measure the integrity of

extrinsic pathway

The most commonly recognized outcome of hypertension is pulmonary disease. a. False b. True

f

A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis. T/F

false

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

false

New-organ damage is a function of both the stage of hypertension and its duration. T/F

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.

Pneumocystitis is a term that refers to a

fungal pneumonia secondary to HIV

Early manifestations of a developing metabolic acidosis include

headache

What are the symptoms of metabolic acidosis?

headache, arrhythmias, confusion, lethargy, (if continuous) coma, abdominal pain (losing all HCO3 in lower digestive track)

What are the symptoms of respiratory acidosis?

headache, tachycardia(trying to circulate blood to compensate), blurred vision (retnas affected directly to CO2 levels)

. Early manifestations of a developing metabolic acidosis include

headache.

Which condition is associated with an elevated reticulocyte count?

hemolytic anemia

In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with

high cardiac output

In contrast to other types of shock, the hyperdynamic phase of septic shock is associated with

high cardiac output

In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with

high cardiac output.

Lack of elasticity in the aorta as occurs with age and contributes to?

higher systolic and lower diastolic blood pressures.

An important mediator of a type I hypersensitivity reaction is - complement. - antigen-antibody immune complexes. - T cells. - histamine.

histamine Histamine mediates type I hypersensitivity reactions. Complement mediates type II hypersensitivity reactions. Antigen-antibody immune complexes mediate type III hypersensitivity reactions. T cells mediate type IV hypersensitivity reactions.

When mast cells degranulate, they release: - perforins and other toxins. - histamine and other inflammatory mediators. - complement. - antibodies.

histamine and other inflammatory mediators. Mast cells release inflammatory mediators such as histamine when they degranulate.

The imbalance that occurs with oliguric renal failure is

hyperkalemia

Risk factors for atherosclerosis include

hyperlipidemia

Which disorder is caused by inhalation of organic substances?

hypersensitivity pneumonitis

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

hypertensive crisis

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.

Chronic elevation of myocardial wall tension results in ________.

hypertrophy

What causes respiratory alkalosis?

hyperventilation -anxiety, pain, hypoxemia (low blood O2), brain stem over stimulation (meningitis, head injury), direct head injury

Which electrolyte imbalance cause increased neuromuscular excitability?

hypocalcemia and hypomagnesemia

An increase in the resting membrane potential (hyperpolarized) is associated with

hypokalemia

Metabolic alkalosis is often accompanied by

hypokalemia

Metabolic alkalosis is often accompanied by

hypokalemia.

A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop

hypophosphatemia

A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to

hypotension

A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to

hypotension.

Respiratory acidosis may be caused by

hypoventilation

If an individual has a fully compensated metabolic acidosis, the blood pH is

in the normal range.

Smooth muscle

in vessels is innervated by adrenergic fibers from the SNS

What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding?

inadequate water intake

The compensatory mechanisms that are triggered following myocardial?

increase myocardial oxygen demands.

A patient has a positive Chvostek sign. The nurse interprets this as a sign of

increased neuromuscular excitability (hypocalcemia, hypomagnesemia)

Uncompensated metabolic alkalosis would result in

increased pH, increased HCO3-

Chronic bronchitis often leads to cor pulmonale because of

increased pulmonary vascular resistance

The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by

increased residual lung volume

The effects of histamine release include

increased vascular permeability

The effects of histamine release include - vasoconstriction. - bronchodilation. - increased vascular permeability. - decreased gut permeability.

increased vascular permeability. Histamine release leads to increased vascular permeability, which fosters fluid movement out of capillaries and into tissues leading to the edema common in type I hypersensitivity. Histamine leads to bronchoconstriction, increased gut permeability, and vasodilation (not vasoconstriction).

Chemotherapy

induce long-term remission

What age group has a larger volume of extracellular fluid than intracellular fluid?

infants

what age group has a larger volume of extracellular fluid than intracellular fluid?

infants

Disseminated intravascular coagulation may be treated with heparin therapy to

inhibit clotting factor consumption.

Coagulative necrosis is caused by

interrupted blood supply

A low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) are characteristic of which type of anemia?

iron deficiency

The cause of the most common form of anemia is

iron deficiency

Type I hypersensitivity

is an immediate allergic or anaphylactic (ex. anaphylactic shock/ allergic response) type of reaction mediated primarily by sensitized mast cells. The reaction is initiated when IgE antibodies located on the mast cell membrane are bound by antigen, with subsequent cross-linking of IgE receptors. Mast cell degranulation releases chemicals that mediate the signs and symptoms of anaphylaxis. Released histamine, kinin, prostaglandins, interleukins, and leukotrienes cause increased vascular permeability, vasodilation, hypotension, urticaria, and bronchoconstriction. Examples of type I reactions include drug reactions, bee sting reactions, and asthma.

Turbulent flow

is an interruption in the forward current of blood flow by crosswise flow manifest as: -Bruit -Thrill -Thrombus formation

Systolic blood pressure?

is defined as the highest pressure detected in the arteries.

Exact cause of hematologic neoplasms

is unknown; basic mechanisms involves cell mutation that disrupts growth control and differentiation pathways Viruses [retro-viruses, herpes viruses, epstein-barr virus(major risk factor hodgkin's lymphoma): risk factor] Radiation exposure [ex. Chemo therapy attack cells that are rapidly dividing / epithelium and blood ] Chemical exposure (slight)

Atherosclerosis puts a patient at risk for (Select all that apply.)

ischemic stroke, retinal injury, renal impairment

The primary source of erythropoietin is provided by the

kidney

A patient has been exposed to meningococcal meningitis, but is not yet demonstrating signs of this disease. This stage of illness is called the _____ stage.

latent

Respiratory Alkalosis

loss of CO2 - cause of excess base

Metabolic Acidosis

loss of HCO3 - cause of excess acid

What causes metabolic alkalosis?

loss of metabolic acid, or gain of metabolic base (by taking antacids. Loss of acid - emesis, diuretic therapy causing hypokalemia (shifts H into cells).

What are the causes of metabolic acidosis?

loss of metabolic base or gain of metabolic acid. Loss of base - diarrhea. Increased acid - Acetoacetic acid (asprin), ketoacidosis (using fat for fuel) from diabetes

Dramatic hypotension sometimes accompanies type I hypersensitivity reactions because

massive histamine release from mast cells leads to vasodilation

Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because

massive histamine release from mast cells leads to vasodilation

Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because - massive histamine release from mast cells leads to vasodilation. - toxins released into the blood interfere with cardiac function. - anaphylaxis results in large volume losses secondary to sweating. - hypoxia resulting from bronchoconstriction impairs cardiac function.

massive histamine release from mast cells leads to vasodilation. Hypotension can occur in type I hypersensitivity resulting from massive histamine release leading to vasodilation. Toxins are not released during type I hypersensitivity reactions. Sweating occurs as a reaction to shock from severe hypotension; the hypotension occurs first and is because of histamine release. Hypoxia occurs in anaphylaxis as a result of shock from severe hypotension; the hypotension occurs first and is because of histamine release.

A primary effector cell of the type I hypersensitivity response is - monocytes. - mast cells. - neutrophils. - cytotoxic cells.

mast cells Mast cells are a primary effector cell of the type I hypersensitivity response. Monocytes, neutrophils, and cytotoxic cells are not primary effectors of the type I hypersensitivity response.

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

mean arterial

Critically ill patients my have parenterally administered vasoactive drugs that are adjusted according to their

mean arterial pressure. MAP is used to calculate the average pressure within the circulatory system throughout the cardiac cycle

The most appropriate treatment for secondary polycythemia is

measured to improve oxygenation

The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called ________

megaloblasts Megaloblasts are large abnormal bone marrow cells.

Two primary acid-base disorders that are present independently are referred to as

mixed acid-base imbalance

Vomiting of stomach contents or continuous nasogastric suctioning may predispose to development of

metabolic acid defecit (metabolic alkalosis)

Diarrhea and other lower intestinal fluid losses will contribute to

metabolic acidosis

Diarrhea causes

metabolic acidosis

The finding of ketones in the blood suggests that a person may have

metabolic acidosis (ketoacidosis)

Emesis causes

metabolic alkalosis

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

mitral regurgitation

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

mitral regurgitation

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

mitral regurgitation.

Blood flow

movement along a pressure gradient within the vascular bed

RhoGAM (an Rh antibody) would be appropriate in an Rh-_____ woman with an _____ Rh-_____ antibody titer carrying an Rh-_____ fetus. - negative; positive; positive - positive; negative; negative - negative; negative; positive - negative; negative; negative

negative; negative; positive If a woman is Rh-negative, RhoGAM is administered for prevention of Rh-positive antibodies. Erythroblastosis fetalis develops during pregnancy when an Rh-negative mother is sensitized to her fetus's Rh-positive red cell group antigens because of exposure during her current or a previous pregnancy. RhoGAM contains antibodies against Rh antigens on fetal blood cells and is given to the mother to destroy fetal cells that may be present in her circulation before her immune system becomes activated and begins to produce anti-Rh antibodies. RhoGAM is not effective if the mother already has a positive antibody titer for fetal Rh antigens. An Rh-positive woman with negative Rh antibody titer carrying Rh-negative fetus does not require RhoGAM because the mother is Rh-positive and the fetus is Rh-negative.

Starling's hypothesis

net filtration is equal to the combined forces fostering filtration minus the combined forces opposing filtration Capillary fluid pressure and plasma colloid osmotic pressure are most clinically relevant

What are the symptoms for metabolic alkalosis?

neuromuscular irritability with severe lethargy, coma: + symptoms of causal condition

Tumor necrosis factor alpha and interleukin-1 contribute to shock states because they induce

nitric oxide

Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of

nitric oxide

Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of

nitric oxide.

Tumor necrosis factor 〈 and interleukin-1 contribute to shock states because they induce production of

nitric oxide.

The prevalence of high blood pressure is higher in

non-Hispanic black adults

The prevalence of high blood pressure is higher in

non-Hispanic black adults.

Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by

norepinephrine

Anemia

pallor, fatigue, malaise, shortness of breath, decreased activity tolerance (decrease RBC and oxygen in blood

A patient with heart failure who reports intermittent shortness of breath during the night is experiencing

paroxysmal nocturnal dyspnea

A patient with heart failure who reports intermittent shortness of breath during the night is experiencing

paroxysmal nocturnal dyspnea.

Hypotension associated with neurogenic and anaphylactic shock is because of

peripheral pooling of blood

Hypotension associated with neurogenic and anaphylactic shock is because of

peripheral pooling of blood.

Hypotension associated with neurogenic and anaphylactic shock is due to?

peripheral pooling of blood.

Persistence of the alarm stage will ultimately result in

permanent damage and death (organ failure)

A deficiency of von Willebrand factor impairs

platelet adhesion to injured tissue

The megakaryocyte is a precursor to

platelets

Accumulation of fluid in the pleural space is called

pleural effusion

A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for

pneumothorax

An erroneously low blood pressure measurement may be caused by

positioning the arm above the heart level

An erroneously low blood pressure measurement may be caused by

positioning the arm above the heart level.

Arterioles

primary tissue is smooth muscle

Left-sided heart failure is characterized by

pulmonary congestion

A patient with pure left-sided heart failure is likely to exhibit

pulmonary congestion with dyspnea

A patient with pure left-sided heart failure is likely to exhibit

pulmonary congestion with dyspnea.

Left-sided heart failure is characterized by

pulmonary congestion.

Left-sided heart failure is characterized by?

pulmonary congestion.

A serious complication of deep vein thrombosis is

pulmonary embolus

Hypertrophy of the right ventricle is a compensatory response to

pulmonary stenosis

Hypertrophy of the right ventricle is a compensatory response to

pulmonary stenosis.

Hypertrophy of the right ventricle is a compensatory response to?

pulmonary stenosis.

Indicators that an individual is experiencing high stress include all the following except

pupil constriction

When preparing for the admission of a client diagnosed with bronchiectasis, the nurse will

put a sputum cup and a box of tissues on the bedside table

The majority of tachydysrhythmias are believed to occur because of

reentry mechanisms

The hypersecretion of mucus resulting for chronic bronchitis is the result of

recurrent infection

Myeloid lineage (hematologic neoplasms)

red cells, platelets, monocytes, and granulocytes (any cell that are) Purpose: CML C- chronic (attack the mature cell) M- myeloid (RBC) L- lineage

Beta-blockers are advocated in the management of heart failure because they

reduce cardiac output

Beta-blockers are advocated in the management of heart failure because they

reduce cardiac output.

Cardiogenic shock is characterized by

reduced cardiac output

The common denominator in all forms of heart failure is

reduced cardiac output

The common denominator in all forms of heart failure is

reduced cardiac output.

The common denominator in all forms of heart failure is?

reduced cardiac output.

Emphysema results from destruction of alveolar walls and capillaries, which is because of

release of proteolytic enzymes from immune cells

Emphysema results from destruction of alveolar walls and capillaries, which is because of

release of proteolytic enzymes from immune cells.

Law of Laplace

represents the relationship between distending pressure and wall tension An increase in radius or distending pressure results in increased wall tension

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells.

renin

Low cardiac output to the kidneys stimulates the release of _______ from the juxtaglomerular cells.

renin

All obstructive pulmonary disorders are characterize by

resistance to airflow

The ________ system compensates for metabolic acidosis and alkalosis.

respiratory

The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3- = 24 mEq/L demonstrates

respiratory alkalosis

The arterial blood gas pH = 7.52, PaCO2 = 30 mmHg, HCO3 - 24 mEg/L demonstrates

respiratory alkalosis

Venous thrombosis

results in edema

Arterial thrombosis

results in ischemia

Complete remission (CR)

return to normal hematopoiesis with normal red cell, neutrophil, and platelet count; no detectable neoplastic cells (no leukimic cells . All bloodcells are back to normal) -not a cure; usually treatment protocols include many chemotherapy cycles; most chemotherapeutic agents induce apoptosis

Cor pulmonale refers to

right ventricle hypertrophy secondary to pulmonary hypertension

Media

smooth muscle tissue (thickest section in arteries)

The electrolyte that as a higher concentration in the extracellular fluid than in the intracellular fluid is ______ ions.

sodiu,

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

sodium

The electrolyte that has a higher concentration in the extracellular fluid than in the intracellular fluid is _____ ions.

sodium

Thrombus

stationary blood clot formed within a vessel or a chamber of the heart -Prophylactic interventions include oral/parenteral anticoagulant therapy, or drugs that block platelet activation/aggregation -Once a thrombus has formed, anticoagulant therapy is initiated to prevent clot enlargement

Which complication of asthma is life threatening?

status asthmaticus

Allogenic translation

stem cells from closely match relative (commonly use as donor)

Autologous transplat

stem cells from patient own blood to be reinfused

A patient with significant aortic stenosis is likely to experience

syncome (fainting)

A patient with significant aortic stenosis is likely to experience

syncope

A patient with significant aortic stenosis is likely to experience

syncope.

Sepsis has been recently defined as

systemic inflammatory response to infection

Improvement in a patient with septic shock is indicated by an increased in

systemic vascular resistance

Improvement in a patient with septic shock is indicated by an increase in

systemic vascular resistance.

Improvement in a patient with septic shock is indicated by an increase in?

systemic vascular resistance.

Pulse pressure is defined as

systolic pressure - diastolic pressure.

Hemostasis

the arrest of bleeding or prevention of blood loss after blood vessel injury Involves the vessel wall, circulating platelets, and plasma coagulation proteins Stopping blood to repair itself Basal constriction if vessel breaks Included in patient history and physical exam Determine if problem exists and underlying(bleeding disorder) cause so appropriate management is initiated Especially indicated for: -Personal/family history of bleeding disorder -During active bleeding that is unresponsive to standard interventions -Screening before surgery (never want any1 go under the knife if they have a bleeding disorder) -Ongoing evaluation of anticoagulation therapy Bleeding too much Low amount of calcium Anti-cogulative theraphy Liver diease (liver makes cogulation factors )

Blood flow throughout the periphery is regulated by

the autonomic nervous system

Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.

true

The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts. T/F

true

The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension. a. False b. True

true

Neuromuscular disorders impair lung function primarily because of

weak muscles of respiration

Clinical manifestations of extracellular fluid volume deficit include

weak pulse, low blood pressure, and increased heart rate.