exam 2 practice questions
what triggers multiple organ dysfunction syndrome (MODS)?
maldistribution of blood flow, supply-dependent oxygen consumption, excessive inflammatory reaction, and maldistribution of blood flow
which type of lung cancer is primarily caused by asbestos exposure?
mesothelioma
which is classified as a myofascial pain syndrome?
muscle strain
what is classified as a myofascial pain syndrome?
muscle strain rationale Myofascial pain syndrome (MPS) is a regional pain syndrome associated with injury to muscle, fascia, and tendons and includes myositis, fibrositis, myofibrositis, myalgia, and muscle strain. These conditions involve myofascial trigger points within a taut band of skeletal muscle. The pain may be the result of low-threshold mechanosensitive afferents projecting to sensitized dorsal horn neurons and the development of peripheral and central sensitization.
which statement is true regarding cellular injury of the myocardium?
myocardial cells remain viable if blood flow returns within 20 minutes rationale Cardiac cells can withstand ischemic conditions for approximately 20 minutes. ECG changes are visible after 30-60 seconds of hypoxia. After 8-10 seconds of decreased blood flow, the myocardial cells are already cyanotic and cooler. Even if cardiac cells are metabolically altered and are nonfunctional, they can remain viable if blood flow returns within 20 minutes.
what does heat exhaustion result in?
a need to ingest cool liquids, profound vasodilation, and profuse sweating rationale internally high temperatures cause the appropriate hypothalamic response of profound vasodilation and profuse sweating. The individual should be encouraged to drink cool fluids to replace fluid lost through sweating. Heat exhaustion is a result of prolonged high core or environmental temperatures that are unique to each incidence.
what abnormalities lead to the mucus plugging seen in children with cystic fibrosis (CF)?
defective chloride secretion and excess sodium absorption thicken the mucus rationale respiratory mucus in CF is dehydrated and viscous because of impaired chloride secretion and excess sodium absorption. the gut's ability to absorb water is not affected. the inflammatory response is active in this disease process. pulmonary remodeling does lead to chronic hypoxia, but this is not related to mucus plugging.
which is a benefit of a fever?
deprives bacteria of a food source rationale Fever has benefits. The higher body temperature decreases serum levels of iron, zinc, and copper, all of which are needed for bacterial replication. It switches from burning glucose to lipolysis and proteolysis, thus depriving bacteria of a food source. Lymphocytic transformation is increased, increasing the immune response, and phagocytosis is increased.
all of the statements below are part of Virchow's Triad except?
developing ST elevation infarction
which type of heart failure has a preserved ejection fraction?
diastolic heart failure
which steps are involved in the process of gas exchange?
diffusion, perfusion, and ventilation rationale Ventilation, diffusion, and perfusion are the three steps involved in gas exchange in the lungs.
match the audiologic problem with its described pathophysiology: benign paroxysmal positional vertigo
displaced otoconia in semicircular canals
Kelly is a 3-year-old female who developed acute bronchitis 7 days ago. Over the last several days her cough has become more productive and frequent, and she has been persistently febrile. You are the primary NP on when Kelly's mother brings her into the urgent care. You perform an exam on Kelly and note the following: Temp 103.3, BP 70/50 HR 180, RR 30, O2 saturation 88% on room air On physical exam, Kelly is drowsy but awakens to touch and loud noise. The skin on her legs and arms appears mottled. What is your primary differential diagnosis for Kelly?
distributive shock
which structures are considered part of the upper airway?
nasopharynx and oropharynx rationale The nasopharynx and oropharynx are the structures of the upper airway. The larynx divides the upper and lower airways. The trachea and bronchi are in the lower airway.
true or false: in cor pulmonae, left heart enlargement/failure occurs as a result of pulmonary arterial hypertension (PAH)
false
true or false: one of the most common presentations of early lung cancer is the presence of pleural pain, due to the high amount of pain receptors in lung parenchyma.
false
true or false: hypoxemia is reduced oxygenation of cells in tissues, whereas hypoxia is reduced oxygenation of arterial blood
false rationale hypoxemia is low oxygen levels in your blood and hypoxia is low oxygen levels in your tissues
which structure allows right to left shunting, which is necessary for fetal circulation?
foramen ovale rationale The foramen ovale is the flapped orifice that allows right-to-left shunting, which is necessary for fetal circulation. Altered development can lead to atrial septal defect. Failure of the septum primum to fuse with the endocardial cushions results in an ostium primum defect. Fenestrations (or openings), which develop in the superior portion of the septum primum, create the ostium secundum. The bulbus cordis is the conal portion of the ventricular septum that separates the aorta from the pulmonary artery.
which of the following is NOT a risk factor for aspiration?
head of bed > 60 degrees
empyemas occur when the pleural space fills with:
pus
which statement is true regarding the specificity theory of pain?
relates the amount of pain to the amount of soft tissue injury rationale The specificity theory of pain postulates that the intensity of pain is directly related to the amount of associated tissue injury. It does not take into account previous experience, emotions, or attention to pain.
a healthcare professional is caring for a patient who was rewarmed after suffering from hypothermia. what possible long-term complication will the professional continue to assess the patient for?
renal failure rationale Rewarming can result in long-term complications that include congestive heart failure, hepatic and renal failure, abnormal erythropoiesis, myocardial infarction, pancreatitis, and neurologic dysfunctions. Short-term complications of rewarming include acidosis, rewarming shock, and dysrhythmias.
what process describes the exchange of carbon dioxide (CO2) for oxygen?
respiration rationale Respiration is the exchange of CO2 for oxygen. Ventilation is the mechanical movement of gas or air into and out of the lungs and is often misnamed respiration. Circulation refers to the actual blood flow and oxygen delivery. Alveolar ventilation refers to the amount of air delivered to the alveoli.
which statement is true regarding bronchiolitis?
respiratory distress develops within 24-72 hours rationale In bronchiolitis respiratory distress with severe hypoxia frequently develops within 24-72 hours. Infiltrates can be seen on chest radiographs. Bronchiolitis is diffuse and is more common in children. A decrease in minute ventilation with resulting carbon dioxide retention may occur as lung restriction worsens in bronchiolitis.
a patient is diagnosed with chronic obstructive pulmonary disease (COPD) and has elevated pulmonary vascular resistance. which complication would the health care professional assess the patient for?
right heart failure
which statement is true regarding stridor?
stridor is high-pitched sounds with inspiration rationale stridor is high-pitched sounds with inspiration. a turbulent flow of air through a partially obstructed airway produces stridor, which is a harsh vibratory sound of variable pitch. inspiratory stridor is generated with obstruction of the extrathoracic airway (above the thoracic inlet). biphasic stridor typically reflects obstruction at the glottis.
true or false: Kussmal respirations can be considered a physiological or pathophysiological response, depending on the cause.
true
true or false: alveolar deadspace is often caused by a blockage in pulmonary circulation, such as a pulmonary embolism
true
true or false: congenital heart disease, valvular heart disease, trauma/procedures, and prosthetic valves are risk factors for infective endocarditis
true
true or false: prolonged exposure to high levels of oxygen can cause inflammation in the pulmonary system
true
true or false: superior vena cava syndrome occurs when a tumor or other mass compresses the superior vena cava
true
true or false: true aneurysms involve all three layers of the arterial wall
true rationale true aneurysms are fusiform and circumferential in nature and involve all three layers of the arterial wall; there is weakening of the vessel wall
true or false: the first line treatment of anaphylaxis is the administration of Epinephrine 0.3-0.5mgs of 1:1,000?
true rationale first line treatment is 0.3-0.5mg of 1:1,000 epinephrine : 1mg of epi diluted in 1000ml ergo 0.01%
Nociceptors are free nerve endings in the afferent peripheral nervous system that selectively respond to different stimuli. They are categorized according to the stimulus to which they respond and the properties of the nerve fibers associated with them. The fibers that transmit dull, aching, or burning sensation are:
unmyelinated C fibers rationale Unmyelinated C fibers are polymodal and transmit sensations, such as burning or aching, that are poorly localized and long lasting. The fibers responsible for causing reflex withdrawal of a body part from the stimulus before a pain sensation is perceived are A-delta fibers. They transmit sharp, well-localized pain sensations. As portions of the neurons cross the midline of the spinal cord, they ascend to various areas of the brain. These tracts are known as funiculi. Enkephalins are a type of opioid transmitter that inhibits the transmission of pain impulses.
Kelly's mom hears you use the term septic shock to describe Kelly's illness. She asks you to explain what it means. What is the BEST reply?
Kelly's lung infection has caused her blood pressure to drop and her body isn't getting the oxygen it needs to work properly
heat stroke is best characterized by_________.
a core body temperature higher than 40C (104.9F)
rapid eye movement (REM) sleep occurs in cycles approximately how often?
90 minutes rationale REM sleep accounts for 20% to 25% of sleep time and is characterized by desynchronized, low-voltage, fast activity that occurs for 5 to 60 minutes approximately every 90 minutes, beginning after 1 to 2 hours of non-REM sleep.
which statement is true regarding acute respiratory distress syndrome (ARDS)?
ARDS can trigger severe pulmonary edema rationale the most common cause of ARDS is either sepsis or multiple trauma, which damages the alveolar capillary membrane and results in severe pulmonary edema. macrophages, neutrophils, complement, and endotoxins are important mediators.
which statement correctly describes acute respiratory distress syndrome (ARDS)?
ARDS is characterized by acute lung inflammation and diffuse alveolocapillary injury
all of the following symptoms are part of the diagnostic criteria for Kawasaki disease except
Koplik's spots rationale the child must exhibit five of these six criteria: 1. fever for 5 days or longer 2. bilateral conjunctival injection without exudation 3. changes in oral mucus such as strawberry tongue 4. a polymorphous rash 5. cervical lymphadenopathy 6. changes in the extremities such as peripheral edema
which factors contribute to sensorineural hearing loss?
Ménière disease, noise exposure
cyanosis, followed by rubor and paraesthesias in the digits, are associated with which condition?
Raynaud phenomenon or disease rationale Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes, characterize Raynaud phenomenon and Raynaud disease. Symptoms include cold and numb digits. Thromboangiitis obliterans, an inflammatory disease of the peripheral arteries, tends to occur in young men who are heavy smokers. Arteries occlude in the feet and hands. The chief symptoms of thromboangiitis obliterans are pain and tenderness of the affected part. Atherosclerosis is an inflammatory disease and is the major cause of coronary artery disease and stroke. A varicose vein is a superficial vein in which blood has pooled.
which cytokines are endogenous pyrogens?
TNF-a, IFN-y, IL-1, and IL-6 rationale Endogenous pyrogens include prostaglandin E2 (PGE2), interleukin-1 (IL-1), IL-6, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ). The other options are not endogenous pyrogens.
atherosclerosis is a chronic inflammatory disorder of medium and large arteries. from the list below select the most commonly affected
abdominal aorta rationale in descending order the most commonly affected arteries are: abdominal aorta, coronary arteries, popliteal arteries, and carotid arteries
a patient is in the ED with heat stroke. what finding does the healthcare provider associate with this condition?
absence of sweating despite a high core temperature rationale The absence of sweating despite a high core temperature is characteristic of heat stroke. The temperature is typically above 40°C (104°F) in heat stroke. Since the patient is not sweating, rapid heat loss via sweat cannot occur. The loss of sodium is characteristic of heat cramps. Prolonged sweating can occur in heat cramps or heat exhaustion.
a patient is diagnosed with septic shock. what action by the healthcare professional will address the main underlying pathophysiologic mechanism of this disorder?
administer antibiotics as soon as possible rationale the mainstay of treatment in septic shock is identifying underlying infectious process and administering antibiotics as soon as possible
which problem is associated with drusen bodies in the deep retinal areas of the eye?
age-related macular degeneration
how is tuberculosis spread from person to person?
air droplet rationale Tuberculosis is extremely contagious and is transmitted via airborne droplets.
which statements are true regarding children's airways?
airway obstruction occurs earlier in infants than it does in children, children have more cartilage in their airways than do infants, airway narrowing significantly affects resistance rationale airway obstruction occurs earlier in infants than it does in older children and is due to the infant's smaller airway and smaller airway diameter. the airway resistance is proportional to the inverse of the fourth power of the radius, which means any narrowing significantly affects resistance. children also have more cartilage than adults, which can collapse more easily. a cough can be a sign of infection, foreign body, or obstruction.
A father is in the cardiac intensive care unit holding the hand of his 1-week-old daughter. After discharge, the mother and father noted that the baby had rapid breathing and was a poor eater. Her color was mottled with crying, and she seemed to sweat when distressed. They took the baby back to the pediatrician's office for a weight check and were immediately transported to a local children's hospital for cardiac evaluation. The parents believe they are responsible because the mother did not receive medical care during her pregnancy. This baby is their third child, and they did not have medical insurance after the father lost his job. Worried about how they are going to pay the medical bills, they meet with financial counselors who are assisting them with information and filing paperwork. Because both parents are high-school dropouts, neither reads well, and they struggle to understand their daughter's diagnosis of TOF. Consisting of four defects, TOF is a congenital cardiac defect that:
allows desaturated blood to enter the systemic system without passing through the lungs rationale Cyanotic heart defects allow desaturated blood to enter the systemic system without passing through the lungs. Cardiac workload must be decreased in cyanotic cardiac defects, and heart function must be increased. TOF is a lesion that causes right ventricular outflow obstruction and shunting from the right side of the heart to the left side. Cardiac lesions that increase pulmonary blood flow include defects that involve septal abnormalities with a left-to-right shunt. TOF causes cyanosis and is a cyanotic birth defect.
which statement is true regarding the gate control theory (GCT) of pain?
an open gate facilitates the brain in processing the pain rationale The open gate in the spinal cord regulates the transmission of pain impulses that ascend to the brain for further processing and interpretation, thus leading to the management of pain. The spinal gate regulates pain transmission to higher centers in the CNS.
which statement is true regarding multiple organ dysfunction syndrome (MODS)?
an uncontrolled inflammatory response can trigger MODS rationale MODS is the progressive dysfunction of two or more organ systems, resulting from uncontrolled inflammatory response, and may occur during sepsis. However, these two terms are not synonymous. The mortality rate for MODS is high.
for which type of shock would antihistamines and corticosteroids be prescribed?
anaphylactic rationale antihistamines and corticosteroids would most likely be prescribed for a patient experiencing anaphylactic shock
which of the following is a cause of high output heart failure?
anemia beriberi sepsis (septicemia) hyperthyroidism
which hormones help diminish the febrile response?
arginine vasopressin (AVP), corticotropin-releasing factor, and melanocyte-stimulating hormone-alpha (a-MSH) rationale During fever, AVP, α-MSH, and corticotropin-releasing factors are released from the brain, and anti-inflammatory cytokines (e.g., IL-1, IL-10) can act as endogenous cryogens or antipyretics to help diminish the febrile response. The other options are not hormones that diminish the febrile response.
when a patient asks the nurse what is the most common cause of myocardial ischemia, which statement is the correct response? the most common cause of myocardial ischemia is:
atherosclerosis
A 57-year-old African-American woman is seen at an urgent care clinic for a headache not relieved by acetaminophen or ibuprofen. Physical examination reveals an overweight woman who is short of breath from the walk to the examination room. Her fingers are puffy with tight rings that she is unable to remove. The woman reports she has a history of cigarette smoking, primary hypertension, high cholesterol, and type 2 diabetes. From these risk factors and the initial impression, the staff fears some form of heart disease, and the woman is transported to a nearby emergency department for further evaluation. The leading cause of coronary artery and cerebrovascular disease is:
atherosclerosis rationale Atherosclerosis, which is the thickening and hardening of vessels, is the leading cause of coronary artery and cerebrovascular disease. Dyslipidemia refers to abnormal concentrations of serum lipoproteins that are the result of a combination of genetic and dietary factors; dyslipidemia is a strong indicator for coronary risk. Hypertension, or a consistent elevation of systemic arterial blood pressure, is the most common primary diagnosis in the United States. Being overweight and sedentary are associated with an even higher risk for coronary artery disease events.
a child who is about to begin school is found to have a crescendo-decrescendo systolic ejection murmur. this finding supports the presence of which cardiac anomaly?
atrial septal defect rationale An atrial septal defect may exhibit a crescendo-decrescendo systolic ejection murmur. Mitral valve prolapse is not usually diagnosed in childhood and is identified by an opening click. A ventricular septal defect has a harsh, loud, holosystolic murmur and systolic thrill. A child with congestive heart failure may show changes in feeding, respirations, or lung sounds.
which congenital heart defect is related to Trisomy 21 (Down Syndrome)?
atrial septal defect rationale an ASD is an abnormal communication (or opening) across the interatrial septum. usually, will cause a left to right shunt due to higher pressure on the left side of the heart. can go undetected until pre-school age. related to Down Syndrome (Trisomy 21)
enkephalins and endorphins act to relieve pain by which process?
attaching to opiate receptor sites rationale Enkephalins and endorphins are neurohormones that act as neurotransmitters by binding to one or more G protein-coupled opioid receptors and thus relieving pain. They do not inhibit cells in the substantia gelantinosa, stimulated descending efferent nerve fibers, or block transduction of nociceptors.
for an infection to progress to septic shock, which of the following factors should the nurse practitioner determine occurred?
bacteria must enter the blood stream
which statements regarding respiratory distress syndrome (RDS) of the newborn are true?
birth by elective cesarean section increases risk, it is more frequently seen in infants of diabetic mothers, the major predisposing factor is birth prior to 36 weeks, and there is increased incidence in American newborns rationale RDS occurs almost exclusively in premature infants, and the incidence has increased in the United States over the past two decades. RDS occurs in 50% to 60% of infants born at 29 weeks' gestation and decreases significantly by 36 weeks. Infants of diabetic mothers and those with cesarean delivery (especially elective C-section) also are more likely to develop RDS. It is more common in boys than girls and more common in whites than nonwhites.
which statement accurately describes blood flow through the heart?
blood flows from the right ventricle through the pulmonic semilunar valve rationale blood flows from the right atrium through the tricuspid valve to the right ventricle. blood then travels from the right ventricle through the pulmonic semilunar valve to the pulmonary circulation. once in the pulmonary circulation, it is oxygenated and travels to the left atrium through the bicuspid valve to the left ventricle. blood leaves the left ventricle through the aortic valve and enters the systemic circulation.
which are signs of deterioration in a child experiencing shock?
bradycardia and prolonged capillary refill rationale Bradycardia is symptom of deterioration in shock and impending cardiovascular collapse. Prolonged capillary refill of greater than 2 seconds indicates compromise in systemic perfusion. Cerebral tissue oxygen saturation over 50% is typical; low rSO2 indicate decline in systemic perfusion. Decreased urine output indicate renal compromise.
match the audiologic problem with its described pathophysiology: otitis media with effusion
buildup of fluid in inner ear; but no infection is present
regarding normal features of cardiac function in the newborn, which statements are true?
by 1 month of age, the newborn's ventricles are approximately equal in weight and oxygen consumption doubles rationale Oxygen consumption doubles at birth, and the newborn's ventricles are approximately equal in weight by 1 month of age. The newborn heart rate is 100-180 bpm, and cardiac output is high. Unlike the adult heart, the newborn heart has right ventricular (RV) dominance with a thickened RV wall.
which assessment findings are a sign of atherosclerosis?
carotid arterial bruits
a patient wants to know what causes atherosclerosis. how should the nurse practitioner respond? in general, atherosclerosis is caused by:
caused by the hardening and thickening of artery walls due to the build up of cholesterol plaques in the vessel lumen
which receptor monitors the pH, partial pressure of CO2 (PaCO2), and the partial pressure of oxygen (PaO2) in arterial blood?
central chemoreceptors rationale Central chemoreceptors indirectly monitor arterial blood by sensing changes in the pH of the cerebral spinal fluid (CSF). Stretch receptors are located in smooth muscle and are sensitive to increases in the size or volume of the lungs. Irritant receptors are found in the epithelium of conducting airways and are sensitive to noxious aerosols, gases, and particles. J-receptors are located near the capillaries in the alveolar septa and are sensitive to increased capillary pressure.
which is true regarding central cyanosis?
central cyanosis is caused by hypoxemia
a person has respirations that are characterized by alternating periods of deep and shallow breathing and apnea. what is the appropriate term for this breathing?
cheyne-stokes rationale Alternating periods of deep and shallow breathing and apnea characterize Cheyne-Stokes respirations. An increased ventilatory rate, large tidal volumes, and no expiratory pause characterize Kussmaul respirations. Hypoventilation is inadequate alveolar ventilation. Hyperpnea is rapid ventilation.
which statement is true regarding burns in children?
children have decreased glycogen stores, and meeting metabolic needs is difficult rationale Children have decreased glycogen stores and thus have difficulty meeting metabolic needs. They are unable to concentrate urine, and this inability places children at increased risk of dehydration. Children may be immunosuppressed for a prolonged period after wound closure is achieved. Children require fluid resuscitation for smaller burns as a result of their limited reserve.
which of the following respiratory disorders is not commonly caused by genetic abnormalities?
chronic bronchitis
which term describes a hypersecretion of mucus and chronic productive cough that continues for at least 3 months of the year for a minimum of 2 consecutive years?
chronic bronchitis rationale the hypersecretion of mucus with a chronic productive cough that lasts for at least 3 months for a minimum of 2 consecutive years characterizes chronic bronchitis. the mucus is thicker and will adhere to embedded bacteria. this condition is increased up to 20 times in smokers
a child has been noted to have hypertension with decreased pulses in the lower extremities. what is the most likely congenital cause for this finding?
coarctation of the aorta rationale coarctation of the aorta is a narrowing of the lumen of the aorta that impedes blood flow. children may have cool, mottled skin, and occasionally leg cramps during exercise. a systolic ejection murmur, heard best at the left interscapular area, is caused by rapid blood flow through the narrowed area, which is often found with hypertension. Children with pulmonary stenosis may have a systolic ejection murmur and possibly exertional dyspnea and fatigability. Atrial septal defects have a murmur. Cyanosis, growth failure, and dyspnea may occur with tricuspid atresia.
which condition is a complication of hypertension?
congestive heart failure rationale Cardiovascular complications include left ventricular hypertrophy, angina pectoris, congestive heart failure (left heart failure), coronary artery disease, myocardial infarction (MI), and sudden death.
which clinical manifestations are characteristic of cardiogenic shock in a child?
cool extremities
what is the appropriate name for the connection between the aorta and the pulmonary artery?
ductus arteriosus rationale The ductus arteriosus is the communication link between the aorta and the pulmonary artery. Once the ductus venosus closes, its remnants form the ligamentum venosum. The foramen ovale is the flapped orifice that allows right-to-left shunting, which is necessary for fetal circulation. The bulbus cordis is the conal portion of the ventricular septum that separates the aorta artery from the pulmonary artery.
what is the most common complication of acute myocardium infarction (AMI)?
dysrhythmias rationale Dysrhythmias (arrhythmias), which are disturbances of the cardiac rhythm, are the most common complication of AMI. Although all of these choices are true complications of AMI, dysrhythmias are the most common. Dressler postinfarction syndrome, which is a delayed form of acute pericarditis, can occur from 1 week to several months after AMI. Congestive heart failure can occur with a weakened cardiac muscle.
a clot in a blood vessel that breaks loose and circulates is called a ________.
embolus
which term describes an occlusion in a blood vessel caused by a bolus of circulating matter in the bloodstream?
embolus rationale An embolus is a bolus of matter that is circulating in the blood. A thrombus is a blood clot that remains attached to the vessel wall. Thrombophlebitis is the inflammation caused by a thrombus. Foam cells are lipid-laden cells that contribute to fatty streaks.
which term is used to describe a respiratory infection that results in pus in the pleural space?
empyema rationale empyema is a term used to describe the presence of pus in the pleural space and is a complication of respiratory infection. abscess is a circumscribed area of suppuration and destruction of lung parenchyma. aa consolidation is inflamed lung tissue that causes the alveoli to fill with exudate. transudate is the presence of fluid with low protein content residing in the pleural space.
match the audiologic problem with its described pathophysiology: Ménière disease
endolymph abnormalities
which is likely to occur in infants with left ventricular heart failure?
failure to thrive rationale poor feed or poor sucking is often found in left ventricular failure and lads to failure to thrive. right ventricular failure is representative of the remaining options
true or false: connective tissue disorder such as Marfan's and Ehler Danlos Syndrome are not known risk factors for aortic dissection
false
true or false: glaucoma is caused by increased intracranial pressure causing pressure on the optic nerve
false
which is the most common cause of pulmonary edema?
heart disease rationale The most common cause of pulmonary edema is heart disease. Toxic gas inhalation, pulmonary hypertension, and ARDS are also causes of pulmonary edema but are not as common as pulmonary edema from heart disease.
which factors determine cardiac output?
heart rate and stroke volume rationale Cardiac output is directly related to the heart rate and stroke volume. Changes in either variable affect the cardiac output. Preload is the pressure generated in the left ventricle at the end of diastole (end-diastolic volume). Afterload is the resistance or impedance to the ejection of blood from the left ventricle. Although the parasympathetic stimulation has a bradycardic effect and sympathetic nervous system increases the frequency of the cardiac pacemaker and may influence cardiac output, these factors are not used in the cardiac output formula; neither are atrial pressures.
the release of catecholamine by the adrenal glands provides which compensatory mechanism in hypovolemic shock?
heart rate is increased rationale the release of catecholamine by the adrenal glands causes the heart rate to increase
you are working in a health tent at a marathon. a person is brought to the tent because he passed out, is exhausted and has profuse sweating. what do you suspect?
heat exhaustion
which of the following are risk factors for hypertension?
high dietary sodium intake, glucose intolerance, and positive family history for hypertension rationale The risk factors for hypertension include a positive family history for hypertension, male gender, advanced age, black race, obesity, and high sodium intake. Factors also include low potassium, calcium, and magnesium intake, diabetes mellitus, labile blood pressure, cigarette smoking, and heavy alcohol consumption.
shock is a complex pathophysiologic process involving all of the following except?
hypertension
which statements are true regarding hypertension?
hypertension is a systolic pressure of 140mmHg or higher, hypertension is defined as diastolic pressure higher than 90mmHg, and approximately two thirds of Americans older than 60 years of age have hypertension rationale Approximately two thirds of Americans older than 60 years of age have hypertension, and approximately 48% of those have adequately controlled hypertension. Hypertension is defined as a diastolic pressure of 90 mmHg or higher or a systolic pressure of 140 mmHg or higher. Between 25% and 37% of adults in the United States are prehypertensive.
which term describes the elevation of the body temperature without an increase in the hypothalamic set point?
hyperthermia
which type of cardiomyopathy is the most common cause of death in those under the age of 35 years of age?
hypertrophic obstructive cardiomyopathy
which factor contributes to the production of mucus associated with chronic bronchitis?
hypertrophy / hyperplasia of mucus producing cells / glands rationale continual bronchial inflammation causes bronchial edema and increases the size and number of mucous glands and goblet cells in the airway epithelium. thick, tenacious mucous is produced and cannot be cleared because of impaired ciliary function. the lung's defense mechanisms are therefore compromised, increasing a susceptibility to pulmonary infection, which contributes to airway injury. frequent infectious exacerbations are complicated by bronchospasm with dyspnea and productive cough.
which neuropeptide dysfunction is linked to narcolepsy?
hypocretins rationale Narcolepsy is related to hypothalamic hypocretin (orexin) deficiency and immune-mediated T-cell destruction of hypocretin-secreting cells. Prostaglandin D2 is a sleep promoter. L-Tryptophan is used commercially for a variety of complaints. Growth factor is released in sleep stage N3.
the major sleep center is located in which section of the brain?
hypothalamus rationale A complex interaction of neural networks and neurotransmitters promote wakefulness and sleep. The hypothalamus, brainstem, and basal forebrain are involved in promoting wakefulness. These cells are not located in the thalamus, cerebellum, or frontal lobe.
which part of the brain is responsible for temperature regulation?
hypothalamus rationale The hypothalamus is responsible for temperature regulation. The thalamus helps regulate sleep. The medulla helps to regulate several functions including breathing and blood vessel function. Also, sensory and motor neurons from the forebrain and midbrain travel through the medulla. The limbic system regulates the emotional response to pain.
what is the appropriate term for inadequate alveolar ventilation in relation to metabolic demands?
hypoventilation rationale Hypoventilation is inadequate ventilation in relation to metabolic demands. Hyperpnea is rapid breathing. Orthopnea is difficulty breathing when an individual is lying flat. Dyspnea is difficulty breathing.
a 2-year-old child is brought into the ER with a 24hr history of diarrhea and vomiting. the nurse practitioner prepares to treat what type of shock?
hypovolemic rationale hypovolemic shock, the most common type of shock in children, is associated with a reduction in the intravascular volume relative to the vascular space. it is most frequently caused by dehydration and trauma
which statement describes hypoxemia?
hypoxemia is low partial pressure of oxygen (PaO2) in the arterial blood
what is the appropriate first-line treatment for shock?
identification and treatment of the underlying cause rationale The most important first-line treatment for shock is to identify and treat the underlying cause. After the underlying cause is detected, treatment is supportive.
the main difference between asthma and COPD is:
in asthma, airflow limitation is reversible
which physiologic alteration is present in an individual with emphysema?
increased compliance rationale Emphysema is associated with increased lung compliance and decreased elastic recoil. Airway resistance refers to the opposition to airflow and is determined by the length, radius, and cross-sectional area of the airways. Surfactant affects the surface tension and alveolar ventilation.
which substance primarily contains cholesterol and protein and is associated with athersclerosis?
low-density lipoproteins (LDLs) rationale LDLs contain primarily cholesterol and protein. VLDLs are primarily triglycerides and protein. triglycerides are the major form of fat stored in the body.
which statements are true regarding congenital heart defects?
infants with trisomy 21 have a high incidence of congenital heart disease, incidence of heart defects is high in stillbirths, low-birth-weight babies, and spontaneous abortions, and congenital heart disease is the second leading cause of death in infants during the first year of life rationale Congenital heart disease is the leading cause of death, excluding prematurity, in infants during the first year of life. The incidence of heart defects also has been found to be high in stillbirths, low-birth-weight or small-for-gestational-age infants, and spontaneous abortions. The use of some drugs during pregnancy is associated with an above-average incidence of congenital heart disease. Examples of these drugs include thalidomide, lithium, phenytoin (Dilantin), and warfarin. The underlying cause of congenital heart disease is known in only 10% of cases. As many as 50% of infants with trisomy 21 have a congenital heart defect, either an atrioventricular (AV) canal defect or a VSD.
which statement is true regarding the pathophysiologic process of asthma?
inflammation results in airway hyperresponsiveness rationale increased bronchial smooth muscle spasm and increased vascular permeability cause asthma. asthma is an immunoglobulin E (IgE) mediated response
which statement best describes thromboangitis obliterans (Buerger disease)?
inflammatory disorder of small and medium size arteries in the feet and sometimes in the hands rationale Buerger disease is an inflammatory disease of the peripheral arteries. inflammation, thrombus formation, and vasospasm can eventually occlude and obliterate portions of small and medium size arteries. the digital, tibial, and plantar arteries of the feet and the digital , palmar, and ulnar arteries of the hands are typically affected. vasospasm in the small arteries and arterioles of the fingers and occasionally toes describes Raynaud disease. it does not involve larger arteries and veins and it is not a neoplastic disease.
which term is used to identify elevated systolic pressure accompanied by normal diastolic pressure (less than 90mmHg)?
isolated systolic hypertension rationale isolated systolic hypertension is an elevated systolic pressure with a normal diastolic pressure. Primary hypertension is the result of extremely complicated interactions of genetics and the environment, mediated by a host of neurohumoral effects. Altered hemodynamics, associated with a primary disease, cause secondary hypertension. Stage 2 hypertension is systolic pressure equal to or greater than 160 mmHg and diastolic pressure equal to or greater than 100 mmHg.
what is true about a fever?
it is in response to a pyrogen
which cardiac chamber has the thickest wall?
left ventricle rationale the atria are approximately 1-2mm thick. the right ventricle is 4-5mm thick, and the left ventricle, the most muscular chamber, is approximately 12-15mm thick
which two systems regulate the complex emotional responses to pain?
limbic and reticular systems rationale the reticular and limbic systems regulate how an individual emotionally responds to pain
which alterations involved with aging are considered normal?
loss of recoil, alterations in gas exchange, and increased flow resistance rationale Normal alterations involved in aging include increases in flow resistance, alterations in gas exchange, stiffening of the chest wall, and loss of elastic recoil.
Several months ago, young woman fell while rock climbing; her left leg was wedged tightly into a crevice. The resulting injury was severe and required amputation below the knee. She reported to her physician that she continues to suffer from phantom limb pain. The theory that best explains this type of pain is:
neuromatrix theory rationale The GCT integrates and builds on other theories to explain pain perception and pain modulation, suggesting that pain may be tempered or adjusted to. The pattern theory is extremely limited and does not account for all types of pain experiences. It describes the role of impulse intensity and the central nervous system. The intensity of pain that is directly related to the amount of associated tissue injury explains the specificity theory. Proposing that the brain produces patterns of nerve impulses drawn from various inputs, such as genetic, psychologic, and cognitive experiences, the neuromatrix theory suggests that pain may be felt in the absence of input from the body. This theory would explain phantom limb pain.
parents of a child report that the child wakes up from sleep expressing intense anxiety. what disorder does the healthcare professional educate the parents about?
night terrors rationale Three types of parasomnias include arousal disorders such as confusional arousals, sleepwalking (somnambulism), and night terrors (dream anxiety attacks). Insomnia is a lack of sleep. Somnambulism is sleep walking. Enuresis is bed-wetting.
which are free nerve endings in the afferent peripheral nervous system that selectively respond to different chemical, mechanical, and thermal stimuli?
nociceptors rationale Nociceptors are receptors located throughout the body that respond to pain. Prostaglandins are lipid compounds that have hormone-like effects in the body. Enkephalins are the most prevalent of the natural opioids and bind to δ opioid receptors. Dynorphins are the most potent of the endogenous opioids binding strongly with κ receptors to impede pain signals in the brain.
which category of pulmonary disease requires more force to expire a volume of air?
obstructive rationale obstructive pulmonary disease is characterized by airway obstruction that is worse with expiration. either more force (i.e., the use of accessory muscles of expiration) or more time is required to expire a given volume of air. restrictive disorders are characterized by decreased lung tissue compliance. acute means sudden onset, or severe. communicable means transmittable.
which is true regarding acute epiglottitis?
patients often present with "hot potato voice"
when atherosclerosis affects the extremities it is called ________.
peripheral artery disease
pneumonia leads to hypoxemia due to which of the following?
persistent pulmonary artery blood flow to consolidated lung that results in shunting (VQ mismatch)
which statement correctly defines preload?
pressure generated by the end-diastolic volume rationale preload is the pressure generated in the left ventricle at the end of diastole (end-diastolic volume). afterload is the resistance or impedance to the ejection of blood from the left ventricle. wall tension is directly related to the product of the intraventricular pressure and internal radius, and inversely related to the wall thickness (Laplace's law). a tension curve lower than normal is characteristic of congestive heart failure.
how can glaucoma cause blindness?
pressure on the optic nerve
a woman with chest pain that occurs at rest is diagnosed as having abnormal vasospasm of her coronary arteries. these symptoms support which medical diagnosis?
prinzmetal angina rationale Prinzmetal angina is an abnormal vasospasm of the coronary vessels that causes transient ischemia, unpredictably and usually at rest, and is more common in women. Stable angina occurs with activity, is often limited, and resolves with rest. Silent ischemia is poor myocardial perfusion that does not cause angina and may be associated only with nonspecific symptoms such as fatigue, dyspnea, or a feeling of unease. Angina pectoris is typically experienced as transient substernal chest discomfort, ranging from a sensation of heaviness or pressure to moderately severe pain.
which pathogen is commonly associated with a pneumonia that is acquired while in the hospital?
pseudomonas aeruginosa rationale Pseudomonas aeruginosa is commonly acquired in hospitals or nursing homes. All of the other choices are community-acquired pneumonias.
An 18-year-old high school football player sustained a torn anterior cruciate ligament (ACL) in the state playoffs. After undergoing repair, he found it difficult to ambulate with the knee brace. Weighing close to 140 kg (~300 pounds), the athlete found it difficult to stand and balance on one leg. His mother was unable to support him by herself. After 1 week, the young man began to have increased pain and swelling in the calf of his affected leg. In the middle of the night, the teen called out to his mother, complaining of a shortness of breath and unexplained anxiety. His mother called 9-1-1, and he was taken to a local hospital. In the emergency department, he was diagnosed with a deep vein thrombosis and a pulmonary embolism. Oxygen and low-molecular-weight heparin were administered, and the young man was admitted to the intensive care unit. As a result of the thrombus lodging in the pulmonary circulation, the sympathetic nervous system is activated. Hemodynamically, this results in:
right heart failure rationale When a thrombus lodges in the pulmonary circulation, a release of neurohumoral substances and inflammatory mediators causes widespread vasoconstriction that further impedes blood flow to the lung. Embolization is the process of selectively occluding a blood vessel by purposefully introducing emboli. This results in increased pulmonary artery pressures and can lead to right heart failure.
which patient is most prone to multiple organ dysfunction syndrome (MODS), a patient with _________.
septic shock
which statements are true regarding the presentation of shock in children?
shock in children most often results from severe dehydration, hemorrhage, progressive heart failure or sepsis and in children, shock may be present with normal, high, or low blood pressure rationale Shock in children is most often due to severe dehydration, hemorrhage, heart failure, or sepsis. When systolic blood pressure is adequate for age but there are signs of inadequate tissue perfusion, the child is in compensated shock. Shock may be present with normal, high, or low blood pressure in children. Prolonged capillary refill (greater than 2 seconds) can be a sign of compromised perfusion and the development of shock in children. Capillary refill greater than 3 seconds is an indicator or sign of shock in children.
which of the following are signs and symptoms of dyspnea?
shortness of breath flaring of nostrils use of accessory muscles of respiration
which part of the heart is responsible for electrical impulse stimulation?
sinus node rationale the sinus node, the pacemaker of the heart, is the site of impulse formation. the atrioventricular node is the junction of the electrical transmission between the atria and the ventricles. the impulse then travels to the bundle of His and, finally, to the right and left bundle branches. the terminal branches are the Purkinje fibers
which statements are true regarding sleep patterns in older adults?
sleep time is decreased and sleep takes longer to initiate rationale The sleep patterns of the older adult differ from that of the younger adult or child. The total sleep time is decreased, and the older adult takes longer to initiate and maintain sleep.
which type of pain arises from connective tissue, muscle, bone, and skin?
somatic rationale Somatic pain arises from connective tissue, muscle, bone, and skin. It may be sharp and well organized or dull, aching, and poorly localized. Referred pain is pain felt in an area removed or distant from its point of origin. Neuropathic pain is chronic pain initiated or caused by a primary lesion or dysfunction in the nervous system and leads to long-term changes in pain pathway structures (neuroplasticity) and abnormal processing of sensory information. Segmental is not a type of pain.
blistering of the skin within minutes occurs in which type of brain injury?
superficial partial thickness rationale the hallmark of superficial partial-thickness injury is the appearance of thin-walled, fluid-filled blisters that develop within only a few minutes after injury. first degree burns only involve the epidermis and can bee compared to a sunburn. a deep partial thickness burn looks waxy white and may initially be indistinguishable from a full thickness burn until new skin buds and hair appear within 7 to 10 days.
what is the primary cause of respiratory distress syndrome (RDS) of the newborn?
surfactant deficiency rationale RDS is primarily caused by surfactant deficiency and secondarily by a deficiency in alveolar surface area for gas exchange. RDS is not caused by having an immature immune system, small alveoli, or anemia.
the young man has an infarction or death of a portion of his lung tissue. absent blood flow to a lung segment causes:
surfactant impairment rationale a decreased production of inactivation of surfactant leads to atelectasis, which causes hypoxemia. absorption atelectasis results from the gradual absorption of air from obstructed or hypoventilated alveoli. additionally, the inhalation of concentrated oxygen or anesthetic agents may cause absorption atelectasis. collateral ventilation of the alveoli occurs with deep breathing and would not have a negative effect on a patient's health. bronchiectasis is persistent abnormal dilation of the bronchi, such as obstruction of an airway with infection or mucous plugs
what are the clinical manifestations of right heart failure?
symptoms of JVD and hepatosplenomegaly
what are the clinical manifestations of left heart failure?
symptoms of pulmonary edema, dyspnea, and frothy sputum
your patient has developed a pleural abnormality involving a site of pleural rupture that is acting as a one-way valve, permitting air to enter on inspiration, but preventing its escape by closing during expiration. you diagnose them with a (an):
tension pneumothorax rationale a tension pneumothorax is a severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures, and compromising cardiopulmonary function.
which statement correctly describes the A wave?
the A wave is generated by atrial contraction rationale the A wave is generated by atrial contraction. the V wave is the early diastolic peak caused by the filling of the atrium. the X descent follows the A wave and is produced because of the descent of the tricuspid valve ring. the Y descent follows the V wave and reflects the rapid flow of blood from the great veins and right atrium into the right ventricle
While in the emergency department, the woman begins to complain of indigestion. The emergency room staff knows that this sensation may be angina pectoris, which is caused by:
the buildup of lactic acid rationale The buildup of lactic acid or abnormal stretching of the ischemic myocardium that irritates myocardial nerve fibers is the cause of the pain. Angina pectoris is chest pain caused by a decreased myocardial blood flow and is usually relieved by rest/nitrates. A lack of relief is an indication that the individual may be developing an infarction. In valvular stenosis, the valve orifice is constricted and narrowed, impeding the forward flow of blood and increasing the workload of the chamber proximal to the diseased valve. Constriction and narrowing do not cause angina. The autonomic nervous system controls the functions of internal organs such as the heart, stomach, and intestines. Dysfunction of this system may alter the sensation but is not responsible for the pain.
strep pneumoniae bacteria multiply rapidly in pneumococcal pneumonia primarily because:
the inflammatory response causes alveolar edema, creating a rich medium for bacterial replication
a 51 year old male presents with recurrent chest pain on exertion. he is diagnosed with angina pectoris. when he asks what causes the pain, how should the nurse respond? the pain occurs when:
the myocardial oxygen supply has fallen below demand
what assessment finding would indicate to the healthcare professional that the patient is no longer in burn shock?
urine output 35mL/hour for 4 hours rationale the most reliable criterion for adequate resuscitation of burn shock is urine output. normal urine output is minimally 30mL/hour. the patient having a normal urine output for 4 hours has shown recovery from burn shock. none of the remaining options are considered as reliable as urine output.
a parent reports that her child has reddened eyes with purulent drainage. what instruction by the healthcare professional is most appropriate?
use a separate towel for this child only rationale Acute bacterial conjunctivitis (pinkeye) is an inflammation of the conjunctiva (mucous membrane covering the front part of the eyeball) and is characterized by pink eyes and mucopurulent drainage. Meticulous handwashing and the use of separate personal care items, like towels, are important to prevent spread. Soothing saline eyedrops may or may not help. This disease is highly contagious, so the child should not be in school until the infection is resolved.
which are signs of severe dyspnea?
use of accessory muscles of respiration, flaring of the nostrils, retraction of the intercostal spaces rationale severe dyspnea, a subjective sensation of uncomfortable breathing is characterized by flaring of the nostrils, use of accessory muscles of respiration, and retraction of the intercostal spaces. hemoptysis is characterized by coughing up blood or bloody secretions
a student asks the professor to explain the basics of vasogenic shock. what statement by the professor is best?
vasodilation from an imbalance between the two nervous systems rationale vasogenic shock refers to a widespread and massive vasodilation resulting from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. widespread hypersensitivity is a characteristic of anaphylactic shock. bacteremia and systemic inflammation are seen in septic shock. the inability to pump adequate blood to tissues and end organs describes cardiogenic shock.
a patient has been diagnosed with Raynaud disease and asks for an explanation. which statement is best?
vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes rationale attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes characterize Raynaud phenomenon and Raynaud disease. the inflammatory disorder of the small and medium size arteries in the feet and sometimes in the hands is Buerger disease. Raynaud disease is not neoplastic and does not involve large arteries and veins.
which of the following dysrhythmias is most likely to cause morbidity and mortality?
ventricular fibrillation
which cardiac anomalies are associated with tetralogy of Fallot?
ventricular septal defect, right ventricular hypertrophy, and pulmonary stenosis rationale Tetralogy of Fallot consists of four defects: (1) a ventricular septal defect (VSD) that is high in the septum and usually large; (2) an aorta that is overriding and straddles the VSD; (3) pulmonary stenosis; and (4) right ventricular hypertrophy. Atrial septal defect may occur as a congenital heart anomaly but is not included in the tetralogy of Fallot. Tricuspid atresia consists of an imperforate tricuspid valve, resulting in no communication between the right atrium and the right ventricle and is not included in the tetralogy of Fallot.
which statements are true regarding viral pneumonia?
viral pneumonia can set the stage for a secondary bacterial infection and viral pneumonia is usually mild and self-limiting rationale Viral pneumonia can set the stage for a secondary bacterial infection, is seasonal, and is usually mild and self-limiting.
pain in internal organs and the lining of the body cavities is called?
visceral pain rationale Visceral pain refers to pain in internal organs and the lining of body cavities. It may be an aching, gnawing, throbbing, or intermittent cramping sensation. Referred pain is pain felt in an area removed or distant from its point of origin. Chronic or persistent pain is usually defined as lasting for more than 3-6 months and is pain lasting well beyond the expected normal healing time. Peripheral neuropathic pain is caused by peripheral nerve lesions and an increase in the sensitivity and excitability of primary sensory neurons and cells in the dorsal root ganglion (peripheral sensitization).
which statement is true regarding sudden infant death syndrome (SIDS)?
young maternal age increases incidence rationale infants of mothers younger than 20 years of age are more likely to die of SIDS. the peak age for SIDS is 3-4 months, and the incidence declines after that. there is a higher frequency in winter months. less prenatal care and poverty are predictive factors