Patho: Check your understanding 16,18,19,20
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) myocardial infarction. C) coronary vasospasm. D) unstable angina.
A) stable angina.
A patient with significant aortic stenosis is likely to experience A) syncope. B) Hypertension C) increased pulse pressure D) peripheral edema
A) syncope.
The progressive stage of hypovolemic shock is characterized by A) tachycardia. B) hypertension. C) lactic acidosis. D) cardiac failure.
A) tachycardia.
The effect of nitric oxide on systemic arterioles is A) vasodilation. B) vasoconstriction. C) not significant. D) opposed by nitrate drugs.
A) vasodilation.
Cor pulmonale refers to A) biventricular failure. B) left ventricular hypertrophy secondary to lung disease. C) right ventricular hypertrophy secondary to pulmonary hypertension. D) right ventricular failure secondary to right ventricular infarction.
C) right ventricular hypertrophy secondary to pulmonary hypertension.
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) arterial obstruction. B) isolated left-sided heart failure. C) right-sided heart failure. D) peripheral vascular disease.
C) right-sided heart failure.
Atherosclerotic plaques with large lipid cores are prone to A) dislodgement. B) binding. C) rupture. D) attachment.
C) rupture.
Hypertension with a specific, identifiable cause is known as _____ hypertension. A) primary B) orthrostatic C) secondary D) malignant
C) secondary
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) serum potassium
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) systemic vascular resistance.
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) systolic pressure - diastolic pressure.
An example of an acyanotic heart defect is A) tetralogy of Fallot. B) transposition of the great arteries. C) ventricular septal defect. D) all right-to-left shunt defects.
C) ventricular septal defect.
Rheumatic heart disease is most often a consequence of A) chronic intravenous drug abuse. B) viral infection with herpesvirus. C) β-hemolytic streptococcal infection. D) cardiomyopathy.
C) β-hemolytic streptococcal infection.
In which dysrhythmias should treatment be instituted immediately? A) Asymptomatic sinus bradycardia at a heart rate of 50 beats/minute B) Fever-induced tachycardia at 122 beats/minute C) Premature atrial complexes occurring every 20 seconds D) Atrial fibrillation with a ventricular rate of 220 beats/minute
D) Atrial fibrillation with a ventricular rate of 220 beats/minute
Which dysrhythmia is thought to be associated with reentrant mechanisms? A) Second-degree AV block B) Sinus bradycardia C) Junctional escape D) Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)
D) Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)
Angina caused by coronary artery spasm is called _____ angina. A) stable B) classic C) unstable D) Prinzmetal variant
D) Prinzmetal variant
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) Septic
What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume? A) Hypotension B) Bradycardia C) Aortic regurgitation D) Tachycardia
D) Tachycardia
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) a medication reaction. D) acute cardiogenic pulmonary edema.
D) acute cardiogenic pulmonary edema.
High blood pressure increases the workload of the left ventricle, because it increases A) Stroke volume B) blood volume C) preload D) afterload
D) afterload
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) antibiotics.
The majority of cardiac cells that die after myocardial infarction do so because of A) cell rupture. B) insufficient glucose. C) thrombus. D) apoptosis.
D) apoptosis.
A patient with heart failure who reports intermittent shortness of breath during the night is experiencing A) orthopnea. B) paroxysmal atrial tachycardia. C) sleep apnea. D) paroxysmal nocturnal dyspnea.
D) paroxysmal nocturnal dyspnea.
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) premature ventricular complexes.
Hypertrophy of the right ventricle is a compensatory response to A) aortic stenosis. B) aortic regurgitation. C) tricuspid stenosis. D) pulmonary stenosis
D) pulmonary stenosis
Hypertrophy of the right ventricle is a compensatory response to A) aortic stenosis. B) aortic regurgitation. C) tricuspid stenosis. D) pulmonary stenosis.
D) pulmonary stenosis.
The majority of tachydysrhythmias are believed to occur because of A) triggered activity. B) enhanced automaticity. C) defective gap junctions. D) reentry mechanisms.
D) reentry mechanisms.
Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells. A) aldosterone B) Norepinephrine C) angiotensinogen D) renin
D) renin
A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock. A) cardiogenic B) hypovolemic C) obstructive D) septic
D) septic
New-organ damage is a function of both the stage of hypertension and its duration. True/ false
False
The most commonly recognized outcome of hypertension is pulmonary disease. True/ false
False
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 I B) Class II C) Class III D) Class IV
A) Class I
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. B) Continue lifestyle modifications plus diuretic therapy. C) Continue lifestyle modifications plus ACE inhibitor therapy. D) Continue lifestyle modifications plus b-blocker therapy.
A) Continue lifestyle modifications only.
Administration of which therapy is most appropriate for hypovolemic shock? A) Crystalloids B) Vasoconstrictor agents C) Inotropic agents D) 5% dextrose in water
A) Crystalloids
Which serum biomarker(s) are indicative of irreversible damage to myocardial cells? A) Elevated CK-MB, troponin I, and troponin T B) Markedly decreased CK-MB and troponin I C) Elevated LDL D) Prolonged coagulation time
A) Elevated CK-MB, troponin I, and troponin T
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 this 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 are not particularly significant.
A) Increased LDL levels are associated with increased risk of coronary artery disease.
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 110/78, HR 98 D) Sitting BP 120/80, HR 100
A) Sitting BP 88/60, HR 118
Aortic regurgitation is associated with A) diastolic murmur. B) elevated left ventricular/aortic systolic pressure gradient. C) elevated systemic diastolic blood pressure. D) shortened ventricular ejection phase.
A) diastolic murmur.
A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n) A) elderly woman without a previous history of MI. B) middle-aged man with a previous history of MI. C) young female athlete with cardiomegaly. D) young sedentary male with a high-stress job
A) elderly woman without a previous history of MI.
Constrictive pericarditis is associated with A) impaired cardiac filling. B) cardiac hypertrophy. C) increased cardiac preload. D) elevated myocardial oxygen consumption.
A) impaired cardiac filling.
Hypertension is closely linked to A)obstructive sleep apnea. B) urinary tract infection. C) de Quervain syndrome. D) spinal stenosis.
A) obstructive sleep apnea.
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) positioning the arm above the heart level
First-degree heart block is characterized by A) prolonged PR interval B) absent P waves C) widened QRS complex D) variable PR interval
A) prolonged PR interval
Left-sided heart failure is characterized by A) pulmonary congestion. B) decreased systemic vascular resistance. C) jugular vein distention. D) peripheral edema.
A) pulmonary congestion.
Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria? A) 118/78 B) 128/82 C) 140/88 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 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 lifestyle modifications. B) Begin antihypertensive drug therapy. C) Recheck blood pressure in 4 to 6 weeks. D) Encourage smoking cessation.
B) Begin antihypertensive drug therapy.
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 I, Initial Stage B) Class II, Compensated Stage C) Class III, Progressive Stage D) Class IV, Refractory Stage
B) Class II, Compensated Stage
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) This is an expected blood pressure in the elderly and has little effect on left ventricular function. B) Left ventricular workload is increased with high afterload. C) High blood pressure enhances left ventricular perfusion during systole. D) High-pressure workload leads to left ventricular atrophy.
B) Left ventricular workload is increased with high afterload.
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) Obstructive C) hypovolemic D) distributive
B) Obstructive
The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is A) severe, crushing chest pain. B) ST-segment elevation. C) dysrhythmias. D) pain radiating to the lower legs.
B) ST-segment elevation.
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) Septic
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) a pressure gradient across the mitral valve.
Myocarditis should be suspected in a patient who presents with A) chest pain and ST elevation B) acute onset of left ventricular dysfunction. C) murmur and abnormal valves on echocardiogram D) family history of cardiomyopathy.
B) acute onset of left ventricular dysfunction.
Patients presenting with symptoms of unstable angina and no ST segment elevation are treated with A) cardiac catheterization. B) antiplatelet drugs. C) acute reperfusion therapy. D) cardiac biomarkers only.
B) antiplatelet drugs.
Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of A) myocardial infarction. B) cardiac tamponade. C) congestive heart failure (CHF). D) cardiomyopathy.
B) cardiac tamponade.
Angiotensin-converting enzyme (ACE) inhibitors block the A) release of rennin B) conversion of angiotensin I to angiotensin II. C) conversion of angiotensinogen to angiotensin I. D) effect of aldosterone on the kidney.
B) conversion of angiotensin I to angiotensin II.
Primary treatment for myocardial infarction (MI) is directed at A) protecting the heart from further ischemia. B) decreasing myocardial oxygen demands. C) reducing heart rate and blood pressure. D) activating the parasympathetic system.
B) decreasing myocardial oxygen demands.
Lusitropic impairment refers to A) poor contractile force. B) impaired diastolic relaxation. C) altered action potential conduction rate. D) altered automaticity.
B) impaired diastolic relaxation.
Second-degree heart block type I (Wenckebach) is characterized by A) absent P waves. B) lengthening PR intervals and dropped P wave. C) constant PR interval and dropped QRS complexes. D) no correlation between P waves and QRS complexes.
B) lengthening PR intervals and dropped P wave.
Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure. A) systolic B) mean arterial C) diastolic D) pulse
B) mean arterial
Hypotension associated with neurogenic and anaphylactic shock is because of A) hypovolemia. B) peripheral pooling of blood. C) poor cardiac contractility. D) high afterload
B) peripheral pooling of blood.
A patient with pure left-sided heart failure is likely to exhibit A) jugular vein distention. B) pulmonary congestion with dyspnea. C) peripheral edema. D) hepatomegaly.
B) pulmonary congestion with dyspnea.
Beta-blockers are advocated in the management of heart failure because they A) increase cardiac output. B) reduce cardiac output. C) enhance sodium absorption. D) reduce blood flow to the kidneys.
B) reduce cardiac output.
The common denominator in all forms of heart failure is A) poor diastolic filling B) reduced cardiac output C) pulmonary edema D) tissue ischemia
B) reduced cardiac output
Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock? A) Cardiogenic B) Hypovolemic C) Anaphylactic D) Neurogenic
C) Anaphylactic
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) Edema
Cardiogenic shock is characterized by A) hypovolemia. B) reduced systemic vascular resistance. C) Reduced cardiac output D) elevated SvO2
C) Reduced cardiac output
Restriction of which electrolytes is recommended in the management of high blood pressure? A) Calcium B) Potassium C) Sodium D) Magnesium
C) Sodium
What results when systemic blood pressure is increased? A) Hypovolemia B) Decreased cardiac output C) Vasoconstriction D) Decreased vascular resistance
C) Vasoconstriction
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) Third-degree heart block B) Junctional tachycardia C) Ventricular escape rhythm D) Sinus bradycardia
C) Ventricular escape rhythm
Sepsis has been recently redefined 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) a systemic inflammatory response to infection.
Tachycardia is an early sign of low cardiac output that occurs because of A) tissue hypoxia B) anxiety C) baroreceptor activity D) acidosis
C) baroreceptor activity
Patent ductus arteriosus is accurately described as a(n) A) opening between the atria. B) stricture of the aorta that impedes blood flow. C) communication between the aorta and the pulmonary artery. D) cyanotic heart defect associated with right-to-left shunt.
C) communication between the aorta and the pulmonary artery.
Administration of a vasodilator to a patient in shock would be expected to A) decrease vascular resistance. B) increase contractility. C) decrease left ventricular afterload. D) increase tissue perfusion.
C) decrease left ventricular afterload.
The therapy that most directly improves cardiac contractility in a patient with systolic hear failure A) preload reduction B) Antagonist agents C) digitalis D) afterload reduction
C) digitalis
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) high cardiac output.
A loud pansystolic murmur that radiates to the axilla is most likely a result of A) aortic regurgitation. B) aortic stenosis. C) mitral regurgitation. D) mitral stenosis.
C) mitral regurgitation.
Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of A) catecholamines. B) clotting factors. C) nitric oxide. D) vasopressin.
C) nitric oxide.
The prevalence of high blood pressure is higher in A) non-Hispanic white adults. B) Mexican-American adults. C) non-Hispanic black adults. D) Asian children.
C) non-Hispanic black adults.
A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis. True/ false
False
A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic. True/ false
False
Chronic elevation of myocardial wall tension results in atrophy. True/ false
False
Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body. True/ false
True
Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes. True/ false
True
The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension. True/false
True
