Disease Path Exam 2 Cardio Application Questions

Following a myocardial infarction, the sac surrounding the heart may become inflamed. Which structure may develop inflammation? Pleural space Thymus Pleural membrane Pericardium

Pericardium

Many medications are available to treat hypertension. Which of the following are you likely to discuss with Mr. Benson? Select all that apply. Corticosteroids ACE inhibitors Diurectics Aspirin Statins Calcium antagonists

ACE inhibitors Diurectics Calcium antagonists Corticosteroids may increase blood pressure, not decrease it. ACE inhibitors block the activation of angiotensin II which reduces vasoconstriction and blood pressure. Diuretics reduce blood volume and thus blood pressure. Calcium antagonists also reduce vasoconstriction and blood pressure. Statins lower cholesterol and aspirins decrease platelet adherence.

Which conduction abnormality is associated with an increased risk for clot formation? PVC AV block AV fibrillation Couplet

AV fibrillation

Which of the following responses are instituted by the body to compensate for low blood pressure? Select all that apply. Increased urine output Increased afterload Activation of the renin-aldosterone-angiotensin system Decreased sodium and water retention Increased blood volume

Activation of the renin-aldosterone-angiotensin system Increased blood volume

Which of the following may be observed in a patient suffering from shock? Select all that apply. Decreased kidney perfusion leading to oliguria. Increased blood flow to the gastrointestinal tract. Activation of the sympathetic nervous system.Inhibition of renin-angiotensin-aldosterone system. Increased susceptibility to clot formation.

Activation of the sympathetic nervous system.Inhibition of renin-angiotensin-aldosterone system. Increased susceptibility to clot formation. Decreased kidney perfusion leading to oliguria.

Everett has experienced increasing blood pressure over the past 2 years. Which cardiac factor indicates the increased work experienced by Everett's heart? Preload Afterload Stroke volume Contractility

Afterload

Which type of shock results from an IgE-mediated allergic reaction? Cardiogenic Neurogenic Anaphylactic Hypovolemic

Anaphylactic

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this type of shock, the cornerstone of treatment is epinephrine, either intramuscular or IV administration. Glucocorticoids are also a standard treatment. Intubation may be necessary. Cardiogenic Neurogenic Anaphylactic

Anaphylactic Epinephrine counteracts many of the responses that lead to anaphylactic shock, such as bronchoconstriction. Glucocorticoids are used to suppress the overwhelming immune response. As bronchospasm is common in anaphylactic shock, intubation may be necessary.

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. This type of shock is manifested by IgE-mediated massive degranulation of mast cells in response to an allergen. Chemical signals result in pronounced vasodilation and bronchospasm. Anaphylactic Neurogenic Septic

Anaphylactic In anaphylactic shock, an allergen has precipitated a massive immune-mediated response that liberates chemical mediators from mast cells. These chemical mediators cause bronchoconstriction, blocking air passage into and out of the lungs. In addition, the signals cause vasodilation and capillary leakage, resulting in reduced blood return to the heart.

Given Helen's medical history, as well as her shortness of breath and feeling of dizziness, you believe she may be suffering from a myocardial infarction. The signs and symptoms of myocardial infarction may present differently in women. Which term applies to the signs and symptoms that may be present in a myocardial infarction that are not considered to be the typical presentation of chest pain? Levine's sign Angina equivalents Intermittent leg claudication Cushing's triad

Angina equivalents Angina equivalents are signs and symptoms associated with a myocardial infarction that differ from the typical angina pectoris presentation. Levine's sign is when a patient suffering from a myocardial infarction places his or her fist over the sternal area. Intermittent leg claudication and Cushing's triad are not associated with myocardial infarctions.

Which of the following statements about angina are true? Select all that apply. Stable angina is considered a medical emergency. Unstable angina may indicate new damage to the heart. Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium. Increased oxygen levels and lactic acid formation may play a role in angina. Unstable angina is chest pain the patient is experiencing for the first time.

Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium. Unstable angina is chest pain the patient is experiencing for the first time.

Which of the following procedures will require the use of a healthy vein or artery to circumvent a coronary artery occlusion? Stent CABG PTCA Angioplasty

CABG

The physician requests that the cardiac biomarkers be tested over time. Which of the following is the expected pattern that may be present in Helen's samples? Both cardiac troponin I and creatine phosphokinase myocardial band peak within 30 minutes of myocardial infarction. Cardiac troponin I and creatine phosphokinase myocardial band will present with an inverse relationship. As one factor elevates, the other factor decreases. Cardiac troponin I elevates within the first 4 to 8 hours after onset of chest pain. Cardiac biomarkers return to baseline within hours of the onset of chest pain.

Cardiac troponin I elevates within the first 4 to 8 hours after onset of chest pain. Cardiac troponin I level rises within 4 to 8 hours of onset of chest pain. The cardiac biomarkers do not return to baseline levels for several days. The cardiac biomarkers do not have an inverse relationship; rather, with damage of myocardial cells, both cardiac biomarkers increase in the serum.

Which type of shock occurs when the heart is unable to meet the body's demands and systolic blood pressure drops below 90 mm Hg for 30 minutes? Septic Cardiogenic Neurogenic Vasogenic

Cardiogenic

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. This type of shock occurs when systolic blood pressure falls to less than 90 mm Hg despite adequate fluid volume and venous return. Baroreceptors detect the fall in blood pressure and activate the sympathetic nervous system. Decreased perfusion of the kidneys activates RAAS, which increases fluid volume within the body. Cardiogenic Hypovolemic Anaphylactic

Cardiogenic As the name implies, cardiogenic shock is related to the functioning of the heart. In this type of shock, fluid volume and other factors are sufficient; the failure to maintain blood pressure results from inadequate cardiac function.

Which term refers to the heart's force of contraction? Preload Chronotropic function Afterload Contractility

Contractility

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If blood volume decreases, then blood pressure may Increase Decrease

Decrease Blood volume and blood pressure are closely related. Without enough fluid in the circulatory system, pressure will fall.

Which of the following may adversely affect heart performance? Select all that apply. Increased calcium levels in the heart Increased contractility Increased afterload Decreased blood volume Decreased preload

Decreased blood volume Decreased preload

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If afterload increases, then stroke volume Increases Decreases

Decreases Afterload is the resistance the heart must work against. The greater the resistance, the less blood the heart is able to eject each beat.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If angiotensin II is inhibited, then vasoconstriction Increases Decreases

Decreases Angiotensin II, part of the RAAS, is a potent vasoconstrictor.

Which of the following pairs are incorrectly matched? Low-output failure - Decreased venous return Systolic dysfunction - Difficulty contracting and pumping effectively High-output failure - Elevated demands on the heart Diastolic dysfunction - Difficulty ejecting blood

Diastolic dysfunction - Difficulty ejecting blood

Given Howard's current health status, what are some medication options? Select all that apply. Diuretics Beta blockers Agents to reduce heart contractility Positive inotropic agents ACE agonists

Diuretics Beta blockers Positive inotropic agents Diuretics reduce the fluid overload that occurs in heart failure, while beta blockers reduce the work load of the heart. Positive inotropic agents stimulate more effective heart contractility. Agents to reduce heart contractility would be determinantal in someone suffering heart failure, as would ACE agonists. ACE inhibitors are usually prescribed to reduce fluid overload and vasoconstriction.

Which of the following are classes of medications used in management of heart failure? Select all that apply. Beta blockers Hormone replacement therapy Diuretics Inotropic agents ACE inhibitors

Diuretics Inotropic agents ACE inhibitors Beta blockers

John is eventually discharged from the hospital. However, John returns 10 days later complaining of chest pain and fever. He states the chest pain worsens when he takes a deep breath. On auscultation of John's chest, a pericardial friction rub is present. What has John developed? Beck's triad Dressler's syndrome Prinzmetal angina Syndrome X

Dressler's syndrome Dressler's syndrome may develop 2 to 3 weeks after a myocardial infarction. Dressler's syndrome is an autoimmune process in which antibodies and an inflammatory response occur as a result of cardiac proteins being released during a myocardial infarction. The immune complexes deposit in the pericardium, causing pericarditis. Pericarditis may present with a pericardial friction rub heard on auscultation.

The physician also orders a blood test for Helen. Which factor supports a diagnosis of myocardial infarction? Elevated LDL levels Elevated HDL levels Elevated Hct levels Elevated cardiac troponin I

Elevated cardiac troponin I Cardiac troponin I is a factor released from cardiac cells undergoing necrosis. This factor elevates in the blood after myocardial infarction and is considered to be the preferred biomarker for myocardial infarction. Creatine phosphokinase myocardial band is another cardiac marker; however, the absence of this factor in the blood would indicate an MI is likely not occurring. Low-density lipoprotein (LDL), high-density lipoprotein (HDL), and hematocrit (Hct) levels are not indicative of MI.

Many medications are used to treat hyperlipidemia. Which of the following statements are true? Select all that apply. Statins block cholesterol absorption in the intestines. Fibrates treat high triglyceride levels. Niacin raises LDL level and raises HDL levels. Hyperlipidemia medications can be combined. Statin treatment cannot reduce atherosclerotic plaques already present.

Fibrates treat high triglyceride levels. Hyperlipidemia medications can be combined. Fibrates are used as first-line treatment for elevated triglyceride concentrations. Cholesterol-lowering medications are commonly used in combination. Statins work by reducing cholesterol synthesis by the liver and have been shown to reduce existing atherosclerotic plaques.

When discussing cholesterol levels with a patient, which of the following is desirable? High HDL, high LDL High cholesterol, high LDL High cholesterol, low HDL High HDL, low LDL

High HDL, low LDL

Based on assessment findings and mixed signs and symptoms, you suspect total heart failure. Which of the following are correct statements regarding the body's attempts to compensate for heart failure? Select all that apply. Heart rate elevates in response to parasympathetic activation. Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume. Pale, cool extremities result from increased blood flow to the skin in attempt to divert excess blood away from the heart. Baroreceptors detect falling blood pressure and initiate increased heart rate to compensate. Peripheral vasodilation is the primary cause of the peripheral pitting edema.

Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume. Baroreceptors detect falling blood pressure and initiate increased heart rate to compensate. Left-side heart failure results in a fall in blood pressure that is detected by the baroreceptors. These receptors activate the sympathetic nervous system to increase heart rate and compensate for the pressure loss. The body also retains fluid to compensate for heart failure. An increase in blood volume results in an increase in pressure. However, excess fluid in the body increases the likelihood of edema.

For cardiac health, which of the following should Ms. West work to elevate? Total cholesterol LDL HDL Triglycerides

HDL HDL, high-density lipoprotein, is considered to the "good cholesterol," as it transports cholesterol from the bloodstream to the liver. A regular exercise program has been shown to increase HDL levels.

Which of his signs and symptoms are associated with the forward effects of left-side heart failure? Select all that apply. Headache Decreased blood pressure Increased heart rate Pulmonary crackles Pulmonary edema

Headache Decreased blood pressure Increased heart rate Forward effects of left-side heart failure result from an inability of ventricle to adequately pump blood into systemic circulation, resulting in decreased blood pressure and increased heart rate to compensate. Headache may occur due to poor perfusion of the brain. Pulmonary crackles and pulmonary edema are due to backward effects of LV failure.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If preload increases within a normal range, then stroke volume Increases Decreases

Increase Preload refers to the volume of blood filling the heart before it contracts. To a certain point, the more the heart is filled with blood, the more blood is ejected with each stroke.

You speak to Mr. Benson about lifestyle modifications and medication options to treat hypertension. Mr. Benson doesn't understand your concern about hypertension, because he does not notice "anything really wrong." You explain to Mr. Benson that many tissues can be damaged by hypertension. Which of the following tissues are most likely to be damaged by hypertension? Select all that apply. Heart Bladder Kidneys Retina Brain Stomach GI tract

Heart Kidneys Retina Brain High blood pressure can result in left ventricular hypertrophy of the heart. The kidneys can be damaged by hypertension, resulting in loss of protein in the urine and reduced filtering of waste products. The arterioles in the retina may be damaged resulting in blindness. Vessel damage in the brain due to hypertension increases the risk for aneurysms.

John's pulmonary function is also being closely monitored. Over time, John seems to have difficulty maintaining adequate arterial oxygen levels. When you auscultate John's lungs you hear the presence of crackles. What complication do you suspect may be developing? Pneumonia Chronic obstructive pulmonary disease (COPD) Heart murmur Heart failure

Heart failure As John's left ventricle was damaged, it may not be able to adequately pump blood forward into circulation. The lack of forward ejection results in blood pooling in the left atrium and finally backing up into pulmonary circulation. As hydrostatic pressure in the pulmonary capillaries increases due to the fluid backup, fluid leaks from the capillaries, leading to pulmonary edema noted by the presence of crackles.

A follow-up angiography shows an occlusion in the left anterior descending artery. Percutaneous coronary intervention (PCI) was used to restore perfusion. Which of the following likely occurred for Helen during PCI? Drug-eluting stent placement Thallium stress test Heart valve replacement Aortic dissection

Heart valve replacement A drug-eluting stent may be placed in the coronary artery to restore perfusion. Heart valve replacement is not considered during an MI. Thrombolytics rather than administration of clotting factors would be a treatment for myocardial infarction.

Because of the concern of myocardial infarction (MI), the physician orders an electrocardiogram (ECG), which reveals Helen has ST segment elevation. Which of the following statements are true? Select all that apply. An ECG is the most definitive diagnostic test for an MI. Helen's results indicate the presence of STEMI. The ST segment elevation is a positive indicator for adequate perfusion of the heart. Helen's ECG indicates the next appropriate step is for Helen to be sent home with instructions to rest and drink plenty of fluids. The ECG results help explain why Helen was experiencing angina equivalents.

Helen's results indicate the presence of STEMI. The ECG results help explain why Helen was experiencing angina equivalents. An ECG is not the diagnostic test for MI, although it may provide important clinical information. The ST segment elevation indicates that Helen is likely experiencing a STEMI (ST segment elevation MI), causing complete occlusion of a coronary artery. The arterial occlusion would explain why Helen was experiencing angina equivalents.

Ms. West requests further information about hyperlipidemia and its effects on the body. Which of the following statements regarding lipids are correct? Select all that apply. LDL lipoproteins and triglycerides play a role in atherosclerosis. Foam cells that result in plaque formation arise from neutrophils. The only source of cholesterol in the body is dietary intake. Atherosclerotic plaques disintegrate into foam cells. High levels of LDL cholesterol and low levels of HDL cholesterol increase risk for cardiovascular disease.

High levels of LDL cholesterol and low levels of HDL cholesterol increase risk for cardiovascular disease. LDL lipoproteins and triglycerides play a role in atherosclerosis. Both LDL lipoproteins and triglycerides are associated with atherosclerosis. The inverse relationship between elevated LDL cholesterol levels and reduced HDL cholesterol levels has been shown to be related to an increase risk of cardiovascular disease.Foam cells are formed from macrophages, not neutrophils. In addition to dietary intake of cholesterol, the liver also synthesizes cholesterol. Atherosclerotic plaques do not disintegrate into foam cells. Foam cells form fatty streaks which lead to atherosclerotic plaques.

Which of the following would cause an increase in aldosterone? Select all that apply. Hypertension Hypotension Increased renin Increased angiotensin Decreased blood volume

Hypertension Increased renin Increased angiotensin Decreased blood volume

Which of the following are general signs and symptoms of shock? Select all that apply. Bradycardia Hypotension Increased respiratory rate Tachycardia Oliguria

Hypotension Increased respiratory rate Tachycardia Oliguria

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. This form of shock results from decreased blood volume, often as a result of trauma. Inadequate blood returns to the heart, reducing cardiac output and blood pressure. Cardiogenic Hypovolemic Neurogenic

Hypovolemic Hypovolemic shock often results from trauma causing hemorrhagic blood loss. The loss of blood prevents adequate venous return to the heart. With insufficient blood to pump, the heart is unable to maintain pressure and perfusion to the tissues.

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this type of shock, fluid replacement is the key treatment. Although initial form of replacement fluid is under debate, most agree that Ringer's lactate or normal saline can be used. Blood transfusions may eventually be necessary. Cardiogenic Hypovolemic Septic

Hypovolemic Hypovolemic shock treatment requires adequate fluid management. Discussions continue as to which fluid should be used first for replacement. However, the key is getting fluid levels to the point that adequate pressure and perfusion can be maintained. Later, the type of fluid infusion or the need for blood transfusions can be considered.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If blood pressure decreases, then compensatory measures cause heart rate to Increase Decrease

Increase The baroreceptors in the aorta and carotids monitor blood pressure. When they detect a fall in blood pressure, they activate the sympathetic nervous system, which in turn stimulates heart rate to compensate for the pressure drop.

The edema present in Howard's lungs and extremities indicates the presence of excess fluid in the body. Which of the following signals are associated with retention of fluid? Select all that apply. Decreased ADH Increased aldosterone Decreased angiotensin Increased natriuretic peptide Increased renin

Increased aldosterone Increased renin Fluid retention results from the activation of the renin-angiotensin-aldosterone system (RAAS) and the release of ADH. Thus, increased renin, increased angiotensin, and increased aldosterone either directly or indirectly contribute to fluid retention. Natriuretic peptide increases urine output and reduces blood volume.

A young patient has suffered a significant amount of blood loss in an auto accident. Which of the following would you expect to observe in this patient? Select all that apply. Decreased urine output Increased renin secretion Decreased anti-diuretic hormone Hypertension Increased heart rate

Increased heart rate Increased renin secretion

Howard undergoes further testing. Which value may provide further evidence that Howard has left ventricular failure? Increased pulmonary capillary wedge pressure (PCWP) Increased albumin Decreased PAP Increased JVD

Increased pulmonary capillary wedge pressure (PCWP) Pulmonary capillary wedge pressure (PCWP) testing estimates the pressure in the left atria. In left ventricular pressure, as fluid backs up in the left side of the heart, PCWP increases. Increased CVP, or central venous pressure, is the measurement used to evaluate right-side heart failure.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If aldosterone is released, then blood volume Increases Decreases

Increases Aldosterone stimulates sodium and water retention, increasing blood volume.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If venous return increases, then preload Increases Decreases

Increases Venous return is the amount of blood returning to the heart. The more blood returning to the heart, the more the heart is filled, a quantity known as preload.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If angiotensin II increases, then aldosterone Increases Decreases

Increases Angiotensin II stimulates the adrenal cortex to release aldosterone.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If capillary hydrostatic pressure increases, then the likelihood of edema Increases Decreases

Increases Capillary hydrostatic pressure is the fluid pressure within a capillary. As capillaries are "leaky," higher fluid pressure inside the capillary results in more fluid leaking out of the capillary.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If blood pressure decreases, then the ADH levels Increases Decreases

Increases Low blood pressure stimulates the release of ADH, which decreases urine output and increases water retention. Increasing fluid volume in the body helps to maintain blood pressure.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If nitric oxide increases, then vasodilation Increases Decreases

Increases Nitric oxide is a potent vasodilator. Nitroglycerin tablets may be used to dilate coronary arteries when the individual experiences chest pain.

This or That? Heart physiology involves many relationships. Changes in the heart set off different compensatory mechanisms. For each "if" statement, select the appropriate "then."If kidney perfusion decreases, then renin release Increases Decreases

Increases Renin is released by the juxtaglomerular (JG) cells of the kidney in response to low blood flow and pressure to the kidneys.

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this stage of shock, a decrease in blood pressure is detected, which activates the sympathetic nervous system. Activation of RAAS also occurs, as the response is similar to the alarm stage of the stress response. Initial Progressive Irreversible

Initial In the initial stages of shock, a decrease in blood pressure is often the first sign detected by the body. The fall in blood pressure is noted by the baroreceptors which activate the sympathetic nervous system. The activation of this system counteracts the falling blood pressure by increasing the heart rate and contractility of the heart. Reduced blood pressure in the kidneys prompts the juxtaglomerular (JG) cells to release renin, activating the renin-angiotensin-aldosterone system (RAAS). This increases blood volume to maintain blood pressure. Stress hormones epinephrine and cortisol are released.

What are the three stages of shock? Select all that apply. Comprehensive Recurrent Initial Progressive Irreversible

Initial Progressive Irreversible

Which of the following lifestyle modifications would you recommend to reduce Ms. West's hyperlipidemia? Select all that apply. Increase trans-fatty acid intake Keep dietary cholesterol intake < 300 mg per day Increase intake of fish oils Increase intake of dietary fiber 30 minutes of aerobic exercise daily

Keep dietary cholesterol intake < 300 mg per day Increase intake of fish oils Increase intake of dietary fiber 30 minutes of aerobic exercise daily Cholesterol intake should be less than 300 mg per day. Aerobic exercise has been shown to reduce LDL cholesterol and raise HDL cholesterol. Dietary fiber and fish oil have been shown to have favorable effects on cholesterol levels. Trans-fatty acids have been shown to increase LDL cholesterol.

this or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this stage of shock, perfusion is reduced to essential tissues, such as the brain and heart. Widespread cellular hypoxia and anaerobic metabolism also occur. Initial Progressive Irreversible

Irreversible In the irreversible stage of shock, the body's compensations have failed to maintain adequate blood flow to the brain and heart. As these primary tissues are compromised, further compensatory and regulatory mechanisms fail. Anaerobic metabolism and cell death begin to occur.

Heart failure may result from which of the following? Select all that apply. Ischemic injury to the heart Dysrhythmias Increased contractility Chronic hypoxia Hypertension

Ischemic injury to the heart Dysrhythmias Chronic hypoxia Hypertension

Which of the following signs and symptoms, although not present in Howard's initial examination, are also associated with right-side heart failure? Select all that apply. Jugular vein distention Orthopnea Enlarged liver and/or spleen Crackles in the lungs Pulmonary edema

Jugular vein distention Enlarged liver and/or spleen Jugular vein distention (JVD) and hepatosplenomegaly (enlarged liver or spleen) are common signs of right-side heart failure. With this condition, blood backs up in the large veins that deliver blood to the heart, causing the veins and organs to enlarge. The other answers listed are associated with left-side heart failure.

Coronary angiography reveals significant blockage in the coronary artery serving the anterior/inferior left ventricle. Which artery is occluded? Left anterior descending Circumflex Posterior interventricular Right marginal

Left anterior descending The left anterior descending (LAD) serves as the artery for the left ventricle (LV), particularly the anterior and inferior portions of the LV. The other arteries listed serve different portions of the heart, including the posterior aspect (posterior interventricular), right ventricle (right marginal), and left side of heart (circumflex).

You tell Mr. Benson that there are many assessments available to determine if any organs are damaged by hypertension. Which of the following assessment results may be associated with hypertensive damage of body tissues? Select all that apply. Increase stomach acid Left ventricular hypertrophy Reduced TSH Microalbuminuria Cerebral hemorrhage Arteriovenous nicking in retina Barrel-chested appearance S4 sound Shift of point of maximal impulse of heart

Microalbuminuria Cerebral hemorrhage Arteriovenous nicking in retina Left ventricular hypertrophy S4 sound Shift of point of maximal impulse of heart As the heart pumps against increased pressure, left ventricular hypertrophy may develop. This may shift the point of maximal impulse. In addition, as blood enters a less compliant left ventricle, a S4 sound may be heard. Damage to retinal vessels may results in appearance of "AV nicking" where arteries and veins cross. Hypertension may damage the filtration membrane of the glomerulus resulting in the appearance of albumin in the urine (microalbuminuria). Damage to vessels of the brain increases the risk for cerebral hemorrhage

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this type of shock, parasympathetic-drive bradycardia must be counteracted. Atropine, an anticholinergic agent, may be given. Vasoconstrictors and fluid may be administered to maintain blood pressure. Cardiogenic Hypovolemic Neurogenic

Neurogenic In neurogenic shock, decreased responsiveness of the cardiac system occurs with sympathetic nervous system disruption. Normally, the sympathetic nervous system increases heart rate to compensate for low blood pressure. If the sympathetic nervous system is not functioning properly, this does not occur as needed. Thus, treatments center on maintain adequate heart rate by blocking parasympathetic bradycardia and using vasoconstrictors to maintain blood pressure.

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this type of shock, disruption of the sympathetic nervous system, as occurs in spinal cord or brain injury, causes widespread vasodilation. The body is unable to compensate for decreases in blood pressure as expected because of disruption of the sympathetic nervous system. Cardiogenic Hypovolemic Neurogenic

Neurogenic In neurogenic shock, disruption of the nervous system, specifically the sympathetic nervous system, results in dysfunction of the circulatory system.

Helen is a 68-year-old woman who has been brought to the emergency department by her friend Karen. According to Karen, she and Helen had been working for several hours cleaning Helen's home. As they were finishing, Helen began to complain of heaviness in her chest, shortness of breath, and dizziness. These were not alleviated by Helen taking a nitroglycerin tablet and resting so Karen thought it best to bring Helen in for evaluation.As Helen experienced her symptoms, why may nitroglycerin tablets help? Nitroglycerin is known to alleviate dizziness. Nitroglycerin vasodilates arterioles helping with coronary blood flow. Nitroglycerine tablets are antianxiety medications. Nitroglycerin increases heart rate helping to maintain cardiac output.

Nitroglycerin vasodilates arterioles helping with coronary blood flow. Nitroglycerin vasodilates arterioles, helping to maintain blood flow to coronary tissue and alleviating chest pain.

Mr. Benson is surprised to hear he has hypertension, because overall he feels fine. You tell Mr. Benson that many patients with hypertension have no symptoms and that he has a number of factors that increase his risk for hypertension. Which of the following are risk factors for hypertension? Select all that apply. Age 20 to 40 years Excess sodium in diet Regular aerobic exercise History of autoimmune disease Obesity African American ethnicity Family history

Obesity African American ethnicity Family history Excess sodium in diet Excess sodium, obesity, African American ethnicity and a family history of hypertension are known risk factors for hypertension. Mr. Benson has all of these risk factors. The risk of hypertension increases with age, while regular aerobic exercise reduces the risk for hypertension. Autoimmune diseases are not a known risk for hypertension.

Which of his signs and symptoms are associated with the backward effects of left-side heart failure? Select all that apply. Headache and memory loss Orthopnea Paroxysmal nocturnal dyspnea Pulmonary crackles Pulmonary edema

Orthopnea Paroxysmal nocturnal dyspnea Pulmonary crackles Pulmonary edema Backward effects of left-side heart failure results in fluid back up on the pulmonary system. Orthopnea, paroxysmal nocturnal dyspnea, pulmonary crackles, and pulmonary edema are all signs of the left ventricle failing to pump blood forward and backward effects of fluid accumulation in the lungs developing.

Helen's vital signs show a heart rate of 82 bpm, BP of 118/78 mm Hg, respiratory rate of 28 breaths per minute, and oxygen saturation of 93%. At the current time, what medication options may be selected for Helen? She continues to complain of heaviness in her chest. Select all that apply. Oxygen Aspirin IV nitrates Morphine Beta-adrenergic blockers

Oxygen Aspirin IV nitrates Morphine Beta-adrenergic blockers All of the listed options can be used to manage myocardial infarctions. Oxygen is given if saturation levels are less than 95%, aspirin reduces platelet aggregation, and nitrates and morphine may be used to alleviate pain. Beta blockers reduce the workload on the heart.

A single, widened QRS complex is referred to as a _______________. bigeminy PVC ventricular tachycardia couplet

PVC

When listening to John's heart you notice a heart murmur that was not noted on John's earlier health history. Which structures may have been damaged by John's myocardial infarction that elicited this new murmur? Superior vena cava Pulmonary artery Aorta Papillary muscles

Papillary muscles The papillary muscles are attached the atrioventricular (AV) valves and help keep the valves closed during ventricular systole. A myocardial infarction may damage the papillary muscles. If the papillary muscles can not function properly, the valve closure may be disrupted, enabling blood to flow through the valve during systole, resulting in turbulent flow and a heart murmur.

Howard, age 58, presents to the emergency department with a variety of signs and symptoms. Howard has a history of cardiac difficulties, including a myocardial infarction 5 years ago. Since that time, Howard has continued to struggle with lifestyle modifications, such as diet and exercise, to reduce his risk of future cardiac events.As the first clinician to see Howard, you record the following signs and symptoms: headache and memory loss; cyanosis; heart rate of 100 bpm; BP of 100/70 mm Hg; ascites; orthopnea; paroxysmal nocturnal dyspnea; pulmonary crackles and edema; peripheral edema; and cool, pale extremities. Which of his signs and symptoms are associated with right-sided heart failure? Select all that apply. Ascites Headache and memory loss Cyanosis Peripheral edema Cool, pale extremities

Peripheral edema Ascites When the right side of the heart fails, fluid backs up into the systemic venous system. Ascites and peripheral edema occur, as the fluid in the capillaries increases. The other signs and symptoms listed are not specific to right-side heart failure.

Which term indicates the volume of blood entering the heart at the end of diastole? Contractility Ejection fraction Afterload Preload

Preload

Before discussing treatments for Mr. Benson, it must be established if Mr. Benson is suffering from primary or secondary hypertension. Which of the following statements are true concerning these categories? Select all that apply. Primary hypertension accounts for 10 to 15% of hypertension. Primary hypertension has no known cause. Secondary hypertension has no known cause. Secondary hypertension may result from oral contraceptive usage. Renal disorders can results in primary hypertension.

Primary hypertension has no known cause. Secondary hypertension may result from oral contraceptive usage. Primary hypertension accounts for 90 to 95% of the cases of hypertension and has no known cause. Secondary hypertension is due to another systemic disorder (i.e. renal , medication, endocrine), so the cause can be determined. Oral contraceptives can result in elevated blood pressure in some women. Disorders of the kidney can lead to hypertension with activation of RAAS.

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this stage of shock, decreased perfusion of kidney, liver, and GI tract develop. Decreased urination and buildup of waste products in the blood occurs. Initial Progressive Irreversible

Progressive In the progressive stage of shock, the body compensates for circulatory failure by initiating vasoconstriction to tissues such as the GI tract, liver, and kidneys. The decreased perfusion of the kidneys results in reduced urine formation and decreased removal of waste products from the blood.

Which test is most helpful in revealing the extent of damage to Helen's heart? Echocardiogram Coronary artery bypass grafting (CABG) Venogram Radionuclide myocardial perfusion imaging

Radionuclide myocardial perfusion imaging Radionuclide myocardial perfusion imaging involves injecting a radionuclide dye into the bloodstream to highlight areas of the heart lacking perfusion. An echocardiogram cannot differentiate an acute MI from an old one, and a venogram examines the veins, not the coronary arteries.

A patient appears with hypotension. Which of the following may contribute to hypotension? Increased sodium and water reabsorption Increased cardiac output Reduced blood volume Activation of the renin-angiotensin-aldosterone system

Reduced blood volume

You are concerned that during Helen's treatment there may be further injury to myocardial cells by normalized oxygen levels. What is the term used for this type of injury? Reentry injury Repolarization injury Angina equivalents Reperfusion injury

Reperfusion injury Reperfusion injuries occur because damaged myocardial cells poorly tolerate normalized levels of oxygen.

John, age 58, has presented in the emergency department complaining of severe chest pain. He states that two nitroglycerin tablets did not alleviate his pain. An electrocardiogram (ECG) is immediately ordered, along with serum laboratory values for cardiac markers.John's ECG revealed a 4-mm ST segment elevation in V2-V6. Which of the following best describes John's condition? NSTEMI STEMI Partial occlusion of coronary artery Stable angina

STEMI The ST segment elevation indicates John is experiencing an ST elevation myocardial infarction (STEMI) event, not a non-ST elevation myocardial infarction (NSTEMI), in which no ST segment elevation would be apparent. A STEMI indicates complete, not partial, occlusion of a coronary vessel. The fact that John's pain was not relieved with nitroglycerin shows it is not stable angina.

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this type of shock, an infectious organism is actively replicating and producing toxins that disrupt circulation. Hypotension results as venous return is decreased to the heart. Hypovolemic Neurogenic Septic

Septic Septic shock is the result of a widespread inflammatory response to an infectious agent. The infectious agents often produce toxins that disrupt circulation. As circulation is disrupted, hypotension and decreased perfusion of tissues occurs.

This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type. In this type of shock, multiple specialists are involved in the treatment. Appropriate antibiotics are needed, and vasoconstrictors and/or respiratory support may be required. Some cases must be resolved with surgery. Control of hyperglycemia is critical. Neurogenic Anaphylactic Septic

Septic Septic shock treatment involves a multidisciplinary team approach. Antibiotics are essential when the infection is bacterial in nature. Surgical removal of the source of infection may be necessary. Control of hyperglycemia through IV insulin is required. Other approaches such as vasoconstrictors, respiratory, and renal support may be needed.

Mr. Benson, a 45-year-old African American male, arrived in the clinic for his "annual" check-up. He is worried about his health, as his sister, age 52, recently suffered a heart attack. Mr. Benson realizes his lifestyle may increase his risk for cardiovascular disease. He tells you he "likes to eat whatever he wants" and he "loves to use the salt shaker." He enrolled in a fitness class near his home but has only attended a couple times.Calculating Mr. Benson's BMI, you note he falls within the "obese" category. Mr. Benson's resting heart rate is 86 bpm and he appears to have shortness of breath upon exertion.The last time Mr. Benson was in the clinic was 3 years ago. At that time, his blood pressure readings were 138/80 mm Hg and 134/82 mm Hg. He was told to return in 6 months for further evaluation. Mr. Benson's blood pressure readings placed him in which category? Normal Elevated Stage 1 HTN Stage 2 HTN

Stage 1 HTN Normal BP: < 120 mm Hg systolic and < 80 mm Hg diastolic Elevated: 120 to 129 mm Hg systolic and < 80 mm Hg diastolic Stage 1 HTN: 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic Stage 2 HTN: ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic

At this appointment, Mr. Benson's BP readings are 146/92 mm Hg and 142/90 mm Hg. What is the classification for Mr. Benson now? Normal Elevated Stage 1 HTN Stage 2 HTN

Stage 2 HTN Normal BP: < 120 mm Hg systolic and < 80 mm Hg diastolicElevated: 120 to 129 mm Hg systolic and < 80 mm Hg diastolicStage 1 HTN: 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolicStage 2 HTN: ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic

Because of the damage to the left ventricle, the physician is concerned about poor ejection and stasis of blood in the ventricular chamber leading to further complications. Which of the following may be a primary concern? Atrial fibrillation Thromboembolism First degree AV block Collateral circulation development

Thromboembolism When stasis of the blood occurs, the risk of clot development increases. In John's case, a poorly performing left ventricle may increase the risk of a thromboembolism forming. This clot can then travel from the heart to other tissues, such as the lungs.

Ms. Karen West, age 58 years, is a retired librarian. She admits to leading a sedentary lifestyle, especially now that she has stopped working. Her only self-reported activity is working in her garden. She reports she has gained "about 15 pounds" in the last several years. At 5 feet, 4 inches, Ms. West weighs 192 pounds.Ms. West has not been seeing a physician in the past 4 years and her last blood laboratory tests were done 8 years ago.Among other tests, the primary care provider orders a lipid profile be completed for Ms. West.The results return with the following values:Total cholesterol: 260 mg/dLLDL cholesterol: 160 mg/dL HDL cholesterol: 35 mg/dL Triglycerides: 210 mg/dLWhich of these values are considered high? Select all that apply. Total cholesterol LDL HDL Triglycerides

Triglycerides Total cholesterol LDL High LDL is 160 to 189 mg/dL and high triglycerides is 200 to 499 mg/dL. Total cholesterol is high (> 240 mg/dL) and HDL is low.

Other laboratory results indicate fasting plasma glucose of 120 mg/dL, an elevated TSH, and reduced thyroxine level. Based on these results and her patient data, which additional risk factors for hyperlipidemia may Ms. West have? Select all that apply. Hyperthyroidism Type 2 diabetes mellitus Hypothyroidism Obesity Pre-menopausal

Type 2 diabetes mellitus Hypothyroidism Obesity Type 2 diabetes mellitus, hypothyroidism, and obesity are all risk factors for hyperlipidemia. Given the laboratory results, Ms. West should have further evaluations for hypothyroidism and type 2 diabetes mellitus. Her BMI currently places her in the "obese" category.

The physician orders an echocardiogram to get a better sense of John's heart function. There is a bulging left ventricular wall. Which of the following terms describe this development? Cardiac tamponade Papillary muscle rupture Ventricular aneurysm Pericarditis

Ventricular aneurysm A ventricular aneurysm is a bulge in the ventricular wall that develops as a result of damage to the tissue. A primary concern of a ventricular aneurysm is that the bulge may rupture leading to a medical emergency. Surgical repair of a ruptured ventricular aneurysm is critical.

The physician is closely monitoring John's ECG because she is worried about a rhythm disturbance that may develop as a result of reentry circuits. Given John's current presentation, which of the following is the most concerning? First degree AV block Ventricular tachycardia Atrial fibrillation A single premature ventricular contraction (PVC)

Ventricular tachycardia Because of the location of John's myocardial infarction, you are most concerned about a conduction disturbance in the ventricles. Ventricular tachycardia is the most worrisome of the conduction disorders listed as it can result in inadequate pumping of blood from the left ventricle. Atrial disorders or a single PVC do not normally result in significant decline in ventricular function at rest.

In addition to the laboratory values, a physical examination of Ms. West is conducted. Which of the following are associated with hyperlipidemia? Select all that apply. Wheezing Xanthoma Clubbing of fingers Skin ulcers Xanthelasma Cyanosis

Xanthoma Xanthelasma Xanthoma and xanthelasma are yellowish deposits under the skin and near the eye.

Rapid, irregular P waves are known as ____________. AV block atrial fibrillation ventricular fibrillation ventricular tachycardia

atrial fibrillation

Factors that influence the amount of damage an MI causes include _____________. Select all that apply. collateral circulation gender location duration age

collateral circulation location duration

In response to hypertension, the left ventricle may undergo hypertrophy, reducing filling volume of the left ventricle. This is an example of _____________. systolic dysfunction diastolic dysfunction total heart failure backward effects

diastolic dysfunction

Stable angina _____________________. is chest pain experienced for the first time. is another name for a heart attack. is consistent, chronic chest pain. requires immediate surgical correction.

is consistent, chronic chest pain.

Baroreceptors detect ______________ and respond by increasing __________. high blood pressure, heart rate increased heart rate, blood pressure decreased heart rate, blood pressure low blood pressure, heart rate

low blood pressure, heart rate

Angina may be relieved by ______________, which vasodilate(s) arterioles. nitroglycerin tablets oxygen sedatives glucose tablets

nitroglycerin tablets

A block at the AV node is likely to appear as a(n) ___________________ on an ECG. widened QRS complex PVC prolonged PR interval inverted P wave

prolonged PR interval

The backward effect of left heart failure may cause ____. Select all that apply. hypertension pulmonary crackles pulmonary edema paroxysmal nocturnal dyspea jugular vein distension

pulmonary crackles pulmonary edema paroxysmal nocturnal dyspea

A patient is diagnosed with a STEMI in the emergency room. This means ______________. the patient is experiencing a minor injury to the heart. the patient is experiencing an aneurysm. the patient is experiencing complete occlusion of a coronary artery. the patient requires careful observation but no treatment at this time.

the patient is experiencing complete occlusion of a coronary artery