PATHO: Week 3 (Midterm Review)

Which condition is an endocrine disorder that causes elevated blood pressure? (Select all that apply.) a. Guillain-Barré syndrome b. Coarctation of the aorta c. Pheochromocytoma d. Cushing disease e. Hyperthyroidism

d. Cushing disease e. Hyperthyroidism Endocrine disorders that result in hypertension include Cushing disease and hyperthyroidism. While Guillain-Barré syndrome results in hypertension, it is neurologic disorder. While coarctation of the aorta causes high blood pressure, it is a cardiac disorder. While pheochromocytoma causes high blood pressure, it is a tumor of adrenal gland tissue.

Which medication classification is used to decrease preload in patients with heart failure? a. Calcium channel blockers b. Corticosteroids c. β-Blockers d. Diuretics

d. Diuretics The right ventricle is particularly sensitive to reductions in preload, and care must be taken to avoid a significant drop in right ventricular output when intravascular volume is decreased. Drugs, such as diuretics, may be administered to reduce intravascular volume. Diuretics promote the excretion of fluid by increasing renal blood flow and blocking sodium and chloride reabsorption, or both. Calcium channel blockers are not commonly used to decrease cardiac preload. Corticosteroids are not used for affecting cardiac preload. β-Blockers slow the heart rate and reduce the force with which the heart muscle contracts, thereby lowering blood pressure.

Which situation causes an increase in blood pressure? a. Blood loss b. Dehydration c. Prolonged bed rest d. Intracerebral hemorrhage

d. Intracerebral hemorrhage Intracerebral hemorrhage and intracranial hematomas are two of the neurologic causes for increased blood pressure through increased secretion of catecholamines. Blood loss, dehydration, and prolonged bed rest can result in hypotension.

A patient with heart failure reports awakening intermittently with shortness of breath. Which terms appropriately describe this clinical manifestation? a. Dyspnea b. Cyanosis c. Bradypnea d. Paroxysmal nocturnal

d. Paroxysmal nocturnal Paroxysmal nocturnal dyspnea refers to intermittent attacks of severe dyspnea that occur during the night. Dyspnea is a general term referring to difficulty breathing. Cyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. Bradypnea describes abnormal slowness of breathing.

Which term is determined by stroke volume, speed of ejection, and arterial distensibility? a. Arterial pulse pressure b. Mean arterial pressure c. Diastolic pressure d. Pulse pressure

d. Pulse pressure Pulse pressure is determined by stroke volume, speed of ejection of the stroke volume, and arterial distensibility. Arterial pulse pressure is the difference between the systolic and diastolic blood pressure. Mean arterial pressure is the average pressure in the circulating system throughout the cardiac cycle. Diastolic pressure is the pressure excreted during the rest phase of the cardiac cycle.

Which term is used to identify hypertension that has a specific disease as its cause? a. Primary b. Essential c. Idiopathic d. Secondary

d. Secondary Secondary is the term given to hypertension that is secondary to a specific disease. Idiopathic, primary, and essential hypertensions are interchangeable terms for hypertension that cannot be related to a specific disease/cause.

Myocarditis should be suspected in a patient who presents with

acute onset of left ventricular dysfunction.

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

antibiotics

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

antiplatelet drugs.

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

apoptosis.

In which dysrhythmias should treatment be instituted immediately?

Atrial fibrillation with a ventricular rate of 220 beats/minute

After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later. The patient reports "moderate" adherence to the recommended lifestyle changes and has experienced a decreased from 165/96 to 148/90 mm Hg in blood pressure. What is the most appropriate intervention for this patient at this time?

Continue lifestyle modifications only.

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

Anaphylactic

A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient's blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time?

Begin antihypertensive drug therapy.

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

Edema

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

Elevated CK-MB, troponin I, and troponin T

Chronic elevation of myocardial wall tension results in atrophy.

FALSE wil result in hypertrophy

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

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

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

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

The most commonly recognized outcome of hypertension is pulmonary disease.

False The most commonly recognized outcome of hypertension is cardiovascular disease.

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

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

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

Left ventricular workload is increased with high afterload

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

Septic

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

Septic

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

Sodium

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

True Acute myocarditis is commonly characterized by left ventricular dysfunction or general dilation of all four heart chambers. Chest pain and ST elevation is indicative of myocardial infarction. Myocarditis is associated with viral infections. Dilated cardiomyopathy runs in families and has a genetic basis.

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

Ventricular escape rhythm

Sepsis has been recently redefined as

a systemic inflammatory response to infection.

Which left atrial pressure readings indicate a risk of increased capillary filtration that results in the clinical manifestations of pulmonary edema? a. 25 mm Hg b. 10 mm Hg c. 6 mm Hg d. 4 mm Hg

a. 25 mm Hg Readings at or above 25 mm Hg are associated with increased capillary filtration and pulmonary edema. The normal left atrial pressure is 4 to 12 mm Hg.

Tetralogy of Fallot is characterized by which of the following? (Select all that apply.) a. A ventricular septal defect b. Right ventricular hypertrophy c. Transposition of the great arteries d. Obstructed right ventricular outflow e. An aorta positioned above the ventricular septal opening

a. A ventricular septal defect b. Right ventricular hypertrophy d. Obstructed right ventricular outflow e. An aorta positioned above the ventricular septal opening Damage to endothelial cells by oxidized lipids releases inflammatory mediators that form atherosclerotic plaques. A decrease in smooth muscle and a chronic buildup of calcium cells do not contribute to the development of coronary atherosclerotic lesions.

Risk factors for the development of high blood pressure are which of the following? (Select all that apply.) a. Age b. Race c. Diet d. Weight e. Chronic illness

a. Age b. Race c. Diet d. Weight The older a person is, the less elastic the blood vessels are, which results in higher systemic vascular resistance. High blood pressure occurs two to three times more frequently in the African American population than in the Caucasian population. Diets high in fat and sodium have been associated with hypertension. An association with elevated body mass index and high blood pressure has been noted; however, the exact mechanism is unclear. Chronic illness will not necessarily result in hypertension.

Which is a risk factor associated with hypertension? (Select all that apply.) a. Age b. Caucasian race c. African American race d. High potassium intake e. History of tobacco smoking

a. Age c. African American race e. History of tobacco smoking Normal aging produces a rising systolic pressure over the course of a lifetime, whereas diastolic pressure increases for approximately 50 years, levels off during the sixth decade, and remains stable or declines later on. African Americans are predisposed to hypertension. Also, tobacco use has been shown to increase the risk of hypertension. Being Caucasian is not a known risk factor for hypertension. Diets high in fat and sodium, and low in potassium have been found to increase the risk of developing hypertension.

The nurse includes what information when educating a client concerning a first-degree heart block? (Select all that apply.) a. An electrocardiogram is used to identify this conduction disorder. b. Congenital heart defects are often the cause of the disorder. c. The condition is monitored, but not actively managed. d. Bradycardia is a common characteristic. e. First-degree blocks are rare.

a. An electrocardiogram is used to identify this conduction disorder. b. Congenital heart defects are often the cause of the disorder. c. The condition is monitored, but not actively managed. First-degree block is generally identified by a prolonged PR interval (more than 0.20 second) on the ECG. Drugs and organic heart disorders, such as myocardial ischemia and congenital heart defects, may cause first-degree block. First-degree block is generally monitored, but not actively managed except to alleviate the underlying cause, if possible. A second-degree type II block may also result in severe bradycardia due to the number of dropped beats. First-degree block is a common finding and may occur in the absence of organic heart disease.

Which diagnostic analysis is used to identify patients with heart failure? (Select all that apply.) a. BNP (B-type natriuretic peptide) b. ANP (atrial natriuretic peptide) c. Complete blood count (CBC) d. Echocardiogram e. Chest x-ray film

a. BNP (B-type natriuretic peptide d. Echocardiogram e. Chest x-ray film BNP is a blood test that assists in identifying patients with heart failure. An echocardiogram uses sound waves to create a moving picture of the heart and is used in the diagnosis of heart failure. A chest x-ray is a physical diagnostic test that shows heart structures and is used in the diagnosis of heart failure. Complete blood count (CBC) is a blood analysis used to determine the composition of blood related to amounts of specific cells in a serum sample. The overall effect of ANP on the body is to counter increases in blood pressure and volume caused by the renin-angiotensin system.

A common cause of heart failure is which of the following? (Select all that apply.) a. Coronary artery disease b. Valvular heart disease c. Cardiomyopathy d. Hypertension e. Anemia

a. Coronary artery disease c. Cardiomyopathy d. Hypertension The most common cause of HF is myocardial ischemia from coronary artery disease, followed by hypertension and dilated cardiomyopathy. Valvular heart disease and anemia are not common causes of heart failure.

A patient is admitted to the hospital with left-sided heart failure. Which clinical manifestation would the nurse expect the client to exhibit? (Select all that apply.) a. Cough b. Dyspnea c. Bradypnea d. Crackles in lungs e. Peripheral edema

a. Cough b. Dyspnea d. Crackles in lungs Common clinical manifestations of left-sided heart failure include cough, dyspnea, and crackles in lungs upon auscultation. Bradypnea describes abnormal slowness of breathing not seen in left-sided heart failure. Peripheral edema is associated with right-sided heart failure.

High blood pressure can be treated with lifestyle modification related to which of the following? (Select all that apply.) a. Decreased sodium intake b. Relaxation techniques c. Weight management d. Medication therapy e. Exercise

a. Decreased sodium intake b. Relaxation techniques c. Weight management e. Exercise A low-sodium diet decreases sodium retention and blood volume, altering stroke volume and cardiac output, which results in a lower blood pressure. Relaxation techniques help manage stress which helps lower blood pressure. Obesity is a major risk factor for hypertension. Exercise increases vascular tone, thus decreasing systemic vascular resistance and blood pressure. Medication therapy is not considered a lifestyle modification.

Systemic blood pressure is determined by which factor(s)? (Select all that apply.) a. Heart rate (HR) b. Stroke volume (SV) c. Cardiac output (CO) d. Systemic vascular resistance (SVR) e. Pulmonary vascular resistance (PVR)

a. Heart rate (HR) b. Stroke volume (SV) c. Cardiac output (CO) d. Systemic vascular resistance (SVR) The systemic arterial blood pressure is the physiologic result of the cardiac output (CO) and the resistance to the ejection (SVR) of blood from the heart. Cardiac output is the product of two variables: stroke volume (SV) and heart rate (HR) (CO = SV × HR). SV is the specific volume of blood leaving the heart with each contraction. Pulmonary vascular resistance (PVR) is not a factor in determining systemic blood pressure.

What effect does stimulation of the sympathetic nervous system have on the arterioles and resulting systemic reaction? (Select all that apply.) a. Increased vascular resistance b. Increased blood pressure c. Increased afterload d. Constriction e. Dilation

a. Increased vascular resistance b. Increased blood pressure c. Increased afterload d. Constriction Stimulation of the sympathetic nervous system results in increased vascular resistance, increased blood pressure, increased afterload, and constriction of the arterioles. Stimulation of the sympathetic nervous system results in constriction, not dilation, of the arterioles.

Which clinical manifestation differentiates myocardial infarction (MI) from angina pectoris? (Select all that apply.) a. Radiating chest pain b. Chest pain initiated by exercise c. ST-segment changes on the ECG d. Elevated serum levels of troponin e. Chest pain aggravated by coughing

a. Radiating chest pain c. ST-segment changes on the ECG e. Chest pain aggravated by coughing Radiating chest pain is a clinical finding for individuals experiencing myocardial infarction. Myocardial ischemia and infarction are indicated on the ECG by ST-segment changes. Serum protein marker elevations such as troponin and CK-MB are clinical findings for individuals experiencing myocardial infarction. Exercise-induced chest pain is a classic symptom of angina pectoris. Chest pain that is aggravated by coughing is more likely observed with angina pectoris than myocardial infarction.

Which type of shock is characterized by generalized vasodilation and peripheral pooling of blood? (Select all that apply.) a. Septic b. Neurogenic c. Cardiogenic d. Anaphylactic e. Hypovolemic

a. Septic b. Neurogenic d. Anaphylactic Septic shock, neurogenic shock, and anaphylactic shock are characterized by excessive vasodilation and peripheral pooling of blood. Cardiac output is inadequate because of reduced preload. Cardiogenic shock occurs primarily as a result of severe dysfunction of the left or right ventricles, or both, that results in inadequate cardiac pumping. Hypovolemic shock is a result of excessive blood loss; vasoconstriction is initially seen in this form of shock.

Which is a major determinant of diastolic blood pressure? a. Vascular resistance b. Stroke volume c. Preload d. Heart rate

a. Vascular resistance Systemic vascular resistance is the major determinant of diastolic blood pressure. It reflects the arteriolar radius and the degree of constriction, and it is the main variable in determining afterload. Stroke volume is the primary factor impacting systolic pressure. The end-diastolic volume is determined by the amount of blood returned to the heart between contractions, and is typically called the heart's preload. Heart rate is the number of times the heart contracts within a 60-second timeframe.

Circulatory shock is best defined as a. inadequate tissue perfusion. b. cardiovascular collapse. c. acute pump failure. d. vasodilation.

a. inadequate tissue perfusion. Circulatory shock is characterized by an imbalance between oxygen supply and oxygen requirements at the cellular level, wherein oxygen supply is decreased. Circulatory shock and acute pump failure are not the only causes of cardiovascular collapse. Vasodilation is not a cause of cardiovascular collapse, but is seen in anaphylactic, neurogenic, and septic shocks.

What is the pathophysiologic phenomenon underlying disseminated intravascular coagulation (DIC)? a. Elevated platelet and fibrinogen levels b. Clotting that leads to bleeding c. Inadequate cardiac output d. Mast cell degranulation

b. Clotting that leads to bleeding DIC is a result of widespread clot formation that consumes platelets and clotting factors, which leaves the patient at risk for serious bleeding. As the result of extensive clotting, platelet and fibrinogen levels are decreased not increased. Inadequate cardiac outcome is the fatal outcome of DIC. Mast cell degranulation is not relevant to DIC.

Systemic vascular resistance (SVR) can be indirectly estimated with the use of which blood pressure measurement? a. Systolic pressure b. Diastolic pressure c. Pulmonary arterial pressure d. Left ventricular end-diastolic pressure

b. Diastolic pressure The systemic diastolic pressure is determined by the narrowing of blood vessel diameter and therefore the resistance to blood flow, whether from peripheral vascular constriction or atherosclerosis. Systolic pressure is not as influenced by the narrowing of blood vessel diameter. Pulmonary arterial pressure is generated by the right ventricle ejecting blood into the pulmonary artery. By definition, the volume of blood within a ventricle immediately before a contraction is known as the end-diastolic volume.

Which statement is true regarding hypertension? a. Hypertension is defined as pressure greater than 160 mm Hg systolic. b. High blood pressure can be associated with headache and seizures c. Diagnosis can be made with one elevated reading. d. Low weight contributes to high blood pressure.

b. High blood pressure can be associated with headache and seizures. Headache and seizures are associated with high blood pressure. The actual definition of high blood pressure is a systolic pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg, or both. The diagnosis of hypertension requires the recording on two separate occasions of these elevations. Obesity, elevated sodium intake, age, ethnicity, and family history are all causes of high blood pressure.

Uncontrolled massive bleeding causes what type of shock? a. Cardiogenic b. Hypovolemic c. Neurogenic d. Septic

b. Hypovolemic Hypovolemic (low-volume) shock occurs in the presence of massive blood loss when the amount of blood available for circulation decreases. Cardiogenic shock is usually a result of severe ventricular dysfunction associated with myocardial infarction. Other causes include cardiomyopathy, ventricular rupture, and congenital heart defects. Neurogenic shock results from depression of the vasomotor center in the medulla or from interruption of sympathetic nerve fibers in the spinal cord. Causes of neurogenic shock include brain trauma that results in depression of the vasomotor center, spinal cord injury, high spinal anesthesia, and drug overdose. Septic shock commonly is associated with Gram-negative infections.

Which describes a pathologic manifestation of neurogenic shock? a. Release of vasodilatory mediators such as histamine into the circulation b. Loss of sympathetic activation of arteriolar smooth muscle c. Increased sympathetic nervous stimulation d. Massive immune system activation

b. Loss of sympathetic activation of arteriolar smooth muscle Neurogenic shock results from loss of sympathetic activation of arteriolar smooth muscle. Medullary depression (brain injury, drug overdose) or lesions of sympathetic nerve fibers (spinal cord injury) are the usual causes. Release of vasodilatory mediators such as histamine into the circulation and massive immune system activation are seen in anaphylactic shock. Increased sympathetic nervous stimulation is not a characteristic of neurogenic shock.

Which condition may result in chronic pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure? a. Aortic valve stenosis b. Mitral valve stenosis c. Acute myocarditis d. Aortic insufficiency

b. Mitral valve stenosis Pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure result from untreated mitral valve stenosis. Syncope, fatigue, low systolic blood pressure, and faint pulses are common signs and symptoms of aortic valve stenosis. Aortic insufficiency is characterized by a high-pitched blowing murmur during ventricular diastole. Patients may complain of palpitations and a throbbing or pounding heart because of the large ventricular stroke volume. Common presenting symptoms of acute myocarditis include fatigue, dyspnea on exertion, and dysrhythmia with associated palpitations.

What stimulates the release of renin? (Select all that apply.) a. Increased heart rate b. Renal hypoperfusion c. Sympathetic activation d. Parasympathetic activation e. Decreased sodium delivery

b. Renal hypoperfusion c. Sympathetic activation e. Decreased sodium delivery Renal hypoperfusion, sympathetic activation, and decreased sodium delivery stimulate renin release. Increased heart rate and parasympathetic activation do not stimulate the release of renin.

What factor causes a congenital heart disease to produce cyanosis? a. Left-to-right shunting of blood b. Right-to-left shunting of blood c. Ventricular septal obstruction d. Atrial septal defect

b. Right-to-left shunting of blood Disorders that result in right-to-left shunting cause cyanosis. A left-to-right shunt occurs when oxygenated blood from the left side of the heart or aorta flows back into the right side to be recirculated through the lungs. The blood reaching the systemic circulation is oxygenated and the infant is not cyanotic (acyanotic defect). However, the right side of the heart has an increased workload because of the extra shunt blood. In time, the overload of the right side of the heart can result in right ventricular hypertrophy and high right-sided heart pressures. Large ventricular septal defects may be apparent at birth because of rapidly developing right-sided heart failure and a loud systolic murmur. The majority of atrial septal defects occur at the location of the foramen ovale. The abnormal septal opening may be of variable size. Small defects (1 cm) are well tolerated. Even larger atrial septal defects may be asymptomatic for many years as long as the shunt flow is left to right and therefore acyanotic.

Atrial fibrillation is best described as when a. the P wave precedes, follows, or is buried in the QRS complex. b. disorganized and irregular atrial waves are accompanied by an irregular ventricular rate. c. an atrial rate of 240 to 350 beats/minute in a sawtooth pattern of atrial depolarization is seen. d. P waves occur earlier than normal, preceded by a P wave with a normal QRS configuration.

b. disorganized and irregular atrial waves are accompanied by an irregular ventricular rate. Atrial fibrillation is described as disorganized and irregular atrial waves accompanied by an irregular ventricular rate. Escape rhythms can present with a P wave that precedes, follows, or is buried in the QRS complex. Atrial flutter is typically manifested by a rapid atrial rate of 240 to 350 beats/minute and a characteristic saw-tooth pattern of atrial depolarizations. Premature atrial complexes (PAC) are characterized by P waves that occur earlier than normal, preceded by a P wave with a normal QRS configuration.

Activation of the renin-angiotensin system in shock causes a. vasodilation. b. fluid retention. c. sodium shifts. d. glucogenesis.

b. fluid retention. Renin triggers and stimulates kidney nephrons to conserve sodium and water. Renin triggers the formation of angiotensin II, which is a potent vasoconstrictor. Renin triggers and stimulates kidney nephrons to conserve not shift sodium. Activation of the renin-angiotensin system does not cause glucogenesis.

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

baroreceptor activity.

Which statement is true about baroreceptors? a. They are sensitive to changes in cardiac output (CO) and systemic vascular resistance (SVR). b. They alter the mean arterial pressure (MAP) to regulate blood pressure. c. An increase in pressure causes an increase in impulse discharge. d. They are located in the left ventricle.

c. An increase in pressure causes an increase in impulse discharge. An increase in pressure (MAP) causes an increase in discharge of the baroreceptors. An increase in firing of the baroreceptors causes a decrease in sympathetic outflow. Baroreceptors alter CO and SVR. Changes in MAP affect the baroreceptors. Baroreceptors are located in the carotid sinus and arch of the aorta.

What is the underlying problem common among all types of shock? a. Cardiac failure b. Generalized vasodilation c. Inadequate cellular oxygenation d. Faulty compensatory mechanisms

c. Inadequate cellular oxygenation Although each type of shock has specific characteristics, all are associated with a deficiency of cellular oxygen consumption. Inadequate cellular oxygenation may result from decreased cardiac output, maldistribution of blood flow, or reduced blood oxygen content. The impaired oxygen utilization by cells may lead to cell death, organ dysfunction, and stimulation of inflammatory reactions. Cardiac failure can be an outcome, but is not a common cause in all types of shock. Vasodilation occurs in only selective forms of shock. Faulty compensatory mechanisms may contribute to the seriousness of all shocks but that is not the cause of all forms of shock.

Which best defines systolic blood pressure? a. Occurs during passive elastic recoil of the aorta b. Is the sole function of aortic compliance c. Occurs during ventricular contraction d. Averages 70 mm Hg

c. Occurs during ventricular contraction Systolic blood pressure occurs during ventricular contraction and is a function of volume ejected and the compliance of the aorta. The diastolic blood pressure occurs during passive elastic recoil of the aorta and is an average of 70 mm Hg. The diastolic blood pressure occurs during passive elastic recoil of the aorta. Systolic blood pressure is a function of volume ejected and the compliance of the aorta, and averages 120 mm Hg.

The pathologic changes that occur in the development of coronary atherosclerotic lesions include cell damage resulting from which of the following? (Select all that apply.) a. A decrease in smooth muscle cells b. A chronic calcium buildup c. The effects of oxidized lipids d. An inflammatory response e. The formation of plaques

c. The effects of oxidized lipids d. An inflammatory response e. The formation of plaques Damage to endothelial cells by oxidized lipids releases inflammatory mediators that form atherosclerotic plaques. A decrease in smooth muscle and a chronic buildup of calcium cells do not contribute to the development of coronary atherosclerotic lesions.

For the patient in hypovolemic shock, what compensatory mechanism will help preserve adequate circulation? a. Increased activity of the parasympathetic nervous system b. Decreased secretion of antidiuretic hormone (ADH) c. The renin-angiotensin-aldosterone cascade d. Vasodilation

c. The renin-angiotensin-aldosterone cascade The sympathetic nervous system stimulates cells in the kidney to release renin, which triggers the renin-angiotensin-aldosterone cascade. The sympathetic and not the parasympathetic nervous system is involved in the compensatory mechanisms of hypovolemic shock. Antidiuretic hormone (ADH, vasopressin) is secreted from the posterior pituitary gland in response to reduced blood volume. ADH stimulates the kidney tubules to reabsorb water and improves the vascular response to catecholamines. Renin triggers the formation of angiotensin II, which is a potent vasoconstrictor, and also stimulates the kidney nephrons to conserve sodium and water.

A patient experiencing an acute myocardial infarction (MI) is given a drug to lyse the clot in the coronary artery. What is the best explanation for the sudden development of a serious arrhythmia once circulation is restored? a. The patient has developed cardiogenic shock. b. An increase in oxygen demand once circulation is restored c. The return of oxygen perfusion resulted in reperfusion injury. d. Resuscitation drugs did not circulate to the heart until the clot was lysed.

c. The return of oxygen perfusion resulted in reperfusion injury. Ischemic cells may produce oxygen-free radicals when oxygen supplies are restored. This process has been called reperfusion injury. Reactive oxygen molecules are unstable and will attack membrane structures, denature proteins, and break apart cell DNA. Cardiogenic shock, increased oxygen, and the effects of resuscitation drugs would not account for the arrhythmia.

A patient has a regular heart rate of 54 beats/minute. The nurse would document this rhythm as a. normal. b. arrhythmia. c. bradycardia. d. tachycardia.

c. bradycardia. Sinus bradycardia is defined as a heart rate of less than 60 beats/minute. Normal sinus rhythm is defined as an impulse rate between 60 and 100 per minute. Sinus arrhythmia is a normal finding associated with fluctuations in autonomic influences and respiratory dynamics. Sinus tachycardia is an abnormally fast heart rate of greater than 100 beats/minute.

Aortic and carotid baroreceptors are activated by ___________, resulting in ___________. a. increased blood pressure; a decrease in blood pressure b. decreased blood pressure; normalization of blood pressure c. decreased blood pressure; an increase in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure d. decreased blood pressure; a decrease in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure

c. decreased blood pressure; an increase in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure The aortic and carotid baroreceptors respond to a decrease in blood pressure by stimulating the sympathetic nervous system of the heart and vascular bed, increasing heart rate, cardiac output, and systemic vascular resistance. They also inhibit the parasympathetic nervous system's influence on the heart, which results in an increased heart rate. Aortic and carotid baroreceptors are activated by a decrease in blood pressure, but the results are not the normalization of blood pressure, but rather an increase in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure.

The shift to anaerobic metabolism in shock results in a. metabolic alkalosis. b. decreased oxygen utilization. c. increased lactate production. d. decreased hydrogen ion production.

c. increased lactate production. When the citric acid cycle is inhibited, pyruvate accumulates in the cytoplasm. Pyruvate accumulation would quickly inhibit further glycolysis and shut down ATP production entirely except that it can be converted to a substance called lactate, which diffuses from the cell and into the extracellular fluid. A shift to anaerobic metabolism in shock does not result in metabolic alkalosis, decreased oxygen utilization, or decreased hydrogen ion production.

Early compensation for hypovolemic shock includes a. decreased heart rate. b. decreased systemic vascular resistance. c. release of epinephrine from adrenal glands. d. shunting of blood from the brain to the extremities.

c. release of epinephrine from adrenal glands. In the early stage of shock, the adrenal medulla is stimulated to release increased amounts of the catecholamines epinephrine and norepinephrine (NE), which circulate to the heart and stimulate β-1 receptors, thus increasing cardiac output. Heart rate initially increases. Systemic vascular resistance is not decreased in early hypovolemic shock. Blood is shunted to the brain in cases of shock.

Atherosclerosis predisposes to a number of processes that are factors in myocardial ischemia. These processes include a. hemorrhage. b. coronary dilation. c. thrombus formation. d. ventricular dysrhythmia.

c. thrombus formation. Atherosclerotic plaques with large lipid cores are fragile and prone to rupture. Rupture of a plaque exposes subendothelial proteins and initiates platelet aggregation and thrombus formation. Hemorrhage can lead to hemorrhagic shock, but death is not directly related to either atherosclerosis or myocardial ischemia, but rather hypovolemia. Coronary dilation would not hinder blood flow which is a cause of myocardial ischemia. Ventricular dysrhythmia affects cardiac conduction and function, but these dysfunctions are not related to atherosclerosis or myocardial ischemia.

Which receptor is responsible for innervation of the arterioles? a. β-1 b. β-2 c. α-1 d. α-2

c. α-1 α-1 receptors are responsive to stimulation by the autonomic nervous system. Stimulation of the α-1 receptor causes vasoconstriction and increased systemic vascular resistance. Renin release is increased when neurotransmitters released by the sympathetic nervous system bind to β1 receptors in the kidney. β-adrenergic agonists, also known as β2-adrenergic receptor agonists, are a class of drugs used to treat asthma and other pulmonary disease states. α2-adrenergic receptors mediate part of the diverse biological effects of the endogenous catecholamines epinephrine and norepinephrine

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

cardiogenic

The renin-angiotensin system (RAS) alters blood pressure in response to a. decreased flow to the brain. b. decreased perfusion to the liver. c. decreased perfusion to the lungs. d. decreased perfusion to the kidney.

d. decreased perfusion to the kidney. When blood flow is restricted to the kidney by low blood volume, low cardiac output, or stricture of the renal artery, the kidney secretes more renin into the bloodstream, which in turn changes angiotensinogen to angiotensin I. Angiotensin-converting enzyme (ACE) then changes angiotensin I to a potent vasoconstrictor, angiotensin II. Angiotensin II then increases vascular constriction, systemic vascular resistance, and blood pressure. The renin-angiotensin system (RAS) is not associated with the brain, liver, or lungs.

In a patient with mitral stenosis, cardiac catheterization findings would indicate increased pressure in the a. right ventricle b. left ventricle c. right atria d. left atria

d. left atria In mitral valve stenosis, left atrial pressure remains higher than ventricular pressure throughout diastole. Mitral valve stenosis is not characterized by increased pressure in the right ventricle, left ventricle, or right atria.

Cardiac output is the product of both a. mean arterial pressure (MAP) and systemic vascular resistance (SVR). b. systemic vascular resistance (SVR) and pulse pressure. c. pulse pressure and mean arterial pressure (MAP). d. stroke volume and heart rate.

d. stroke volume and heart rate. The product of stroke volume and heart rate provides the amount of cardiac output. None of the other options (MAP, SVR, or pulse pressure) are factors in cardiac output.

The vasoactive mediators released in septic shock contribute to increase a. systemic vascular resistance. b. destruction of microemboli. c. systemic vasoconstriction. d. vascular permeability.

d. vascular permeability. The kinin system is activated and bradykinin is released, which results in vasodilation and increased capillary permeability. Histamine also increases capillary permeability, which enhances edema formation. Systemic vascular resistance is decreased in septic shock. The complement system is activated with release of C5a and C3a, which can produce microemboli and endothelial cell destruction. The coagulation system is activated and may enhance the development of microemboli. Histamine, a potent vasodilator, is released by mast cells.

The primary cause of sudden cardiac death is usually because of a. heart failure. b. cardiomyopathy. c. atherosclerotic plaques. d. ventricular dysrhythmia.

d. ventricular dysrhythmia. Lethal dysrhythmia as ventricular fibrillation is usually the primary cause of sudden cardiac death. While heart failure, cardiomyopathy, and atherosclerosis are serious cardiac conditions they are not the primary causes of sudden cardiac death.

What is the marker of choice for detecting a myocardial infarction? a. Elevated T waves on an ECG b. Elevated serum levels of C-MB c. Elevated serum levels of cardiac myoglobin d.Elevated serum levels of cardiac troponin

d.Elevated serum levels of cardiac troponin Two proteins that make up part of the cardiac cell contractile apparatus, troponins I and T, have become the markers of choice for detecting MI. Cardiac troponin levels become elevated in serum at about the same time as CK-MB, but they remain elevated for a longer period. ST-segment elevation is thought to represent acute cell injury and ischemia. An elevated level of serum CK-MB is a highly specific indicator of MI and considered to be diagnostic. However, CK-MB remains elevated for only 48 to 72 hours after MI. Cardiac myoglobin levels are elevated in serum very quickly after MI and may be helpful in early detection; however, cardiac myoglobin is less specific than the other markers.

A loud pansystolic murmur that radiates to the axilla is most likely a result of

mitral regurgitation.

Aortic regurgitation is associated with

diastolic murmur.

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

digitalis

Abnormal vascular regulation by endothelial cells in small vessels of the heart contributes to a. hypertension. b. dysrhythmias. c. truncus arteriosus. e. ischemic heart disease.

e. ischemic heart disease. Endothelial cells are important regulators of vascular tone. They secrete variable amounts of constricting and relaxing factors to control tissue perfusion. Hypertension is a result of a variety of factors not all related to vascular tone. Dysrhythmias would affect conduction and the function of the heart chambers but not vascular tone. Truncus arteriosus results in only one large artery leaving the heart.

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

elderly woman without a previous history of MI.

A patient presents to the emergency department with a diastolic blood pressure of 132 mm Hg, retinopathy, and symptoms of an ischemic stroke. This symptomology is likely the result of

hypertensive crisis.

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

lengthening PR intervals and dropped P wave.

Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of

nitric oxide.

The prevalence of high blood pressure is higher in

non-Hispanic black adults.

Hypertension is closely linked to

obstructive sleep apnea.

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

paroxysmal nocturnal dyspnea.

An erroneously low blood pressure measurement may be caused by

positioning the arm above the heart level.

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

premature ventricular complexes.

First-degree heart block is characterized by

prolonged PR interval.

Left-sided heart failure is characterized by

pulmonary congestion

Cardiogenic shock is characterized by

reduced cardiac output

The common denominator in all forms of heart failure is

reduced cardiac output.

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells.

renin

Cor pulmonale refers to

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

right-sided heart failure.

Atherosclerotic plaques with large lipid cores are prone to

rupture.

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

septic In the progressive stage of septic shock, some patients deteriorate to a hypodynamic state. This is characterized by decreased cardiac output and cold, clammy skin as a result of narrowed pulse pressure. Profound hypotension generally occurs which is unresponsive to treatment. Cardiogenic shock is evidenced by decreased cardiac output, elevated left ventricular end-diastolic pressure, S 3 heart sounds, and pulmonary edema. Hypotension occurs with hypovolemic shock, but extremities are not likely to be cold and edematous. Cold edematous extremities along with low cardiac output and profound hypotension are not manifestations of obstructive shock.

A patient with a history of myocardial infarction continues to complain of intermittent chest pain brought on by exertion and relieved by rest. The likely cause of this pain is

stable angina.

A patient with significant aortic stenosis is likely to experience

syncope

Improvement in a patient with septic shock is indicated by an increase in

systemic vascular resistance.

The effect of nitric oxide on systemic arterioles is

vasodilation.

An example of an acyanotic heart defect is

ventricular septal defect