Davis Advantage Exam 3

Many medications are available to treat hypertension. Which of the following are you likely to discuss with Mr. Benson?

ACE inhibitors Diurectics Calcium channel blocker Corticosteroids may increase blood pressure, not decrease it. ACE inhibitors block the activation of angiotensin II which reduces vasoconstriction and blood pressure. Diurectics reduce blood volume and thus blood pressure. Calcium channel blockers also reduce vasoconstriction and blood pressure.

A client with known mitral stenosis presents with left-sided weakness and slurred speech. What would a nurse suspect as the cause of the client's clinical presentation? An embolic stroke Diminished coronary artery blood flow Diminished blood volume in the pulmonary artery Congestion of the pulmonary veins Pulmonary hypertension

An embolic stroke

What condition refers to a weakened, bulging arterial wall?

Aneurysm

Which of the following is an immediate, life-threatening condition? Peripheral artery disease Aortic dissection Atherosclerosis Arterial plaque formation Arterial dilation

Aortic Dissection

Left ventricular hypertrophy may develop in response to _______________. pulmonic valve stenosis. aortic valve insufficiency. aortic valve stenosis. tricuspid valve insufficiency. tricuspid valve stenosis.

Aortic valve stenosis

Which of the following are systolic murmurs? Select all that apply. Mitral valve stenosis Aortic valve stenosis Tricuspid valve insufficiency Mitral valve insufficiency Pulmonic valve stenosis

Aortic valve stenosis Tricuspid valve insufficiency Mitral valve insufficiency Pulmonic valve stenosis

What basic physiological change underlies most cardiovascular disease?

Atherosclerosis

Ankylosing spondylitis

Autoimmune disorder Fusion of vertebral bodies Spine and sacroiliac joint affected Systemic rheumatic disease HLA B-27 Ankylosing spondylitis is an autoimmune disorder. Those who test positive for HLA B-27 are at increased risk for developing ankylosing spondylitis. The disease normally presents with pain in the sacroiliac area. As the disease progressions, spinal fusion may occur.

Polymyalgia arthritis

Autoimmune disorder Pain worse in morning Shoulder affected first, also cervical neck, pelvic girdle Abrupt onset, bilateral joint pain The hallmark of polymyalgia arthritis is the abrupt onset of bilateral joint pain, including the shoulders and pelvic girdle. Normally, the pain is the worst in the morning and lessens throughout the day. Polymyalgia arthritis is considered an autoimmune disorder.

Atherosclerosis

Basic physiological change that results in cardiovascular disease Foam cell formation C-reactive protein and homocysteine levels are used for assessment Atherosclerosis is a form of arteriosclerosis in which the lumen of arterial wall becomes occluded with plaques. The plaques are formed from cholesterol and white blood cells forming foam cells. Although white blood cells are involved, formation of the plaques is not due to an autoimmune response. Elevated C-reactive protein (an inflammation marker) and homocysteine levels have been associated with atherosclerosis.

Aortic Dissection

Blood pressure differential between right and left arm Sudden onset of symptoms including chest pain and tearing sound Surgical repair required 33% of patients die within first 24 hours Aortic dissection is a life-threatening condition in which a tear in the inner layer of the aortic wall appears. Blood pours into the tear, separating (dissecting) the inner layer from the middle layer. If the tear ruptures, death may result. Almost one-third of patients with aortic dissection die within the first 24 hours. Surgical repair of the tear is needed. Signs and symptoms include a sudden onset of severe chest pain. Depending on the location of the dissection, blood flow to either arm may be compromised, resulting in a difference in pressure between the arms.

Mycobacterium tuberculosis

Bone biopsy for diagnosis PPD test may be negative Pott's disease EPTB EPTB stands for extrapulmonary tuberculosis, which occurs when Mycobacterium tuberculosis infects tissues other than the lungs. Most commonly, the vertebrae of the spine are affected and this is known as Pott's disease. Bone biopsy helps diagnose the condition. The PPD test is used to exposure to tuberculosis. In extrapulmonary tuberculosis, PPD tests may be negative.

A child is recently diagnosed with rickets. What characteristics would you expect to observe?

Bow-shaped femurs Delayed tooth development

A patient's test results reveal a significant occlusion of a coronary artery, and bypass surgery is immediately scheduled. What is another term or acronym for bypass surgery?

CABG

Having fallen from her swing set, Julie, age 7, suffered the most common of all childhood fractures. What type of fracture did Julie experience?

Clavicle Fracture The clavicle is the most common bone to be fractured in children. Often, this results from some type of impact to the shoulder area, which is transmitted to the clavicle bone. Vertebral compression fractures appear, normally, in elderly individuals, the result of osteoporotic damage to the vertebrae.

complains that every time she walks up the stairs, her joints "pop" and "click."

Crepitus Crepitus refers to the sound made when joints "click." Bursitis is inflammation of the bursae, fluid-filled sacs located in some joints.

Lack of vitamin ______ may result in decreased bone mineralization.

D

Kevin, age 56 years, presents with severe back pain that worsens whenever he has to stoop or bend over. He states he even had to have his wife tie his shoes for him the other day. He reports the sensation of "pins and needles" along his left leg. On one occasion, he was particularly concerned as his lower leg and foot went numb. What disorder does Kevin have?

Degenerative Disk Disease Back pain accompanied by numbness and alterations in sensation may indicate disruption of spinal nerve conduction. As intervertebral discs become worn down with age and trauma, degenerative disc disease manifests. As these discs degenerate, the spine may become misaligned, and impingement of spinal nerves may occur, causing sensory and motor function problems.

In relation to the S1 and S2 heart sounds, which of the following are true? Select all that apply. Systole occurs immediately prior to S1. Diastole occurs between S2 and S1. S2 marks the end of systole. Systole occurs between S1 and S2. S1 marks the end of diastole.

Diastole occurs between S2 and S1. S2 marks the end of systole. Systole occurs between S1 and S2. S1 marks the end of diastole.

Septic arthritis

Direct invasion of joint space Single erythematous, edematous joint Nongonococcal and Gonococcal forms Also known as infectious arthritis Septic arthritis is also known as infectious arthritis. In this situation, infectious agents directly invade the joint space. A range of organisms may cause septic arthritis, although gonococcal septic arthritis presents with different signs and symptoms. As the infection occurs in the joint space, the appearance of redness and inflammation is not systemic, but rather limited to the infected joint.

Which of the following signs are associated with Lyme disease? Fusion of vertebrae Pain in big toe Erythema migrans Difficulty swallowing Reduced joint pain

Erythema migrans

Which of the following are risk factors for hypertension? Select all that apply.

Excess sodium in diet Obesity African American ethnicity Family history 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.

Many medications are used to treat hyperlipidemia. Which of the following statements is true?

Fibrates treat high triglyceride levels. Fibrates are used as first-line treatment for elevated triglyceride concentrations. The rest of the above statements are not true. Statins work by reducing cholesterol synthesis by the liver and they have been shown to reduce existing atherosclerotic plaques. Hyperlipidemia medications are commonly used in combination.

Dermatomyositis

Gradual muscle weakness Inflammatory myopathy Linked to underlying malignancies Purple-red rash on eyelids and chest A purple-red rash on the eyelids and the chest are some of the key signs of dermatomyositis. Dermatomyositis, as the name implies, is an inflammatory myopathy, linked to underlying malignancies. Patients often complain of gradual, progressive muscle soreness.

The "good" cholesterol, thought to provide a cardioprotective effect, is known as____________.

HDL

For cardiac health, which of the following should be elevated?

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 the following tissues are most likely to be damaged by hypertension?

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.

Osteomyelitis

IV antibiotic treatment Hematogenous or contiguous forms Infection of bone tissue S. aureus Osteomyelitis is infection of the bone. It may be hematogenous, spreading to the bone from the blood, or contiguous, spreading from nearby tissue. Although several organisms may cause osteomyelitis, Staphylococcus aureus is the most common cause. In order to have adequate of antimicrobial tissues penetrate the bone tissue, IV antibiotics are often used.

Vasculitis

Immune complexes deposited in arterial walls Takayasu arteritis is an example Associated with autoimmune process Vasculitis is inflammation of the vessels, and both arteries and veins may be involved. The disease may be systemic or affect one area or tissue of the body. Several forms of vasculitis exist, and an autoimmune component, with immune complexes deposited in the arterial walls, has been found to play a role. Signs and symptoms of vasculitis vary, depending on the tissues involved. Takayasu arteritis is one example of vasculitis; it affects the aorta and pulmonary arteries.

Peripheral Arterial Disease (PAD)

Intermittent claudication Decreased peripheral pulses Ankle-brachial index used for assessment Peripheral artery disease results in decreased blood flow to the extremities. Most commonly, the arteries of the legs are affected. Depending on the extent of the blockage, peripheral pulses may be diminished. The ankle-brachial index (ABI) compares the blood pressure in the ankles with the blood pressure in the arms and may be reduced with peripheral arterial disease in the lower extremities. When blood flow through the narrowed arteries cannot match the metabolic demands of the tissues, intermittent claudication results.

Which of the following conditions may appear with tricuspid valve stenosis? Decreased blood pressure Jugular vein distension Pulmonary hypertension Pulmonary edema Flushed appearance

Jugular vein distension

Which of the following lifestyle modifications would you recommend to reduce Ms. West's hyperlipidemia?

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 are shown to have a favorable effect on cholesterol levels. Trans-fatty acids have been shown to increase LDL cholesterol.

The results return with the following values: Total cholesterol: 238 mg/dL LDL cholesterol: 160 mg/dL HDL cholesterol: 35 mg/dL Triglycerides: 210 mg/dL Which of these values are considered high?

LDL and Triglycerides High LDL is 160 to 189 mg/dL and high triglycerides is 200 to 499 mg/dL. Total cholesterol is borderline high (200 to 239 mg/dL) and HDL is low.

What molecule contributes to the formation of atherosclerotic plaque?

LDL cholesterol

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. High levels of LDL cholesterol and low levels of HDL cholesterol increase risk for cardiovascular disease. 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 assessment results may be associated with hypertensive damage of body tissues?

Left ventricular hypertrophy Microalbuminuria Cerebral aneurysm Arteriovenous nicking in retina 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 aneurysm.

Disc degeneration most commonly occurs in the _____________ areas.

Lumbar and Cervical

Which of the following conditions would make it difficult for blood to move from the left atria into the left ventricle? Mitral valve stenosis Tricuspid valve stenosis Aortic stenosis Mitral valve insufficiency Tricuspid valve insufficiency

Mitral valve stenosis

Polymyositis

Muscle proteins misidentified as antigens Linked to autoimmune disorders Symmetric, gradual muscle weakness Inflammation of multiple muscle groups Polymyositis involves inflammation of the muscles, resulting in muscle weakness. This inflammation is thought to result from an immune response brought on by the misidentification of muscle proteins as antigens. An autoimmune component appears to play a role in the development of this disease.

_______________causes the wearing down of joint cartilage.

Osteoarthritis

Debbie works as an administrative assistant. Debbie is overweight and leads a sedentary lifestyle. She recently turned 50 and presents with a primary complaint of joint pain, especially in the morning, and her joints "snap" and "pop." She states the pain makes her not want to get out of bed. At work, her hands often hurt while typing. Examination of her hands reveals the presence of Heberden's nodes. What disorder does Debbie have?

Osteoarthritis Osteoarthritis is degeneration of the joints resulting in pain and stiffness, especially in the morning. Previous trauma of the joint is frequently a precipitating factor. Crepitus, or joint "clicking," is also a very common sign. Heberden's nodes develop in the distal interphalangeal joint in osteoarthritis of the fingers.

Bill, age 66 years, lives in northern Minnesota. Because he has had two basal cell carcinomas, Bill is now a self-described "sunscreen addict." He avoids being out in the sun at all costs. He states that he does not take any vitamin or mineral supplements. His diet consists primarily of "snacking" as he lives alone and does not like to cook. He avoids dairy products as they upset his stomach. Bill complains that he has been feeling tired and weak lately and his back hurts whenever he does anything. What disorder does Bill have?

Osteomalacia Living in a northern climate and robust use of sunscreen may put an individual at risk for low vitamin D levels, as vitamin D is formed by ultraviolet light striking the skin. In this case, lack of vitamin D intake may also be present, because no vitamin or mineral supplement usage is reported, and dairy products are avoided. Lack of vitamin D and calcium in adulthood can cause the disease of osteomalacia.

Violet is a 62-year-old Caucasian woman of petite stature. She recently fell while stepping off a curb on an icy morning. She suffered a transverse fracture of her right, distal radius. Height and weight measurements show that Violet has lost a half an inch in height over recent years. Her posture shows slight kyphosis. Violet informs you that, prior to her fall, she had volunteered at the community health fair and received a complimentary bone mineral density test. She was confused about her score, which was a T score of -2.8. She said they recommended she make an appointment with her physician. What disorder does Violet have?

Osteoporosis A bone mineral density T score of -2.8 indicates osteoporosis. T scores are based on standard deviations from a normalized reference population. A distal radius fracture in an elderly individual may indicate weakened bones. A loss of height in an individual accompanied by developing kyphosis may indicate compression fractures of the vertebrae, common in osteoporosis.

Kevin injured his hip when he began running longer distances. As his hip hurt every time he took a step, Kevin went to see his physician, who suggested Kevin work with a physical therapist. While at physical therapy, the physical therapist had Kevin relax his leg, while the physical therapist manipulated the leg to determine the range of motion. What type of range of motion was being tested?

Passive Passive range of motion is assessed while the patient relaxes and the examiner moves the joint. In active range of motion testing, the patient contracts the muscles and moves the joint without assistance.

An outpatient in the clinic complains of leg pain while walking. However, the patient adds that the pain ceases when he is at rest. Which condition would the nurse suspect?

Peripheral arterial disease

Every time Leslie stepped out of bed in the morning, she would sense pain in both feet. The bottoms of her feet were particularly painful on the mornings following days in which she had been standing on her feet a great deal. Once Leslie began moving, her feet seemed to relax, and she was able to walk more easily. What condition is Leslie suffering from?

Plantar fasciitis Plantar fasciitis is a condition in which the plantar fascia, located at the base of the foot, becomes inflamed. Soreness when walking is common, especially in the morning. Calcaneal spur refers to a heel spur.

Infection with Mycobacterium tuberculosis may lead to the development of _____________.

Pott's disease

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?

Prehypertension Normal BP = < 120/80 mm Hg Prehypertension = 120-139/80-89 mm Hg Stage 1 HTN = 140-159/90-99 mm Hg Stage 2 HTN = > 160/>100 mm Hg

If a patient presents with hypertension and no known cause exists, what type of hypertension does the patient have?

Primary

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?

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.

Gout

Restrict alcohol and meat in diet Hyperuricemia Podagra Joint aspiration, urate crystals Gout is due to uric acid crystal deposition in the joints. High levels of uric acid in the blood, hyperuricemia, are often noted. One of the key features of some forms of gout is podagra, intense pain in the big toe due to uric acid crystallization in the joint.

Unusual X-rays of a 14-month old infant reveal bowed femurs and tibias. Costochondral swelling and asymmetry of the thoracic cage are also noted. Blood laboratory reports reveal hypocalcemia, elevated PTH, and decreased vitamin D. What condition do you suspect?

Rickets Rickets is a condition of weakened bones due to lack of vitamin D and/or calcium. Rickets appears in children, especially young children. A pronounced bow-legged appearance is a hallmark of the disease, as well as a deformed thoracic cage.

While pitching for his college team, Randy suffered injury to his subscapularis. Which type of injury does Randy have?

Rotator cuff injury The rotator cuff is a group of four muscles (teres minor, subscapularis, supraspinatus, infraspinatus) that enable rotation of the shoulder. Movements, such as pitching in baseball, place extensive strain on these muscles and may cause rotator cuff injury.

Lori seeks medical attention for "shooting" pain down her left leg. The pain is very sharp and can happen at any time. What condition is Lori suffering from?

Sciatica Sciatica develops when the sciatic nerve, which is the largest nerve in the body, is damaged or injured. The sciatic nerve travels down the back of each leg. Impingement or damage of the nerve can cause severe pain in the leg. Cervical strain is often referred to as whiplash and occurs in the neck area.

While learning to snowboard, she falls. She tries to catch herself by placing her hands on the ground. The impact is too great for the wrist, and anterior displacement of her radius occurs. What type of fracture?

Smith Fracture A Smith fracture is anterior displacement of the radius, while a Colles fracture is posterior displacement.

suffers a severe ankle sprain that will likely sideline him for several games. What tissues are injured in a sprain?

Sprains are ligamentous damage

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?

Stage 1 HTN Normal BP < 120/80 mm Hg Prehypertension = 120-139/80-89 mm Hg Stage 1 HTN = 140-159/90-99 mm Hg Stage 2 HTN = > 160/>100 mm Hg

A patient has blood pressure readings of 142/92 mm Hg and 140/94 mm Hg. Which hypertension category would apply to this patient?

Stage 1 hypertension

Which of the following medications work to lower cholesterol?

Statins Bile acid sequestrants

Small bone fractures that develop in response to repetitive, cumulative trauma are known as __________ fractures.

Stress

Sara has been training for her first marathon. She has begun running more frequently and for greater distances. She feels she needs to cut back her training, though, as she had developed a sharp pain in her foot. Every time her foot strikes the pavement while running, the pain appears in the same location. What may be causing Sara's pain?

Stress Fracture A stress fracture develops from repetitive microdamage. In Sara's case, her increase in training likely stimulated damage to her bones. Malunion is when a bone heals in an unacceptable position.

Psoriatic arthritis

Swelling over joints with distinct skin and nail changes Linked to psoriasis Autoimmune disorder Five patterns or forms Psoriatic arthritis, as the name indicates, is linked to the autoimmune skin disorder, psoriasis. In psoriatic arthritis, joint swelling accompanies skin changes.

Lyme disease

Transmitted by ticks Myalgias and arthralgias "Bull's eye" rash Borrelia burgdefori Lyme disease is the result of infection with the bacterium, Borrelia burgdefori. Transmission of the bacterium occurs through a tick bite. Frequently, a "bull's eye" rash appears around the area of the infectious bite. Severe myalgias and arthralgias are common complaints. Left untreated, Lyme disease may progress to neurological and cardiovascular problems.

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 she have?

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.

Cole was skiing a route that was beyond his capabilities. As he lost control of his skis, Cole crashed into a tree, resulting in a compound fracture of his right femur. What type of femoral shaft fracture did Cole experience?

Type III Femoral Shaft Fracture A type I femoral shaft fracture is a spiral or transverse fracture. In a type III femoral shaft fracture, an open, or compound, fracture occurs.

Gout pain is due to ______________ crystal deposits in the joints.

Urate

Which of the following is a potential complication of hypertension?

Ventricular Hypertrophy

Aneurysm

Weak arterial wall resulting in bulging of the artery Abdominal aorta most commonly affected Fusiform and saccular shapes An aneurysm is a bulge in an arterial wall. The most common location for an aneurysm is the abdominal aorta. An aneurysm may present in different forms including fusiform and saccular. Surgical repair is not always necessary with an aneurysm, and death does not occur at a high rate within the first 24 hours of development. Takayasu arteritis is a form of vasculitis, and is not a type of aneurysm.

In addition to the laboratory values, a physical examination of Ms. West is conducted. Which of the following are associated with hyperlipidemia?

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

Fusion of the vertebrae and inflammation of the ligaments of the spine and sacroiliac joint are associated with ________________.

ankylosing spondylitis

He is complaining of fatigue that worsens when he tries to exercise. He complains that he "can't catch his breath." He also tells you that he has to sleep with several pillows in order to make his breathing easier. He has a history of rheumatic fever. The health care provider orders laboratory work, an ECG, and echocardiogram. Findings include left ventricle dilatation and left ventricular impulse displacement. Auscultation reveals a murmur in the third intercostal space, pronounced during diastole with diastolic thrill.

aortic insufficiency Rheumatic fever can damage the aortic valve. Left ventricle dilatation indicates excess fluid in the left ventricle. John's murmur occurs during diastole when the heart is trying to fill. The aortic valve should be closed, but blood is leaking through it during diastole. As blood flows backwards into the left ventricle, because of improper closure of the aortic valve, perfusion of the tissues is compromised, especially during activity. John has aortic insufficiency.

He comes to the emergency department complaining of dyspnea, chest pain, and syncope upon exertion. States that he is getting worried because his condition seems to be worsening. 72 years old and has a history of cardiac issues. In addition to blood laboratory work and an ECG, the physician orders an echocardiogram. Echocardiogram results reveal left ventricular enlargement and left ventricular hypertrophy. Auscultation reveals a systolic murmur with an opening snap that ends at S2.

aortic stenosis William's age (above 65 years) and history of cardiac problems are consistent with aortic valve stenosis. The systolic murmur indicates a problem with contraction and ejection of blood (blood cannot exit the left ventricle due to resistance of the aortic valve). The echocardiogram shows left ventricular involvement.

Gerald, 62 years of age, has suffered from pain and neuropathy from degenerative disc disease in the lumbar/sacral area for the past 8 years. He has treated his condition with over-the-counter anti-inflammatories, stretching, and occasional chiropractic appointments. His history shows worsening symptoms over the years. Gerald had been considering surgery to see if that may relieve his pain. Today, however, his wife has called the clinic very upset as Gerald has lost bladder and bowel function, and sensation in his leg. Hearing this, you know Gerald's condition is now a medical emergency. What condition is consistent with Gerald's signs and symptoms?

cauda equina syndrome The cauda equine (horse's tail) is located at the base of the spinal cord. The nerve fibers innervate the sphincters for urination and defecation. They also innervate the perineum and are involved in sexual function. Stenosis and degeneration of this area of the spine may impinge upon these nerves to such an extent that bladder and bowel function are lost. When this occurs, it is a medical emergency.

The S1 heart sound is due to ________________. blood rushing into the atria opening of the atrioventricular valves. opening of the semi-lunar valves. ventricular ejection. closure of the atrioventricular valves.

closure of the atrioventricular valves.

Which type of fracture is common in the vertebrae?

compression

Samuel has undergone a thallium stress test during which a nuclear scan was performed. When he steps off the treadmill, he becomes lightheaded and loses consciousness briefly. Based on this episode and his test results, the physician feels Samuel needs immediate surgical intervention for his blocked arteries.

coronary artery bypass graft Coronary artery bypass graft, or CABG, is a form of treatment used to "get around", or bypass, blocked coronary arteries. Atherosclerotic plaques are usually the cause of this obstruction. In the CABG procedure, a portion of a vein or artery from another part of the body is attached to the blocked coronary arteries in such a way to divert, or detour, blood flow around the blockage. This restores blood flow to the affected areas. CABG may be performed on several vessels, and may be referred to as a "double", "triple", or "quadruple" bypass depending on the number of vessels involved.

A mitral murmur is best heard at the ___________________. base of the heart first intercostal space third intercostal space sternal border fifth intercostal space (apex)

fifth intercostal space (apex)

Infection which spreads from the bloodstream to the musculoskeletal system is known as _____________.

hematogenous

Stable angina _____________________.

is consistent, chronic chest pain.

Factors that influence the amount of damage an MI causes include _____________. Select all that apply.

location duration collateral circulation

The grade of a murmur refers to its _______________. pitch loudness shape timing severity

loudness

After experiencing a recent myocardial infarction, a 62-year-old retail supervisor, has done little to improve his cardiac health. He feels he is doing "worse" and "on his way to another heart attack." He presents with the primary complaint of angina. When asked about any other changes, He reports he struggles to breathe at night even while "just sleeping." Auscultation reveals a holosystolic murmur and S3 sound. Further evaluation with echocardiography confirms an enlarged left atrium.

mitral insufficiency Problems breathing may indicate left-side heart problems. Holosystolic murmur (abnormal sound during contraction) combined with left atrial enlargement indicates back flow into the left atrium. The myocardial infarction that Hank experienced may have damaged the tissues surrounding the mitral valve, preventing proper closure of the valve. Hank has mitral insufficiency.

Person has a history of rheumatic fever. She is currently on anticoagulant therapy and beta blockers for her valve disorder. Auscultation over the apex revealed a murmur, present during diastole and appearing with an opening snap. Has begun to complain of dyspnea on exertion and extreme fatigue whenever she tries "to do anything."

mitral stenosis Helen's history of rheumatic fever is a major risk factor for valvular disorders. The diastolic murmur over the apex indicates mitral valve involvement. The murmur reflects blood flow from the left atrium to the left ventricle during diastole. Helen's dyspnea and fatigue are likely to related to left-side back-up of blood into lungs. Assessment findings and signs and symptoms indicate Helen has mitral stenosis.

On a routine physical examination, a systolic murmur with a midsystolic "click" was heard. She has no other apparent signs or symptoms of her disorder. The cause of her underlying issue is myxomatous degeneration of the mitral valve due to unknown reasons. At this point, no treatment is needed for the disorder.

mitral valve prolapse Mitral valve prolapse (MVP) is more common in women and can be present with no signs or symptoms. MVP allows blood to regurgitate from the left ventricle into the left atrium, thus creating a systolic murmur (occurring during contraction of the left ventricle).

Antonia is a 63-year old lawyer with the district attorney's office. She mentions she occasionally gets a crushing pain in her chest that radiates to her neck and jaw that usually last about 5 to 10 seconds. The doctor suspects stable angina.

nitrates Nitrates, also known as "nitroglycerin", are potent vasodilators. Chest pain, such as Antonia is experiencing, often manifests as a result of poor blood flow through coronary vessels. When blood flow to tissues is reduced, anaerobic metabolism and the subsequent formation of lactic acid occurs, which results in the sensation of pain. By dilating the vessels, nitrates serve to increase blood flow to affected areas, relieving chest pain.

Angina may be relieved by ______________, which vasodilate(s) coronary arteries.

nitroglycerin tablets

Marcus thinks he has the flu, but after his physical examination and diagnostic tests the doctor suspects Marcus has myocarditis. He is given activity restrictions as well as nitrates, beta blockers, and corticosteroids. He is told if his condition is not improving at his follow-up appointment, he may need additional intervention.

pacemaker Inflammation of the myocardium, or middle layer of the heart wall, is known as myocarditis. The heart muscle cells or the electrical conduction system of the heart may be affected. Myocarditis may present with chest pain, fatigue, light-headedness, and fever. Such symptoms may account for Marcus's belief that he has the flu. When the heart is inflamed, additional stressors on the heart, such as exercise should be avoided. Beta blockers and nitrates are prescribed to increase heart functioning, while corticosteroids are used to reduce inflammation. Disruption of the electrical conduction system may require the insertion of a pacemaker to stabilize the heart rhythm.

Vivienne's tests are showing that she has endocarditis. She has a history of heart issues and had surgery years ago to have prosthetic heart valves inserted. She is told that surgery to remove the valves may be needed, but she will first be given a 6-week round of medication.

parenteral antibiotics Endocarditis is inflammation of the endocardium, or inner lining of the heart. The inflammation is usually due to some type of infection, and frequently, as we see in Vivienne's case, involves the heart valves. Prosthetic heart valves can be particularly susceptible to colonization by infectious agents, such as Staphylococcus and Streptococcus bacterium. The fact that Vivienne's treatment involves antibiotic therapy indicates the presence of a bacterial infection. The valves receive a limited blood supply, which makes delivery of medications to the area of infection difficult; parenteral delivery of antibiotics is used.

Phillip is undergoing surgery for unstable angina. The surgeons are inserting a catheter with a balloon tip through the femoral artery of Phillip's leg. The catheter will be threaded up the aorta into the obstructed coronary artery. At the point of obstruction, the balloon is inflated and pushes the plaque content against the walls of the artery.

percutaneous transluminal coronary angioplasty Percutaneous transluminal coronary angioplasty (PCTA) is a procedure used to open blocked coronary arteries. PCTA can be used to treat unstable angina and multi-vessel coronary artery disease. The purpose of PCTA is to expand the lumen of a vessel blocked by some type of obstruction, such as an atherosclerotic plaque. Atherosclerotic plaques are initially formed from endothelial injury resulting in the formation of foam cells, which transform into plaques lining the inner wall of the artery. They can become so large that they obstruct blood flow to tissues. Inflating a balloon catheter near the atherosclerotic plaque pushes the plaque to the side of the vessel wall, reestablishing adequate blood flow through the vessel.

Which of the following groups may be at risk for osteoporosis? Postmenopausal women Teenage males Teenage females Women of reproductive age Infants

postmenopausal women

A 62-year-old patient with pulmonary hypertension is a current patient. She appears to be doing well. Does not have jugular vein distention, ascites, or ankle edema. Upon auscultation, you detect a Graham Steel murmur following S2. The murmur is detected in the second intercostal space, left sternal border and is high-pitched and blowing.

pulmonic insufficiency Pulmonary hypertension is the most common cause of pulmonic insufficiency. Graham Steell murmurs are heard with pulmonic valve insufficiency. The pulmonary valve does not close completely, causing regurgitation of blood back into the right ventricle during diastole.

Examination reveals that he has a murmur in the second intercostal space. The murmur occurs during systole, with a late S2, and has a crescendo-decrescendo sound. The physician explains that if his disorder becomes severe, he may develop JVD, ascites, and hepatosplenomegaly.

pulmonic stenosis Fred's heart murmur occurs during systole, indicating ejection of blood from the ventricles. Detection of the murmur in the second intercostal space reveals involvement of the pulmonary valve. A delayed S2 indicates slow opening and closing of the valve. Potential complications of JVC and ascites may develop if the stenosis of the valve worsens, preventing ejection of blood from the right ventricle and the backing up of blood into the jugular veins and abdomen. Fred has pulmonic stensois.

Systemic edema and jugular vein distention may result from ______________. Select all that apply. aortic valve stenosis pulmonic valve stenosis mitral valve insufficiency tricuspid valve insufficiency mitral valve stenosis

pulmonic valve stenosis tricuspid valve insufficiency

Rotator cuff injuries affect the ____.

shoulder

The most common location for joint dislocation is the ___.

shoulder

Strains are small tears in a muscle or __________, whereas sprains are injuries to the _______.

tendons, ligament

A patient is diagnosed with a STEMI in the emergency room. This means ______________.

the patient is experiencing complete occlusion of a coronary artery.

A heart rhythm disturbance is the reason she appeared at the clinic today. She is very worried as she is having "another heart attack." Her heart "races and races sometimes." She has a history of myocardial infarction of the right ventricle. She has completed cardiac rehabilitation, and she states that up until this time she has been fine. An echocardiogram reveals right atrial dilatation. ECG results show that her sense of a "racing" heart is likely due to atrial fibrillation. She also tells you that she has experienced swelling in her abdomen and ankles recently.

tricuspid insufficiency An MI in the right ventricle may damage the papillary muscles preventing the tricuspid valve from closing properly. This results in backflow of fluid from the right ventricle into the right atrium, causing right atrium dilatation. The stretch on the right atrium increases the risk for rhythm disturbances. You suspect Maryann has tricuspid insufficiency

He recently suffered a bout of infectious endocarditis. He is particularly at risk for this disease, because he is an intravenous drug user. Despite much work on rehabilitation, he continued to use intravenous drugs. In his most recent appointment, auscultation revealed a diastolic murmur over the left lower, sternal border. When asked to take a deep breath, the murmur was more pronounced. In addition, physical assessment revealed a slight jugular vein distention.

tricuspid stenosis Because bacteria enter into the venous injection site, intravenous drug users are at risk for endocarditis. Tricuspid stenosis is often a sequela of infective endocarditis. Tricuspid valve murmurs appear at left lower sternal border during diastole, as blood cannot move easily from the right atrium to the right ventricle. Blood pools in venous system causing jugular vein distention.