Patho Quiz 3
7 "P's" of Acute arterial embolism
1) Pistol shot (acute onset) 2) Pallor 3) Polar (cold) or Poikilothermia - blood vessels vasodilate in the leg in an attempt to give blood flow 4) Pulselessness 5) Pain 6) Paresthesia 7) Paralysis * necrosis usually develops at bottom of toe and goes up
Acute Arterial Occlusion:
A sudden event that interrupts the arterial flow to the affected tissues or organ - Embolus or thrombus Atherosclerotic occlusive disease: - Progressive narrowing of the arteries in the lower extremities Peripheral Arterial Disease (PAD)
Which of the following clients would be at high risk for developing primary varicose veins? Select all that apply. A) A 47-year-old waitress who works 12-hour shifts three or four times/week B) A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week C) A 56-year-old male who has been immobile due to back surgery and has developed a deep vein thrombosis D) A Marathon runner who has completed three marathons in the past 3 months E) A new peritoneal dialysis client who has been utilizing a home machine and performing dialysis every evening beginning at 8 PM
A) A 47-year-old waitress who works 12-hour shifts three or four times/week B) A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week
Which of the following is a non-modifiable risk factor for the development of primary hypertension? A) African American race B) High salt intake C) Male gender D) Obesity
A) African American race Hypertension not only is more prevalent in blacks than whites, but also is more severe, tends to occur earlier, and often is not treated early enough or aggressively enough. Also tend to experience greater cardiovascular and renal damage at any level of pressure.
A client's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this agent achieve its therapeutic effect? A) By decreasing vascular volume by increasing sodium and water excretion B) By blocking the release of antidiuretic hormone from the posterior pituitary C) By inhibiting the conversion of angiotensin I to angiotensin II D) By inhibiting the movement of calcium into arterial smooth muscle cells
A) By decreasing vascular volume by increasing sodium and water excretion Diuretics lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing sodium and water excretion) and cardiac output.
A client is receiving home care for the treatment of a wound on the inside of her lower leg that is 3 cm in diameter with a yellow wound bed and clear exudate. Assessment of the client's legs reveals edema and a darkened pigmentation over the ankles and shins of both legs. What is this client's most likely diagnosis? A) Chronic venous insufficiency B) Deep vein thrombosis C) Varicose veins D) Peripheral arterial disease
A) Chronic venous insufficiency In contrast to the ischemia caused by arterial insufficiency, venous insufficiency leads to tissue congestion, edema, and eventual impairment of tissue nutrition (development of a venous ulcer). The edema is exacerbated by long periods of standing. Necrosis of subcutaneous fat deposits occurs, followed by skin atrophy. Brown pigmentation of the skin caused by hemosiderin deposits resulting from the breakdown of red blood cells is common.
A client is admitted with dilated cardiomyopathy with left ventricular dysfunction. The nurse should assess for which of the following clinical manifestations? Select all that apply. A) Dyspnea B) Orthopnea C) Extreme fatigue with activity D) Excess abdominal fluid E) Fainting
A) Dyspnea B) Orthopnea C) Extreme fatigue with activity The most common clinical manifestations of DCM are those related to heart failure, such as dyspnea, orthopnea, and reduced exercise capacity. Hypertrophic cardiomyopathy (HCM) is characterized by myocardial thickening and abnormal diastolic filling. They experience fainting/syncope.
An elderly client is admitted with the diagnosis of severe aortic regurgitation. Which of the following client reports support this diagnosis? Select all that apply. A) Exertional dyspnea B) Orthopnea C) Frequent angina D) Paroxysmal nocturnal dyspnea E) Palpitations
A) Exertional dyspnea B) Orthopnea D) Paroxysmal nocturnal dyspnea E) Palpitations As aortic regurgitation progresses, signs and symptoms of left ventricular failure begin to appear. These include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Angina is a rare symptom. Tachycardia, occurring with emotional stress or exertion, may produce palpitations, head pounding, and premature ventricular contractions.
Which of the following would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL? A) High-calorie diet B) Diabetes mellitus C) Bile-binding resin D) Cholesterol ingestion
A) High-calorie diet Obesity with high-calorie intake increases the production of VLDL, with triglyceride elevation and high conversion of VLDL to LDL. Excessive cholesterol intake reduces formation of LDL receptors.
Which of the following diagnostic/assessment findings would been seen in a client with worsening mitral valve stenosis? Select all that apply. A) Low-pitched diastolic murmur that is increasing in duration B) Sharp elevation in left atrial pressure C) Decreased cardiac output D) Severe elevation in left ventricular end-diastolic pressure E) Left ventricle increases its stroke volume
A) Low-pitched diastolic murmur that is increasing in duration B) Sharp elevation in left atrial pressure C) Decreased cardiac output
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes? A) Peripheral vascular resistance B) Electrical impulses in the heart C) Release of stress hormones D) Rigidity of the ventricular walls
A) Peripheral vascular resistance
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?
At the apex of the heart
A client asks, "Why do I have clogged arteries but my neighbor has higher 'bad cholesterol' levels and yet he is just fine?" The health care provider bases the reply on which of the following physiological principles about lipoprotein? A) "Your neighbor probably has higher amounts of good cholesterol (HDL) as well." B) "You more than likely have small, dense type of 'bad cholesterol' (LDL)." C) "Your neighbor has larger 'bad cholesterol' particles that can move into blood vessels but park in joints/tendons." D) "You must have a genetic predisposition to having clogged arteries."
B) "You more than likely have small, dense type of 'bad cholesterol' (LDL)." There are different types of LDL, and some people with markedly elevated LDL do not develop atherosclerotic vascular disease, whereas other people with only modest elevations in LDL develop severe disease. Small, dense LDL is more toxic or atherogenic to the endothelium than large, buoyant LDL. It is more likely to enter the vessel wall, become oxidized, and trigger the atherosclerotic process.
A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the client's increased blood pressure? A) Increased levels of adrenocortical hormones B) Activation of the renin-angiotensin-aldosterone mechanism C) Increased sympathetic stimulation by the autonomic nervous system (ANS) D) Coarctation of the client's aorta
B) Activation of the renin-angiotensin-aldosterone mechanism Renovascular hypertension refers to hypertension caused by reduced renal blood flow and activation of the renin-angiotensin-aldosterone mechanism. It is the most common cause of secondary hypertension, accounting for 1% to 2% of all cases of hypertension.
On the 3rd day following an acute myocardial infarction, the client is being discharged home. The nurse is explaining how the heart tissue heals following an MI. "Since today is your 3rd day after your heart attack, the tissue is: A) Soft, mushy, and yellow." B) Acutely inflamed." C) Forming granulation tissue." D) Developed a fibrous scar."
B) Acutely inflamed. Approximately 2 to 3 days post-myocardial infarction, an acute inflammatory response develops in the area surrounding the necrotic tissue. The damaged area is gradually replaced with vascularized granulation tissue, which in turn becomes less vascular and more fibrous in composition. At 4 to 7 days, the center of the infarcted area is soft and yellow. By the 7th week, the necrotic area is completely replaced by fibrous scar tissue.
Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is: A) Edema B) Calf pain C) Varicosities D) Strong pulse
B) Calf pain The primary symptom of chronic obstructive arterial disease is pain with walking or claudication. (pain with walking) Typically, persons with the disorder complain of calf pain because the gastrocnemius muscle has the highest oxygen consumption of any muscle group in the leg during walking. The extremity will be thin, dry (no edema), and have weak low-pressure pulses due to severely reduced blood flow to the distal vessels.
A client consistently has an elevated systolic BP greater than 150 mm Hg but a diastolic pressure in the 80s. The health care provider should be assessing for which of the following complications? A) Peripheral edema in lower legs from renal disease B) Crackles in bilateral lung bases caused by left-sided heart failure C) Ascites due to liver damage D) Confusion due to atherosclerosis of the carotid arteries
B) Crackles in bilateral lung bases caused by left-sided heart failure Systolic hypertension has been defined as a systolic pressure of 140 mm Hg or greater and a diastolic pressure of less than 90 mm Hg. Elevated pressures during systole favor the development of left ventricular hypertrophy, increased myocardial oxygen demands, and eventual left heart failure.
Clients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant: A) Heart murmurs B) ECG changes C) Pulmonary disease D) Pericardial effusion
B) ECG changes Persons with ischemic coronary vessel disease and ACS are routinely classified as low or high risk for acute myocardial infarction based on clinical history, ECG variables, and serum cardiac biomarkers.
Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: A) Red thrombus B) Large lipid core C) Calcified lesion D) Vessel wall injury
B) Large lipid core
The most important complication of atherosclerosis that may cause occlusion of small heart vessels is: A) Ulceration B) Thrombosis C) Fatty streaks D) Fibrous plaque
B) Thrombosis Thrombus formations on complicated atherosclerotic lesions are the result of sluggish blood flow and turbulence in the ulcerated plaque region.
Which of the following conditions will result in pathological changes arising from pulseless electrical activity? A.Pericardial effusion B.Cardiac tamponade C.Pericarditis
B. Cardiac tamponade Cardiac tamponade is the result of restricted movement of the muscle and will inhibit ventricular contraction. The conduction is intact, but there will be little or no SV.
Which of the following assessment findings would be suggestive of cardiac tamponade? A) Increasing PaCO2 and decreasing PaO2 B) Audible crackles on chest auscultation and presence of frothy sputum C) A 20 mm Hg drop in systolic blood pressure during respiration D) Normal ECG combined with complaints of chest pain and shortness of breath
C) A 20 mm Hg drop in systolic blood pressure during respiration A key diagnostic finding in cardiac tamponade is pulsus paradoxus, or an exaggeration of the normal variation in the systolic blood pressure, commonly defined as a 10 mm Hg or more fall in the systolic blood pressure, which occurs with inspiration.
A client with persistent, primary hypertension remains apathetic about his high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement? A) "Actually, high blood pressure makes you very susceptible to getting diabetes in the future." B) "That's true, but it's an indicator that you're not taking very good care of yourself." C) "You may not sense any problems, but it really increases your risk of heart disease and stroke." D) "You're right, but it's still worthwhile to monitor it in case you do develop problems."
C) "You may not sense any problems, but it really increases your risk of heart disease and stroke." Hypertension is a highly significant risk factor for heart disease and stroke. It would be inappropriate to promote monitoring without promoting lifestyle modifications or other interventions to lower the client's blood pressure, or teaching the client about the deleterious effects of hypertension.
A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the client's following statements indicates a need for further health promotion teaching? A) "I've starting going to the gym before work three times a week." B) "I'm trying to cut back on the amount of salt that I cook with and add to my food." C) "I'm resolving to eat organic foods from now on and to drink a lot more water." D) "I'm planning to lose 15 pounds before the end of this year."
C) "I'm resolving to eat organic foods from now on and to drink a lot more water." Weight loss, exercise, and salt reduction are all useful strategies in the management of hypertension. An organic diet and increased fluid intake are not known to reduce blood pressure.
A father experienced the onset of chest pain and dies suddenly. The family asks, "What caused him to die so suddenly?" The health care provider's reply that is most appropriate would be, "There's a high probability that your loved one developed an acute heart attack and experienced: A) Acute myocarditis." B) High troponin levels." C) Acute ventricular arrhythmia." D) Hypertrophic cardiomyopathy."
C) Acute ventricular arrhythmia. Sudden death from an acute myocardial infarction in an adult is usually caused by fatal (ventricular) arrhythmias.
A client asks why his blood pressure pills seem to make him go to the bathroom to urinate frequently when they are not water pills (diuretics). Which of the following physiologic processes explains the long-term regulation of blood pressure most accurately? A) Actions of the renin-angiotensin-aldosterone system B) Release of antidiuretic hormone (vasopressin) by the posterior pituitary C) Renal monitoring and adjustment of extracellular fluid volume D) Integration and modulation of the autonomic nervous system (ANS)
C) Renal monitoring and adjustment of extracellular fluid volume
Congenital heart defects can cause a right heart-to-left heart shunting of blood that results in increased: A) Pulmonary blood volume B) Right ventricle workload C) Unoxygenated blood flow D) Right atrial blood volume
C) Unoxygenated blood flow Right-to-left shunts transfer unoxygenated blood from the right side of the heart to the left side, diluting the oxygen content of blood that is being ejected into the systemic circulation and causing cyanosis. Left-to-right shunts cause recycling of blood through the pulmonary vessels and the right side of the heart, causing increased volume and workload of the right side of the heart and pulmonary circulation.
A health care provider was asked by a client, "Why do my hands turn blue when I drive my car in the winter without gloves?" Which of the following is the best response? A) "Nothing to worry about. We all develop this as we age." B) "We better order a CT scan. It might be due to a blood clot in your radial artery." C) "This sounds like an inflammation in the lining of your veins. You need to take some NSAIDs." D) "Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen."
D) "Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen." Raynaud disease is caused by vasospasms of small distal arteries; thromboangiitis obliterans is caused by an inflammatory process that affects veins and nerves.
A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which have culminated in a diagnosis of deep vein thrombosis. What treatment option will be of greatest benefit to this client? A) Analgesics and use of a pneumatic compression device B) Massage followed by vascular surgery C) Frequent ambulation and the use of compression stockings D) Anticoagulation therapy and elevation of the leg
D) Anticoagulation therapy and elevation of the leg Anticoagulants, immobilization, and elevation of the affected extremity are used in the treatment of DVT.
Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease? A) Leukocytosis B) Homocysteine C) Serum lipoprotein D) C-reactive protein
D) C-reactive protein
In addition to direct invasion of the vascular wall by an infectious agent, this pathogenic mechanism is a common cause of vasculitis? A) Necrotizing granulomatous B) Tissue necrosis C) Mononuclear cells D) Immune-mediated inflammation
D) Immune-mediated inflammation
Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by: A) Chronic atrial fibrillation B) Myocardial inflammation C) Left ventricle hypertrophy D) Vegetative valve destruction
D) Vegetative valve destruction Murmurs are sounds produced by blood flow through incompetent valves. Both infective endocarditis and carditis of rheumatic heart disease are characterized by growth of vegetation on valve leaflets, causing destruction, regurgitation, and murmur.
Heart murmurs involving the mitral and aortic valves are common in what population? Why?
Elderly; calcific changes occur in mitral and aortic valves with age
vWhich of the following is considered the "good" cholesterol. Discuss why in small groups. A.Chylomicrons B.Very-low-density lipoprotein (VLDL) C.Intermediate-density lipoprotein (IDL) D.Low-density lipoprotein (LDL) E.High-density lipoprotein
High-density lipoprotein Due to its function of taking cholesterol from the tissues and moving it to the liver for metabolic breakdown
What are the mitral valve disorders?
Mitral valve stenosis - the incomplete opening of the mitral valve during diastole, causing left atrial distention and impaired LV filling. Mitral valve regurgitation is the incomplete closure of the mitral valve, with LV SV divided between the forward SV that moves into the aorta and the regurgitant SV that moves back into the left atrium during systole Mitral valve prolapse occurs in 1% to 2.5% of the general population. The disorder is seen more frequently in females than males and may have a familial basis.
Ranges for hypertension:
Normal - <120 systolic & <80 diastolic Elevated - 120-129 systolic & <80 diastolic Stg 1 HTN - 130-139 systolic & 80-89 diastolic Stg 2 HTN - >140 systolic & >\= 90 diastolic
What are the three factors of Virchow's triad:
Three factors contribute to venous thrombus formation: (1) loss of integrity of the vessel wall (e.g., injury) (2) abnormalities of blood flow (e.g., slow blood flow in calf veins associated with bed rest) (3) alterations in blood constituents (e.g., a change in clotting factors or increased platelet activity).
Venous ulcers manifestations
Venous insufficiency leads to tissue congestion, edema, and eventual impairment of tissue nutrition. Most lesions are located medially over the ankle and lower leg, with the highest frequency above the medial malleolus. Venous insufficiency is the most common cause of lower leg ulcers. Treatment includes compression therapy with dressings and inelastic or elastic bandages.
Pericardial effusion can lead to:
a condition called cardiac tamponade, in which there is compression of the heart due to the accumulation of fluid, pus, or blood in the pericardial sac.
Signs and symptoms of Raynaud disease
changes in skin color that progress from pallor to cyanosis, a sensation of cold, and changes in sensory perception, such as numbness and tingling. Color changes are usually first noticed in the tips of the fingers, moving into one or more of the distal phalanges
Modifiable risk factors for primary hypertension:
diet, levels of blood lipids, tobacco and alcohol consumption, fitness and activity level, overweight/obesity, and blood glucose control.
Heart murmurs are most commonly caused by what?
heart valve deformity, valve dysfunction, defects in the heart wall
As venous distention progresses in right-sided heart failure, blood backs up in the ______ veins that drain into the inferior vena cava, and the liver becomes engorged.
hepatic
Signs and symptoms of Atherosclerotic disease
intermittent claudication (pain with walking). People often complain of calf pain (the gastrocnemius has the highest oxygen consumption of all leg muscles required for walking)
Myocardial infarction
ischemic death of myocardial tissue associated with obstructed blood flow in the coronary arteries because of plaque disruption and occlusion of blood flow.
A major effect of right-sided heart failure is the development of ______?
peripheral edema