Pathophysiology week 3

Administration of which therapy is most appropriate for hypovolemic shock? a. crystalloids b. Vasoconstrictor agents c. Inotropic agents d. 5% dextrose in water

a. crystalloids

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria? a. 118/78 b. 128/82 c. 140/88 d. 138/94

b. 128/82

A patient who was involved in a fall from a tree becomes short of breath. The lung sounds are absent on one side. This patient is experiencing ________ shock. a. cardiogenic b. obstructive c. hypovolemic d. distributive

b. obstructive

Hypotension associated with neurogenic and anaphylactic shock is because of a. hypovolemia. b. peripheral pooling of blood. c. poor cardiac contractility. d. high afterload.

b. peripheral pooling of blood

Beta-blockers are advocated in the management of heart failure because they a. increase cardiac output. b. reduce cardiac output. c. enhance sodium absorption. d. reduce blood flow to the kidneys.

b. reduce cardiac output

The common denominator in all forms of heart failure is a. poor diastolic filling. b. reduced cardiac output. c. pulmonary edema. d. tissue ischemia.

b. reduced cardiac output.

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock? a. Cardiogenic b. Hypovolemic c. Anaphylactic d. Neurogenic

c. Anaphylactic

Increased preload of the cardiac chambers may lead to which patient symptom? a. Decreased heart rate b. Decreased respiratory rate c. Edema d. Excitability

c. Edema

A patient who reports dizziness and who has absent P waves, wide QRS complexes, and a heart rate of 38 beats/minute on an ECG is most likely in which rhythm? a. Third-degree heart block b. Junctional tachycardia c. Ventricular escape rhythm d. Sinus bradycardia

c. Ventricular escape rhythm

Sepsis has been recently redefined as a. a systemic infection with viable organisms in the bloodstream. b. a systemic inflammatory response to ischemia. c. a systemic inflammatory response to infection. d. severe hypotension in an infected patient.

c. a systemic inflammatory response to infection.

Tachycardia is an early sign of low cardiac output that occurs because of a. tissue hypoxia. b. anxiety. c. baroreceptor activity. d. acidosis.

c. baroreceptor activity.

A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic. Group of answer choicesTrue true or false

false

Chronic elevation of myocardial wall tension results in atrophy. true or flase

false

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

True

After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later. The patient reports "moderate" adherence to the recommended lifestyle changes and has experienced a decreased from 165/96 to 148/90 mm Hg in blood pressure. What is the most appropriate intervention for this patient at this time? a. Continue lifestyle modifications only. b. Continue lifestyle modifications plus diuretic therapy. c. Continue lifestyle modifications plus ACE inhibitor therapy. d. Continue lifestyle modifications plus b-blocker therapy.

a. Continue lifestyle modifications only.

While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding? a. Increased LDL levels are associated with increased risk of coronary artery disease. b. Measures to decrease LDL levels in the elderly would be unlikely to affect the progression of this disease. c. Increased LDL levels are indicative of moderate alcohol intake, and patients should be advised to abstain. d. Elevated LDL levels are an expected finding in the elderly and therefore are not particularly significant.

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

Aortic regurgitation is associated with a. diastolic murmur. b. elevated left ventricular/aortic systolic pressure gradient. c. elevated systemic diastolic blood pressure. d. shortened ventricular ejection phase.

a. diastolic murmur. Aortic regurgitation results from an incompetent aortic valve that allows blood to leak back from the aorta into the left ventricle during diastole. In aortic regurgitation, there is not an elevated left ventricular/aortic pressure gradient. Diastolic blood pressure is generally lower because of rapid runoff of blood into the ventricle. Aortic regurgitation is associated with a longer ventricular ejection phase.

A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n) a. elderly woman without a previous history of MI. b. middle-aged man with a previous history of MI. c. young female athlete with cardiomegaly. d. young sedentary male with a high-stress job.

a. elderly woman without a previous history of MI.

Constrictive pericarditis is associated with a. impaired cardiac filling. b. cardiac hypertrophy. c. increased cardiac preload. d. elevated myocardial oxygen consumption.

a. impaired cardiac filling.Variant, or Prinzmetal, angina is the term applied to vasospasm-initiated anginal symptoms caused by significant atherosclerotic plaques. These spasms usually respond promptly to vasodilating agents. Coronary artery spasm does not produce stable angina. Classic or typical angina is often associated with physical exertion. Unstable angina presents a similar clinical picture as myocardial infarction.

Hypertension is closely linked to a. obstructive sleep apnea. b. urinary tract infection. c. de Quervain syndrome. d. spinal stenos

a. obstructive sleep apnea.Hypertension is present in 45% to 60% of those diagnosed with obstructive sleep apnea. Urinary tract infection is not directly linked to hypertension. de Quervain syndrome is a type of tendonitis and is not linked to hypertension. Spinal stenosis is not closely associated with hypertension.

Left-sided heart failure is characterized by a. pulmonary congestion. b. decreased systemic vascular resistance. c. jugular vein distention. d. peripheral edema.

a. pulmonary congestion

A patient with a history of myocardial infarction continues to complain of intermittent chest pain brought on by exertion and relieved by rest. The likely cause of this pain is a. stable angina. b. myocardial infarction. c. coronary vasospasm. d. unstable angina

a. stable angina.

The progressive stage of hypovolemic shock is characterized by a. tachycardia. b. hypertension. c. lactic acidosis. d. cardiac failure.

a. tachycardia.

The effect of nitric oxide on systemic arterioles is a. vasodilation. b. vasoconstriction. c. not significant. d. opposed by nitrate drugs.

a. vasodilation.

A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient's blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time? a. Begin lifestyle modifications. b. Begin antihypertensive drug therapy. c. Recheck blood pressure in 4 to 6 weeks. d. Encourage smoking cessation.

b. Begin antihypertensive drug therapy. Antihypertensive drug therapy is not the first intervention in a person with modifiable risk factors. Therefore, lifestyle alterations are attempted first. Lifestyle alterations include exercise, smoking cessation, and weight loss. Blood pressure should be rechecked in 4 to 6 weeks. Smoking cessation counseling is an appropriate lifestyle alteration.

An elderly patient's blood pressure is measured at 160/98. How would the patient's left ventricular function be affected by this level of blood pressure? a. This is an expected blood pressure in the elderly and has little effect on left ventricular function. b. Left ventricular workload is increased with high afterload. c. High blood pressure enhances left ventricular perfusion during systole. d. High-pressure workload leads to left ventricular atrophy.

b. Left ventricular workload is increased with high afterload.

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock a. Cardiogenic b. Septic c. Anaphylactic d. Neurogenic

b. Septic

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock? a. Cardiogenic b. Septic c. Anaphylactic d. Neurogenic

b. Septic

Mitral stenosis is associated with a. a prominent S4 heart sound. b. a pressure gradient across the mitral valve. c. left ventricular hypertrophy. d. a muffled second heart sound (S2).

b. a pressure gradient across the mitral valve.

Angiotensin-converting enzyme (ACE) inhibitors block the a. release of rennin. b. conversion of angiotensin I to angiotensin II. c. conversion of angiotensinogen to angiotensin I. d. effect of aldosterone on the kidney.

b. conversion of angiotensin I to angiotensin II. Angiotensin I is converted into angiotensin II while it is circulating through the pulmonary vessels, by the angiotensin-converting enzyme. ACE inhibitors block the conversion of angiotension I to angiotension II. Renin plays a role in the regulation of arterial blood pressure. ACE inhibitors do not block the conversion of angiotensinogen to angiotensin or the effect of aldosterone on the kidney.

Primary treatment for myocardial infarction (MI) is directed at a. protecting the heart from further ischemia. b. decreasing myocardial oxygen demands. c. reducing heart rate and blood pressure. d. activating the parasympathetic system.

b. decreasing myocardial oxygen demands.

Second-degree heart block type I (Wenckebach) is characterized by a. absent P waves b. lengthening PR interval and dropped P wave c. constant PR interval and dropped QRS complexes d. no correlation between P waves and QRS complexes

b. lengthening PR interval and dropped P wave

Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure. Group of answer choicessystolic a. systolic b. mean arterial c. diastolic d. pulse

b. mean arterial

Patent ductus arteriosus is accurately described as a(n) a. opening between the atria. b. stricture of the aorta that impedes blood flow. c. communication between the aorta and the pulmonary artery. d. cyanotic heart defect associated with right-to-left shunt.

c. communication between the aorta and the pulmonary artery. A patent ductus arteriosus is a normal channel between the pulmonary artery and the aorta that remains open during intrauterine life. A patent ductus arteriosus is not an opening or a stricture in the atria. Patent ductus arteriosus is an acyanotic congenital defect.

The prevalence of high blood pressure is higher in a. non-Hispanic white adults. b. Mexican-American adults. c. non-Hispanic black adults. d. Asian children.

c. non-Hispanic black adults. The prevalence of high blood pressure remains higher among non-Hispanic black adults. Non-Hispanic white adults have a lower prevalence of high blood pressure. Mexican-American adults have a lower prevalence than black adults. Asian children do not display a high prevalence for high blood pressure.

Cardiogenic shock is characterized by a. hypovolemia. b. reduced systemic vascular resistance. c. reduced cardiac output. d. elevated SvO2.

c. reduced cardiac output.

Cor pulmonale refers to a. biventricular failure. b. left ventricular hypertrophy secondary to lung disease. c. right ventricular hypertrophy secondary to pulmonary hypertension. d. right ventricular failure secondary to right ventricular infarction.

c. right ventricular hypertrophy secondary to pulmonary hypertension.

Atherosclerotic plaques with large lipid cores are prone to a. dislodgement. b. binding. c. rupture. d. attachmen

c. rupture.

Hypertension with a specific, identifiable cause is known as _____ hypertension. a. primary b. orthostatic c. secondary d. malignant

c. secondary

A laboratory test that should be routinely monitored in patients receiving digitalis therapy is a. serum sodium. b. albumin level. c. serum potassium. d. serum calcium.

c. serum potassium.

Improvement in a patient with septic shock is indicated by an increase in a. cardiac output. b. SvO2. c. systemic vascular resistance. d. serum lactate level

c. systemic vascular resistance.

An example of an acyanotic heart defect is a. tetralogy of Fallot. b. transposition of the great arteries. c. ventricular septal defect. d. all right-to-left shunt defects.

c. ventricular septal defect An example of an acyanotic heart defect is a ventricular septal defect. In this condition, blood from the left ventricle leaks into the right ventricle because of a defect in the ventricular wall. This leakage causes extra pressure in the right ventricle resulting in pulmonary hypertension. Tetralogy of Fallot is a cyanotic congenital defect. Transposition of the great vessels is a cyanotic congenital defect. The category of cyanotic congenital defects refers to those that are right-to-left shunts

In which dysrhythmias should treatment be instituted immediately a. Asymptomatic sinus bradycardia at a heart rate of 50 beats/minute b. Fever-induced tachycardia at 122 beats/minute c. Premature atrial complexes occurring every 20 seconds d. Atrial fibrillation with a ventricular rate of 220 beats/minute

d. Atrial fibrillation with a ventricular rate of 220 beats/minute

In which dysrhythmias should treatment be instituted immediately? a. Asymptomatic sinus bradycardia at a heart rate of 50 beats/minute b. Fever-induced tachycardia at 122 beats/minute c. Premature atrial complexes occurring every 20 seconds d. Atrial fibrillation with a ventricular rate of 220 beats/minute

d. Atrial fibrillation with a ventricular rate of 220 beats/minute

Which dysrhythmia is thought to be associated with reentrant mechanisms a. Second-degree AV block b. Sinus bradycardia c. Junctional escape d. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

d. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

Which dysrhythmia is thought to be associated with reentrant mechanisms? a. Second-degree AV block b. Sinus bradycardia c. Junctional escape d. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

d. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

Angina caused by coronary artery spasm is called _____ angina. a. stable b. classic c. unstable d. Prinzmetal variant

d. Prinzmetal variant

A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum. This patient is most likely experiencing a. right-sided heart failure. b. cardiomyopathy. c. a medication reaction. d. acute cardiogenic pulmonary edema.

d. acute cardiogenic pulmonary edema.

The majority of cardiac cells that die after myocardial infarction do so because of a. cell rupture. b. insufficient glucose. c. thrombus. d. apoptosis.

d. apoptosis.

The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is a. afterload reduction. b. β-antagonist agents. c. preload reduction. d. digitalis.

d. digitalis

A patient with heart failure who reports intermittent shortness of breath during the night is experiencing a. orthopnea b. paroxysmal atria; tachycardia c. sleep apnea d. paroxysmal nocturnal dyspnea

d. paroxysmal nocturnal dyspnea

Hypertrophy of the right ventricle is a compensatory response to a. aortic stenosis. b. aortic regurgitation. c. tricuspid stenosis. d. pulmonary stenosis.

d. pulmonary stenosis

Hypertrophy of the right ventricle is a compensatory response to a. aortic stenosis. b. aortic regurgitation. c. tricuspid stenosis. d. pulmonary stenosis.

d. pulmonary stenosis.

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells a. aldosterone b. norepinephrine c. angiotensinogen d. renin

d. renin

A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock. a. cardiogenic b. hypovolemic c. obstructive d. septic

d. septic