Week 3 Check Your Understanding

Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of

cardiac tamponade.

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

cardiogenic

Patent ductus arteriosus is accurately described as a(n)

communication between the aorta and the pulmonary artery.

Administration of which therapy is most appropriate for hypovolemic shock?

crystalloids

Primary treatment for myocardial infarction (MI) is directed at

decreasing myocardial oxygen demands.

A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to

hypotension

Constrictive pericarditis is associated with

impaired cardiac filling.

Lusitropic impairment refers to

impaired diastolic relaxation

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

lengthening PR intervals and dropped P wave.

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

mitral regurtitation

Hypotension associated with neurogenic and anaphylactic shock is because of

peripheral pooling of blood.

Hypertrophy of the right ventricle is a compensatory response to

pulmonary stenosis

Cardiogenic shock is characterized by

reduced cardiac output.

The majority of tachydysrhythmias are believed to occur because of

reentry mechanisms.

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.

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

true

The effect of nitric oxide on systemic arterioles is

vasodilation

Rheumatic heart disease is most often a consequence of

β-hemolytic streptococcal infection.

In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing?

Class II, Compensated Stage

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

Septic

Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.

True

The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.

True

The most commonly recognized outcome of hypertension is pulmonary disease.

True

The prevalence of high blood pressure is higher in

Vasoconstriction

What results when systemic blood pressure is increased?

Vasoconstriction

Myocarditis should be suspected in a patient who presents with

acute onset of left ventricular dysfunction.

In which dysrhythmias should treatment be instituted immediately?

atrial fibrillation with a ventricular rate of 220 beats/minute

Administration of a vasodilator to a patient in shock would be expected to

decrease left ventricular afterload.

Aortic regurgitation is associated with

diastolic murmur.

Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure.

mean arterial

First-degree heart block is characterized by

prolonged PR interval.

A patient with pure left-sided heart failure is likely to exhibit

pulmonary congestion with dyspnea.

Left-sided heart failure is characterized by

pulmonary congestion.

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria?

128/82

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

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

Elevated CK-MB, troponin I, and troponin T

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

False

Chronic elevation of myocardial wall tension results in atrophy.

False

New-organ damage is a function of both the stage of hypertension and its duration.

False

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.

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.

High blood pressure increases the workload of the left ventricle, because it increases

afterload

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

Anaphylactic

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.

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.

Which dysrhythmia is thought to be associated with reentrant mechanisms?

Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

Angina caused by coronary artery spasm is called _____ angina.

Prinzmetal variant

Atherosclerotic plaques with large lipid cores are prone to

Rupture

The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is

ST-segment elevation.

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

Septic

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

Septic

Which finding is indicative of orthostatic hypotension in a person with a supine blood pressure (BP) of 110/70 and a heart rate (HR) of 100?

Sitting BP 88/60, HR 118

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

Sodium

What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume?

Tachycardia

Mitral stenosis is associated with

a pressure gradient across the mitral valve.

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

baroreceptor activity

Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class?

Class I

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

digitalis

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

edema

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.

In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with

high cardiac output.

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

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.

obstructive

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

Beta-blockers are advocated in the management of heart failure because they

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

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.

Hypertension with a specific, identifiable cause is known as _____ hypertension.

secondary

A laboratory test that should be routinely monitored in patients receiving digitalis therapy is

serum potassium.

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.

Sepsis has been recently redefined as

systemic inflammatory response to infection

Pulse pressure is defined as

systolic pressure - diastolic pressure

The progressive stage of hypovolemic shock is characterized by

tachycardia

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

An example of an acyanotic heart defect is

ventricular septal defect