Patho quiz 3
Administration of which therapy is most appropriate for hypovolemic shock? a. Crystalloids b. Inotropic agents c. 5% dextrose in water d. Vasoconstrictor agents
Crystalloids
A patient with pure left-sided heart failure is likely to exhibit a. peripheral edema. b. jugular vein distention. c. hepatomegaly. d. pulmonary congestion with dyspnea.
pulmonary congestion with dyspnea.
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. septic d. obstructive
Septic
What results when systemic blood pressure is increased? a. Decreased cardiac output b. Vasoconstriction c. Hypovolemia d. Decreased vascular resistance
Vasoconstriction
The progressive stage of hypovolemic shock is characterized by a. tachycardia. b. hypertension. c. cardiac failure. d. lactic acidosis.
a. tachycardia.
After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence of a. peripheral vascular disease. b. isolated left-sided heart failure. c. right-sided heart failure. d. arterial obstruction.
c. right-sided heart failure.
Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class? a. Class III b. Class II c. Class IV d. Class I
d. Class I
An abnormally wide (more than 0.10 second) QRS complex is characteristic of a. paroxysmal atrial tachycardia. b. supraventricular tachycardia. c. junctional escape rhythm. d. premature ventricular complexes.
d. premature ventricular complexes.
The effect of nitric oxide on systemic arterioles is a. not significant. b. vasoconstriction. c. opposed by nitrate drugs. d. vasodilation.
d. vasodilation.
A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to a. deep vein thrombosis. b. hypertension. c. angina. d. hypotension.
hypotension
Lusitropic impairment refers to a. impaired diastolic relaxation. b. altered automaticity. c. altered action potential conduction rate. d. poor contractile force.
impaired diastolic relaxation.
The most commonly recognized outcome of hypertension is pulmonary disease. a. False b. True
False
A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis. a. True b. False
False *alkalosis
New-organ damage is a function of both the stage of hypertension and its duration. a. False b. True
False *end damage
A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic. a. True b. False
False *neurogenic shock.
The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension. a. False b. True
True
Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock? a. Septic b. Hypovolemic c. Cardiogenic d. Anaphylactic
a. Septic
Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body. a. True b. False
a. True
Myocarditis should be suspected in a patient who presents with a. acute onset of left ventricular dysfunction. b. chest pain and ST elevation. c. family history of cardiomyopathy. d. murmur and abnormal valves on echocardiogram.
a. acute onset of left ventricular dysfunction.
Administration of a vasodilator to a patient in shock would be expected to a. decrease left ventricular afterload. b. increase tissue perfusion. c. increase contractility. d. decrease vascular resistance.
a. decrease left ventricular afterload.
Primary treatment for myocardial infarction (MI) is directed at a. decreasing myocardial oxygen demands. b. activating the parasympathetic system. c. protecting the heart from further ischemia. d. reducing heart rate and blood pressure
a. decreasing myocardial oxygen demands.
Constrictive pericarditis is associated with a. impaired cardiac filling. b. increased cardiac preload. c. elevated myocardial oxygen consumption. d. cardiac hypertrophy.
a. impaired cardiac filling.
Cardiogenic shock is characterized by a. reduced cardiac output. b. reduced systemic vascular resistance. c. elevated SvO2. d. hypovolemia.
a. reduced cardiac output.
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. unstable angina. c. coronary vasospasm. d. myocardial infarction.
a. stable angina.
In which dysrhythmias should treatment be instituted immediately? a. Premature atrial complexes occurring every 20 seconds b. Atrial fibrillation with a ventricular rate of 220 beats/minute c. Asymptomatic sinus bradycardia at a heart rate of 50 beats/minute d. Fever-induced tachycardia at 122 beats/minute
b. Atrial fibrillation with a ventricular rate of 220 beats/minute
Hypertrophy of the right ventricle is a compensatory response to a. aortic stenosis. b. pulmonary stenosis. c. aortic regurgitation. d. tricuspid stenosis.
b. pulmonary stenosis.
Beta-blockers are advocated in the management of heart failure because they a. reduce blood flow to the kidneys. b. reduce cardiac output. c. increase cardiac output. d. enhance sodium absorption.
b. reduce cardiac output.
The common denominator in all forms of heart failure is a. tissue ischemia. b. reduced cardiac output. c. pulmonary edema. d. poor diastolic filling.
b. reduced cardiac output.
improvement in a patient with septic shock is indicated by an increase in a. SvO2. b. systemic vascular resistance. c. serum lactate level. d. cardiac output. 0.125 points
b. systemic vascular resistance.
An example of an acyanotic heart defect is a. transposition of the great arteries. b. ventricular septal defect. c. all right-to-left shunt defects. d. tetralogy of Fallot.
b. ventricular septal defect.
Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of a. congestive heart failure (CHF). b. cardiomyopathy. c. cardiac tamponade. d. myocardial infarction.
c. cardiac tamponade.
Patent ductus arteriosus is accurately described as a(n) a. stricture of the aorta that impedes blood flow. b. cyanotic heart defect associated with right-to-left shunt. c. communication between the aorta and the pulmonary artery. d. opening between the atria.
c. communication between the aorta and the pulmonary artery.
The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is a. preload reduction. b. β-antagonist agents. c. digitalis. d. afterload reduction.
c. digitalis.
Second-degree heart block type I (Wenckebach) is characterized by a. absent P waves. b. no correlation between P waves and QRS complexes. c. lengthening PR intervals and dropped P wave. d. constant PR interval and dropped QRS complexes.
c. lengthening PR intervals and dropped P wave.
Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure. a. pulse b. systolic c. mean arterial d. diastolic
c. mean arterial
The prevalence of high blood pressure is higher in a. Mexican-American adults. b. Asian children. c. non-Hispanic black adults. d. non-Hispanic white adults.
c. non-Hispanic black adults.
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. hypovolemic c. obstructive d. distributive
c. obstructive
A patient with heart failure who reports intermittent shortness of breath during the night is experiencing a. paroxysmal atrial tachycardia. b. orthopnea. c. paroxysmal nocturnal dyspnea. d. sleep apnea.
c. paroxysmal nocturnal dyspnea.
Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells. a. norepinephrine b. aldosterone c. renin d. angiotensinogen
c. renin
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.
Pulse pressure is defined as a. two thirds of systolic pressure + diastolic pressure. b. systolic pressure + diastolic pressure. c. systolic pressure - diastolic pressure. d. systolic pressure × systemic resistance.
c. systolic pressure - diastolic pressure.
Rheumatic heart disease is most often a consequence of a. cardiomyopathy. b. chronic intravenous drug abuse. c. β-hemolytic streptococcal infection. d. viral infection with herpesvirus.
c. β-hemolytic streptococcal infection.
First-degree heart block is characterized by a. variable PR interval. b. widened QRS complex. c. absent P waves. d. prolonged PR interval.
prolonged PR interval.
Cor pulmonale refers to a. right ventricular failure secondary to right ventricular infarction. b. biventricular failure. c. left ventricular hypertrophy secondary to lung disease. d. right ventricular hypertrophy secondary to pulmonary hypertension.
right ventricular hypertrophy secondary to pulmonary hypertension.
A patient with significant aortic stenosis is likely to experience a. syncope. b. peripheral edema. c. hypertension. d. increased pulse pressure.
syncope
Which serum biomarker(s) are indicative of irreversible damage to myocardial cells? a. Markedly decreased CK-MB and troponin I b. Prolonged coagulation time c. Elevated CK-MB, troponin I, and troponin T d. Elevated LDL
Elevated CK-MB, troponin I, and troponin T
The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is a. ST-segment elevation. b. severe, crushing chest pain. c. pain radiating to the lower legs. d. dysrhythmias.
ST-segment elevation.
Restriction of which electrolytes is recommended in the management of high blood pressure? a. Potassium b. Sodium c. Calcium d. Magnesium
Sodium
Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria? a. 128/82 b. 118/78 c. 140/88 d. 138/94
a. 128/82
Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock? a. Anaphylactic b. Cardiogenic c. Hypovolemic d. Neurogenic
a. Anaphylactic
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 his 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 not particularly significant.
a. Increased LDL levels are associated with increased risk of coronary artery disease.
High blood pressure increases the workload of the left ventricle, because it increases a. preload. b. afterload. c. blood volume. d. stroke volume.
afterload.
The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with a. perfumes. b. antibiotics. c. animal proteins or dander. d. incompatible blood products.
antibiotics
Patients presenting with symptoms of unstable angina and no ST segment elevation are treated with a. cardiac biomarkers only. b. antiplatelet drugs. c. cardiac catheterization. d. acute reperfusion therapy.
antiplatelet drugs.
The majority of cardiac cells that die after myocardial infarction do so because of a. cell rupture. b. insufficient glucose. c. apoptosis. d. thrombus.
apoptosis.
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. Recheck blood pressure in 4 to 6 weeks. b. Begin antihypertensive drug therapy. c. Encourage smoking cessation. d. Begin lifestyle modifications.
b. Begin antihypertensive drug therapy.
Angina caused by coronary artery spasm is called _____ angina. a. unstable b. Prinzmetal variant c. classic d. stable
b. Prinzmetal variant
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. Junctional tachycardia b. Ventricular escape rhythm c. Third-degree heart block d. Sinus bradycardia
b. Ventricular escape rhythm
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.
A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n) a. young female athlete with cardiomegaly. b. elderly woman without a previous history of MI. c. middle-aged man with a previous history of MI. d. young sedentary male with a high-stress job.
b. 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 a. reduced contractility. b. high cardiac output. c. high afterload. d. low cardiac output.
b. high cardiac output.
Hypotension associated with neurogenic and anaphylactic shock is because of a. high afterload. b. peripheral pooling of blood. c. hypovolemia. d. poor cardiac contractility.
b. peripheral pooling of blood.
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
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? a. Sitting BP 120/80, HR 100 b. Sitting BP 110/78, HR 98 c. Sitting BP 88/60, HR 118 d. Sitting BP 108/68, HR 102
c. Sitting BP 88/60, HR 118
Low cardiac output in association with high preload is characteristic of ________ shock. a. septic b. hypovolemic c. anaphylactic d. cardiogenic
cardiogenic
Angiotensin-converting enzyme (ACE) inhibitors block the
conversion of angiotensin I to angiotensin II.
Aortic regurgitation is associated with a. elevated systemic diastolic blood pressure. b. shortened ventricular ejection phase. c. elevated left ventricular/aortic systolic pressure gradient. d. diastolic murmur.
diastolic murmur.
A loud pansystolic murmur that radiates to the axilla is most likely a result of a. mitral regurgitation. b. aortic stenosis. c. aortic regurgitation. d. mitral stenosis.
mitral regurgitation.
Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of a. catecholamines b. clotting factors c. nitric oxide d. vasopressin
nitric oxide.
Hypertension is closely linked to a. de Quervain syndrome. b. obstructive sleep apnea. c. spinal stenosis. d. urinary tract infection.
obstructive sleep apnea.
An erroneously low blood pressure measurement may be caused by a. positioning the arm above the heart level. b. using a cuff that is too small. c. positioning the arm at heart level. d. measuring blood pressure after exercise.
positioning the arm above the heart level.
Left-sided heart failure is characterized by a. peripheral edema. b. decreased systemic vascular resistance. c. pulmonary congestion. d. jugular vein distention.
pulmonary congestion.
The majority of tachydysrhythmias are believed to occur because of a. enhanced automaticity. b. defective gap junctions. c. triggered activity. d. reentry mechanisms.
reentry mechanisms.
Atherosclerotic plaques with large lipid cores are prone to a. rupture. b. dislodgement. c. attachment. d. binding.
rupture.
Hypertension with a specific, identifiable cause is known as _____ hypertension. a. primary b. orthostatic c. secondary d. malignant
secondary
Chronic elevation of myocardial wall tension results in atrophy. a. False b. True
False
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? a. Class I, Initial Stage b. Class II, Compensated Stage c. Class III, Progressive Stage d. Class IV, Refractory Stage
Class II, Compensated Stage
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 plus ACE inhibitor therapy. b. Continue lifestyle modifications plus b-blocker therapy. c. Continue lifestyle modifications only. d. Continue lifestyle modifications plus diuretic therapy.
Continue lifestyle modifications only.
What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume? a. Aortic regurgitation b. Tachycardia c. Hypotension d. Bradycardia
Tachycardia
Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes. a. True b. False
True
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. High blood pressure enhances left ventricular perfusion during systole. b. High-pressure workload leads to left ventricular atrophy. c. This is an expected blood pressure in the elderly and has little effect on left ventricular function. d. Left ventricular workload is increased with high afterload.
d. Left ventricular workload is increased with high afterload.
Which dysrhythmia is thought to be associated with reentrant mechanisms? a. Second-degree AV block b. Junctional escape c. Sinus bradycardia d. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)
d. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)
A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock? a. Neurogenic b. Anaphylactic c. Cardiogenic d. Septic
d. Septic
Sepsis has been recently redefined as a. severe hypotension in an infected patient. b. a systemic inflammatory response to ischemia. c. a systemic infection with viable organisms in the bloodstream. d. a systemic inflammatory response to infection.
d. a systemic inflammatory response to infection.
Tachycardia is an early sign of low cardiac output that occurs because of a. anxiety. b. acidosis. c. tissue hypoxia. d. baroreceptor activity.
d. baroreceptor activity
Administration of a vasodilator to a patient in shock would be expected to a. decrease vascular resistance b. increase contractility c. decrease left ventricular afterload d. increase tissue perfusion
decrease left ventricular afterload
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 a. myocardial infarction. b. angina. c. arthrosclerosis. d. hypertensive crisis.
hypertensive crisis.
