PORTAGE LEARNING NURS 231: Pathophysiology 2022 MODULE 4

PORTAGE LEARNING NURS 231: Pathophysiology 2022 MODULE 4 Question 1 2.5 / 2.5 pts Which of the following increases the chance of clotting? Select all that apply. Vitamin K deficiency Von Willebrand factor deficiency Correct! Protein C deficiency Thrombocytopenia Question 2 2.5 / 2.5 pts A deficiency in which of the following would lead to a hypercoagulable state? Select all that apply. Correct! Protein C Correct! Protein S Factor II Factor VII Factor IX Factor X Correct! Antithrombin III Question 3 2.5 / 2.5 pts Which of the following is a hypercoagulable state? Select all that apply. Hemophilia A Correct! Congestive heart failure Correct! Smoking Thrombocytopenia Correct! Postsurgical state Question 4 0 / 2.5 pts Which of the following is FALSE of disseminated intravascular coagulation (DIC)? Select all that apply. Microthrombi cause vessel occlusion and tissue ischemia You Answered It can cause multiple organ failure Severe hemorrhage results Obstetric disorders are the main cause of DIC Correct! Lab results show a decreased PT, PTT Question 5 2.5 / 2.5 pts Well-known causes of disseminated intravascular coagulation (DIC) include each of the following conditions except: Retained dead fetus Carcinoma Gram-negative sepsis Correct! Heparin administration Question 6 2.5 / 2.5 pts Which of the following does NOT affect the heart’s ability to increase its output? Preload Afterload Cardiac contractility Correct! Cardiac reserve Heart rate Question 7 2.5 / 2.5 pts Which of the following is NOT a regulator of blood pressure? Baroreceptors Renin-angiotensin-aldosterone system Vasopressin Correct! Parasympathetic nervous system activation Question 8 2.5 / 2.5 pts Antiphospholipid syndrome is NOT associated with which of the following? Select all that apply. Correct! Bleeding risk Thrombus risk Recurrent fetal loss Thrombocytopenia Can be seen with SLE Question 9 2.5 / 2.5 pts Multiple Choice What is the most specific test for diagnosing iron deficiency anemia? Correct! Ferritin RBC Total iron binding capacity Hematocrit Question 10 2.5 / 2.5 pts Multiple Choice Hemolytic anemias are characterized by each of the following except: Premature destruction of red cells Correct! Decrease in erythropoiesis Sickle cell disease and thalassemias are included Bone marrow is hyperactive Question 11 2.5 / 2.5 pts Which of the following are potential causes of a sickle crisis in sickle cell anemia? Select all that apply. Alkalosis Correct! Dehydration Correct! Cold exposure Correct! Physical exertion Question 12 0 / 2.5 pts Multiple Choice: A 23-year-old African-American man with a history of severe lifelong anemia requiring many transfusions has nonhealing leg ulcers and recurrent periods of abdominal and chest pain. These signs and symptoms are most likely to be associated with which one of the following laboratory abnormalities? Correct Answer Sickle cells on peripheral blood smear Loss of intrinsic factor You Answered Decreased erythropoietin Decreased ferritin Question 13 2.5 / 2.5 pts Multiple Choice: Which of the following is NOT true of vitamin B12 deficiency anemia? Dietary deficiencies are not common Peripheral neuropathy can be a result of deficiency Vitamin B12 is bound to intrinsic factor Correct! MCV is decreased Question 14 2.5 / 2.5 pts Multiple Choice: Each of the following are risk factors for secondary hyperlipidemia except? Obesity Diabetes mellitus High cholesterol diet Correct! Autosomal dominant disorder of LDL receptor Question 15 2.5 / 2.5 pts Multiple Choice: Risk factors for coronary heart disease include each of the following except: Correct! HDL > 60 Smoking Hypertension Family history of heart disease Question 16 2.5 / 2.5 pts Multiple Choice: Risk factors for atherosclerosis include each of the following except: Increasing age Correct! Female gender (pre-menopause) Elevated CRP levels Cigarette smoking Question 17 8 / 10 pts Matching: Match the cardiac procedures to their description and what they are best used for. 2 answers per question (1 from Set 1, and 1 from Set 2). 1. Cardiac catheterization 2. Exercise stress testing 3. Electrocardiography 4. Echocardiography Set 1: a. Records electrical potential differences during the cardiac cycle b. Observes cardiac function under stress c. Checks for structure and function of the heart d. Catheter is inserted into the great vessels and chambers of the heart Set 2: a. Best to assess ventricular function and heart failure b. Best to assess for arrhythmias and myocardial infarction c. Best to assess need for coronary artery bypass graft and stenting d. Best to assess suspected ischemic heart disease Your Answer: 1. D, C 2. B, D 3. A, A 4. C, B 1. Set 1: d, Set 2: c 2. Set 1: b, Set 2: d 3. Set 1: a, Set 2: b 4 . Set 1: c, Set 2: a Question 18 10 / 10 pts Explain the differences in the pathophysiology, symptoms, and whether nitroglycerin and/or rest will relieve symptoms in stable angina, unstable angina, and myocardial infarction. Your Answer: In stable angina, with exertion, the vessels cannot properly vasodilate. This can cause chest pain, tightness or shortness of breath. Heart is stable at rest, but cannot keep up with the exertion demand. It is relieved with rest and/or use of nitroglycerin. With increasing occlusion of the coronary vessel, the demands of the resting heart may become too great. Unstable agina is when patient has angina without exertion. Rest is insuffient, but can be releived with nitroglycerin. If the plaque ruptures, complete occulsion can occur. This can lead to lack of oxygen to tissues in the heart and muscle can die. This is myocardial infarction. Chest pain unrelieved by rest, sharp pain down left arm, vomitting are signs of distress. Emergency/hospital interventions are needed. With atherosclerotic disease, the coronary vessel lumens are narrowed and blood supply to the heart is diminished. With exertion, the vessels cannot adequately vasodilate. This can manifest as chest pain or tightness and/or shortness of breath. Stable angina- The heart is stable at rest but cannot keep up with the demand of exertion. Stable angina typically has a >70% stenosis of the coronary arteries. It is relieved by rest or nitroglycerin (vasodilator). Unstable angina- With increasing occlusion of the coronary vessel(s), the demands of the resting heart may become too great. When the patient experiences angina without exertion, or when the level of exertion necessary to cause anginal symptoms decreases, this is called unstable angina. It can be relieved by nitroglycerin, but not rest. Unstable angina means one or more coronary vessels is nearly totally occluded. Myocardial infarction- If a plaque ruptures, coronary thrombosis can cause complete occlusion. If collateral flow is inadequate, the tissue supplied becomes ischemic. Without oxygen, a portion of the muscle can die. MI can present as chest pain unrelieved by rest, sometimes radiating down the left ram or into the jaw or neck, dyspnea, nausea/vomiting, sweating, and/or other signs of distress. Other symptoms include a crushing pain or like “something is sitting on my chest.” Women may present with weakness, fatigue, shortness of breath, or GI complaints. Symptoms are not relieved by nitroglycerin. Question 19 10 / 10 pts 1. Name 2 lifestyle changes to prevent further progression of atherosclerotic diseases: 2. Name 2 medications used to treat someone with coronary artery disease and their mechanisms of action: Your Answer: 1. Stop smoking and frequent exercise 2. ACE inhibitors prevent conversion of angiotensin I to angiotensin II, which decreases vasocontriction, aldosterone production, sodium and water retiention by the kidneys. Diuretics promote the excretion of fluids, reducing preload. 1. Reduction in fat intake, quitting smoking, weight loss, exercise 2. Aspirin or other platelet inhibitors are used to prevent thrombosis formation. Beta-blockers and calcium channel blockers (CCB) – both decrease the heart rate and contractile force – can be initiated to decrease the heart’s demand of oxygen. CCB also increase coronary vasodilatation and decrease coronary vasospasm. Nitrates are used to quickly dilate the coronary vessels. Nitrates also dilate veins, decreasing the heart’s work by decreasing preload and afterload. Question 20 2.5 / 2.5 pts Multiple Choice: With increasing occlusion of the coronary vessel(s), the demands of the resting heart may become too great. When the patient experiences angina without exertion, or when the level of exertion necessary to cause anginal symptoms decreases, this is called what? Stable angina Correct! Unstable angina Myocardial infarction Question 21 2.5 / 2.5 pts Multiple Choice: Which of the following is NOT a risk factor for hypertension? Correct! Increased potassium intake Increased salt intake Increased alcohol intake Increased caloric intake Question 22 2.5 / 2.5 pts Multiple Choice: Each of the following lifestyle modifications will help to decrease blood pressure except: Losing weight Increase fruits and vegetables Correct! 3 drinks or more of alcohol Limiting salt intake Question 23 2.5 / 2.5 pts Multiple Choice: With atherosclerotic disease, the coronary vessel lumens are narrowed and blood supply to the heart is diminished. With exertion, the vessels cannot adequately vasodilate. This can manifest as chest pain or tightness and/or shortness of breath. What is this referred to as? Correct! Stable angina Unstable angina Myocardial infarction Question 24 2.5 / 2.5 pts Multiple Choice: Which arrhythmia is the most common chronic arrhythmia and incidence increases with age? Sinus bradycardia Sinus tachycardia Correct! Atrial fibrillation Atrial flutter Question 25 2.5 / 2.5 pts Fill in the blank: The laboratory test that measures the volume of red cells in 100 mL of blood is . Your Answer: hematocrit hematocrit Question 26 2.5 / 2.5 pts Fill in the blank: are a group of inherited disorders of hemoglobin synthesis common among Mediterranean populations. Your Answer: thalassemias Thalassemias Question 27 2.5 / 2.5 pts Fill in the blank: The drug most commonly associated with inhibition of platelet aggregation is .Your Answer: aspirin aspirin Question 28 10 / 10 pts Patient is found to have the above: What risk factors mostly led to this disease state? What is this person at risk for developing? What lifestyle modifications would you suggest for them?Your Answer: 1. Smoking, poor diet, high cholesteral values, obesity, diabetes 2. Atherosclerosis 3. Stop smoking, exercise, dietary changes, reduce alcohol consumption Answer: Picture is of an atherosclerotic plaque Hyperlipidemia, cigarette smoking, obesity and visceral fat, hypertension, diabetes mellitus. Increasing age, family history of premature CHD, and male sex. May also include C-reactiveprotein (CRP) and serum lipoprotein(a). Coronary artery disease, angina, myocardial infarction, aneurysm, stroke (ischemia, thrombosis, emboli). Stop smoking, lose weight/exercise, healthy diet (low-fat, low-cholesterol), adhere to medication forblood pressure, hyperlipidemia, and/or diabetes.