Pathophysiology - Cardiovascular Function exam with complete solutions

A 60-year-old male presents to his primary care provider reporting chest pain. He is diagnosed with atherosclerosis. This disease is caused by: a. Arterial wall thinning and weakening b. Abnormally dilated arteries and veins c. Abnormal thickening and hardening of vessel walls d. Autonomic nervous system imbalances - ANSWER-ANS: C Atherosclerosis is a form of arteriosclerosis characterized by thickening and hardening of the vessel wall. A patient wants to know what causes atherosclerosis. How should the nurse respond? In general, atherosclerosis is caused by: a. High serum cholesterol levels b. Endothelial injury and inflammation c. An increase in antithrombotic substances d. Congenital heart disease - ANSWER-ANS: B Atherosclerosis begins with injury to the endothelial cells that line artery walls. High serum cholesterol levels are associated with atherosclerosis, but are not its cause. A staff member asks a nurse what foam cells are. What is the nurse's best response? Foam cells in a fatty streak are: a. Deposited adipose cells b. Injured neutrophils c. Macrophages that engulf low-density lipoprotein (LDL) d. Lipid-laden mast cells - ANSWER-ANS: C Foam cells are lipid-laden macrophages that engulf LDL. A nurse takes an adult patient's blood pressure and determines it to be normal. What reading did the nurse obtain? a. Systolic pressure between 140 mm Hg and 150 mm Hg b. Systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg c. Systolic pressure less than 100 mm Hg regardless of diastolic pressure d. Systolic pressure greater than 140 mm Hg and a diastolic pressure of 100 mm Hg - ANSWER-ANS: B Normal blood pressure has a systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg. A systolic pressure of 140 mm Hg or more would indicate stage I hypertension. A systolic pressure of less than 100 mm Hg would indicate low blood pressure. A diastolic pressure greater than 90 mm Hg would indicate hypertension. Most cases of combined systolic and diastolic hypertension have no known cause and are documented on the chart as _____ hypertension. a. Primary b. Secondary c. Congenital d. Acquired - ANSWER-ANS: A Most cases of hypertension are diagnosed as primary hypertension. Most cases of hypertension are diagnosed as primary hypertension, not secondary, which is due to a known cause. A 30-year-old Caucasian female was recently diagnosed with primary hypertension. She reports that she eats fairly well, usually having red meat and potatoes daily. She also reports that her father has hypertension as well. A nurse determines which of the following risk factors is most likely associated with this diagnosis? a. Race b. Diet c. Age d. Genes - ANSWER-ANS: D Genetic factors, such as family history of hypertension, are the number one factor in the development of hypertension. A 65-year-old male presents for a routine checkup. A blood pressure check reveals a systolic pressure of 160 mm Hg and a diastolic pressure of 70 mm Hg. Which of the following is the most likely cause of this type of pressure elevation? a. Vasospasm b. Rigidity of the aorta c. Decreased sodium intake d. Lung disease - ANSWER-ANS: B Older adults experience stiffening of the arteries, which could lead to hypertension. A vasospasm could lead to chest pain, not hypertension. Increased sodium intake, not decreased, could lead to increased blood volume and hypertension. Lung disease would not lead to hypertension. A 52-year-old male is diagnosed with primary hypertension. He has no other health problems. Present treatment would cause the nurse to anticipate administering which drug to the patient? a. A beta-adrenergic agonist b. An alpha-adrenergic agonist c. A diuretic d. A calcium channel agonist - ANSWER-ANS: C Diuretics have been shown to be the safest and most effective medications for lowering blood pressure and preventing the cardiovascular complications of hypertension. A 55-year-old female has undiagnosed hypertension. She presents to her primary care provider reporting impaired vision and chronic edema. Lab tests reveal that she also has renal insufficiency. While planning care, the nurse realizes the most likely cause for these findings is: a. Clotting and gangrene b. Free radical injury and cell toxicity c. End-organ damage d. Hypertrophy and hyperplasia - ANSWER-ANS: C The patient is experiencing end-organ damage, as indicated by renal insufficiency. A nurse monitors the patient for _____ when rapid onset of malignant hypertension results. a. Atherosclerosis b. Encephalopathy c. Pulmonary edema d. Acute renal failure - ANSWER-ANS: B Malignant hypertension leads to cerebral edema and cerebral dysfunction (encephalopathy) and even death. When a nurse checks the patient for orthostatic hypotension, what did the nurse have the patient do? a. Physical exertion b. Eat c. Stand up d. Lie down - ANSWER-ANS: C Orthostatic hypotension refers to a drop in blood pressure when standing up. A 50-year-old male is diagnosed with orthostatic hypotension. Which of the following symptoms would he most likely experience? a. Headache and blurred vision b. Nausea and vomiting c. Chest pain and palpitations d. Syncope and fainting - ANSWER-ANS: D Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and syncope or fainting. A 65-year-old female presents to the emergency department reporting difficulty swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the: a. Cerebral vessels b. Renal arteries c. Inferior vena cava d. Thoracic aorta - ANSWER-ANS: D Thoracic aortic aneurysms can cause dysphagia (difficulty swallowing) and dyspnea (breathlessness). Aneurysms in cerebral vessels will produce a headache. Aneurysms in the renal arteries will produce flank pain. Aneurysms in the inferior vena cava may produce chest pain. A 60-year-old male is diagnosed with cerebral aneurysm. Where does the nurse suspect the cerebral aneurysm is located? a. Vertebral arteries b. Basilar artery c. Circle of Willis d. Carotid arteries - ANSWER-ANS: C Cerebral aneurysms often occur in the circle of Willis. What term should the nurse document for a detached blood clot? a. Thrombus b. Embolus c. Thromboembolus d. Infarction - ANSWER-ANS: C A detached thrombus is a thromboembolus. A thrombus is a clot that remains attached to a vessel wall. An embolus is a bolus of material floating in the blood stream. An infarction is death of tissue. A 32-year-old female presents with lower leg pain, with swelling and redness. While obtaining the patient's history, which finding could have caused her condition? a. Venous thrombus b. Heart valve damage c. Bacterial infection d. Atherosclerosis - ANSWER-ANS: A A thrombus formation in the vein leads to inflammation that may cause pain and redness with obstruction. Increased pressure in the vein behind the clot may lead to edema of the extremity. A 28-year-old female presents with severe chest pain and shortness of breath. She is diagnosed with pulmonary embolism, which most likely originated from the: a. Left ventricle b. Systemic arteries c. Deep veins of the leg d. Superficial veins of the arm - ANSWER-ANS: C The most likely origin of the embolism is from the deep veins of the legs. Individuals with Raynaud disease need to be counseled to avoid which of the following conditions to prevent severe symptoms? a. Allergic reactions b. Cold exposure c. Hot water immersion d. Tissue injury - ANSWER-ANS: B Raynaud disease consists of vasospastic attacks triggered by brief exposure to cold. A 75-year-old obese female presents to her primary care provider reporting edema in the lower extremities. Physical exam reveals that she has varicose veins. Upon performing the history, which of the following is a possible cause for the varicose veins? a. Extreme exercise b. Long periods of standing c. Trauma to the deep veins d. Ischemia - ANSWER-ANS: B The probable cause of the patient's varicose veins is gradual venous distention caused by the action of gravity on blood in the legs due to long periods of standing. A 52-year-old male presents with pooling of blood in the veins of the lower extremities and edema. The diagnosis is chronic venous insufficiency, and an expected assessment finding of this disorder is: a. Deep vein thrombus formation b. Skin hyperpigmentation c. Gangrene d. Edema above the knee - ANSWER-ANS: B Symptoms include edema of the lower extremities and hyperpigmentation of the skin of the feet and ankles. Edema in these areas may extend to the knees. Symptoms include edema and hyperpigmentation of the skin, but deep vein thrombi do not form. Gangrene does not occur in veins, but in arteries. Edema does not occur above the knee. While planning care for a patient with superior vena cava syndrome (SVCS), which principle should the nurse remember? SVCS is a progressive _____ of the superior vena cava (SVC) that leads to venous distention of the upper extremities and head. a. Inflammation b. Occlusion c. Distention d. Sclerosis - ANSWER-ANS: B SVCS is a progressive occlusion of the SVC that leads to venous distention in the upper extremities and head. A 50-year-old male with a 30-year history of smoking was diagnosed with bronchogenic cancer. He developed edema and venous distention in the upper extremities and face. Which of the following diagnosis will the nurse observe on the chart? a. Thromboembolism b. Deep vein thrombosis c. Superior vena cava syndrome (SVCS) d. Chronic venous insufficiency - ANSWER-ANS: C SVCS is a progressive occlusion of the superior vena cava that leads to venous distention in the upper extremities and head. Thromboembolism would not lead to the generalized symptoms described in the patient. Deep vein thrombosis would not lead to upper extremity symptoms. Chronic venous insufficiency would primarily affect one extremity. A 52-year-old female is diagnosed with coronary artery disease. The nurse assesses for myocardial: a. Hypertrophy b. Ischemia c. Necrosis d. Inflammation - ANSWER-ANS: B Coronary artery disease leads to myocardial ischemia. A 56-year-old male is diagnosed with coronary artery disease. Which of the following modifiable risk factors would the nurse suggest the patient change? a. Eating meat b. Living arrangements c. Drinking tomato juice d. Smoking cigarettes - ANSWER-ANS: D Cigarette smoking leads to vasoconstriction and should be the first behavior the patient changes. A 50-year-old obese male with hypertension and coronary artery disease visits a nutritionist for food counseling. He has an elevated level of low-density lipoprotein (LDL) and a low level of high-density lipoprotein (HDL). Which of the following should the nurse advise him to avoid? a. Monounsaturated fats b. Polyunsaturated fats c. Saturated fats d. Trans fats - ANSWER-ANS: D Trans fats are primarily found in artificially solidified (hydrogenated) oils (e.g., margarine and vegetable shortening). By becoming more solid, they lose essential fatty acids (EFAs). They can raise LDL and lower HDL levels. When a patient asks the nurse what is the most common cause of myocardial ischemia, which statement is the correct response? The most common cause of myocardial ischemia is: a. Idiopathic vasospasm b. Arterial emboli from heart valve c. Atherosclerosis d. Venous emboli - ANSWER-ANS: C The most common cause of myocardial ischemia is atherosclerosis. A 51-year-old male presents with recurrent chest pain on exertion. He is diagnosed with angina pectoris. When he asks what causes the pain, how should the nurse respond? The pain occurs when: a. Cardiac output has fallen below normal levels. b. The myocardial oxygen supply has fallen below demand. c. Myocardial stretch has exceeded the upper limits. d. The vagus nerve is stimulated. - ANSWER-ANS: B Angina is chest pain caused by myocardial ischemia, which develops if the flow or oxygen content of coronary blood is insufficient to meet the metabolic demands of myocardial cells. A decrease in cardiac output would lead to general systemic symptoms, not just chest pain, which is due to a decrease in myocardial oxygenation. Myocardial stretch does not affect angina symptoms. When the vagus nerve is stimulated, a change in rate occurs; it does not precipitate chest pain. A 62-year-old male presents to his primary care provider reporting chest pain at rest and with exertion. He does not have a history of coronary artery disease and reports that the pain often occurs at night. He is most likely experiencing which type of angina? a. Unstable b. Stable c. Prinzmetal d Silent - ANSWER-ANS: C Chest pain that occurs at rest and at night is descriptive of Prinzmetal angina. Unstable angina is a form of acute coronary syndrome that results from reversible myocardial ischemia. Stable angina is predictable and occurs with activity. Silent angina has few, if any, symptoms. A 51-year-old male is at the health clinic for an annual physical exam. After walking from the car to the clinic, he developed substernal pain. He also reported discomfort in his left shoulder and his jaw, lasting 2 to 3 minutes and then subsiding with rest. He indicates that this has occurred frequently over the past few months with similar exertion. The nurse suspects he is most likely experiencing: a. Stable angina b. Unstable angina c. Prinzmetal angina d. Myocardial infarction (MI) - ANSWER-ANS: A Stable angina is associated with activity and subsides with rest. Unstable angina is a form of acute coronary syndrome that results from reversible myocardial ischemia and occurs at rest. Chest pain that occurs at rest and at night is descriptive of Prinzmetal angina. MI pain does not subside with rest. A 49-year-old male presents to his primary care provider reporting chest pain. EKG reveals ST elevation. He is diagnosed with myocardial ischemia. Which of the following interventions would be most beneficial? a. Administer a diuretic to decrease volume. b. Apply oxygen to increase myocardial oxygen supply. c. Encourage exercise to increase heart rate. d. Give an antibiotic to decrease infection. - ANSWER-ANS: B Increase myocardial oxygen supply is indicated to treat ischemia. Oxygen is indicated, not a decrease in volume. Heart rate should be decreased to decrease cardiac workload. Antibiotics are not the most beneficial; oxygen is. A 68-year-old male presents to the ER reporting chest pain. He has a history of stable angina that now appears to be unstable. He most likely has: a.Mild to moderate atherosclerosis b. Impending myocardial infarction (MI) c. Electrical conduction problems in the heart d. Decreased myocardial oxygen demand - ANSWER-ANS: B Unstable angina is an indication of impending MI. A 55-year-old male died of a myocardial infarction. Autopsy would most likely reveal: a. Embolization of plaque from the aorta b. Decreased ventricular diastolic filling time c. Platelet aggregation within the atherosclerotic coronary artery d. Smooth muscle dysplasia in the coronary artery - ANSWER-ANS: C The autopsy would reveal platelet aggregation within an atherosclerotic coronary artery (occlusion of the coronary artery) A 60-year-old female had a myocardial infarction. She was brought to the hospital 30 minutes later. She survived, but now the nurse is providing care for impaired ventricular function because: a. There is a temporary alteration in electrolyte balance. b. There is too much stress on the heart. c. The cells become hypertrophic. d. The resulting ischemia leads to hypoxic injury and myocardial cell death. - ANSWER-ANS: D The patient has impaired ventricular functioning because a portion of the myocardium has died due to ischemia. A 75-year-old male has severe chest pain and dials 911. Lab tests at the hospital reveal elevated levels of cardiac troponins I and T. Based upon the lab findings, the nurse suspects which of the following has occurred? a. Raynaud disease b. Myocardial infarction (MI) c. Orthostatic hypotension d. Varicose veins - ANSWER-ANS: B The diagnosis of acute MI is made on the basis of serial cardiac biomarker alterations. The cardiac troponins (troponins I and T) are the most specific indicators of MI. A 28-year-old female presents to the ER reporting severe chest pain that worsens with respirations or lying down. She has a fever, tachycardia, and a friction rub. Based upon the assessment findings, the nurse determines the patient is experiencing: a. Acute pericarditis b. Myocardial infarction (MI) c. Stable angina d. Pericardial effusion - ANSWER-ANS: A Severe chest pain that worsens with respirations or lying down in a patient with fever, tachycardia, and a friction rub is characteristic of acute pericarditis. A 56-year-old male presents to his primary care provider for a checkup. Physical exam reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is of greatest concern to the nurse? a. Tamponade b. Exudate c. Aneurysm d. Pulsus paradoxus - ANSWER-ANS: A Muffled heart sounds is an indication of tamponade, and with tamponade the blood backs up into the venous system, leading to hepatomegaly. A 42-year-old female is diagnosed with constrictive pericarditis. The nurse assesses the blood pressure for decreased cardiac output because of: a. Pericardial effusions b. Fibrosis and calcification of the pericardial layers c. Cardiomyopathy d. Hemorrhage in the pericardial cavity - ANSWER-ANS: B In constrictive pericarditis, fibrous scarring compresses the heart and eventually reduces cardiac output. Pericardial effusion is manifested by chest pain. Cardiomyopathy is a general term for pathophysiological changes in the heart. Hemorrhage in the pericardial cavity will lead to tamponade. Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following conditions should alert the nurse that the patient may have both types of valve dysfunction? a. Heart failure b. Connective tissue disorders c. Rheumatic fever or heart disease d. Syphilis infection - ANSWER-ANS: C Valvular dysfunction is often related to rheumatic fever. While planning care, the nurse remembers which principle? In valvular _____, the valve opening is constricted and narrowed because the valve leaflets, or cusps, fail to open completely. a. Regurgitation b. Insufficiency c. Stenosis d. Incompetence - ANSWER-ANS: C Valvular stenosis occurs when the valve opening is constricted and narrowed. Valvular regurgitation occurs when blood moves backward into the chamber from which it came. Valvular insufficiency occurs when blood regurgitates backward into the chamber from where it came. Valvular incompetence leads to regurgitation. A 67-year-old female was previously diagnosed with rheumatic heart disease. Tests reveal lipoprotein deposition with chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which of the following is the most likely diagnosis recorded on the chart? a. Aortic regurgitation b. Aortic stenosis c. Mitral regurgitation d. Mitral stenosis - ANSWER-ANS: B Aortic stenosis would impair blood flow from the left ventricle to the aorta. Aortic regurgitation would allow blood to flow back into the left ventricle. Mitral regurgitation would allow blood to flow from the left ventricle to the left atrium. Mitral stenosis would impair blood flow from the left atrium to the left ventricle. A 60-year-old female was diagnosed with mitral stenosis. As a result, the nurse realizes the patient has incomplete emptying of the: a. Right atrium b. Right ventricle c. Left atrium d. Left ventricle - ANSWER-ANS: C Mitral stenosis would result in incomplete emptying of the left atrium, as the mitral valve is located between the left atrium and left ventricle. A 72-year-old female has a history of hypertension and atherosclerosis. An echocardiogram reveals backflow of blood into the left ventricle. Which of the following is the most likely diagnosis documented on the chart? a. Mitral regurgitation b. Mitral stenosis c. Aortic regurgitation d. Aortic stenosis - ANSWER-ANS: C Aortic regurgitation would allow backward flow of blood into the left ventricle. Upon assessment of the patient, the nurse finds a widened pulse pressure and throbbing peripheral pulses. Which valve disorder does the nurse suspect? a. Mitral regurgitation b. Mitral stenosis c. Aortic regurgitation d. Aortic stenosis - ANSWER-ANS: C Aortic regurgitation is manifested by widened pulse pressure resulting from increased stroke volume and diastolic backflow. Mitral regurgitation is manifested by heart failure. Mitral stenosis is manifested by pulmonary edema and heart failure. Aortic stenosis is manifested by narrowed pulse pressure. A 35-year-old male presents with pulmonary hypertension. Testing reveals he is in right heart failure. Which of the following is the most likely diagnosis the nurse will see listed on the chart? a. Aortic stenosis b. Tricuspid regurgitation c. Aortic regurgitation d. Mitral regurgitation - ANSWER-ANS: B Tricuspid regurgitation leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure, and right heart failure. Aortic stenosis is manifested by narrowed pulse pressure. Aortic regurgitation is manifested by widened pulse pressure resulting from increased stroke volume and diastolic backflow. Mitral regurgitation is manifested by heart failure, but not pulmonary hypertension. A nurse recalls the most common cardiac valve disease in the United States, which tends to be most prevalent in young women, is: a. Mitral valve prolapse b. Pulmonary stenosis c. Tricuspid valve prolapse d. Aortic stenosis - ANSWER-ANS: A Mitral valve prolapse is the most common valve disorder in the United States. A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. When a staff member asks what caused the disease, what is the nurse's most correct response? The most likely cause of this disease is: a. Congenital heart defects b. Human immunodeficiency virus (HIV) infections c. Group A ß-hemolytic streptococcus infections d. Acute pericarditis - ANSWER-ANS: C Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated immune response to infection by the group A â-hemolytic streptococcus. A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. While planning care, which characteristic changes should the nurse remember? a. Blood-borne organisms that adhere to the valvular surface b. Antigens that bind to the valvular lining, triggering an autoimmune response c. High fevers that damage collagen in valve leaflets d. Rheumatoid factor in the blood, stimulating valvular degeneration - ANSWER-ANS: B The immune response cross-reacts with molecularly similar self-antigens in heart, muscle, joints, and the brain, causing an autoimmune response resulting in diffuse, proliferative, and exudative inflammatory lesions in these tissues. A 30-year-old female presents to her primary care provider with fever, cardiac murmur, and petechial skin lesions. She is diagnosed with infective endocarditis. When the patient wants to know what caused the disease, what is the nurse's best response? The most likely cause of the disease is: a. Bacteria b. Viruses c. Fungi d. Parasites - ANSWER-ANS: A Infective carditis is due to a bacterial infection. A nurse is teaching staff about endocarditis. Which information should the nurse include? Inflammatory cells have difficulty limiting the colonization of microorganisms in infective endocarditis because the: a. Microorganisms are resistant. b. Valves are avascular. c. Microorganisms are sequestered in a fibrin clot. d. Colonies overwhelm the phagocytes. - ANSWER-ANS: C In endocarditis, bacterial colonies are inaccessible to host defenses because they are embedded in the protective fibrin clots. A 50-year-old male visits the cardiologist for an EKG. Results indicate that he has no PR interval and a variable QRS rate with rhythm irregularity. Which of the following is the most likely diagnosis to be recorded on the chart? a. Atrial tachycardia b. Atrial fibrillation c. Sinus dysrhythmia d. Idioventricular rhythm - ANSWER-ANS: B Atrial fibrillation is characterized by no PR interval and a variable QRS response. Atrial tachycardia is characterized by a normal PR interval. Sinus dysrhythmia is characterized by a change in rhythm associated with inspiration and expiration. Idioventricular dysrhythmia is characterized by absent P waves. Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses: a. Left ventricular preload increases. b. Systemic vascular resistance decreases. c. Left end-diastolic volume decreases. d. Pulmonary vascular resistance decreases. - ANSWER-ANS: A Left ventricular preload increases in left heart failure because less blood is ejected from the left ventricle. Left heart failure does not lead to a decrease in systemic resistance; it leads to an increase in resistance. Left end-diastolic volume will increase. Pulmonary vascular resistance will increase. A 65-year-old male with a history of untreated hypertension is now experiencing left heart failure. A nurse recalls his untreated hypertension led to: a. Ventricular dilation and wall thinning b. Myocardial hypertrophy and ventricular remodeling c. Inhibition of renin and aldosterone d. Alterations in alpha and beta receptor function - ANSWER-ANS: B With hypertension comes increased afterload and resistance to ventricular emptying and more workload for the ventricle, which responds with hypertrophy of the myocardium and ventricular remodeling. A 59-year-old female is diagnosed with left ventricular failure. If a decrease in kidney perfusion occurs, the nurse knows this would ultimately cause: a. Decreased left ventricular preload b. Increased pulmonary capillary permeability c. Increased systemic vascular resistance d. Decreased cardiac oxygen demand - ANSWER-ANS: C With a decrease in kidney perfusion, renin is released with the ultimate outcome of increased systemic vascular resistance to raise blood pressure to increase blood flow to the kidney. Ventricular preload will increase, not decrease. Capillary permeability will likely decrease. Cardiac oxygen demand will increase, not decrease. A 68-year-old female is experiencing left heart failure. Physical exam reveals elevated blood pressure. The nurse understands this is most likely caused by: a. Sympathetic nervous system compensation for decreased cardiac output b. Stress hormones promoting increased cardiac contractility c. Cardiotoxic effects of catecholamines and angiotensin d. Diastolic dysfunction - ANSWER-ANS: A The sympathetic nervous system increases peripheral vascular resistance (PVR) and leads to hypertension. When a patient with left heart failure starts to have a cough and dyspnea, which principle should the nurse remember? Pulmonary symptoms, common to left heart failure, are a result of: a. Inflammatory pulmonary edema b. Decreased cardiac output c. Pulmonary vascular congestion d. Bronchoconstriction - ANSWER-ANS: C The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation. A 73-year-old female has increased pulmonary pressure resulting in right heart failure. The nurse should monitor for a possible complication because a potential cause for her heart to fail is: a. Hypertension b. Left heart failure c. Acute pneumonia d. Pericarditis - ANSWER-ANS: B Right-sided failure often follows left-sided failure when pulmonary congestion forces backward flow of blood into the left ventricle. A 65-year-old male is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures should the nurse assess for in this patient? a. Right heart failure b. Left heart failure c. Low-output failure d. High-output failure - ANSWER-ANS: A Right-sided failure occurs when the patient experiences chronic pulmonary disease and elevated pulmonary vascular resistance because the blood has difficulty overcoming the pressure and blood builds up in the right side of the heart. A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure? a. Significant edema to both lower legs and feet b. Hypertension c. Decreased urine output d. Dyspnea upon exertion - ANSWER-ANS: A Right-sided failure allows blood to back up into the systemic circulation, leading to peripheral edema. Which condition should cause the nurse to assess for high-output failure in a patient? a. Metabolic alkalosis b. Hypothyroidism c. Hypovolemia d. Anemia - ANSWER-ANS: D Common causes of high-output failure include anemia. When a person is in shock, a nurse remembers impairment in cellular metabolism is cause by: a. Release of toxic substances b. Free radical formation c. Inadequate tissue perfusion d. Lack of nervous or endocrine stimulation - ANSWER-ANS: C In shock, impaired cellular metabolism is caused by inadequate tissue perfusion. One consequence of switching from aerobic to anaerobic cellular metabolism during shock states is: a. Decreased adenosine triphosphate (ATP) production b. Cellular dehydration c. Cellular alkalosis d. Free radical formation - ANSWER-ANS: A Anaerobic metabolism leads to decreased ATP production. A nurse is planning care for a patient in shock. Which principle should the nurse remember? During shock states, glucose uptake is usually: a. Enhanced b. Normal c. Impaired d. Energy intensive - ANSWER-ANS: C Some compensatory mechanisms activated by shock contribute to decreased glucose uptake by the cells. A 50-year-old male was admitted to the intensive care unit with a diagnosis of acute myocardial infarction (MI). He is being treated for shock. His cardiopulmonary symptoms include low blood pressure, tachycardia, and tachypnea. His skin is pale and cool. The primary cause of his shock is most likely: a. Rapid heart rate b. Decreased cardiac contractility c. Increased capillary permeability d. Decreased afterload due to vasodilation - ANSWER-ANS: B MI leads to decreased cardiac contractility due to a damaged myocardium and would lead to shock. An 82-year-old female was admitted to the hospital with confusion and severe hypotension. Her body's compensatory mechanisms are increased heart rate, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment. What kind of shock does the nurse suspect the patient is experiencing? a. Anaphylactic b. Hypovolemic c. Neurogenic d. Septic - ANSWER-ANS: B In hypovolemic shock, heart rate and SVR increase, boosting both cardiac output and tissue perfusion pressures. Interstitial fluid moves into the vascular compartment. In anaphylactic shock, bronchoconstriction occurs with hypotension. In neurogenic shock, hypotension occurs, but fluid does not shift. In septic shock, interstitial fluid shift does not occur. A 27-year-old male is admitted to a neurologic unit with a complete C-5 spinal cord transection. On initial assessment, he is bradycardic, hypotensive, and hyperventilating. He appears to be going into shock. The most likely mechanism of his shock is: a. Hypovolemia caused by blood loss b. Hypovolemia caused by evaporative fluid losses c. Vasodilation caused by gram-negative bacterial infection d. Vasodilation caused by a decrease in sympathetic stimulation - ANSWER-ANS: D The patient is experiencing neurogenic shock in which blood volume has not changed, but SVR decreases drastically so that the amount of space containing the blood has increased, leading to hypotension. In this type of shock, blood loss has not occurred. In this type of shock, fluid loss has not occurred. Vasodilation due to infection would be septic shock; the type of shock described in the patient is due to loss of sympathetic stimulation. What factors make a patient prone to neurogenic shock? Neurogenic shock can be caused by any factor that inhibits the: a. Parasympathetic nervous system b. Sympathetic nervous system c. Somatic nervous system d. Thalamus - ANSWER-ANS: B Neurogenic shock is caused by any factor that inhibits the sympathetic nervous system. A 15-year-old male who is allergic to peanuts eats a peanut butter cup. He then goes into anaphylactic shock. Which assessment findings will the nurse assess for? a. Bradycardia, decreased arterial pressure, and oliguria b. Bronchoconstriction, hives or edema, and hypotension c. Hypertension, anxiety, and tachycardia d. Fever, hypotension, and erythematous rash - ANSWER-ANS: B Anaphylactic shock is characterized by bronchoconstriction, hives, and hypotension. A nurse is teaching a patient about anaphylactic shock. Which information should the nurse include? The onset of anaphylactic shock is usually: a. Mild b. Immediate and life threatening c. Delayed by several hours d. Delayed by 24 hours - ANSWER-ANS: B The onset of anaphylactic shock is usually immediate and life threatening. For an infection to progress to septic shock, which of the following factors should the nurse determine occurred? a. The individual must be immunosuppressed. b. The myocardium must be impaired. c. The infection must be gram negative. d. Bacteria must enter the bloodstream. - ANSWER-ANS: D For septic shock to occur, bacteria must enter the bloodstream. A 20-year-old female is being admitted to the hospital with fever and septic shock. Which set of assessment findings would the nurse expect the patient to exhibit? a. Bradycardia, palpitations, confusion, truncal rash b. Severe respiratory distress, jugular venous distention, chest pain c. Low blood pressure, tachycardia, generalized edema d. Reduced cardiac output, increased systemic vascular resistance, moist cough - ANSWER-ANS: C Clinical manifestations of shock will include a low blood pressure and tachycardia. Tachycardia, not bradycardia, will occur. Severe respiratory distress, jugular vein distention, and chest pain are symptoms of heart failure, particularly pulmonary edema. Cardiac output is reduced, but there is a decrease in systemic vascular resistance. The hypotensive state seen in septic shock can lead to: a. Bradycardia due to an overworked heart b. Gut lining disruption and the translocation of bacteria into the bloodstream c. Decreased oxygen demand of highly metabolic tissue d. The increased spread of infection - ANSWER-ANS: B Gastrointestinal mucosa changes cause the translocation of bacteria from the gut into the bloodstream. Tachycardia, rather than bradycardia, occurs. The hypotensive state would lead to an increased demand of all tissues. The hypotensive state would decrease the spread of infection. Which patient is most prone to multiple organ dysfunction syndrome (MODS)? In a patient with: a. Myocardial infarction (MI) b. Pulmonary disease c. Septic shock d. Autoimmune disease - ANSWER-ANS: C The most common cause of MODS is septic shock. A 75-year-old female has been critically ill with multiple organ dysfunction syndrome (MODS) for longer than a week and has developed a severe oxygen supply and demand imbalance. The statement that best describes this imbalance is which of the following? a. Increased oxygen delivery to cells fails to meet decreased oxygen demands. b. The amount of oxygen consumed by cells depends only on the needs of cells, because there is oxygen in reserve. c. The situation results in supply-independent consumption. d. The reserve has been exhausted, and the amount of oxygen consumed depends on the amount the circulation is able to deliver. - ANSWER-ANS: D In MODS, the reserve has been exhausted and the body cannot meet the oxygenation demands. It is true that oxygen fails to meet demand, but there is no increase in oxygen because reserves are exhausted. There is no oxygen in reserve. The situation is supply and demand, but the demand cannot be met. Which organ should the nurse monitor closely since it is often the first to fail in patients with multiple organ dysfunction syndrome (MODS)? a. Liver b. Heart c. Lungs d. Pancreas - ANSWER-ANS: C The lungs are the first to fail in MODS. Which of the following findings in the patient with Raynaud disease would indicate a need for further teaching? a. The patient eats bananas twice a day. b. The patient smokes cigarettes. c. The patient wears mittens outside. d. The patient takes calcium channel blockers. - ANSWER-ANS: B Cigarette smoking should be stopped to eliminate the vasoconstricting effects of nicotine. Which of the following lab tests will the nurse check to help diagnose heart failure and provide insight into its severity? a. Renin level b. Brain natriuretic c. Potassium d. Troponin - ANSWER-ANS: B The level of serum brain natriuretic peptide (BNP) can also help make the diagnosis of heart failure and give some insight into its severity. Renin levels would not assist in the diagnosis of heart failure, but are elevated in hypertension. Potassium levels would not assist with the diagnosis of heart failure. Troponin assists in the diagnosis of myocardial infarction. A nurse recalls acute orthostatic hypotension can be caused by (select all that apply): a. Prolonged immobility b. Drug action c. Starvation d. Volume depletion e. Exercise - ANSWER-ANS: A, B, C, D Acute orthostatic hypotension occurs as a result of drug action, prolonged immobility, starvation, and volume depletion. Physical exhaustion, rather than exercise, could cause orthostatic hypotension. 1. A patient has been researching cardiac cells on the internet. Which information indicates the patient has a good understanding? Cardiac cells can withstand ischemic conditions for _____ minutes before irreversible cell injury occurs. - ANSWER-ANS: 20