Exam 2: NSG 3850 / NSG3850 (Latest 2025 / 2026 Update) Pathophysiology for Nurses II | Questions and verified Answers | Grade A | 100% Correct – Galen

Exam 2: NSG 3850 / NSG3850 (Latest 2025 / 2026 Update) Pathophysiology for Nurses II | Questions and verified Answers | Grade A | 100% Correct – Galen The amount of gas remaining in the lungs after a maximal expiration is called the a. residual volume. b. functional residual capacity. c. expiratory reserve volume. d. vital capacity. ANS: A Residual volume is the amount of gas remaining in the lungs after a maximal expiration. Functional residual capacity is the amount of gas left in the lungs at the end of a normal expiration. Expiratory reserve volume is the amount of gas expired beyond tidal volume. Vital capacity is the total volume of gas that can be exhaled during maximal expiration. An increase in filtration of fluid from the pulmonary capillaries into the interstitium occurs with ________ pressure. a. increased capillary colloid b. increased capillary hydrostatic c. decreased capillary hydrostatic d. decreased interstitial colloid ANS: B When capillary hydrostatic pressure exceeds capillary colloid osmotic pressure, fluid moves from the capillary to the interstitium. Increased capillary colloid pressure, decreased capillary hydrostatic pressure, or decreased interstitial colloid pressure would all prevent fluid movement out of the capillaries. The central chemoreceptors for respiratory control are a. located in the carotid artery. responsive primarily to changes in pH and CO2. b. responsive primarily to hypoxemia. c. less important than the peripheral d. chemoreceptors in maintaining respiration. ANS: B Central chemoreceptors for respiratory control are responsive primarily to changes in pH and CO2. The central chemoreceptors are located in the medullary center, are responsive to pH and CO2, and are more important than the peripheral chemoreceptors in controlling respirations. The peripheral chemoreceptors a. are located in the medulla oblongata. b. lead to hypoventilation when stimulated. c. respond to the arterial oxygen level. d. are unresponsive to pH and CO2 levels. ANS: C The peripheral chemoreceptors respond to reduced arterial oxygen (hypoxemia). The peripheral chemoreceptors are located in the aortic arch and carotid bodies, lead to hyperventilation when stimulated, and respond to pH and CO2 levels in addition to arterial oxygen level. Hypoxic pulmonary vasoconstriction a. diverts blood to hypoxic regions. b. increases blood flow to the base of the lung. c. can lead to secondary pulmonary hypertension. d. is always detrimental to the patient. ANS: C Increased resistance to blood flow resulting from hypoxic vasoconstriction can lead to secondary pulmonary hypertension. Hypoxic pulmonary vasoconstriction diverts blood to nonhypoxic regions, diverts blood to any area of the lung needed, and is helpful in maintaining adequate oxygenation. Most of the carbon dioxide in blood is a. transported as bicarbonate. b. transported on the hemoglobin molecule. c. transported as carbonic acid. d. dissolved in plasma. ANS: A Sixty to seventy percent of carbon dioxide in blood is transported as bicarbonate. Only 20% to 30% is carried on the hemoglobin molecule. An insignificant amount of carbon dioxide in blood is transported as carbonic acid. Only 5% to 10% is dissolved in plasma. Shifts in the oxyhemoglobin dissociation curve represent the a. effect of carbonic anhydrase on the uptake of CO2. b. ability of blood to pick up more CO2 when PaO2 is low. c. amount of hydrogen in solution in the blood. d. changes in hemoglobin affinity for oxygen. ANS: D Shifts in the oxyhemoglobin dissociation curve represent the changes in hemoglobin affinity for oxygen. Shifts in the oxyhemoglobin dissociation curve do not represent the effect of carbonic anhydrase on the uptake of CO2, the ability of blood to pick up more CO2 when PaO2 is low, or the amount of hydrogen in solution in the blood. Surfactant is a phospholipid that reduces a. pulmonary vascular capacitance. b. elastic recoil force. c. alveolar surface tension. d. pulmonary capillary fragility. ANS: C Surfactant reduces alveolar surface tension. Surfactant does not reduce pulmonary vascular capacitance, elastic recoil force, or pulmonary capillary fragility. Secondary pulmonary hypertension is most often caused by a. increased pulmonary blood flow. b. increased pulmonary vascular resistance. c. increased left atrial pressure. d. decreased alveolar compliance. ANS: B Secondary pulmonary hypertension is most often caused by increased pulmonary vascular resistance. Although increased pulmonary blood flow and increased left atrial pressure can lead to secondary pulmonary hypertension, the most common cause is increased pulmonary vascular resistance. Decreased alveolar compliance does not cause pulmonary hypertension. The pulmonary structure that has the least pulmonary blood flow is a. lung apex. b. middle lung. c. lower lung. d. zone 4. ANS: A Zone 1 (apex) has no perfusion and is equivalent to dead space. Zone 2 (middle lung) is intermittently perfused. Zone 3 (lower lung) is continuously perfused. There is no zone 4. Autonomic nervous system stimulation effects on the respiratory system include a. parasympathetic stimulation dilates airways. b. sympathetic stimulation constricts airways. c. sympathetic stimulation relaxes bronchial smooth muscle. d. the autonomic system has no effect on the respiratory system. ANS: C Sympathetic nervous system stimulation relaxes bronchial smooth muscle. Parasympathetic stimulation constricts airways. Sympathetic stimulation dilates airways. The autonomic nervous system does affect the respiratory system by relaxing the pulmonary blood vessels. Primary pulmonary hypertension is a. more common in men. b. readily treatable. c. caused by genetic mutation. d. rapidly progressive. ANS: D Primary pulmonary hypertension is rapidly progressive. Primary pulmonary hypertension is more common in women and is not responsive to treatment. While primary pulmonary hypertension may be genetic in some individuals, the cause is unknown. Hypoventilation causes a. hypoxemia. b. respiratory alkalosis. c. increased minute ventilation. d. decreased PaCO2. ANS: A Hypoventilation causes increased PaCO2 and resultant hypoxemia. Hypoventilation does not cause increased minute ventilation. Hyperventilation causes respiratory alkalosis and decreased PaCO2. Which person is at greatest risk for developing a pulmonary embolism? a. A 25-year-old man with asthma b. A 28-year-old woman in the first trimester of a normal pregnancy c. A 42-year-old woman with a broken ankle d. A 67-year-old man with a deep vein thrombosis in the femoral vein ANS: D The presence of deep vein thrombosis in the lower limbs is the most important risk factor for pulmonary embolism. Older age is also a risk factor. Asthma is not a specific risk factor for pulmonary embolism. The risk of developing blood clots and pulmonary emboli occurs later in pregnancy. Fractures of the pelvis or long bones can lead to fat emboli to the lung, but not fractures to small bones. Chronic pulmonary hypertension can eventually cause which complication? a. Pulmonary emboli b. Respiratory acidosis c. Chronic obstructive pulmonary disease d. Right heart failure ANS: D Increased right ventricular afterload from pulmonary hypertension can lead to right heart failure, also known as cor pulmonale. Chronic pulmonary hypertension is not a risk factor for pulmonary emboli. Chronic respiratory acidosis is a common cause of pulmonary hypertension, rather than a complication of it. Chronic pulmonary hypertension does not cause chronic obstructive pulmonary disease; COPD may cause chronic pulmonary hypertension. Virchow's triad can result in a. decreased pulmonary arterial pressure. b. alveolar collapse. c. pulmonary embolus. d. bronchoconstriction. ANS: C Virchow's triad consists of three physiologic factors that can predispose patients to thrombus formation, increasing the risk of PE. In Virchow's triad, pulmonary arterial pressure increases. Alveolar collapse and bronchoconstriction are not a result of Virchow's triad. Right-sided heart failure secondary to pulmonary hypertension is also called a. diastolic heart failure. b. high output failure. c. coronary disease. d. cor pulmonale. ANS: D Cor pulmonale is right-sided heart failure secondary to pulmonary hypertension. Cor pulmonale, not diastolic heart failure, is right-sided heart failure secondary to pulmonary hypertension. High output failure refers to left or biventricular failure caused by high output conditions such as sepsis or anemia. Coronary disease is atherosclerosis of the coronary arteries. "My doctor said I have cor pul-something, which is a heart problem," says Mr. Garabedian. "I thought I just had these bad lungs that can't be fixed. How can that make my heart go bad?" Which mechanism leads to the development of cor pulmonale, which should serve as the basis for your response to Mr. Garabedian? a. Left ventricular failure causes pulmonary venous congestion and pulmonary edema. b. Pneumothorax causes compression atelectasis, decreased alveolar ventilation, and impaired oxygenation. c. Increased resistance to pulmonary arterial flow leads to compensatory right ventricular hypertrophy. d. Impaired ventilation causes decreased PaO2, which precipitates cardiac dysrhythmias. ANS: C Cor pulmonale is right ventricular hypertrophy that occurs as a compensatory response to chronically increased resistance to pulmonary arterial flow. Left ventricular failure, pneumothorax and compression atelectasis, and cardiac dysrhythmias are not part of the pathogenesis of cor pulmonale. Structure(s) that engage in exchange of respiratory gases include(s) the (Select all that apply.) a. trachea. b. bronchi. c. pulmonary artery. d. pulmonary capillaries. e. alveoli. ANS: A, B, D, E The trachea, bronchi, pulmonary capillaries, and alveoli are all involved in the respiratory gas exchange process. The pulmonary artery is not involved in gas exchange. Which is true about lung compliance? (Select all that apply.) a. Represents lung expandability b. Decreases in the elderly c. Can be decreased by obesity, abdominal distention, pregnancy d. Is decreased in emphysema e. Is affected by body position ANS: A, B, C, E Lung compliance is lung expandability; decreases in the elderly; can decrease in obesity, abdominal distention, and pregnancy; and is affected by body position. Lung compliance is increased in emphysema. Copious amounts of foul-smelling sputum are generally associated with a. emphysema. b. epiglottitis. c. pulmonary edema. d. bronchiectasis. ANS: D Copious, foul-smelling respiratory secretions are associated with bronchiectasis. Copious, foul-smelling respiratory secretions are not associated with emphysema, epiglottitis, or pulmonary edema. Emphysema results from destruction of alveolar walls and capillaries, which is because of a. release of proteolytic enzymes from immune cells. b. air trapping with resultant excessive alveolar pressure. c. excessive 1-antitrypsin. d. autoantibodies against pulmonary basement membrane. ANS: A The pathologic changes leading to alveolar destruction are associated with the release of proteolytic enzymes from inflammatory cells such as neutrophils and macrophages. While air trapping occurs in emphysema, the destruction of alveolar walls and capillaries is because of release of proteolytic enzymes. Lack of 1-antitrypsin can result in emphysema. Autoantibodies are not involved in destruction of alveolar walls and capillaries in emphysema. Chronic bronchitis often leads to cor pulmonale because of a. ventricular hypoxia. b. increased pulmonary vascular resistance. c. left ventricular strain. d. hypervolemia. ANS: B Chronic bronchitis often leads to cor pulmonale as a result of increased pulmonary vascular resistance when right ventricular end-diastolic pressure increases. Ventricular hypoxia, left ventricular strain, and hypervolemia do not lead to cor pulmonale. All obstructive pulmonary disorders are characterized by a. resistance to airflow. b. hyperresponsiveness. c. decreased residual volumes. d. decreased lung compliance. ANS: A Obstructive lung diseases are characterized by increased resistance to airflow. Only asthma is characterized by hyperresponsiveness. Increased residual volume is common in obstructive pulmonary disorders. Emphysema is characterized by increased lung compliance caused by a loss of alveoli and elastic tissue. Obstructive disorders are associated with a. low residual volumes. b. low expiratory flow rates. c. increased expiratory reserve volume. d. decreased total lung capacity. ANS: B Obstructive disorders are associated with low expiratory flow rates. Obstructive disorders are associated with high residual volume. Increased expiratory reserve volume and decreased total lung capacity are not characteristic of obstructive disorders. COPD leads to a barrel chest, because it causes a. pulmonary edema. b. muscle atrophy. c. prolonged inspiration. d. air trapping. ANS: D Destruction of alveolar walls reduces lung elastic recoil, which allows airway collapse during exhalation. Air enters the alveoli during inhalation, but has difficulty escaping during exhalation. When air is trapped in the alveoli, residual volume increases, causing a barrel chest. Destruction of alveolar walls does not cause pulmonary edema, muscle atrophy, or prolonged inspiration. Lack of -antitrypsin in emphysema causes a. chronic mucous secretion and airway fibrosis. b. destruction of alveolar tissue. c. pulmonary edema and increased alveolar compliance. d. bronchoconstriction and airway edema. ANS: B Lack of a1-antitrypsin in emphysema causes destruction of alveolar tissue, as it is a protective enzyme that prohibits proteolytic breakdown of alveolar tissue. Lack of alpha1-antitrypsin does not cause chronic mucous secretion and airway fibrosis, pulmonary edema and increased alveolar compliance, or bronchoconstriction and airway edema. The hypersecretion of mucus resulting for chronic bronchitis is the result of a. recurrent infection. b. destruction of alveolar septa. c. reduced inflammation. d. barrel chest. ANS: A Mucus provides a hospitable environment for bacterial colonization and recurrent infection. Destruction of alveolar septa and reduced inflammation are not complications of chronic bronchitis. Hypersecretion of mucus does not contribute to barrel chest. When preparing for the admission of a client diagnosed with bronchiectasis, the nurse will a. put a sputum cup and a box of tissues on the bedside table. b. remove the telephone to reduce myocardial oxygen demand. c. add a box of surgical masks to the nursing supplies near the door. d. remove the water pitcher to comply with anticipated fluid restrictions. ANS: A People who have bronchiectasis have a productive cough, usually with foul-smelling sputum. Bronchiectasis is not contagious or a cardiac condition. Fluid restriction is not part of the treatment for bronchiectasis. // Which assessment would support a diagnosis of type A COPD rather than type B COPD a. Copious sputum, dyspnea, cor pulmonale b. Noisy breath sounds, fatigue, high PaCO2, overweight c. Normal PaCO2, scant sputum, accessory muscle use, barrel chest d. Barrel chest, productive cough, cyanosis, very decreased PaO2 ANS: C Barrel chest and obvious respiratory effort that maintains near normal blood gases are consistent with type A COPD in the early stages. Copious sputum, dyspnea, and cor pulmonale are consistent with type B COPD. Noisy breath sounds, fatigue, high PaCO2, and overweight are consistent with type B COPD. Barrel chest, productive cough, cyanosis, and very decreased PaO2 are not consistent with type A COPD. // To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke a. impairs 1-antitrypsin, allowing elastase to predominate. b. paralyzes the cilia, causing impaired mucociliary clearance. c. predisposes to respiratory infections. d. introduces carcinogens into the lungs. ANS: A Cigarette smoking impairs 1-antitrypsin, allowing elastase to predominate and destroy lung tissue, causing emphysema. Although cigarette smoking does paralyze cilia, this action predisposes to respiratory infections rather than to emphysema. Although cigarette smoking does predispose to respiratory infections, that is not the mechanism that causes emphysema. Carcinogens introduced by cigarette smoking increase the risk of developing lung cancer, but they are not responsible for emphysema. When a client diagnosed with COPD type A asks, "Why is my chest so big and round?", the nurse responds that a. "Loss of elastic tissue in your lungs allows your airways to close and trap air, which makes your chest round." b. "Swelling and mucus in your airways causes air to be trapped in your lungs, which makes your chest round." c. "Coughing caused by your condition has changed the structure of your airways, which makes your chest round." d. "Scar tissue in your lungs makes them stiff and more full of air than usual, which makes your chest round." ANS: A Loss of elastic tissue in the lungs allows premature airway closure, which traps air, creating a barrel chest. The other answer choices do not describe the pathophysiology that causes barrel chest in persons with COPD type A. Airway obstruction in chronic bronchitis is because of a. thick mucus, fibrosis, and smooth muscle hypertrophy. b. loss of alveolar elastin. c. pulmonary edema. d. hyperplasia and deformation of bronchial cartilage. ANS: A Airway obstruction in chronic bronchitis is as a result of thick mucus, fibrosis, and smooth muscle hypertrophy. Loss of alveolar elastin, pulmonary edema, and hyperplasia and deformation of bronchial cartilage are not part of the pathophysiology of chronic bronchitis. Individuals who have chronic bronchitis most often have a. a productive cough. b. normal lung sounds. c. a barrel chest. d. substantial weight loss. ANS: A A productive cough for at least 3 months is the classic sign of chronic bronchitis. People who have chronic bronchitis commonly have abnormal lung sounds resulting from mucus in their airways. Barrel chest is a classic sign of emphysema. Substantial weight loss is characteristic of emphysema, but not of chronic bronchitis. The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by a. increased pulmonary blood flow. b. increased expiratory flowNratRes. c. increased residual lung volumes. d. decreased chest wall compliance. ANS: C Increased residual lung volumes are because of air trapping in obstructive lung disease and cause a barrel chest. Increased pulmonary blood flow does not affect chest diameter. Increased expiratory flow rates would decrease air trapping rather than increase chest diameter. Obstructive lung disease does not involve decreased chest wall compliance. It is increased as a result of loss of alveoli and elastic tissue. // Viral pneumonia is characterized by a. a productive cough. b. a dry cough. c. exudative consolidation. d. significant ventilation-perfusion imbalance. ANS: B No exudative fluids are produced. Viral pneumonia does not produce exudates, so the cough is non-productive. Ventilation-perfusion imbalance does not usually occur in viral pneumonia. The characteristic x-ray findings in tuberculosis include a. diffuse white-out. b. Ghon tubercles. c. bibasilar infiltrates. d. tracheal deviation. ANS: B Tuberculosis results in Ghon tubercles that show up as nodules with infiltrates. Diffuse white-out, basilar infiltrates, and tracheal deviation are not characteristic x-ray findings in tuberculosis. Which is indicative of a left tension pneumothorax? a. Course crackles throughout the left chest b. Tracheal deviation to the left c. Absent breath sounds on the left d. Respiratory acidosis ANS: C A left pneumothorax results in absent breath sounds on the affected side. Crackles will not be heard because breath sounds are not present. Tracheal deviation occurs on the contralateral side. Pneumothorax results in acute respiratory alkalosis. A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for a. pneumonia. b. pneumothorax. c. pulmonary edema. d. pulmonary embolus. ANS: B Pneumothorax leads to a tracheal shift to the side opposite the pneumothorax. Pneumonia, pulmonary edema, and pulmonary embolus do not lead to tracheal shift. A patient with a productive cough and parenchymal infiltrates on x-ray is demonstrating symptomology of a. bacterial pneumonia. b. viral pneumonia. c. tuberculosis. d. acute respiratory distress syndrome. ANS: A Bacterial pneumonia produces a productive cough and parenchymal infiltrates (white shadows) on x-ray. Viral pneumonia does not produce a productive cough. Tuberculosis may produce a productive cough but does not show parenchymal infiltrates (white shadows) on x-ray. Acute respiratory distress syndrome produces a non-productive cough. The organism that causes pulmonary tuberculosis is a. Mycobacterium tuberculosis. b. Haemophilus tuberculosis. c. Tuberculosis tuberculoci. d. Mycococcidio tuberculosis. ANS: A Mycobacterium tuberculosis causes pulmonary tuberculosis. Haemophilus tuberculosis, Tuberculosis tuberculoci, and Mycococcidio tuberculosis do not cause pulmonary tuberculosis. Which clinical manifestation is not likely the result of a tuberculosis infection? a. Productive cough b. Low-grade fever c. Night sweats d. Cyanosis ANS: D Cyanosis is not a typical manifestation of tuberculosis infection. A productive cough, low-grade fever, and night sweats are the typical manifestations of tuberculosis infection. Which disorder is caused by inhalation of organic substances? a. Diffuse interstitial lung disease b. Hypersensitivity pneumonitis c. Sarcoidosis d. Acute respiratory distress syndrome ANS: B Hypersensitivity pneumonitis is caused by inhalation of organic substances that produces an inflammatory immunologic reaction. Diffuse interstitial lung disease is probably related to an immune reaction but not from inhalation of organic substances. Sarcoidosis likely has an immunologic basis, but not from inhalation of organic substances. Acute respiratory distress syndrome is associated with severe trauma, sepsis, and shock. Empyema is defined as an a. exudative bronchitis. b. infection in the pleural space. c. infection localized in the lung. d. infection in the blood. ANS: B Empyema is infection in the pleural space. Empyema is not exudative bronchitis, localized infection in the lung, or an infection in the blood. A patient with flail chest will demonstrate a. absence of chest movement with breaths. b. no inspiratory breath sounds. c. fluttering chest movements on expirations. d. outward chest movement on expiration. ANS: D Flail chest is demonstrated by paradoxical inward movement on inspiration and outward movement on expiration. Flail chest is not demonstrated by absence of chest movement with breaths, no inspiratory breath sounds, or fluttering chest movements on expiration. Obstructive sleep apnea would most likely be found in a patient diagnosed with a. myasthenia gravis. b. poliomyelitis. c. Pickwickian syndrome. d. pneumonia. ANS: C Pickwickian syndrome is hypoventilation caused by obesity. Sleep apnea is often a problem in obese individuals. Obstructive sleep apnea is not likely to be found in a patient with myasthenia gravis, poliomyelitis, or pneumonia. The most definitive diagnostic method for active tuberculosis is acquired via a. sputum culture. b. Mantoux skin test. c. chest x-ray. d. blood culture. ANS: A The most definitive diagnostic method for active tuberculosis is via sputum culture to identify the acid-fast bacillus. The Mantoux skin test does not distinguish between active infection and past infection. Although a chest x-ray will show characteristic nodules, a sputum culture is the most definitive diagnostic method for active tuberculosis. Unless a patient is septic (infection in the blood), the tuberculosis organism will not be found in the blood. A major cause of treatment failure in tuberculosis is a. resistant organism. b. allergy to drugs used. c. noncompliance. d. immunosuppression. ANS: C The major cause of treatment failure in tuberculosis is non-adherence to drug therapy. The major cause of treatment failure in tuberculosis is not a resistant organism, drug allergy, or immunosuppression. Neuromuscular disorders impair lung function primarily because of a. inflammatory events in the lung. b. secondary pneumonia. c. weak muscles of respiration. d. inactivity secondary to the disorder. ANS: C Neuromuscular disorders weaken respiratory muscle function resulting in poor ventilation. Inflammatory events in the lung, secondary pneumonia, and inactivity secondary to the disorder are not the primary reasons neuromuscular disorders impair lung function. Legionnaires disease is characterized by a. presence of systemic illness. b. airborne mechanism of communicability. c. mild symptomatology. d. resolution with or without antimicrobial therapy. ANS: A Legionnaires disease produces system manifestations such as fever, diarrhea, abdominal pain, and pneumonia. The organism that causes Legionnaires disease is transmitted by means of contaminated water. Symptoms are severe, and the disease requires antimicrobial therapy. Bacterial pneumonia leads to hypoxemia caused by a. cardiogenic pulmonary edema. b. upper airway obstruction. c. accumulation of alveolar exudates. d. interstitial edema. ANS: C The inflammatory response to bacterial pneumonia causes accumulation of exudates in the alveoli and impairs oxygenation. Bacterial pneumonia does not cause cardiogenic pulmonary edema. Pneumonia involves lower airway obstruction. Bacterial pneumonia does not lead to interstitial edema. A common characteristic of viral pneumonia is a. high fever. b. alveolar infiltrates on a chest x-ray. c. increased white blood cell count. d. dry cough. ANS: D Viral pneumonia typically manifests with a dry cough. Viral infections usually do not cause high fever. Viral pneumonia typically does not produce alveolar infiltrates or leukocytosis. A major risk factor for the development of active pulmonary tuberculosis (TB) disease is a. contaminated water. b. immunosuppression. c. being a male. d. overuse of antibiotics. ANS: B Immunosuppressed individuals, such as those with HIV, are at high risk for active TB disease. Contaminated water and gender are not major risk factors for pulmonary tuberculosis. Excessive use of antibiotics can lead to opportunistic yeast and fungal infections or cause bacterial resistance to available antibiotics, but it is not a major risk factor for TB. // Accumulation of fluid in the pleural space is called a. an abscess. b. pleurisy. c. flail chest. d. pleural effusion. ANS: D Pleural effusion is accumulation of fluid in the pleural space. A lung abscess is a circumscribed area of suppuration and lung tissue destruction. Pleurisy is inflammation of the pleura that often manifests with pain on inspiration, fever, and chills. Flail chest is the fracture of several consecutive ribs. A restrictive respiratory disorder is characterized by a. increased total lung capacity. b. decreased residual volume. c. inspiratory wheezing. d. expiratory wheezing. ANS: B Restrictive respiratory disorders are characterized by decreased residual volume. Restrictive respiratory disorders are not characterized by increased residual volume. Inspiratory and expiratory wheezing are not characteristic of restrictive respiratory disorder. Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called a. tension pneumothorax. b. open pneumothorax. c. pleural effusion. d. empyema. ANS: A Air that enters the pleural space during inspiration but is unable to exit during expiration causes a tension pneumothorax. The question does not describe open pneumothorax, pleural effusion, or empyema. When a parent of a toddler recently diagnosed with pneumococcal pneumonia asks why their child is so much sicker than a classmate was when they were diagnosed with pneumonia, the nurse replies a. "It sounds as if the classmate was just lucky and less exposed at daycare." b. "It sounds like your child has a case of bacterial pneumonia, while the classmate had viral pneumonia." c. "It sounds as if your child is having a severe reaction to bacterial pneumonia. It hits some children harder than others." d. "It sounds as if your child has a case of viral pneumonia, while the classmate had bacterial pneumonia." ANS: B Viral pneumonia does not produce exudate so the cough is non-productive. In general, symptoms of viral pneumonia are less severe than those of bacterial pneumonia. The uncle's case of viral pneumonia has less acute symptoms than the children's case of bacterial pneumonia. Pneumococcal pneumonia is not necessarily more severe in children. The children most likely have bacterial pneumonia, which is why their symptoms are more acute than the classmate's case of viral pneumonia. // Common characteristics of sarcoidosis include (Select all that apply.) a. presence of CD4+ T cells. b. a non-productive cough. c. leukocytosis. d. granulomas in multiple body systems. e. fatigue, weight loss, and fever. ANS: A, B, D, E Common characteristics of sarcoidosis include the presence of CD4+ T cells; a non-productive cough; granulomas in lungs and other body systems; and fatigue, weight loss, and fever. Leukopenia is characteristic of this disorder. Clinical manifestations of pleural effusion include (Select all that apply.) a. dyspnea. b. sharp pain in expiration. c. productive cough. d. diminished breath sounds. e. a tracheal shift, if large. ANS: A, D, E Clinical manifestations of pleural effusion include dyspnea, diminished breath sounds, and tracheal shift if a large amount of fluid is present. With pleural effusion, pain is worse on inspiration and the cough is non-productive. If productive, an infectious process within the lung is suspected. // Restrictive respiratory disorders include (Select all that apply.) a. pneumothorax. b. emphysema. c. chronic asthma. d. type B COPD. e. ARDS. ANS: A, E Pneumothorax is a restrictive respiratory disorder that involves the pleural space and ARDS is a restrictive respiratory disorder that involves lung parenchyma. Emphysema, chronic asthma, and type B COPD are obstructive respiratory diseases. A normal bleeding time in association with normal platelet count, and increased prothrombin time (PT) and INR, is indicative of a. vitamin K deficiency. b. hemophilia B. c. hemophilia A. d. idiopathic thrombocytopenia. ANS: AVitamin K deficiency should be considered as the cause for bleeding when the PT and INR are increased but other coagulation studies are normal. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Hemophilia A results from factor deficiency or the abnormal function of factor VIII. In idiopathic thrombocytopenia, a decreased platelet count is seen in prolonged bleeding times. The final step in clot formation is a. conversion of prothrombin to thrombin. b. platelet degranulation and adhesion. c. conversion of fibrinogen to fibrin. d. clot retraction. ANS: D Clot retraction, the final stage of clot formation, occurs when the components of the fibrin clot are compressed or contracted to form a firm clot. Platelets serve as a catalyst in accelerating the conversion of prothrombin to thrombin. Platelet degranulation is not involved in clot formation. The formation of a fibrin clot occurs when fibrinogen is converted to fibrin, usually at the site of an injury. Dysfunction of which organ would lead to clotting factor deficiency? a. Liver b. Kidney c. Spleen d. Pancreas ANS: A The liver is responsible for the synthesis of coagulation factors. A clotting factor deficiency is the result of liver dysfunction. Coagulation does not occur in the kidneys. About 25% of the total number of platelets can be found in the spleen. The pancreas is not a location where coagulation occurs. // The conversion of plasminogen to plasmin results in a. clot retraction. b. fibrinolysis. c. platelet aggregation. d. activation of thrombin. ANS: B Fibrinolysis is the process of clot dissolution and occurs when plasminogen activators cleave plasminogen to plasmin. Clot retraction occurs when the components of the fibrin clot are compressed or contracted to form a clot. Factors released from platelets contribute to hemostasis by enhancing vasoconstriction, platelet aggregation, and vessel repair. Platelet aggregation is not the result of plasmin conversion. Thrombin cleaves fibrinogen to form a fibrin clot. Activation of the extrinsic pathway of coagulation is initiated by a. platelet factors. b. collagen exposure. c. tissue thromboplastin. d. factor VII. ANS: C The extrinsic pathway of coagulation begins when the vascular wall is traumatized. Tissue factor from injured tissue activates factors which in turn activate and convert into thrombin for clotting. Platelets play a major role in primary hemostasis as well as secondary hemostasis and clot retraction. Platelets accelerate the conversion of prothrombin to thrombin. Platelets adhere to collagen exposed by trauma and initiate degranulation. Factor VII is involved in the extrinsic pathway of coagulation when it is activated by tissue factor following a traumatic injury. The prothrombin time (PT) and INR (international normalized ratio) measure the integrity of a. platelet function. b. extrinsic pathway. c. intrinsic pathway. d. fibrinolysis. ANS: B The PT and INR assess the extrinsic pathway of coagulation. Platelet function is measured through a CBC. The aPTT assesses the intrinsic pathway of coagulation. The D-dimer assay reflects fibrinolysis. The activated partial thromboplastin time (aPTT) is a measure of the integrity of a. the extrinsic pathway. b. the intrinsic pathway. c. factor VIII synthesis. d. plasminogen. ANS: BThe intrinsic pathway is assessed through the aPTT. The extrinsic pathway is assessed through measurements of the PT and INR. An abnormal factor VIII function results in hemophilia A. The deficiency is verified by factor assay. The aPTT is not utilized to assess the integrity of plasminogen. A commonly ingested substance associated with prolongation of the bleeding time is a. acetaminophen. b. tobacco. c. caffeine. d. aspirin. ANS: D Many drugs are associated with prolonged bleeding times. Aspirin is known to alter normal platelet function. Acetaminophen is not associated with prolongation of bleeding time. Tobacco does not interfere with bleeding times. Caffeine does not interfere with bleeding times. The megakaryocyte is a precursor to a. factor IX. b. white blood cells. c. red blood cells. d. platelets. ANS: D Platelets are produced by bone marrow megakaryocytes. Production falls when the number of megakaryocytes is reduced or when the process of platelet production is ineffective. One major role in the formation of factor IX is the presence of calcium. White blood cells are not formed in response to megakaryocytes. Megakaryocytes are not a precursor to red blood cells. A cause of thrombocytopenia includes a. hypoxemia. b. reduced erythropoietin. c. chemotherapy. d. secondary polycythemia. ANS: C Bone marrow suppression from chemotherapy, recent immunizations, and alcohol ingestion are common causes of platelet production. Underlying systemic diseases may be presently related to bleeding problems. Hypoxemia is not directly associated with thrombocytopenia. A reduction in erythropoietin is not associated with alterations in coagulation. Secondary polycythemia is not a cause of thrombocytopenia. A 3-year-old boy who exhibits prolonged bleeding after minor trauma and a prolonged aPTT, but a normal platelet count, is likely to be diagnosed with a. hemophilia. b. liver dysfunction. c. disseminated intravascular coagulation. d. thrombocytopenia. ANS: A Hemophilia is rare, but it is the most common severe inherited coagulation disorder. Prolonged bleeding from a minor trauma is a characteristic manifestation. Liver disease is commonly manifested by a decreased platelet count and prolonged coagulation studies. DIC is more often seen in adults as the result of trauma or sepsis. A very low platelet count is often seen in thrombocytopenia. Treatment for hemophilia A includes a. heparin administration. b. factor IX replacement. c. factor VIII replacement. d. platelet transfusion. ANS: C Factor VIII administration is a common treatment choice for hemophilia A, particularly with dental procedures requiring local anesthesia. Heparin administration is typically highly contraindicated in an individual with a bleeding disorder although in some cases it is given to patients with DIC. Factor IX may be available as a treatment option for hemophilia B. A platelet transfusion is not of benefit in the hemophilia A patient. A deficiency of von Willebrand factor impairs a. activation of the coagulation cascade. b. platelet aggregation. c. platelet adhesion to injured tissue. d. platelet production. ANS: C Absence of platelet adhesion at the site of vascular injury and deficient factor VIII activity in the intrinsic coagulation pathway contribute to the bleeding seen in von Willebrand disease. The coagulation cascade is not activated by a deficiency of von Willebrand factor. Platelet aggregation is not related to a deficiency of the von Willebrand factor. von Willebrand factor is necessary for normal adherence of platelets for damaged vascular endothelium. What is involved in the release of plasminogen activators? ( Select all that apply.) a. Factor X b. Factor XII c. HMWK d. Kallikrein e. Thrombin ANS: B, C, D, E Factor XII, HMWK, kallikrein, and thrombin are involved in the release of plasminogen activators. Factor X initiates the common final pathway of coagulation. Which involves bleeding associated with vascular or platelet defects? ( Select all that apply.) a. Bleeding that occurs immediately after trauma b. Bleeding that involves skin or mucous membranes c. Bleeding that is brief in duration d. Bleeding that is delayed e. Bleeding into muscles or joints ANS: A, B, C Bleeding associated with vascular or platelet defects usually occurs immediately after trauma (e.g., dental extraction), involves skin or mucous membranes, and is brief. Delayed bleeding or bleeding into muscles or joints is more typical of a coagulation defect. Which diseases may be associated with a bleeding problem? ( Select all that apply.) a. Urinary retention b. Renal failure c. Cirrhosis d. Systemic lupus erythematosus e. Ovarian cancer ANS: B, C, D, E Renal failure may be associated with a bleeding problem. Liver disease, such as cirrhosis, may be associated with a bleeding problem. Systemic lupus erythematosus may be associated with a bleeding problem. Malignancies, such as ovarian cancer, may be associated with a bleeding problem. Urinary retention is not a disease. A male patient involved in a motor vehicle accident is brought to the emergency department with acute flank pain. What additional signs of bleeding may the patient exhibit? ( Select all that apply.) a. Hematuria b. Melena c. Hematemesis d. Menorrhagia e. Hemoptysis ANS: A, B, C, E Blood in the urine is indicative of a bleeding disorder. Blood in the feces could indicate internal bleeding. Blood in vomit may signify a bleeding disorder. Menorrhea is excessive menstrual bleeding, which would not be seen in the male patient. Bloody sputum is a common symptom of a bleeding disorder. T/F The liver is responsible for the synthesis of coagulation factors, with the exception of part of VIII. ANS: T The liver is responsible for the synthesis of coagulation factors, with the exception of part of factor VIII. T/F Hemophilia B is also known as Christmas disease. ANS: T Hemophilia B is also known as Christmas disease. Which vessel normally demonstrates the most rapid blood flow? a. An arteriole b. A capillary c. A venule d. The vena cava ANS: DThe vena cava has the most rapid rate of flow. Arterioles don't offer the most rapid blood flow. Capillaries are composed of a single thickness of endothelial cells attached to a protein network called the basement membrane and don't offer the most rapid blood flow. A venule begins where the arteriole ends and doesn't offer the most rapid blood flow. The movement of blood through the vascular system is opposed by the force of a. viscosity. b. the vessel length. c. the vessel radius. d. resistance. ANS: D The movement of blood through the vascular system is opposed by the force of resistance. Three determinants of resistance are vessel length, vessel radius, and blood viscosity. Viscosity is the thickness of fluid and has an effect on resistance. The length of the vessel does have an effect on the resistance. Vessel radius has an effect on resistance. Which causes vasoconstriction? a. Norepinephrine b. Calcium channel blocker c. alpha-Adrenergic antagonist d. Acetylcholine ANS: A The release of norepinephrine results in arterial vasoconstriction via receptors located on the vascular smooth muscle walls. Calcium channel blockers produce vasodilation by interfering with calcium intake into the vascular smooth muscle cells. -Adrenergic antagonists do not cause vasoconstriction. Acetylcholine does not have an effect on vasoconstriction. When systemic vascular resistance is decreased, blood flow a. increases. b. decreases. c. stays the same. d. moves to the extremities. ANS: B When SVR is pathologically decreased, the blood is spread over a larger area and blood flow slows dramatically. Individual organs, such as the kidney and brain, may not obtain sufficient blood flow to meet metabolic needs. Blood flow decreases in response to decreases in vascular resistance. When SVR is pathologically decreased, the blood is spread over a larger area and blood flow slows dramatically. Individual organs, such as the kidney and brain, may not obtain sufficient blood flow to meet metabolic needs. Blood flow is not diverted to the extremities when systemic vascular resistance is decreased. However, the vital organs may not have sufficient blood flow to maintain metabolic needs. Blood flow is slow through capillaries because capillaries a. are so far away from the heart. b. have the largest total cross- sectional area. c. are so narrow. d. have no smooth muscle. ANS: B The increased cross-sectional area in the capillary bed results in a significant decrease in velocity compared to the arterial and venous networks. Blood flow through the capillaries is not affected by the distance to the heart. Capillaries do have a diameter that is very small, but they have spaces that permit constituents to pass in and out of the capillaries. In some tissues, one or two smooth muscle cells form a precapillary sphincter that controls flow through the vessel. What is the effect on resistance if the radius of a vessel is halved? a. Resistance doubles. b. Resistance decreases by a factor of 16. c. Resistance decreases by half. d. Resistance increases by a factor of 16. ANS: D Doubling the radius of a vessel on the flow of blood results in a 16 times greater blood flow that increases the vessel's resistance by a factor of 16. The resistance is not doubled, it is increased by a factor of 16. The resistance is not decreased when the radius of a vessel is halved. // Clinical manifestations of chronic arterial obstruction include a. edema. b. intermittent claudication. c. decreased pressure proximal to the obstruction. d. distal hyperemia. ANS: B Arterial thrombosis is usually manifested by intermittent claudication (pain with activity) in the affected limb that improves with rest. Venous obstructions are manifested by edema. Ischemia can occur distal to the point of the occlusion. An increase in blood flow causes hyperemia, which is located in the area proximal to the obstruction. Peripheral edema is a result of a. arterial insufficiency. b. venous thrombosis. c. hypertension. d. atherosclerosis. ANS: B In the venous system, thrombosis alters venous return, impairing removal of metabolic wastes and producing edema. In arterial obstruction, distal flow results in ischemia. Hypertension does not cause peripheral edema. Atherosclerosis is not directly associated with peripheral edema. The relationship of blood flow (Q), resistance (R), and pressure (P) in a vessel can be expressed by which equation? a. Q = P/R b. Q = R/P c. R=PQ d. P=Q/R ANS: A The relationship between the variables of pressure and resistance is expressed by Ohm's law: Q = P/R. Q is the blood flow, P is the pressure difference, and R is the resistance. Ohm's law is Q = P/R. R = PQ is not the expression for the relationship between blood flow, resistance, and pressure. P = Q/R is not the correct expression reflecting Ohm's law. Risk factors for atherosclerosis include a. female gender. b. hyperlipidemia. c. high-protein diet. d. low-fiber diet. ANS: B Hyperlipidemia is a modifiable risk factor associated with atherosclerosis. Men have a higher incidence of atherosclerosis earlier in life than women. A high-protein diet is not associated with atherosclerosis. Dietary fats do play a role as a modifiable risk factor. A low-fiber diet is not a risk factor for atherosclerosis. Which is not a manifestation of acute arterial obstruction? a. Pain b. Purpura c. Pallor d. Pulselessness ANS: B Purpura is purple-colored spots on the skin, which are not a manifestation of acute arterial obstruction. Pain is intense, continuous, and unrelated to activity in an acute arterial obstruction. In an acute arterial obstruction, pallor is seen in the involved extremity. Pulselessness may occur in the affected extremity of an acute arterial occlusion, although often a weak pulse may be noted by Doppler. The goal of long term heparin for the management of a deep vein thrombosis is to a. relieve edema. b. prevent clot dislodgement. c. dissolve the thrombus. d. prevent further clot formation. ANS: D Anticoagulation is utilized in deep vein thrombosis to prevent further clot formation. Heparin does not play a role in edema. Prevention of clot dislodgement is not the goal of therapy with the use of heparin. Heparin is not utilized to dissolve a thrombus. Which condition enhances lymphatic flow? a. Increased tissue hydrostatic pressure b. Increased interstitial fluid colloid osmotic pressure c. Decreased capillary hydrostatic pressure d. Increased capillary oncotic pressure ANS: B Lymphatic flow is controlled by increasing interstitial fluid colloid osmotic pressure and by the stimulation of the contractile fibers (often called lymphatic pumps) as they are stretched. Increasing interstitial fluid colloid osmotic pressure enhances lymphatic flow. Lymphatic flow is not enhanced by decreased capillary hydrostatic pressure. Lymphatic flow is controlled by increases in osmotic pressure, not oncotic pressure. Tissues are able to autoregulate their rate of blood flow by controlling a. perfusion pressure. b. arterial blood pressure. c. vascular resistance. d. venous return to the heart. ANS: C Systemic vascular resistance is used to determine the resistance of vessels, diseases, or drug therapies that affect vessels. Any condition that increases vascular resistance requires more work for the heart to overcome the resistance and eject blood volume. Blood moves from an area of higher pressure to an area of lower pressure. The arterial and arteriolar walls with their muscular media coats provide the high-pressure end of the gradient. Seeking a lower pressure, blood moves toward the venous system. The thinner, more pliable walls of the venous bed furnish the low-pressure portion of the pressure gradient. Blood flow throughout the periphery is regulated by a. cardiac output. b. the autonomic nervous system. c. velocity. d. hemodynamics. ANS: B Blood flow throughout the periphery is controlled by central mechanisms that are mediated by the autonomic nervous system, the venous and thoracic pumps, and intrinsic autoregulatory mechanisms. Cardiac output does not control peripheral blood flow. Velocity is the measure of distance traveled in a given interval. Hemodynamics is the principle that governs the quantity of blood passing by a given point at a certain period. Venous obstruction leads to edema because it ________ pressure. a. increases capillary oncotic b. increases arterial blood c. decreases tissue d. increases capillary hydrostatic ANS: D Increased fluid accumulation in the interstitial space also occurs when the lymphatic flow is impaired or when capillaries become more permeable and "leak" fluid. These pressure gradients lead to edema. Interstitial fluid colloid osmotic pressure increases play a role in edema. Arterial blood pressure does not lead to edema. Decreased tissue pressure does not lead to edema in venous obstruction. // A serious complication of deep vein thrombosis is a. stroke. b. hypertensive crisis. c. extremity necrosis. d. pulmonary embolus. ANS: D Deep vein thrombosis is treated aggressively, as it is the most frequent source of pulmonary embolus. Deep vein thrombosis is not the cause of a stroke. Hypertensive crisis is unrelated to deep vein thrombosis. Extremity necrosis could result from prolonged arterial occlusion. Which is not considered to be a risk factor for thrombus formation? a. Thrombocytopenia b. Vascular trauma c. Stasis of blood flow d. Circulatory shock ANS: A Thrombocytopenia is not involved in the development of thrombi. Thrombi may form in the chambers of the heart following a myocardial infarction or damage to the heart valves. NURSINGTB.COM Venous stasis can be a risk factor for thrombus formation as a result of the alteration in blood flow to the extremity. Circulatory shock states occur when individual organs may not obtain sufficient blood flow to meet metabolic needs. Which clinical finding is indicative of compartment syndrome? a. Peripheral edema b. Absent peripheral pulses c. Redness and swelling d. Atrophy of distal tissues ANS: B Compartment syndrome creates an effective absence of arterial circulation to an extremity. Swelling within a cast or tight dressing may contribute to the development of compartment syndrome. Compartment syndrome creates pallor in the affected extremity. Acute arterial occlusion is an emergency, and could result in profound ischemia in the involved limb. Velocity of blood flow is measured in a. centimeters per second. b. millimeters per minute. c. yards per hour. d. kilometers per minute. ANS: A Velocity of blood flow is measured in centimeters per second. Millimeters per minute is the not the measurement of the velocity of blood flow. Yards per hour is not a measurement of velocity. The velocity of blood flow is not measured in kilometers per minute. When a patient is struck in the eye by a baseball, the result is redness and swelling. This increase in blood flow to a localized area is called a. autoregulation. b. edema. c. hyperemia. d. hypoxia. ANS: C Hyperemia is a local increase in blood flow. Autoregulation is the ability of blood vessels within organs to maintain a constant blood flow. Edema is the swelling that results from hyperemia. Hypoxia is an insufficient supply of oxygen. The pain characteristics of chronic venous insufficiency include ( Select all that apply.) a. aching and cramping in the affected area. b. relief with elevation to the area. c. relief with ambulation if pain is in the legs. d. burning and prickling in the affected area. e. relief with massage to the area. ANS: A, B, C The pain characteristics associated with chronic venous insufficiency include aching and cramping in the affected area; relief with elevation to the area; and relief with ambulation if pain is in the legs. Burning and prickling pain is not associated with chronic venous insufficiency. Massage to the affected area does not relieve pain in chronic venous insufficiency. The primary functions of the circulatory system are ( Select all that apply.) a. transport oxygen. b. transport nutrients. c. remove metabolic waste. d. reabsorb leaking fluid. e. return leukocytes to the circulation. ANS: A, B, C The circulatory system transports oxygen and nutrients and removes metabolic waste. The lymphatic system reabsorbs leaking fluid and, in conjunction with the circulatory system, returns lymph to the circulation. Which changes in the circulatory system occur in the older adult? ( Select all that apply.) a. Increased baroreceptor function b. Increased response to hypertensive stimuli c. Increased systemic vascular resistance (SVR) d. Decreased afterload e. Decreased elasticity of vessel walls ANS: C, E The vessels become inflexible tubes that increase system vascular resistance. The vessel walls lose elastic flexibility and recoil, becoming stiffer and less compliant. Baroreceptor function is reduced because of decreased sensitivity of the receptors and diminished responsiveness of the vessels because of their rigidity. The rigid vessels decrease the body's ability to respond to hypotensive and hypertensive stimuli. The decreased compliance of the systemic vascular system increases afterload Blood flow is measured as a given number of ( Select all that apply.) a. liters. b. milliliters. c. nanoliters. d. cubic centimeters. e. cubic millimeters. ANS: A, B, D Blood flow is measured as a given number of liters, milliliters, or cubic centimeters per second, minute, or hour. Nanoliters is not a measurement of blood flow. Cubic millimeters is not a measurement of blood flow. 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 (x) systemic resistance. ANS: C Pulse pressure is defined as the difference between systolic and diastolic blood pressure. Pulse pressure is the difference between systolic and diastolic pressure. Pulse pressure is not the sum of the systolic and diastolic pressures. Systemic resistance is not involved in determining the pulse pressure. What results when systemic blood pressure is increased? a. Hypovolemia b. Decreased cardiac output c. Vasoconstriction d. Decreased vascular resistance ANS: C At the smooth muscle of the arterial system, neurotransmitters bind to receptors to initiate vasoconstriction and increase systemic vascular resistance. An increase in vascular resistance causes the heart to work harder and thus increases blood pressure. Hypovolemia does not result in an increase in blood pressure. Cardiac output is not decreased when systemic blood pressure is increased. Vascular resistance is actually increased when the systemic blood pressure is increased. 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. ANS: A An erroneous blood pressure result could occur with the arm above the level of the heart. It is important to measure blood pressure with the appropriate size cuff. The arm should be positioned at the level of the heart for a more accurate reading. Measuring pressure after exercise yields a higher measurement. 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. ANS: B 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. 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 88/60, HR 118 b. Sitting BP 108/68, HR 102 c. Sitting BP 110/78, HR 98 d. Sitting BP 120/80, HR 100 ANS: A The definition of orthostatic hypotension is a decrease in systolic blood pressure greater than 20 mm Hg or a decrease in systolic pressure that is greater than 10 mm Hg within 3 minutes of moving to an upright position. The measurements of BP 108/68, HR 102 and BP 110/78, HR 98 are not indicative of orthostatic hypotension. An increase in blood pressure do not occur with orthostatic hypotension. 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. ANS: B 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. 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 beta-blocker therapy. ANS: A The patient should be encouraged to continue compliance with lifestyle changes since the patient has exhibited some positive response to his changes. Diuretics are not needed at this time. ACE inhibitors should not be added to the therapy yet. Beta-blockers are not required at this time. High blood pressure increases the workload of the left ventricle, because it increases a. stroke volume. b. blood volume. c. preload. d. afterload. ANS: D Hypertension reflects an elevation in SVR; rising afterload increases myocardial oxygen demand and overall cardiac workload. The workload of the left ventricle does not increase the stroke volume, blood volume, or preload. 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 ANS: B In adults, a normal blood pressure is 120 mm Hg systolic and 80 mm Hg diastolic pressure. Stage 1 hypertension begins with a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg. Between these values, the individual is said to have prehypertension, and interventions related to lifestyle changes should be initiated for primary hypertension. 118/78 is considered normal. An individual with a reading of 140/88 or 138/94 may be considered to have stage 1 hypertension. // Restriction of which electrolytes is recommended in the management of high blood pressure? a. Calcium b. Potassium c. Sodium d. Magnesium ANS: C The balance of the intake of water and sodium with their excretion by the kidney remains the central feature of long-term blood pressure maintenance. Sodium is not rapidly eliminated by the kidney like water and adds to the body's fluid volume. It is not necessary to restrict the intake of calcium when managing high blood pressure. Potassium does not need to be restricted in the management of high blood pressure. Magnesium does not play a role in the management of high blood pressure. Hypertension with a specific, identifiable cause is known as _____ hypertension. a. primary b. orthostatic c. secondary d. malignant ANS: C Secondary hypertension has a specific identifiable cause such as a specific pathology or a condition that results in hypertension. Primary hypertension does not have a clearly identifiable etiology and is therefore an idiopathic disorder. Positional changes do not generally result in hypertension. Malignant hypertension is a hypertensive crisis. Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure. a. systolic b. mean arterial c. diastolic d. pulse ANS: B The mean arterial pressure is used to make incremental adjustments to vasoactive drugs. The MAP is the calculated average pressure within the circulatory system throughout the cardiac cycle. The systolic pressure is a part of the calculation but is not the data element used in adjustment of vasoactive medications. The diastolic reading is involved in calculating the MAP, but is not the number used in titration of vasoactive medications. The pulse pressure is the difference between the systolic and diastolic pressure. 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. ANS: C 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. Hypertension is closely linked to a. obstructive sleep apnea. b. urinary tract infection. c. de Quervain syndrome. d. spinal stenosis. ANS: A 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. 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. arthrosclerosis. b. angina. c. myocardial infarction. d. hypertensive crisis. ANS: D Hypertensive crisis is characterized by a diastolic blood pressure of greater than 120 mm Hg, and symptoms of end-organ damage such as retinopathy and ischemic stroke. Blood pressure is not an indication of arthrosclerosis. Angina may accompany hypertensive crisis, but the question stem relates directly to hypertensive crisis. The patient may be having a myocardial infarction, but the addition of end-organ damage symptoms points to hypertensive crisis. A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to a. hypertension. b. hypotension. c. deep vein thrombosis. d. angina. ANS: B Hypotension is low blood pressure characterized by dizziness, blurred vision, syncope, and injury from falls. Hypertension is high blood pressure characterized by headache, confusion, chest pain, and difficulty breathing. Deep vein thrombosis is evidenced by calf pain or tenderness. Angina is characterized by chest, shoulder, or jaw pain. It can be explained to a patient that high blood pressure increases the risk of ( Select all that apply.) a. stroke. b. renal disease. c. diabetes. d. ischemic