CH 16, 18-20

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Pathophysiology - E-Book
Chapters 16, 18-20
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1

An abnormally wide (more than 0.10 second) QRS complex is characteristic of

premature ventricular complexes.

2

Improvement in a patient with septic shock is indicated by an increase in

systemic vascular resistance.

3

The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with

antibiotics.

4

Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of

nitric oxide.

5

A patient presents to the emergency department with a diastolic blood pressure of 132 mm Hg, retinopathy, and symptoms of an ischemic stroke. This symptomology is likely the result of

hypertensive crisis.

6

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

False

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

7

A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient’s blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time?

Begin antihypertensive drug therapy.

8

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

Septic

9

Aortic regurgitation is associated with

diastolic murmur.

10

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

cardiogenic

11

The prevalence of high blood pressure is higher in

non-Hispanic black adults.

12

A patient with heart failure who reports intermittent shortness of breath during the night is experiencing

paroxysmal nocturnal dyspnea.

13

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

baroreceptor activity.

14

The effect of nitric oxide on systemic arterioles is

vasodilation.

15

A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n)

elderly woman without a previous history of MI.

16

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

digitalis.

17

Hypertension is closely linked to

obstructive sleep apnea.

18

After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later. The patient reports “moderate” adherence to the recommended lifestyle changes and has experienced a decreased from 165/96 to 148/90 mm Hg in blood pressure. What is the most appropriate intervention for this patient at this time?

Continue lifestyle modifications only.

19

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells.

renin

20

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

Septic

21

Chronic elevation of myocardial wall tension results in atrophy.

False

Chronic elevation of myocardial wall tension results in hypertrophy

22

Myocarditis should be suspected in a patient who presents with

acute onset of left ventricular dysfunction.

23

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

True

Acute myocarditis is commonly characterized by left ventricular dysfunction or general dilation of all four heart chambers. Chest pain and ST elevation is indicative of myocardial infarction. Myocarditis is associated with viral infections. Dilated cardiomyopathy runs in families and has a genetic basis.

24

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

lengthening PR intervals and dropped P wave.

25

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

Edema

26

An erroneously low blood pressure measurement may be caused by

positioning the arm above the heart level.

27

In which dysrhythmias should treatment be instituted immediately?

Atrial fibrillation with a ventricular rate of 220 beats/minute

28

First-degree heart block is characterized by

prolonged PR interval.

29

Atherosclerotic plaques with large lipid cores are prone to

rupture.

30

Left-sided heart failure is characterized by

pulmonary congestion.

31

A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis.

False

A patient diagnosed with cardiogenic shock who is hyperventilating is at risk for respiratory alkalosis.

32

The most commonly recognized outcome of hypertension is pulmonary disease.

False

The most commonly recognized outcome of hypertension is cardiovascular disease.

33

While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding?

Increased LDL levels are associated with increased risk of coronary artery disease

34

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

Sodium

35

A patient who reports dizziness and who has absent P waves, wide QRS complexes, and a heart rate of 38 beats/minute on an ECG is most likely in which rhythm?

Ventricular escape rhythm

36

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

septic

In the progressive stage of septic shock, some patients deteriorate to a hypodynamic state. This is characterized by decreased cardiac output and cold, clammy skin as a result of narrowed pulse pressure. Profound hypotension generally occurs which is unresponsive to treatment. Cardiogenic shock is evidenced by decreased cardiac output, elevated left ventricular end-diastolic pressure, S 3 heart sounds, and pulmonary edema. Hypotension occurs with hypovolemic shock, but extremities are not likely to be cold and edematous. Cold edematous extremities along with low cardiac output and profound hypotension are not manifestations of obstructive shock.

37

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

mitral regurgitation.

38

A patient with significant aortic stenosis is likely to experience

syncope.

39

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

secondary

40

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

Elevated CK-MB, troponin I, and troponin T

41

A patient with a history of myocardial infarction continues to complain of intermittent chest pain brought on by exertion and relieved by rest. The likely cause of this pain is

stable angina.

42

Cardiogenic shock is characterized by

reduced cardiac output.

43

The common denominator in all forms of heart failure is

reduced cardiac output.

44

An example of an acyanotic heart defect is

ventricular septal defect.

45

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

Anaphylactic

46

Sepsis has been recently redefined as

a systemic inflammatory response to infection.

47

An elderly patient's blood pressure is measured at 160/98. How would the patient's left ventricular function be affected by this level of blood pressure?

Left ventricular workload is increased with high afterload

48

After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence of

right-sided heart failure.

49

Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of

nitric oxide

50

Patients presenting with symptoms of unstable angina and no ST segment elevation are treated with

antiplatelet drugs.

51

Cor pulmonale refers to

right ventricular hypertrophy secondary to pulmonary hypertension.

52

The majority of cardiac cells that die after myocardial infarction do so because of

apoptosis.

53

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

ST-segment elevation.

54

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

serum potassium

55

Angina caused by coronary artery spasm is called

Prinzmetal angina

56

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

reduce cardiac output.

57

Hypotension associated with neurogenic and anaphylactic shock is because of

peripheral pooling of blood.

58

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

hypotension.

59

Which dysrhythmia is thought to be associated with reentrant mechanisms?

Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

60

A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum. This patient is most likely experiencing

acute cardiogenic pulmonary edema

61

Constrictive pericarditis is associated with:

Impaired cardiac filling

62

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

Cardiac tamponade

63

Pulse pressure is defined as

Systolic - Diastolic

64

Angiotensin-converting enzyme (ACE) inhibitors block the:

Conversion of angiotensin I to angiotensin II

65

A patient who was involved in a fall from a tree becomes short of breath. The lung sounds are absent on one side. This patient is experiencing ________ shock

obstructive

66

Constrictive pericarditis is associated with

impaired cardiac filling.