WCU Pathophysiology Midterm

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.

In which dysrhythmias should treatment be instituted immediately?

Atrial fibrillation with a ventricular rate of 220 beats/minute

Aortic regurgitation is associated with

diastolic murmur.

Mitral stenosis is associated with

a pressure gradient across the mitral valve.

First-degree heart block is characterized by

prolonged PR interval.

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria?

128/82

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

Edema

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

reduce cardiac output.

Hypotension associated with neurogenic and anaphylactic shock is because of

peripheral pooling of blood.

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.

Hypertension is closely linked to

obstructive sleep apnea.

In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing?

Class II, Compensated Stage

Administration of which therapy is most appropriate for hypovolemic shock?

Crystalloids

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?

Sitting BP 88/60, HR 118

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.

Rheumatic heart disease is most often a consequence of

β-hemolytic streptococcal infection.

Left-sided heart failure is characterized by

pulmonary congestion.

Atherosclerotic plaques with large lipid cores are prone to

rupture.

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

Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class?

Class I

Chronic elevation of myocardial wall tension results in atrophy.

False

Chronic elevation of myocardial wall tension results in hypertrophy.

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

systemic vascular resistance.

The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.

True

In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with

high cardiac output.

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

nitric oxide.

An example of an acyanotic heart defect is

ventricular septal defect.

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

False

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

premature ventricular complexes.

Myocarditis should be suspected in a patient who presents with

acute onset of left ventricular dysfunction.

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

cardiogenic

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.

Sepsis has been recently redefined as

a systemic inflammatory response to infection.

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.

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

cardiac tamponade.

Lusitropic impairment refers to

impaired diastolic relaxation.

What results when systemic blood pressure is increased?

Vasoconstriction

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.

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

septic

Patent ductus arteriosus is accurately described as a(n)

communication between the aorta and the pulmonary artery.

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

renin

How is a patient hospitalized with a malignant tumor that secretes parathyroid hormone-related peptide monitored for the resulting electrolyte imbalance?

Two primary acid-base disorders that are present independently are referred to as

The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by

Lack of α-antitrypsin in emphysema causes

Legionnaires disease is characterized by

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

Which electrolyte imbalances cause increased neuromuscular excitability?

A major cause of treatment failure in tuberculosis is

A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician?

Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with

Which acid are the kidneys unable to excrete?

A 3-year-old is diagnosed with starvation ketoacidosis. What signs and symptoms should you anticipate in your assessment?

Obstructive sleep apnea would most likely be found in a patient diagnosed with

A patient diagnosed with chronic compensated heart failure reports that, "My feet swell if I eat salt but I don't understand why" The nurse's best response is

When a parent asks how they will know if their 2-month-old baby, who is throwing up and has frequent diarrhea, is dehydrated, the nurse's best response is

When a parent asks how they will know if their 2-month-old baby, who is throwing up and has frequent diarrhea, is dehydrated, the nurse's best response is

To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke

Which acid are the kidneys unable to excrete?

A. Metabolic

B. Carbonic

C. Bicarbonate

D. Ammonia

B

The body compensates for metabolic alkalosis by

A. hypoventilation

B. decreasing arterial carbon dioxide

C. increasing bicarbonate ion excretion

D. hyperventilation

A

The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3 = 24 mEq/L demonstrates

A. metabolic acidosis

B. respiratory acidosis

C. respiratory alkalosis

D. mixed alkalosis

C

Two primary acid-base disorders that are present independently are referred to as

A. metabolic acidosis

B. metabolic alkalosis

C. respiratory alkalosis

D. mixed acid-base imbalance

D

Diarrhea and other lower intestinal fluid losses will contribute to

A. metabolic alkalosis

B. metabolic acidosis

C. respiratory acidosis

D. mixed acid-base disorders

B

Fully compensated respiratory acidosis is demonstrated by

A. pH 7.36, PaCO2 55, HCO3 36

B. pH 7.45, PaCO2 40, HCO3 28

C. pH 7.26, PaCO2 60, HCO3 26

D. pH 7.40, PaCO2 40, HCO3 24

A

Respiratory acidosis is associated with

A. increased carbonic acid

B. hypokalemia

C. increased neuromuscular excitability

D. increased pH

A

Vomiting of stomach contents or continuous nasogastric suctioning may predispose to development of

A. carbonic acid defecit

B. metabolic acid deficit

C. metabolic acidosis

D. carbonic acid excess

B

The finding of ketones in the blood suggests that a person may have

A. metabolic acidosis

B. metabolic alkalosis

C. respiratory acidosis

D. respiratory alkalosis

A

A person with acute hypoxemia may have hyperventilation and develop

A. respiratory acidosis

B. respiratory alkalosis

C. metabolic alkalosis

D. metabolic acidosis

B

A person who experiences a panic attack and develops hyperventilation symptoms may experience

A. neuromuscular depression

B. anxiety acidosis

C. numbness and tingling in the extremities

D. acute compensatory metabolic acidosis

C

The major buffer in the extracellular fluid is

A. hemoglobin

B. albumin

C. bicarbonate

D. phosphate

C

Renal compensation for respiratory acidosis is evidenced by

A. decreased carbon dioxide

B. elevated carbon dioxide

C. decreased bicarbonate ion concentration

D. elevated bicarbonate ion concentration.

D

Causes of metabolic acidosis include

A. hyperventilation

B. massive blood transfusion

C. tissue anoxia

D. hypoventilation

C

Respiratory acidosis may be caused by

A. hyperventilation

B. massive blood transfusion

C. tissue hypoxia

D. hypoventilation

D

Emesis causes

A. respiratory acidosis

B. respiratory alkalosis

C. metabolic acidosis

D. metabolic alkalosis

D

Diarrhea causes

A. respiratory acidosis

B. respiratory alkalosis

C. metabolic acidosis

D. metabolic alkalosis

C

The ? system compensates for metabolic acidosis and alkalosis?

A. gastrointestinal

B. renal

C. cardiac

D. respiratory

D

Uncompensated metabolic alkalosis would result in

A. increased pH, increased HCO3

B. increased pH, decreased HCO3

C. decreased pH, increased HCO3

D. decreased pH, decreased HCO3

A

Respiratory alkalosis is caused by

A. hyperventilation

B. pneumonia

C. chest muscle weakness

D. pulmonary edema

A

If an individual has a fully compensated metabolic acidosis, the blood pH is

A. high

B. low

C. in the normal range

D. either high or low, depending on the type of compensation

C

Early manifestations of a developing metabolic acidosis include

A. coma

B. headache

C. muscle cramps

D. short and shallow respirations

B

Metabolic alkalosis is often accompanied by

A. hypernatremia

B. hyponatremia

C. hyperkalemia

D. hypokalemia

D

The patient who requires the most careful monitoring for development of metabolic acidosis is a patient who

A. is in the diuretic phase of acute renal failure

B. has had hypokalemia for over a week

C. has had diarrhea for over a week

D. has newly diagnosed Cushing syndrome

C

A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician?

A. pH in high part of normal range, PaO2 normal, PaCO2 normal, bicarbonate normal

B. pH in high part of normal range, PaO2 normal, PaCO2 high bicarbonate high

C. pH in low part of normal range, PaO2 normal, PaCO2 low, bicarbonate low

D. pH in low part of normal range, PaO2 normal, PaCO2 normal, bicarbonate normal

B

A 3 year old is diagnosed with starvation ketoacidosis. What signs and symptoms should you anticipate in your assessment?

A. Slow, shallow breathing, belligerence, hyperexcitability

B. Slow, shallow breathing, numbness and tingling around his mouth

C. Rapid, deep breathing, lethargy, abdominal pain

D. Rapid, deep breathing, tremors, elevated blood pressure

C

somatic death

death of the entire organism

what age group has a larger volume of extracellular fluid than intracellular fluid?

infants

Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by

norepinephrine

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

edema

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

The most effective therapy for anemia associated with kidney failure is

erythropoietin administration

Widespread activation of the clotting cascade secondary to massive trauma is called

disseminated intravascular coagulation DIC

Renal compensation for respiratory acidosis is evidenced by

elevated bicarbonate ion concentration

Risk factors for atherosclerosis include

hyperlipidemia

Causes of metabolic acidosis include

tissue anorexia

Lusitropic impairment refers to

impaired diastolic relaxation

Excessive red cell lysis can be detected by measuring the serum

bilirubin

Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because

massive histamine release from mast cells leads to vasodilation

The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts.

T/F

true

An example of an acyanotic heart defect is

ventricular septal defect

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

mitral regurgitation

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

T/F

false