Pathophysiology Test Bank Exam 2 with Accurate Solution 2024

Pathophysiology Test Bank Exam 2 with Accurate Solution 2024 In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems? - A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate and history of a-fib Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? - Muffled heart tones, narrowed pulse pressure and low BP 84/60 Cardiac tamponade results in increased intracardiac pressure, progressive limitation of ventricular diastolic filling and decrease SV and CO Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand? - Increased aortic pressure Results in rise in afterload, wall tension, ultimately MVO2 Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health? - The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge and result in thrombus formation Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction? - An 80-year-old woman whose pain started at 6am shortly after awakening and was not relieved by nitrates or rest; the ECG showed St-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose The chest pain of MI does not respond to rest or nitrates Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome? - Elevated creatinine kinase and troponin, both of which normally exist intracellularly rather than in circulation Myocardial necrosis releases creatinine kinase and troponin that normally exist intracellularly A number of clients have presented to the emergency department in the last 32 hours with complaints that preliminarily indicative of MI, which of the following clients is least likely to have a STEMI? - A 71-year-old man who has most skin, fever and chest pain that is excruciating when he moves but relieved when at rest STEMI pain not normally relieved by rest, nor would fever be a common symptom Following a STEMI, the nurse should be assessing the pt for which of the following complications? - Large amount of pink, frothy sputum and new onset of murmur A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis? - I'm going to start you on a low-dose aspirin, and it will help greatly if you can lose weight and keep exercising. An IV drug abuser walks into the ED telling the nurse that, "he is sick". He looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echo was ordered that shows large vegetation growing on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient for which possible life-threatening complications? - Systemic emboli, especially to the brain Systemic emboli develop and break off the mitral valve and travel into the vascular system A 34-year-old man who is an IV drug user has presented to the ED with malaise, abdominal pain & lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics? - Echo, blood cx and temperature. Echo helps visualize the heart, while blood cx would confirm presence or absence of microorganisms in the circulation, and temperature would gauge presence of infection. A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? - Ventricular dilation and wall tension are significantly lower than normal. A nurse will be providing care for a female patient who has diagnosis of heart failure that has been characterized as being primarily right sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client - has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional right upper quadrant pain. The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? - Dyspnea and crackles in BL lung bases Although it may preserve the resting cardiac output, the resulting chronic elevation of left ventricular end-diastolic pressure is transmitted to the atria and the pulmonary circulation, causing pulmonary congestion. A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the ER with a rapid heart rate and feeling of "impending doom". Based on pathophysiologic principles, the nurse knows the rapid heart rate could - be a result of catecholamines released from SNS that could increase the myocardial oxygen demand A increase in sympathetic activity by stimulation of the B-adrenergic receptors of the heart leads to tachycardia, vasoconstriction, and arrhythmia. A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following criteria should the nurses prioritize in their practice? - Measurement of urine output and mental status assessment Both increased and decreased urine output can be markers of heart failure, as can changes in mental status not attributable to other factors Mr. V has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into the room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to - call for emergency assistance utilizing hospital protocol Mr. V is experiencing acute pulmonary edema A female older adult client has presented with a new onset of shortness of breath, and the client's physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of bloodwork? - BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology Elevated BNP levels help confirm the diagnosis of HF as opposed to respiratory etiologies A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? - Diuretic, ACE inhibitor, beta-blocker Emergency medical technicians respond to a call to find an 80-year-old man who is showing S/S of severe shock. Which of the following phenomena is most likely taking place? - The man's alpha & beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased HR Central response to all types of shock A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessment would be considered one the earliest signs of venous congestion in this toddler? - Enlargement of the liver With RV function impaired, systemic venous congestion develops Which of the following changes associated with aging contributes to heart failure development in older adults? - Elevated diastolic BP Increased vascular stiffness Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate? - Displays of aggression, confusion and restlessness when the resident has no history of such behavior can be a sign of heart failure Cognitive changes can often accompany heart failure in the elderly As part of pre-surgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which of the following teaching points best conveys an aspect of human circulatory system? - The blood pressure varies widely between arteries and veins and between pulmonary and systemic circulation In which of the following situations would blood most likely rapidly relocate from central circulation to the lower extremities? - A client is helped out of bed and stands up Which of the following statements most accurately captures a principle of blood flow? - With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow Doubling the radius of a vessel is associated with a fourth-power increase in flow, provided that pressure remains constant A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this to happen now?" The clinic nurse responds, - "Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur." Heart murmur results from turbulent flow through a diseased heart valve that may be too narrow, too stiff, or too floppy. During an automobile accident where the patient is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need? - Veins