NURS 5315 PATHO QUIZ M5 Questions and Answers_ latest 2021
Which patient is at the most risk for developing heart failure?
A 45-year-old
... [Show More] male with a history of uncontrolled hypertension, diabetes, and CAD.
A 65-year-old female with a pulmonary embolus.
A 35-year-old male with prediabetes.
A 45-year-old male with a history of gout.
The 45-year-old male with a history of uncontrolled hypertension, diabetes, and CAD has the greatest risk for developing heart failure. All of his comorbid conditions are risk factors for heart failure. Prediabetes, pulmonary embolus, and gout are not risk factors for heart failure.
At which age, after birth, is pulmonary resistance equal to that of an adult?
1.5 years Correct Answer 8 weeks
6 months
4 weeks
At 2 months of age pulmonary resistance is equal to that of an adult.
A 74-year-old female presents to the emergency department after having a syncopal
episode. On examination the patient is noted to have a systolic murmur at the second intercostal space, right of the sternal border which radiates to the neck. Which of the following is the most likely cause of the syncope?
Angina
Correct Answer
Aortic Stenosis
Mitral Regurgitation
Aortic Regurgitation
The clinical scenario is consistent with an aortic stenosis. Aortic stenosis is more common in females and the elderly. An aortic stenosis causes a decrease in cerebral perfusion which may result in syncope. Systolic murmurs, heard at the second intercostal space right of the sternal border which radiate to the neck originate from the aortic valve. Systolic murmurs which radiate to the axilla originate from the mitral valve. A valve which has regurgitation allows some blood to flow back through the valve during the cardiac cycle. Perfusion is not typically an issue with valvular regurgitation. There is no mention of chest pain; therefore, the syncope is not related to angina.
Which set of clinical manifestations are consistent with right sided heart failure? Pulmonary edema, Hypoxia and MAP of 70mmHg
Jugular Vein Distention, Peripheral Edema and Right Atrial Hypertrophy
Ejection fraction of 50% with a restrictive filling pattern of the left ventricle
Intermittent Claudication, syncope, and chest pain
Jugular vein distention, peripheral edema and right atrial hypertrophy are signs of right sided heart failure. Pulmonary edema, hypoxia and a MAP of 70mmHg are more consistent with left sided systolic heart failure. An EF of 50% and a restrictive filling pattern is consistent with diastolic heart failure of the left ventricle. Intermittent claudication is a sign of peripheral arterial disease.
A 76-year-old female is admitted to the hospital with a complaint of syncope. Diagnostic evaluation reveals that she has an atrial fibrillation with a heart rate of 160. Which statement below best explains the reason why this patient had a syncopal episode.
She stood up to fast and experienced an orthostatic hypotensive episode.
A cardiac embolus temporarily blocked cerebral perfusion.
A decrease in cardiac output caused a decrease in cerebral perfusion.
A stenotic aortic valve resulted in a decrease in cerebral perfusion.
Atrial fibrillation results in a loss of the atrial kick which supplies 20% of the cardiac output. There was indeed decreased perfusion to the brain but it was due to a low cardiac output secondary to the atrial fibrillation. The question does not give any information in it to suggest that the patient experienced an orthostatic hypotensive episode.
A patient presents to the emergency department with shortness of breath. An echocardiogram shows a restrictive filling pattern of the left ventricle. Which of the following diagnoses is correct?
Acute Respiratory Failure
Dilated Cardiomyopathy Correct Answer Diastolic Heart Failure
Coronary Artery Disease
An echocardiogram is only used to diagnose structural defects of the heart. A restrictive filling pattern or impaired relaxation of a ventricle is consistent with a diastolic heart failure. Coronary artery disease is not diagnosed using an echocardiogram; however, visible structural changes may suggest acute or chronic ischemia, but further testing is warranted to make the diagnosis. A dilated ventricle is visible on an echocardiogram in a dilated cardiomyopathy.
A 72-year-old male patient with a history of diabetes mellitus type 2 and systolic heart failure. He has never been diagnosed with hypertension and his physical exam is normal. What is the most likely cause of his heart failure?
Valvular Disease
Infectious
Infiltrative
Correct Answer
Coronary Artery Disease
The most likely cause of this patient’s heart failure is chronic ischemic changes secondary to coronary artery disease. Diabetes mellitus increases the risk for the development of coronary artery disease. He does not have any risk factors which suggests a different cause.
Myocardial contraction is highly dependent upon the intracellular concentration of which ion?
Sodium
Phosphorus Correct Answer Calcium
Potassium
Myocardial contraction is highly dependent upon the intracellular concentration of calcium. The greater the amount of intracellular calcium, the greater the contraction.
A 56-year-old male presents to the ED with a complaint of chest pain. He has no prior medical history. One exam he has a holosystolic murmur with an S3 heart sound.
Troponin levels are elevated. Which pathological condition best explains the clinical manifestations?
Growth of vegetation on the aortic valve.
Myocardial injury from the immune/inflammatory response associated with rheumatic fever.
A connective tissue disorder has progressed to cause an aortic regurgitation.
Correct Answer
Papillary muscle rupture secondary to cardiac infarction.
The clinical manifestations are consistent with an acute coronary syndrome which has resulted in a papillary muscle rupture. The papillary muscle rupture presents with an acute onset of
a holosystolic murmur and S3 sound.
An 84-year-old female patient with a history of severe aortic stenosis is going to surgery tomorrow for a repair of a right hip fracture. Which of the following complications is the patient most likely to have post-operatively?
Pulmonary Fibrosis
Left Ventricular Hypertrophy
Right Ventricular Hypertrophy
Correct Answer
Pulmonary edema
Aortic stenosis is a narrowing of the aortic valve. Blood from the left ventricle passes through the aortic valve into the aorta to perfuse the body. Understanding this anatomy is essential to answering the question correctly. In an aortic stenosis the valve is narrowed. The more severe the narrowing of the aortic valve, the less blood moves through the valve to perfuse the body. As a result blood backs up in the left ventricle and over time causes left ventricular hypertrophy. The backup of blood will also eventually cause left atrial hypertrophy, left-sided heart failure, pulmonary HTN, right ventricular
hypertrophy and right-sided heart failure. As a result an individual with severe aortic stenosis is at an increased risk for pulmonary edema post-operatively because they are unable to appropriately compensate for the IV fluids given during surgery. Ventricular hypertrophy may happen as a result of the stenosis but it is not an acute complication. Pulmonary fibrosis is a chronic condition in the lungs which results in the scarring of the lung tissue and it is not related to aortic stenosis.
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