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Chapter 18 JONES
Which of the following actions causes the atrioventricular valves to close
increased intraventricular pressure
When stroke volume decreases, which of the following could maintain cardiac output?
increased heart rate
Each of the following compares the output of blood from the left and right ventricles with each contraction of a normal heart. Which is correct?
Left ventricular output equals the right ventricular output.
Which of the following describes the pericardial cavity correctly?
It is a potential space containing a very small amount of serous fluid.
Which of the following factors greatly improves venous return to the heart during strenuous exercise?
contraction and relaxation of skeletal muscle
What is the function of the baroreceptors? To:
signal the cardiovascular control center of changes in systemic blood pressure
The normal delay in conduction through the atrioventricular node is essential for:
completing ventricular filling
Which of the following results from increased secretion of epinephrine?
increased heart rate and force of contraction
Which of the following causes increased heart rate?
Stimulation of the sympathetic nervous system
Which event causes the QRS wave on an ECG tracing?
What is the cardiac reserve?
the ability of the heart to increase cardiac output when needed
What does the term preload refer to?
volume of venous return
Which are the first arteries to branch off the aorta?
Vasodilation in the skin and viscera results directly from:
relaxation of smooth muscle in the arterioles
Which of the following drugs decrease sodium and fluid retention in the body?
hydrochlorothiazide (Hydro DIURIL)
Which of the following are predisposing factors to thrombus formation in the circulation?
2. damaged blood vessel walls
4. prosthetic valves
Which drug is taken in small doses on a continuing basis to reduce platelet adhesion?
acetylsalicylic acid (ASA)
What will a partial obstruction in a coronary artery likely cause?
Cigarette smoking is a risk factor in coronary artery disease because smoking:
promotes platelet adhesion
What does the term arteriosclerosis specifically refer to?
degeneration with loss of elasticity and obstruction in small arteries
Modifiable factor that increase the risk for atherosclerosis include:
sedentary life style
An atheroma develops from:
accumulated lipids, cells, and fibrin where endothelial injury has occurred
Low-density lipoproteins (LDL):
promote atheroma development
Factors that may precipitate an angina attack include all of the following EXCEPT:
walking down stairs
When comparing angina with myocardial infarction (MI), which statement is true?
Angina pain is relieved by rest and intake of nitroglycerin; the pain of MI is not.
Which of the following best describes the basic pathophysiology of myocardial infarction?
Total obstruction of a coronary artery causes myocardial necrosis.
Which of the following are typical early signs or symptoms of myocardial infarction?
persistent chest pain radiating to the left arm, pallor, and rapid, weak pulse
Which statement describes a coronary artery bypass procedure?
attaching a section of vein to the coronary artery proximal and distal to the obstruction
Calcium-channel blocking drugs are effective in:
reducing cardiac and smooth muscle contractions
Which of the following confirms the presence of a myocardial infarction?
characteristic patterns for serum isoenzymes and the ECG
The size of the necrotic area resulting from myocardial infarction may be minimized by all of the following EXCEPT:
removing the predisposing factors to atheroma development
What is the most common cause of death immediately following a myocardial infarction?
Why does ventricular fibrillation result in cardiac arrest?
Insufficient blood is supplied to the myocardium.
What does the term cardiac arrest mean?
cessation of all cardiac function
Which change results from total heart block?
spontaneous slow ventricular contractions, not coordinated with atrial contraction
What does the term PVC mean?
Additional contractions arise from ectopic foci in the ventricular muscle.
Which of the following is most likely to cause left-sided congestive heart failure?
uncontrolled essential hypertension
Which is the best definition of congestive heart failure?
inability of the heart to pump enough blood to meet the metabolic needs of the body
Which of the following are significant signs of right-sided congestive heart failure?
edematous feet and legs with hepatomegaly
Paroxysmal nocturnal dyspnea is marked by:
hemoptysis and rales
Which of the following occur as compensation mechanisms for decreased cardiac output in cases of congestive heart failure?
increased renin and aldosterone secretions
In which blood vessels will failure of the left ventricle cause increased hydrostatic pressure?
Which of the following drugs improves cardiac efficiency by slowing the heart rate and increasing the force of cardiac contractions?
In an infant, which of the following is frequently the initial indication of congestive heart failure?
Which of the following effects may be expected from a beta-adrenergic blocking drug?
decreased sympathetic stimulation of the heart
Which of the following is a sign of aortic stenosis?
a heart murmur
What would an incompetent mitral valve cause?
decreased output from the left ventricle
Which of the following describes the blood flow occurring with a ventricular septal defect?
from the left ventricle to the right ventricle
In children with tetralogy of Fallot, why does unoxygenated blood enter the systemic circulation?
Pulmonary stenosis changes the ventricular pressures.
Why does cyanosis occur in children with tetralogy of Fallot?
A large amount of hemoglobin in the general circulation is unoxygenated.
Which of the following represent(s) the pathophysiologic changes in the heart in cases of rheumatic fever?
an abnormal immune response, causing acute inflammation in all layers of the heart
Common signs of rheumatic fever include all of the following EXCEPT:
arthritis causing deformity of the small joints in the hands and feet
How does rheumatic heart disease usually manifest in later years?
cardiac arrhythmias and heart murmurs
Why are septic emboli a common complication of infective endocarditis?
Vegetations are loosely attached and fragile.
Which of the following apply to subacute infective endocarditis?
A microbe of low virulence attacks abnormal or damaged heart valves.
Why does pericarditis cause a reduction in cardiac output?
Excess fluid in the pericardial cavity decreases ventricular filling.
Which of the following may cause pericarditis?
2. abnormal immune responses
4. malignant neoplasm
Which of the following could be the source of an embolus causing an obstruction in the brain?
What is considered to be the basic pathophysiologic change in essential hypertension?
increased systemic vasoconstriction
Where is uncontrolled hypertension most likely to cause ischemia and loss of function?
kidneys, brain, and retinas of the eye
When is a diagnosis of essential hypertension likely to be considered in young or middle-aged individuals?
blood pressure remains consistently above 140/90
What is atherosclerosis in the iliac or femoral arteries likely to cause?
1. gangrenous ulcers in the legs
3. intermittent claudication
What does the term intermittent claudication refer to?
ischemic muscle pain in the legs, particularly with exercise
What is the primary reason for amputation of gangrenous toes or feet in patients with peripheral vascular disease?
prevents spread of infection and reduces pain
An echocardiogram is used to demonstrate any abnormal:
movement of the heart valves
A friction rub is associated with:
How does a dissecting aortic aneurysm develop?
A tear in the intimal lining allows blood flow between layers of the aortic wall.
What is the outcome for many aortic aneurysms?
rupture and hemorrhage
Which factor predisposes to varicose veins during pregnancy?
compressed pelvic veins
Phlebothrombosis is more likely to cause pulmonary emboli than is thrombophlebitis because:
thrombus forms in a vein and is asymptomatic
How is shock defined?
decreased circulating blood and tissue perfusion
When does shock follow myocardial infarction?
A large portion of the myocardium is damaged.
What are the early signs of circulatory shock?
1. pale moist skin 3. anxiety and restlessness
What indicates compensation for shock?
increased heart rate and oliguria
Why does anaphylactic shock cause severe hypoxia very quickly?
Bronchoconstriction and bronchial edema reduce airflow.
Why does neurogenic (vasogenic) shock result from systemic vasodilation?
increased capacity of the vascular system and reduced venous return
What is a prolonged period of shock likely to cause?
damage and increased permeability of pulmonary capillaries
What would indicate decompensated acidosis related to shock?
serum pH below normal range
With shock, anaerobic cell metabolism and decreased renal blood flow cause:
Why does shock develop in patients with severe burns?
pain and loss of plasma
The classic early manifestation(s) of left-sided congestive heart failure are ____, whereas the early indicator(s) of right-sided failure are _______.
shortness of breath on exertion or lying down; swelling of the ankles
Which is a common adverse effect of many antihypertensive medications?
The cause of essential hypertension is considered to be:
For which of the following would a cardiac pacemaker likely be inserted?
Which of the following is considered to be the most dangerous arrhythmia?
Which of the following is NOT true of the drug nitroglycerin?
It strengthens the myocardial contraction.
Which of the following would confirm the diagnosis of a myocardial infarction?
1. specific changes in the ECG
3. elevation of cardiac isoenzymes in serum
Which of the following statements regarding aneurysms is true?
Manifestations of aneurysms result from compression of adjacent structures.
What is the most common factor predisposing to the development of varicose veins?
increased venous pressure
In the period immediately following a myocardial infarction, the manifestations of pallor and diaphoresis, rapid pulse, and anxiety result from:
onset of circulatory shock
Septic shock differs from hypovolemic shock in that it is frequently manifested by:
fever and flushed face
Heart block, in which a conduction delay at the AV node results in intermittent missed ventricular contractions, is called:
More extensive permanent damage is likely when a myocardial infarction is caused by:
A very rapid heart rate reduces cardiac output because:
ventricular filling is reduced.
The right side of the heart would fail first in the case of:
3. large infarction in the right ventricle
4. advanced COPD
Which of the following compensations that develop in patients with congestive heart failure eventually increase the workload of the heart?
a. faster heart rate and cardiomegaly
b. peripheral vasoconstriction
c. increased secretion of renin
Which statement applies to paroxysmal nocturnal dyspnea?
It is caused by increased blood in the lungs when lying in a supine position.
In patients with congestive heart failure, ACE inhibitor drugs are useful because they:
reduce renin and aldosterone secretion
In a child with ventricular septal defect, altered blood flow:
is called a left-to-right shunt
In a child with acute rheumatic fever, arrhythmias may develop due to the presence of:
Prophylactic antibacterial drugs such as amoxicillin are given to those with certain congenital heart defects or damaged heart valves immediately before invasive procedures to prevent:
Varicose ulcers may develop and be slow to heal because:
edema reduces arterial blood supply to the area
Excessive fluid in the pericardial space causes:
reduced venous return
Aortic stenosis means the aortic valve:
cannot fully open during systole