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Study Review 16,18,19,20
Terms in this set (20)
Which term is used to identify hypertension that has a specific disease as its cause?
Secondary is the term given to hypertension that is secondary to a specific disease. Idiopathic, primary, and essential hypertension are interchangeable terms for hypertension that cannot be related to a specific disease/cause.
Which is a risk factor associated with hypertension? (Select all that apply.)
History of tobacco smoking
Normal aging produces a rising systolic pressure over the course of a lifetime, whereas diastolic pressure increases for approximately 50 years, levels off during the sixth decade, and remains stable or declines later on. African Americans are predisposed to hypertension. Also, tobacco use has been shown to increase the risk of hypertension. Being Caucasian is not a known risk factor for hypertension. Diets high in fat and sodium, and low in potassium have been found to increase the risk of developing hypertension.
Risk factors for the development of high blood pressure are which of the following? (Select all that apply.)
The older a person is, the less elastic the blood vessels are, which results in higher systemic vascular resistance. High blood pressure occurs two to three times more frequently in the African American population than in the Caucasian population. Diets high in fat and sodium have been associated with hypertension. An association with elevated body mass index and high blood pressure has been noted; however, the exact mechanism is unclear. Chronic illness will not necessarily result in hypertension.
What is the marker of choice for detecting a myocardial infarction?
Elevated serum levels of cardiac troponin
Two proteins that make up part of the cardiac cell contractile apparatus, troponins I and T, have become the markers of choice for detecting MI. Cardiac troponin levels become elevated in serum at about the same time as CK-MB, but they remain elevated for a longer period. ST-segment elevation is thought to represent acute cell injury and ischemia. An elevated level of serum CK-MB is a highly specific indicator of MI and considered to be diagnostic. However, CK-MB remains elevated for only 48 to 72 hours after MI. Cardiac myoglobin levels are elevated in serum very quickly after MI and may be helpful in early detection; however, cardiac myoglobin is less specific than the other markers.
Which condition may result in chronic pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure?
Mitral valve stenosis
Pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure result from untreated mitral valve stenosis. Syncope, fatigue, low systolic blood pressure, and faint pulses are common signs and symptoms of aortic valve stenosis. Aortic insufficiency is characterized by a high-pitched blowing murmur during ventricular diastole. Patients may complain of palpitations and a throbbing or pounding heart because of the large ventricular stroke volume. Common presenting symptoms of acute myocarditis include fatigue, dyspnea on exertion, and dysrhythmia with associated palpitations.
Which statement is true regarding hypertension?
High blood pressure can be associated with headache and seizures.
Headache and seizures are associated with high blood pressure. The actual definition of high blood pressure is a systolic pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg, or both. The diagnosis of hypertension requires the recording on two separate occasions of these elevations. Obesity, elevated sodium intake, age, ethnicity, and family history are all causes of high blood pressure.
What is another name for vasopressin?
Another name for antidiuretic hormone is vasopressin Atrial natriuretic peptide, angiotensin, and aldosterone are not other names for vasopressin.
Uncontrolled massive bleeding causes what type of shock?
Hypovolemic (low-volume) shock occurs in the presence of massive blood loss when the amount of blood available for circulation decreases. Cardiogenic shock is usually a result of severe ventricular dysfunction associated with myocardial infarction. Other causes include cardiomyopathy, ventricular rupture, and congenital heart defects. Neurogenic shock results from depression of the vasomotor center in the medulla or from interruption of sympathetic nerve fibers in the spinal cord. Causes of neurogenic shock include brain trauma that results in depression of the vasomotor center, spinal cord injury, high spinal anesthesia, and drug overdose. Septic shock commonly is associated with Gram-negative infections.
A common cause of heart failure is which of the following? (Select all that apply.)
Coronary artery disease
The most common cause of HF is myocardial ischemia from coronary artery disease, followed by hypertension and dilated cardiomyopathy. Valvular heart disease and anemia are not common causes of heart failure.
A patient with heart failure reports awakening intermittently with shortness of breath. Which terms appropriately describes this clinical manifestation?
Paroxysmal nocturnal dyspnea refers to intermittent attacks of severe dyspnea that occur during the night. Dyspnea is a general term referring to difficulty breathing. Cyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. Bradypnea describes abnormal slowness of breathing.
Atherosclerosis predisposes to a number of processes that are factors in myocardial ischemia. These processes include
Atherosclerotic plaques with large lipid cores are fragile and prone to rupture. Rupture of a plaque exposes subendothelial proteins and initiates platelet aggregation and thrombus formation. Hemorrhage can lead to hemorrhagic shock, but death is not directly related to either atherosclerosis or myocardial ischemia, but rather hypovolemia. Coronary dilation would not hinder blood flow which is a cause of myocardial ischemia. Ventricular dysrhythmia affects cardiac conduction and function, but these dysfunctions are not related to atherosclerosis or myocardial ischemia.
The shift to anaerobic metabolism in shock results in
Increased lactate production
When the citric acid cycle is inhibited, pyruvate accumulates in the cytoplasm. Pyruvate accumulation would quickly inhibit further glycolysis and shut down ATP production entirely except that it can be converted to a substance called lactate, which diffuses from the cell and into the extracellular fluid. A shift to anaerobic metabolism in shock does not result in metabolic alkalosis, decreased oxygen utilization, or decreased hydrogen ion production.
High blood pressure can be treated with lifestyle modification related to which of the following? (Select all that apply.)
Decreased sodium intake
A low-sodium diet decreases sodium retention and blood volume, altering stroke volume and cardiac output, which results in a lower blood pressure. Relaxation techniques help manage stress which helps lower blood pressure. Obesity is a major risk factor for hypertension. Exercise increases vascular tone, thus decreasing systemic vascular resistance and blood pressure. Medication therapy is not considered a lifestyle modification.
Cardiac output is the product of both
Stroke volume and heart rate
The product of stroke volume and heart rate provides the amount of cardiac output. None of the other options (MAP, SVR, or pulse pressure) are factors in cardiac output.
Which describes a pathologic manifestation of neurogenic shock?
Loss of sympathetic activation of arteriolar smooth muscle
Neurogenic shock results from loss of sympathetic activation of arteriolar smooth muscle. Medullary depression (brain injury, drug overdose) or lesions of sympathetic nerve fibers (spinal cord injury) are the usual causes. Release of vasodilatory mediators such as histamine into the circulation and massive immune system activation are seen in anaphylactic shock. Increased sympathetic nervous stimulation is not a characteristic of neurogenic shock.
Which clinical manifestation differentiates myocardial infarction (MI) from angina pectoris? (Select all that apply.)
Radiating chest pain
ST-segment changes on the ECG
Elevated serum levels of troponin
Radiating chest pain is a clinical finding for individuals experiencing myocardial infarction. Myocardial ischemia and infarction are indicated on the ECG by ST-segment changes. Serum protein marker elevations such as troponin and CK-MB are clinical findings for individuals experiencing myocardial infarction. Exercise induced chest pain is a classic symptom of angina pectoris. Chest pain that is aggravated by coughing is more likely observed with angina pectoris than myocardial infarction.
What is the underlying problem common among all types of shock?
Inadequate cellular oxygenation
Although each type of shock has specific characteristics, all are associated with a deficiency of cellular oxygen consumption. Inadequate cellular oxygenation may result from decreased cardiac output, maldistribution of blood flow, or reduced blood oxygen content. The impaired oxygen utilization by cells may lead to cell death, organ dysfunction, and stimulation of inflammatory reactions. Cardiac failure can be an outcome, but is not a common cause in all types of shock. Vasodilation occurs in only selective forms of shock. Faulty compensatory mechanisms may contribute to the seriousness of all shocks but that is not the cause of all forms of shock.
A patient is admitted to the hospital with left-sided heart failure. Which clinical manifestation would the nurse expect the client to exhibit? (Select all that apply.)
Crackles in lungs
Common clinical manifestations of left-sided heart failure include cough, dyspnea, and crackles in lungs upon auscultation. Bradypnea describes abnormal slowness of breathing not seen in left-sided heart failure. Peripheral edema is associated with right-sided heart failure.
Abnormal vascular regulation by endothelial cells in small vessels of the heart contributes to
Ischemic heart disease
Endothelial cells are important regulators of vascular tone. They secrete variable amounts of constricting and relaxing factors to control tissue perfusion. Hypertension is a result of a variety of factors not all related to vascular tone. Dysrhythmias would affect conduction and the function of the heart chambers but not vascular tone. Truncus arteriosus results in only one large artery leaving the heart.
Which type of shock is characterized by generalized vasodilation and peripheral pooling of blood? (Select all that apply.)
Septic shock, neurogenic shock, and anaphylactic shock are characterized by excessive vasodilation and peripheral pooling of blood. Cardiac output is inadequate because of reduced preload. Cardiogenic shock occurs primarily as a result of severe dysfunction of the left or right ventricles, or both, that results in inadequate cardiac pumping. Hypovolemic shock is a result of excessive blood loss; vasoconstriction is initially seen in this form of shock.
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