Patho Exam 3

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?


Which would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL

High-calorie diet

A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head


Which intervention is the priority for the medical management of a client with a dissecting aortic aneurysm

Administration of sodium nitroprusside and beta-adrenergic blocking medications (beta-blockers)

A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure?

Activation of the renin-angiotensin-aldosterone mechanism

Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process

Decreased elasticity in arterial connective tissue

The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:


The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system


An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug


The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?

Elevated total cholesterol

A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client

Raynaud disease

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms

Headache and confusion

A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?

Elevation of triglycerides

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent

Pulmonary embolism

A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo

percutaneous transluminal angioplasty and stent placement.

While working triage in the emergency department, which client report should alert the nurse to imminent danger and, thus, that client should be seen first?

A client holding the abdomen and reporting a tearing and ripping feeling inside.

A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as

Valvular regurgitation

A client asks the purpose of an exercise stress test. What is the nurse's best response

The test is used to measure functional status during stress

The nursing instructor, while teaching the physiology of the heart, informs the students that there are 3 major determinants of myocardial oxygen demand, which include the heart rate, left ventricular contractility, and systolic pressure. Which does she tell them is the most important factor in myocardial oxygen demand

Heart Rate

A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?


Which serum biomarker is highly specific for myocardial tissue


The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as

The condition is getting worse

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be

improving quality of life by relieving symptoms

The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is

decreased afterload

A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue

When the client experiences chest pain

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be

The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells


A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

hypovolemic shock due to acute intravascular volume loss

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged, resulting in a pulmonary embolism. Which type of shock is this client at risk of experiencing

Obstructive shock

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death

Hypertrophic cardiomyopathy (HCM

Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences

Backflow from the left ventricle to left atrium

The nurse knows that which statement regarding heart failure is most accurate

In compensated failure, an increase in preload causes an increase in ventricular contractility

The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock

Septic shock

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output

compensatory mechanisms

A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:

This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure.

A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing

Pericardial effusion

A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure

Hypertrophic cardiomyopathy

The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology

Inhibition of the renin-angiotensin-aldosterone system

A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening

Weight gain

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often follows the vascular response in anaphylaxis

Laryngeal edema

A client in the nursing home wonders why he is having these signs and symptoms of left-sided heart failure. Which explanation will the nurse give the client

The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs

A nurse educator explains a type of cardiac condition as "a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation and often lead to cardiovascular death or progressive heart failure." Which condition fits this definition


What are the components of oxygen supply and demand in the myocardium?

Heart rate, contractility, and ventricular-wall tension are the three factors that determine myocardial oxygen demand

What diagnostic tests are used to assess cardiac blood flow and perfusion

Electrocardiogram (ECG). ...Stress test (also called treadmill or exercise ECG). ...Echocardiogram

What is the pathophysiology of coronary artery disease

is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis

What are the pathophysiological changes with myocardial infarction

This most commonly occurs when a coronary artery becomes occluded following the rupture of an atherosclerotic plaque, which then leads to the formation of a blood clot (coronary thrombosis). results in irreversible damage to the heart muscle due to a lack of oxygen. An MI may lead to impairment in diastolic and systolic function and make the patient prone to arrhythmias.

What are the clinical manifestations of acute myocardial infarction

Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back. Nausea, indigestion, heartburn or abdominal pain. Shortness of breath. Cold sweat

What are the diagnostics, treatment goals, and interventions for AMI

After the initial management and stabilization of the patient in the early and critical phase of acute myocardial infarction (MI), the goals of care for these patients is to restore normal activities, prevent long-term complications, as well as aggressively modify lifestyle and risk factors

A client in the nursing home wonders why he is having these signs and symptoms of left-sided heart failure. Which explanation will the nurse give the client

The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs.

What is ventilation?

inspiration and expirationInspiration, which is the expansion of the chest with a negative intrapulmonary pressure when air flows into the thorax; andExpiration, when the intrapulmonary pressure is higher than the atmosphere, air will flow out of the lungs

What is diffusion?

is the process whereby gases move from an area of high pressure to low pressure. This includes during - Internal respiration - this is the movement in the internal tissues between cells and capillaries

What is perfusion?

the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue

The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond

You have a 25% chance that your next child will have CF.

A child struggling to breathe is brought to the emergency department with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. What is the most likely diagnosis

Severe asthma attack

Which client most likely faces the highest risk of developing secondary pulmonary hypertension

A client with COPD and a 35 pack-year smoking history.

The nurse determines that the client has clubbing of the fingertips. Which is the best intervention

Check the client's O2 saturation level.

Which client is at risk for developing a preventable disorder related to prolonged immobility

A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stockings

A client sustained a puncture injury to the chest resulting in development of a tension pneumothorax. What is the pathogenesis behind a tension pneumothorax

Air is permitted to enter but not leave the pleural space, causing lung collapse.

A client with primary lung disease has developed right heart failure. The health care provider would document this as:

Cor pulmonale

A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, "Are our baby's kidneys not working right? Why is he so swollen?" The nurse bases the reply on which physiologic principles?

The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen.

Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person to chronic respiratory infections from a small group of organisms. Which organisms create chronic infection in a child with cystic fibrosis

Pseudomonas aeruginosa and Staphylococcus aureus

A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client

beta-adrenergic agonists

What is the average GFA for an adult?

125 ML per min

Loop Diuretics

Exert their effect in the thick ascending loop of Henle

Thiazide diuretics

prevent the reabsorption of NaCl in the distal convoluted tubule

Potassium sparing diuretics

reduce the amount of water in the body. do not cause potassium loss

How much urine is produced daily?

1.5 L

what are renal casts?

molds of the distal nephron loop. develop when the protein concentration in the urine is high


failure of an organ to develop normally


Absence; failure of formation of any part.


incomplete organ development

what are the four types of kidney stones?

calcium, magnesium ammonium phosphate, uric acid, cystine

Renal tubular acidosis

Type 1 - distal (impaired distal tubule acidification) - urine pH > 5.5, hypokalemiaType 2 - proximal (reduced tubular bicarbonate reabsorption) hypokalemia , urine pH <5.5 (intact ability to acidify urine); HCO3 level 16-18

Reviewing pathology for an exam on pulmonary vasculature, the nursing student states that blood enters the right side of the heart via the vena cava, then to the right atrium, right ventricle, and then which vessel carries the deoxygenated blood into the pulmonary system

Pulmonary artery

A client diagnosed with asthma is scheduled for a pulmonary function test. During the test, the technician instructs the client to forcefully exhale air for 1 second to evaluate

Forced expiratory volume

During the admission interview the client, who is admitted with bacterial pneumonia, reveals a 20 pack per year smoking history. The nurse relates the possible cause of this pneumonia to the decreased defense of the pulmonary system caused by cigarette smoking. Smoking affects the pulmonary defense system in what way

Damage or destruction of cilli

A client's chest x-ray and pathology report identify a granulomatous lesion that contains the tubercle bacilli. The health care provider uses which term to describe this lesion

Ghon focus

A client with a diagnosis of community-acquired pneumonia is producing copious secretions that are physically obstructing the airway. Which pathophysiologic process will result from this condition

perfusion without ventilation

The pulmonary rehabilitation specialist is educating medical students on a respiratory disease process that causes a severe compromise in exhalation due to air trapping. Air trapping is caused by the loss of elastic recoil, especially in the alveoli, which occurs after overstretching in which disease?


Which condition places the client at risk for hypercapnia if given high-flow oxygen as treatment for a ventilation perfusion mismatch

Chronic bronchitis from smoking

A client reports chest pain to the nurse. Which characteristics of the pain indicate pleuritis?

Sudden sharp pain in one side made worse by deep breathing

What is hydronephrosis?

A condition characterized by excess fluid in a kidney due to a backup of urine.

What is acute pyelonephritis?

bacterial infection of the kidney and causes them to swell