Mechanisms of Defense, Alterations and Infection; Alterations in Hematologic and Lymphatic Systems; Circulatory System Disorders.
Please note that this assignment is in three (3) parts, PART I to III, and are to be submitted as one document.
PART I
Questions 1-3 refer to this scenario: A man presents to an ER with a large laceration sustained at a construction site a few hours before. The area around the laceration is erythematous, painful, and swollen.
1.The erythema and swelling can be explained at a cellular level by all the following EXCEPT
a.mast cell degranulation and release of histamine.
b.pro-inflammatory prostaglandins released.
c.increased vasomotor tone (tightening) of the capillaries in the area.
d.local reaction to acute phase reactants.
2.The patient is given a TIG (tetanus immunoglobulin) injection because the wound is high risk for tetanus exposure and he doesn’t remember ever having a tetanus vaccination.The purpose of the TIG is to
a.prevent any tetanus bacteria from activating the inflammatory system.
b.introduce tetanus bacteria so that the immunocyte system can create antibodies to tetanus.
c.give the patient natural active acquired immunity.
d.provide tetanus antibodies to fight any tetanus bacteria that might be present.
3.The patient ______(should or should not) be instructed to also get a tetanus vaccination, because_____.
a.should: he needs protection against future tetanus exposure.
b.should: the vaccination will provide additional passive immunity.
c.should not: the TIG is enough, as it will provide long term active acquired immunity
d.should not: the vaccine will do nothing for the current exposure.
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note: “B-cells” & “T-cells” are short-cut terms for B-lymphocytes & T-lymphocytes
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4.A microbe invades the body for the first time.Which statement is most likely about the processes that follow?
a.Plasma cells (a type of B-lymphocyte) will immediately secrete T-cells specific to that microbe.
b.CD4 cells will introduce remnants of the microbe to the plasma cells, which directly phagocytize the remnants.
c.Antigens will be created from the memory cells of immunocytes.
d.Immunocytes will begin the process of developing memory to that microbe.
5.A patient has a systemic inflammation.All the following are likely associated with his condition EXCEPT
a.increased acute phase reactants.
b.lab results showing a high C-reactive protein (CRP).
c.lab results showing leukopenia.
d.increased pro-inflammatory prostaglandins.
6.A baby who has received immunoglobulins against the “XYZ” virus via its mother’s milk now has
a.natural active acquired immunity.
b.natural passive acquired immunity.
c.passive innate immunity.
d.active innate immunity.
7.The baby in the previous question will________.
a.have lifelong immunity to the XYZ virus because of receiving the immunoglobulins that are specific to that particular microbe.
b.develop temporary immunity to the XYZ virus due to receiving Mom’s antibodies that are specific to that particular microbe.
c.now have complete 2nd line of defense protection, having received it in the breast milk.
d.develop alphabetophobia due overdose of anti-XYZ immunoglobulins.
8.A person starts Jazzercise for the first time and becomes very sore all over.The most appropriate self-treatment for this person is to __________, because _______.
a.take an NSAID such as Aleve : it powerfully suppresses phospholipase enzymes in the arachidonic pathway.
b.take an NSAID such as Advil : it is an effective suppressor of certain levels of pro-inflammatory prostaglandin activity.
c.go in for a CRP test: it will determine the degree of pain.
d.take an antihistamine: it will suppress steroidal influence.
9.A patient has been in the hospital for treatment of an infection.One day his BP drops to 80/50 (normal ~ 120/80), he has a fever of 102, and he becomes restless and confused.All the following are correct about this situation EXCEPT
a.a likely diagnosis is septic shock, partly because his BP is low, and he has S&S related to low blood volume to the brain.
b.a good mini-concept map would be:infection goes systemic (sepsis)à increases circulating acute phase reactantsàsystemic vasodilationàless blood centrallyà low BP.
c.a good mini-concept map would be:local infection gets worseà invades lining of blood vessels in the areaàlocal sepsis developsà chronic inflammation results in hypotension.
d.the patient’s blood work will show leukocytosis, neutrophilia, and high CRP as part of the high degree of inflammatory response in his body.
See the table on the next page. It is numbered I-XIV. In the right column are words and phrases that link in some way with each of the numbered items on the left.In other words, this is a typical “matching” exercise.Fill out the table, and use it to answer questions 10-15 directly below (these are what you will submit electronically).ONLY ONE ANSWER TO EACH LEFT-HAND TERM, AND DO NOT CHOOSE THE SAME ANSWER MORE THAN ONCE—CHOOSE THE BEST FIT.
10.Granuloma (#I)
a.I
b.N
c.A
d.F
11.Example of qualitative defect of “not enough” inflammatory function (#IV)
a.K
b.L
c.G
d.N
12.Leukopenia (#V11)
a.D
b.E
c.K
d.O
13.Part of inflammation in which vasomotor tone of capillaries “relaxes”(#X)
a.H
b.N
c.A
d.J
14. Steroidal suppression of protective prostaglandins(#XII)
a.B
b.F
c.M
d.G
15.A way of conferring artificial active acquired immunity. (#XI)
a.D
b.A
c.B
d.C
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I.granuloma______
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A.vasodilation
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II. erythema______
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B. booster shot
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III. decrease in phagocytic functions______
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C.steroid
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IV. example of qualitative defect of “not enough” inflammatory function______
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D. oncogenic event resulting in defective creation of multiple cells
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V. breach of first line of defense______
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E. example of quantitative defect of “not enough” inflammatory function
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VI. serosanguinous exudate______
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F.degranulation releases histamine, prostaglandins, leukotrienes
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VII. leukopenia ______
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G. stomach ulcers
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VIII.benign neoplasm of the bone______
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H. wound fluid leakage contains serous fluid and blood
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IX.mast cells of tissue______
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I. reddened, inflamed appearance of skin
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X.part of inflammation in which vasomotor tone of capillaries “relaxes”______
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J. results in decreased inflammatory response and less healing ability
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K. chemotactic defect
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XI.a way of conferring artificial active acquired immunity______
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L.can have negative effect on normal bowel flora, resulting in breach of body’s defenses
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XII.steroidal suppression of protective prostaglandins______
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M.Sjogren’s syndrome
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XIII.suppresses pro-inflammatory aspects of prostaglandins___C___ (giving you one answer to get started)
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N. local chronic inflammatory tissue reaction
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XIV.antibiotics______
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O. osteoma
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16.A patient has just had a liver transplant and is beginning to display S&S consistent with rejection. The following is most likely a true statement about the situation:
a.The patient is undergoing an autoimmune hypersensitivity.
b.The patient is undergoing an IgE-mediated hypersensitivity reaction.
c.The donor’s immunoglobulins are attacking the HLA’s on the patient’s RBCs.
d.The recipient’s immunoglobulins are attacking the HLA’s on the donor liver.
Questions 17-19 refer to the following scenario:A woman has just been diagnosed with SLE (lupus).
17.In educating the patient about her disease, the nurse shows complete understanding of the pathophysiology of SLE when he tells the patient:
a.“Unfortunately, you will need to be on a gluten-free diet.”
b.“You should expect to have swelling in the area of your thyroid.”
c.“Fortunately SLE only affects one area, usually the joints in your hands.”
d.“You may have a variety of symptoms that come and go.”
18.Some labs are done.Which of the following is a likely finding?
a.Test results that indicate hemolytic anemia.
b.A low CRP.
c.A positive ANA.
d.Test results that indicate a low ANA.
19.The pathophysiology related to the above test is best described by which of the following?
a.Vasculitis caused breakdown of RBCs, resulting in anemia that the lab test detects.
b.SLE is a hypersensitivity disorder in which autoantibodies attack nucleic acids and form detectable complexes that circulate in the blood.
c.SLE is a hypersensitivity disorder in which autoantibodies attack DNA and form detectable complexes
that migrate to one type of tissue.
d.Immune complexes invade CD4 cells, a phenomenon which is detected by lab tests as a low ANA.
20.A patient tells his nurse practitioner (NP) that he had rheumatic fever as a child.Knowing the pathophysiology behind this disease, the NP will need to assess the patient for
a.angioedema.
b.S&S of immunodeficiency.
c.heart valve problems.
d.urticaria.
21.A patient who receives blood with an incompatible blood type may develop
a.an alloimmune reaction.
b.an opportunistic infection.
c.ahumoral autoimmune reaction.
d.a cell-mediated hyposensitive reaction.
22.Which of the following compatibility situations is most likely?A patient who is
a.B positive and receives B negative blood will have a transfusion reaction.
b.AB positive and receives B negative blood will do fine.
c.A negative and receives A positive blood will do fine.
d.A negative and receives O negative blood will have a transfusion reaction.
23.A patient presents with generalized itching, urticaria, and wheezing.She says it started after she was stung
by a bee.The patient is most likely experiencing
a.the effects of complement system opsonization of an invading microbe.
b.localized effects of mast cell degranulation.
c.a cell-mediated response.
d.anaphylaxis.
24.The wheezing in the patient scenario above is at least partly caused by
a.bronchoconstriction due to leukotriene over-release from mast cells throughout the body.
b.over-active response to immune complex deposition in the lung tissue.
c.bronchoconstriction from humoral immunodeficiency.
d.vasoconstriction from the effect of autoimmune over-degranulation.
Questions 25-28 refer to the following scenario:Upon his yearly physical a 68 year old male patient was found to be HIV positive.Six months later he had a CD4 count of 400 and for many years it stays at this level. Now the patient presents to his NP with complaints of difficult and painful swallowing (dysphagia); upon examination, the NP notes white patchy areas in the mouth and throat.The NP orders a CD4 count, which is 198.
(Norm CD4 ct = >600)
25.To establish the diagnosis of being HIV positive, all the following were true of this patient picture EXCEPT
that the
a.ELISA test showed antibodies to HIV.
b.Western blot was positive.
c.CD4 count was 198.
d.ELISA was positive.
26.Which is true?
a.A diagnosis of AIDS was established when the patient’s CD4 count was 400.
b.The patient officially has AIDS because of the opportunistic infection in his mouth and because of his
HIV+ status.
c.An AIDS diagnosis is automatic when the ELISA test shows antibodies to HIV.
d.The patient officially has AIDS because of the opportunistic infection in his mouth and because of the
CD4 count of 198.
27.The patient’s nurse describes to him a couple of opportunistic disease processes that he is at high risk for.Which of the following shows that the nurse has a complete understanding of the link between AIDS and opportunistic infections?
a.“You are more likely to get PCP (pneumocystis carinii pneumonia) because your HIV antibody level is
so high.”
b.“The numbers of your infection-fighting cells is low, so you are more likely to get unusual infections
such as CMV retinitis.”
c . “The numbers of your infection-fighting cells is low, so you are more likely to get autoimmune
diseases such as lupus.”
d.“Your CD4 count of 198 is ok for now, but when it drops below 50 you will need to avoid people with
common infections such as a cold or the flu.”
28.This patient is put on several medications.All the following are steps in the HIV invasion process that a medication might target EXCEPTthe
a.use of viral protease to make new viral proteins in the CD4 cell.
b.insertion of the HIV DNA molecule into the CD4 cytoplasm.
c.use of the viral enzyme reverse transcriptase.
d.use of integrase to insert viral DNA into the CD4 nucleus.
29.A patient presents to the ED with fever, chills, myalgia, and a dry cough.He says he has recently traveled to
China.He says he got a flu shot a year ago. Which is most likely in this case?
a.This disease is pertussis, probably contracted from an unvaccinated contact when he visited China.
b.The disease is probably not influenza, since he had a flu shot during last year’s flu season.
c.The diagnosis is influenza, probably contracted via fecal/oral route while in China.
d.The diagnosis is influenza, possibly contracted because patient did not have this year’s flu shot.
30The disease mentioned above has the following characteristic:
a.The causative microbe can also cause a membrane across the pharynx.
b.This disease is difficult to treat because of the antigenic drift of its exotoxin.
c.Mutations of proteins on the causative organism’s viral cell envelope result in a different version each year.
d.A later outbreak may include skin lesions in a dermatome pattern.
31.A commonality of herpetic organisms that cause diseases like chicken pox and shingles is that
a.each is caused by a bacterial organism that penetrates the nervous system.
b.the causative microbe can remain dormant in the nervous system.
c.the causative microbe causes bloody diarrhea.
d.each is transmitted via vector.
32.An otherwise healthy Texas rancher whose water supply comes from a well is more at risk for a _____
infection than a Dallas suburbanite.
a.giardia
b.trichinosis
c.C. diff
d.cysticercosis
33.A 4 year old patient presents with bloody diarrhea.Possible causes include _______ because_______
a.shigella: the microbe has caused inflammation in the lining of the intestines.
b.pseudomembranous colitis: C. diff has eradicated normal flora.
c.giardia: this protozoa invades the intestinal wall and causes necrosis.
d.diphtheria: this bacteria causes parotid enlargement.
34.After coming home from an overseas assignment a young army officer begins complaining of extreme fatigue and arthralgia.He has a very high fever and shaking chills, and he is anemic.The most likely etiology of his
S&S is
a.infection with rabies virus.
b.protozoal invasion of his RBCs
c.Staph aureus-related cellulitis.
d.Guinea worm infestation.
Questions 35-38 refer to the following scenario:A patient presents to the ED with a local skin infection (cellulitis). She says she has no idea how she got it.She is told that it is a staph infection.A penicillin-type antibiotic called Augmentin is prescribed, and she is sent home.A week later, despite taking all her Augmentin, she is back with worsening of the local infection, plus fever and leukocytosis.She is hospitalized.A culture of the wound shows MRSA and she is placed on more appropriate antibiotics.
35.Which best describes the pathology behind the events in this scenario?
a.A certain Staphylococcus aureas species developed special bonding affinity with methicillin.
b.The patient likely had a compromised immune system, as evidenced by the leukocytosis.
c.A certain Staphylococcus aureas species developed beta-lactamase, which destroyed the penicillin molecule.
d.Staphylococcus aureas is an organism that doesn’t respond to any kind of penicillin.
36.The fever and leukocytosis
a.are evidence that the staph infection may have become systemic.
b.show that the patient is unable to mount an appropriate inflammatory response to the infection.
c.show that the patient’s third line of defense is not needed.
d.are evidence that the patient likely has VRE.
37.After three of weeks of being on strong antibiotics, the patient develops chronic diarrhea.Her stool is cultured. In this question’s context, what organism would you expect the stool culture to grow?
a.MRSA.
b.VRE.
c.Salmonella.
d.C. diff.
38.Choose the mini-concept map that best describes the links from the events and pathophysiology to the diagnosis.
a.3 weeks on antibioticsà normal bowel flora wiped outà Clostridium difficile has no competition and
flourishesàpseudomembranous colitis.
b.3 weeks on antibioticsà normal bowel flora proliferateà bowel walls are irritatedà
inflammationàantibiotic-associated diarrhea.
c.vancomycinà destroys enterococcus in bowelà other bowel flora have no competition and flourishà
pseudomembranous diarrhea.
d.iatrogenic antibioticsà normal bowel flora wiped outà giardia invadesà bowel inflammationà
nosocomial diarrhea.
39.A patient who is undergoing a course of chemotherapy for cancer contracts chicken pox and almost dies.What is the most likely reason for this severe response to a fairly mild disease?
a.Because of the cancer, the patient likely has neutropenia, which is a state of overabundance of nonfunctional WBCs.
b.Because of the chemotherapy, the patient likely has acquired combined B-cell and T-cell immunodeficiency.
c.The patient developed shingles, which is a secondary infection that is harder to treat.
d.The patient probably has severe combined immunodeficiency syndrome (SCIDS).
40.A woman whose blood type is AB+ is pregnant with a baby who is B- (B negative)Which is true about getting aRhogam shot?
a.Mom would not need a Rhogam shot, since the baby’s RBCs have a B antigen, which is compatible with mom’s AB blood.
b.Mom will always need a Rhogam shot following pregnancies in which the baby is Rh negative, such as this baby.
c.The baby will need Rhogam; otherwise he will develop Rh-antibodies that will attack the Rh antigen on the mom’s RBCs.
d.Mom will never need a Rhogam shot with any pregnancy; she will never develop antibodies to Rh antigens on an Rh+ baby’s RBCs.
PART II
Questions 1-4 refer to the following scenario: A young woman presents to her nurse practitioner complaining of SOB and fatigue.She states that her menstrual periods have been very heavy.
(norm RBC count/L = 4-6million; norm MCV = 80-95).
1.What is her most likely diagnosis and CBC results?
a.macrocytic anemia; RBCs = 3 mill & MCV = 102.
b.microcytic anemia; RBCs = 3 mill & MCV = 70.
c.normocytic anemia; RBCs = 5 mill & MCV = 90.
d.polycythemia vera; RBCs = 20 mill & MCV = 90.
2.Based on the diagnosis, the patient’s S&S can be explained by the following:
a.a malfunction in DNA during erythropoiesis causes inadequate ATP formation.
b.an underlying chronic disease causes a sudden loss in RBCs.
c.a steady loss of iron results in insufficient hemoglobin production.
d.a malformed hemoglobin molecule that decreases oxygen-carrying capacity of each RBC.
3.The patient probably has a certain degree of hypoxemia because
a.her low levels of iron have decreased the O2-carrying capacity of her Hgb.
b.a secondary polycythemia has resulted from an underlying lung disease.
c.she is not breathing in enough oxygen, resulting in unsaturated Hgb molecules.
d.her heavy periods have led to a loss of Von Willebrand factor.
4.Which of the following will most likely be part of the treatment rationales for this patient?
a.Iron (Fe) supplements will help the SOB by increasing the capacity of Hgb to carry O2.
b.A well-rounded diet will provide nutrients to increase production of intrinsic factor.
c.Give her blood thinners for the polycythemia.
d.Injections of vitamin B12 will increase the size of the RBCs.
5.A patient recently diagnosed with a vertebral fracture says, “I can’t understand how I broke it.I sat down a little too hard, but not hard enough to break anything.”His diagnosis is possibly _____because _____.
a.Hodgkin’s lymphoma: it causes widespread lymphadenopathy.
b.idiopathic thrombocytopenia purpura (ITP): the low platelet count causes increased risk of bleeding.
c.anemia: suppression of bone marrow stem cell proliferation causes pancytopenia.
d.multiple myeloma: increased osteoclastic activity causes osteoporosis.
6.The patient above most likely has additional S&S of this disease, including
a.multiple petechiae due to coagulopathy.
b.leukocytosis due to the infection and inflammation.
c.lethargy from the hypercalcemia.
d.decreased production of clotting factors.
7.A person with cirrhosis (bad liver disease) and splenomegaly notices ecchymosis under her skin in several areas of her body but denies any substantial trauma to those areas.These ecchymoses are can be linked to the presence of all the following EXCEPT:
a.hypoproteinemia.
b.increased thrombosis.
c.hypersplenism.
d.thrombocytopenia.
8.The patient in the previous question is also anemic.What mechanism is most likely?
a.Increased hemolysis of RBCs from hypersplenism.
b.Parasitic infection that caused leeching of nutrients.
c.Thrombocytosis from hypersplenism.
d.Decreased hemolysis of RBCs because of splenic shrinkage.
9.A 92-year old patient presents with complaints of fatigue and strange burning sensations of the legs. Upon assessment, the nurse notes an appearance of undernourishment and pallor, and a CBC that shows:RBCs 2.5 mill; MCV 110; platelets 200,000. (norm RBC = 4-6million; norm MCV = 80-95; norm platelets = 150,000-400,000; norm WBCs = 6-10,000).Which of the following is the best mini-concept map to explain aspects of this scenario?
a.older adultà less parietal cell function in stomachàdiminished ability to absorb nutrientsà normocytic anemia.
b.paresthesia of legsà general discomfortà less appetiteà less vitamin B12 absorptionà faulty DNA coding of RBCsàerythrocytosis.
c.older adultàless intrinsic factor producedà less vitamin B12 absorbedàfaulty DNA coding of RBCsàmacrocytic anemia.
d.macrocytic anemiaàtoo fatigued to eat muchànot eating enough vitamin B12 àless intrinsic factor producedàparesthesia of legs.
10.A patient has developed random ecchymotic areas on her skin over the last few months.A CBC shows: RBCs 1.5 mill; MCV 95; platelets 95,000; WBCs 50,0000 (see norms above).Which of the following is the best mini-concept map to explain aspects of this scenario?
a.She has developed leukemiaàpathologic leukocyte proliferation has crowded out development of other cells like plateletsà thrombocytopeniaàeasy bleeding.
b.An infection has developedà WBCs and coagulation factors are used up à leukopenia and easy bleedingàanemia.
c.Bone marrow canceràpathologic leukocyte, RBC, and thrombocyte proliferation àerythrocytosis, leukocytosis, thrombocytosisà thickening of the blood.
d.She has developed hemophiliaà lack of coagulation factorsàeasy bleedingà anemia.
See the table below. It is numbered I-X. In the right column are words and phrases that link in some way with each of the numbered items on the left.In other words, this is a typical “matching” exercise.Fill out the table, and use it to answer questions 11-15.ONLY ONE ANSWER TO EACH LEFT-HAND TERM, AND DO NOT CHOOSE THE SAME ANSWER MORE THAN ONCE—CHOOSE THE BEST FIT.
MATCH CORRECT LETTER FROM RIGHT COLUMN TO NUMBER ON LEFT
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I.easy bleeding due to diminished platelet-binding tissue substance.______
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A. hypocalcemia
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II.glossitis______
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B. idiopathic thrombocytopenia purpura (ITP)
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III. a type of neuropathy ______
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C.pathologically increased osteoclastic activity
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IV.pinpoint-sized pathological bleeding under the skin ______
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D. associated with stasis of blood that can increase thrombosis
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V.easy bleeding due to diminished numbers of platelets. ______
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E. hypercalcemia
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VI.causes increased resorption of calcium ______
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F.Hodgkin’s lymphoma
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VII. a blood electrolyte abnormality associated with multiple myeloma ______
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G.splenomegaly
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VIII.associated with increased hemolysis of blood cells ______
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H.von Willebrand disease
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IX.polycythemia ______
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I.paresthesia
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X.type of cancer associated with lymphadenopathy______
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J.petechiae
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K.a pathologic sign associated with the need to get extra vitamin B12
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11.Polycythemia (#IX)
a.G
b.K
c.D
d.B
12.Glossitis (#II)
a.K
b.H
c.F
d.J
13.A blood electrolyte abnormality associated with multiple myeloma (#V11)
a.A
b.E
c.I
d.B
14.Associated with increased hemolysis of blood cells (#VIII)
a.H
b.G
c.B
d.D
15.A type of neuropathy (III)
a.I
b.H
c.F
d.J
PART III
1.A patient has intermittent claudication and a history of atherosclerosis.What other findings are most likely?
a.pitting edema of the ankles.
b.jugular vein distention.
c.cool feet with diminished pulses.
d.S&S of increased preload.
2.A patient is diagnosed with venous insufficiency.What treatment is most likely and why?
a.a clot-busting medication, because it is used to dissolve arterial clots that block off flow.
b.drop the legs lower than the heart so that circulation can bypass DVTs.
c.complete bedrest, as venous stasis is the best way to prevent thrombosis.
d.elevation of feet as often as possible, because it enhances venous return.
***Questions 3-7 refer to this scenario:A patient with a history of atherosclerosis and HTN is complaining of chest pain, SOB, and pain radiating to his left arm.He is diagnosed with an MI of his left ventricular wall.
3.What S&S would be expected and would indicate decreased CO /perfusion?
a.ankle edema and varicose veins.
b.decreased urine output and capillary refill of 4 seconds.
c.BP of 190/90 and capillary refill of 2 seconds.
d.strong, bounding DP & PT pulses.
4.Lab work done during the MI most likely shows high blood levels of certain substances, including:
a.troponin.
b.BNP.
c.histamine.
d.inotropes.
5.He develops a blood pressure of 80/50.Which statement is most accurate?
a.The patient is in cardiogenic shock and should be given meds to increase SVR (systemic vascular resistance).
b.The patient should be given a negative inotrope, as this will cause vasodilation.
.c.The patient is hypotensive and should be given large volumes of fluid.
d.The patient is in cardiogenic shock and should be given a positive inotrope.
6.Several days later the patient manifests S&S of heart failure.Given the area of his heart involved in the MI, which are the most likely S&S?
a.increased preload & ankle edema.
b.decreased afterload & intermittent claudication.
c.tricuspid regurgitation & right atrial hypertrophy.
d.shortness of breath and lung crackles.
7.When the patient was suspected of developing the heart failure (HF), lab work was drawn that specifically corroborated the diagnosis of HF by showing that the ______was elevated.
a.CRP.
b.BNP.
c.CK.
d.RBC.
8.A 40-year-old man is undergoing a yearly physical.Everything is fine except that the nurse practitioner hears a murmur.All the following are likely etiologies EXCEPT:
a.pulmonic valve insufficiency.
b.a heart valve that is ischemic from a coronary artery blockage.
c.incompetent venous valves.
d.a stenotic mitral valve.
9.A patient with CAD reports that he gets angina only when he walks more than a mile.It always goes away when he rests or takes a NTG.Which statement best fits this patient?
a.He has unstable angina due to worsening of an atherosclerotic plaque.
b.He has ACS that is stable due to development of collateral circulation over time.
c.He has stable angina due to development of collateral circulation over time.
d.His pain is caused by increased preload from venous congestion.
10.The patient in the question above is on medications.All the following are likely EXCEPT that he takes
a.NTG to maximize coronary artery patency.
b.NTG to dilate coronaries.
c.aspirin to prevent inflammation that leads to increased plaque formation.
d.negative inotropic medications.
11.A patient in atrial fibrillation has an increased likelihood of
a.no cardiac output and dying immediately.
b.an arterial embolus to the lungs.
c.a venous embolus to the brain.
d.a thromboembolic event.
12.Lab work done on a heart patient shows a potassium of 5.5 (normal = 3.5 – 5.0).The patient is at risk for
a.ventricular fibrillation because his heart cells will be more irritable.
b.bradycardia because his heart cells will be more sluggish.
c.atrial fibrillation because he will be in heart failure.
d.increased afterload for the left ventricular because of systemic vasoconstriction.
13.A patient has a DVT of the right calf.Which of the following is the LEAST LIKELY to develop?
a.Pain at the DVT site.
b.Loss of perfusion in right foot because of the thrombus blocking distal arterial flow.
c.Erythema of the skin in the local DVT area.
d.Shortness of breath secondary to an embolus that breaks off the DVT.
14.An otherwise healthy patient has had hypertension (HTN) for many years.Which of the following is most likely true?
a.He has secondary hypertension.
b.Etiologic factors of the HTN include epinephrine depletion.
c.The atrial natriuretic peptide system is in overdrive.
d.Etiologic factors of the HTN include pathologic overaction of the RAAS.
15.A patient with chronic bronchitis says: “Look how swollen my legs and feet and belly are.This has been increasing over the last couple of years.What’s going on?”As his nurse, you would most likely suspect that the patient has all the following EXCEPT
a.venous backflow from LHF.
b.core pulmonale.
c.ascites from RHF backflow.
d.venous backflow from increased PVR.
***Questions 16 & 17 refer to this scenario:An 80-year old woman with a medical history of HTN and CAD goes to her NP for a check-up.She complains that her vision has been slightly blurry but otherwise has no changes in her usual S&S.Her VS (vital signs) are as follows: BP 168/100, HR 100, RR 20.Lab work is done which shows a high LDL and HDL of 38 (desired = > 40).Urinalysis is normal except for proteinuria and hematuria (normally there is no protein or blood in the urine).
16.The patient’s blurred vision is likely caused by
a.accumulation of cholesterol on the sclera of both eyes.
b.coronary arterial blockage causing sudden myocardial infarction with resultant lack
of blood flow to the eyes.
c.chronic hypertensive damage to the retinal arterioles.
d.the low heart rate causing low cardiac output and thus ischemia to the optic nerve.
17.Which concept map best explains the proteinuria and/or hematuria?
a.Heart diseaseà high density lipoproteins accumulate and overcome renal
thresholdà spill into urineà proteinuriaà HDL now too low.
b.HTN + CAD à weakened walls of renal veinsàsubstances such as RBCs
pathologically spill into urineà hematuria.
c.Interaction between HDLs and LDLs cause damage to kidneysà spillage of
lipoproteins into urineà proteinuria.
d.Chronic HTNà high pressures inside renal arterial system cause damage and “leakiness”àspillage of substances into urine from renal capillariesà hematuria.
***Questions 18 -20 refer to this patient scenario:A patient with CAD presents to her NP with a change in her usual pattern of angina.Her usual pattern for the last several years is to have anginal pain (rated “3/10”) after walking up a flight of stairs, but the pain usually quickly subsides after resting a few minutes.Now she says she has pain rated at “6/10” with minimal activity and it will only go away after taking 2 NTG pills.The NP hospitalizes the patient with a diagnosis of ACS.
18.To which category of CAD did this patient belong before the current change in anginal pattern?
a.Unstable angina.
b.Stable angina.
c.Stable aortic aneurysm.
d.CVI (chronic venous insufficiency).
19.What concept map best explains the pathology behind the several years of unchanged anginal pattern?
a.Slow-developing plaque in coronary arteryàcompensatory collateral circulation
developsàdistal tissue receives enough O2 for all but most strenuous activities.
b.Small thrombi grow in coronary arteriesà emboli develop slowlyàblood flow not blocked off till emboli break off and fill lumen.
c.Slow-developing plaque in coronary arteryàcompensatory higher venous pressures in distal tissueà perfusion stays steady for many years.
d.Ischemic pain from CAD actually worsens but patient ignores the anginaà only seeks help when higher activity levels cause shortness of breath (SOB) and nausea.
20.In the hospital, the patient begins complaining of worsening pain (“8/10”).The RN suspects she is having a myocardial infarction, and the MI is located in her right ventricle. All of the following fit with the RN’s thinking EXCEPT
a.the patient’s EKG monitor shows bradycardia, which is often associated with sino-atrial (SA) node ischemia from a right coronary artery blockage.
b.it is likely that a previously stable right coronary plaque has ruptured and completely
blocked off flow to distal tissue.
c.the high level of pain indicates there are areas of myocardial tissue that are
undergoing necrosis because of lack of O2.
d.the patient has a heart rate (HR) of 90 beats/minute and a BP of 118/80, indicating probable high preload and afterload.
See the table on next page. It is numbered I-X. In the right column are words and phrases that link in
some way with each of the numbered items on the left.In other words, this is a typical “matching”
exercise.Fill out the table FIRST, then use it to answer questions 21-25 directly below.ONLY ONE
ANSWER TO EACH LEFT-HAND TERM, AND DO NOT CHOOSE THE SAME ANSWER MORE THAN ONCE.
CHOOSE THE BEST FIT.
21.Person has chronic lung diseaseàlungs very stiffàpulmonary vascular resistance increasesàRV struggles to push blood into the high pressure pulmonary system àRV failsà back pressure eventually results in peripheral edema (III)
a.E
b.G
c.C
d.J
22.Pathology underlying why diuretics (meds that increase urination) are given in a person with heart failure (I)
a.F
b.B
c.H
d.E
23.BNP (B-type natriuretic peptide) (IX)
a.A
b.J
c.F
d.B
24.Mini-concept map that explains S&S of LHF (II)
a.A
b.D
c.G
d.J
25.A treatment for a person with heart failure(V)
a.F
b.C
c.H
d.I
Matching (put ONE correct letter next to the term in first column).
|
I.pathology underlying why diuretics (meds that increase urination) are given in a person with heart failure_____
|
A.decreased cardiac outputàkidneys sense this and increase renin as a compensatory responseà RAAS kicks in but its results exacerbate the problem.
|
|
II.mini-concept map that explains S&S of LHF _____
|
B. increased preload is almost always part of the heart failure picture
|
|
III.person has chronic lung diseaseàlungs very stiffàpulmonary vascular resistance increasesàRV struggles to push blood into the high pressure pulmonary system àRV failsà back pressure eventually results in peripheral edema______
|
C.one of the S&S associated with RHF
|
|
IV.clinical presentation of LHF _____
|
D.right ventricular MIàmyocardial tissue damageàRV can’t pump forward as wellà back pressure accumulatesàfluid eventually forced from veins of legs and feet into tissue (peripheral edema)
|
|
V. a treatment for a person with heart failure _____
|
E classic picture of cor pulmonale
|
|
VI. jugular venous distention _____
|
F.increases during heart failure because body is “frantically” trying to rid of fluid
|
|
VII. main etiology of fluid overload in any kind of heart failure _____
|
G.left ventricular MIàmyocardial tissue damageàLV can’t pump forward as wellà back pressure accumulatesàfluid eventually forced from capillaries of lungs into the alveoli (pulmonary edema)
|
|
VIII. mini-concept map that explains S&S of RHF_____
|
H. sound of air going through fluid in alveoli when there is pulmonary edema
|
|
IX.BNP (B-type natriuretic peptide) _____
|
I.decrease systemic vascular resistance (SVR), a type of afterload, by giving vasodilating drugs
|
|
X.explains crackles heard in lungs upon auscultation with a stethoscope_____
|
J.classic pulmonary edema S&S of SOB, orthopnea, hemoptysis
|
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Control of Labor Costs Using the exhibit 7.11 steps in your eBook, describe how you will control your labor costs in the F & B Diner scenario from Unit 5 Discussion. Be specific and provide your projected customer forecasts/labor hours, and staff schedule.Respond per the guidelines in your Syllabus.