Deck 29: Structure and Function of the Respiratory System

Question 1

If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in

A) arterial wall weakening resulting in aneurysm formation.
B) release of excess fatty plaque causing numerous pulmonary emboli.
C) contraction of the underlying smooth muscles within the vessels.
D) overproduction of growth factors resulting in new vessel production.

Answer 1

contraction of the underlying smooth muscles within the vessels.

Question 2

A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer thus resulting in decreased vessel lumen radius?

A) Nitric oxide
B) Adrenal glands
C) Fibroblast growth factor
D) Norepinephrine

Answer 2

Norepinephrine

Question 3

A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient?

A) Hyperlipidemia is a consequence of diet and lifestyle rather than genetics.
B) HDL cholesterol is often characterized as being beneficial to health.
C) Cholesterol is a metabolic waste product that the liver is responsible for clearing.
D) The goal of medical treatment is to eliminate cholesterol from the vascular system.

Answer 3

HDL cholesterol is often characterized as being beneficial to health.

Question 4

Which of the following patients will likely experience difficulty in maintaining lipoprotein synthesis resulting in elevated LDL levels?

A) A 55-year-old male admitted for exacerbation of chronic obstructive pulmonary disease (COPD)
B) A 44-year-old female admitted for hysterectomy due to cervical cancer with metastasis
C) A 35-year-old patient with a history of hepatitis C and B with end-stage liver disease
D) A 27-year-old patient with pancreatitis related to alcohol abuse

Question 5

In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels?

A) A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy
B) A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and with a history of hypothyroidism
C) A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness
D) A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension

Question 6

A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session?

A) "Remember the 'H' in HDL and the 'L' in LDL correspond to high danger and low danger to your health."
B) "Having high cholesterol increases your risk of developing diabetes and irregular heart rate."
C) "Smoking and being overweight increases your risk of primary hypercholesterolemia."
D) "Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk."

Question 7

Which of the following medications will likely be prescribed for a patient with elevated LDL and triglyceride levels?

A) Zocor (simvastatin), an HMG-CoA reductase inhibitor or "statin"
B) Cholestyramine (Questran), a bile acid sequestrant
C) Nicotinic acid (Niacin), a B vitamin
D) Fenofibrate (Tricor), a fibric acid

Question 8

When a 55-year-old patient's routine blood work returns, the nurse notes that his C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds,

A) "You must eat a lot of red meat since this means you have a lot of fat floating in your vessels."
B) "You are consuming high levels of folate, which works with the B vitamins and riboflavin to metabolize animal protein."
C) "This means you have high levels of HDL to balance the LDL found in animal proteins."
D) "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

Question 9

A patient is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which of the following excerpts from the educational brochure warrants correction?

A) "Because smoking causes a permanent increase in your risk of heart disease, it's best not to start."
B) "All things being equal, men have a higher risk of coronary heart disease than perimenopausal women."
C) "High blood pressure often accompanies, or even causes, clogging of the arteries."
D) "Every bit that you can lower your cholesterol means that you'll have a lower risk of developing heart disease."

Question 10

When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate?

A) The end result of oxidation is rupture of the plaque resulting in hemorrhage.
B) Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.
C) Oxidized free radicals produce toxic metabolic waste that can kill liver cells.
D) Activated cells roam in the vascular system looking for inflammatory cells to engulf.

Question 11

A nurse is providing care for a client who has a history of severe atherosclerosis. Which of the following clinical manifestations of the client's illness should the nurse anticipate and assess in the client?

A) Motor deficits in muscles distal to plaque formation
B) Peripheral vasodilation to compensate for ischemia
C) Cognitive deficits due to ischemia or thrombosis
D) Aneurysm formation due to weakening of blood vessel walls
E) Necrosis of the vessel wall

Question 12

Which of the following assessment findings of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa?

A) The man's blood work indicates polycythemia (elevated red cell levels) and leukocytosis (elevated white cells).
B) The man's blood pressure is 178/102, and he has abnormal liver function tests.
C) The man is acutely short of breath, and his oxygen saturation is 87%.
D) The man's temperature is 101.9°F, and he is diaphoretic (heavily sweating).

Question 13

A patient arrives at the ED complaining of numbness in the left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses nonpalpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on the fact that

A) acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow.
B) submersion in a whirlpool with warm water will improve the venous blood flow and restore pulses.
C) the immediate infusion of tissue plasminogen activator (tPA) will not correct the problem and should only be used for CVAs.
D) administration of an aspirin and sublingual nitroglycerin will vasodilate the artery to restore perfusion.

Question 14

A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable, and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plans listed below?

A) Acute arterial occlusion that will be treated with angioplasty
B) Raynaud disease that will require antiplatelet medications
C) Atherosclerotic occlusive disease necessitating thrombolytic therapy
D) Giant cell temporal arteritis that will be treated with corticosteroids

Question 15

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught stating, "I've always been healthy, and I can't believe I have a disease now." What would be her physician's most appropriate response?

A) "This likely won't have a huge effect on your quality of life, and I'll prescribe anticlotting drugs to prevent attacks."
B) "I'll teach you some strategies to minimize its effect on your life, and minor surgery to open up your blood vessels will help too."
C) "You need to make sure you never start smoking, and most of the symptoms can be alleviated by regular physical activity."
D) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

Question 16

During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the client, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides?

A) Aneurysms are commonly a result of poorly controlled diabetes mellitus.
B) Hypertension is a frequent modifiable contributor to aneurysms.
C) Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.
D) Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 17

In which of the following patients is the emergency department staff most likely to suspect an abdominal aortic aneurysm?

A) A 60-year-old client with diminished oxygen saturation, low red blood cell levels, and pallor
B) A 70-year-old woman with jugular venous distention, shortness of breath, and pulmonary edema
C) A 66-year-old client with facial edema, cough, and neck vein distention
D) An 81-year-old man with acute cognitive changes as well as difficulty in speaking and swallowing

Question 18

A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman?

A) "Once you have varicose veins, there's little that can be done to reverse them."
B) "Your varicose veins are likely a consequence of an existing cardiac problem."
C) "If you're able to stay off your feet and wear tight stockings, normal vein tone can be reestablished."
D) "The use of blood thinner medications will likely relieve the backflow that is causing your varicose veins."

Question 19

An elderly patient arrives to the health care provider's office complaining of a "sore" that would not heal on his lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the patient that the usual treatment is

A) hydrotherapy to facilitate improvement in circulation.
B) compression therapy to help facilitate blood flow back to the vena cava.
C) initiation of Coumadin therapy to maintain an INR of 2 to 3 above norm.
D) long-term antibiotic therapy to facilitate healing of the wound.

Question 20

A physician is explaining to a group of medical students the concept of Virchow triad as it applies to venous thrombosis. Which of the following clinical observations of a 50-year-old male client is most likely unrelated to a component of Virchow triad?

A) The man has decreased cardiac output and an ejection fraction of 30%.
B) The man's prothrombin time and international normalized ratio (INR) are both low.
C) The man has a previous history of a dissecting aneurysm.
D) There is bilateral, brown pigmentation of his lower legs.