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Medical Terminology for Health Professions8th EditionAnn Ehrlich, Carol L Schroeder, Katrina A Schroeder, Laura Ehrlich 1,792 solutions Which patient is at the highest risk of dying from a myocardial infarction? 4 Age is the most important risk factor in women for developing coronary artery disease. A postmenopausal woman, such as the 70-year-old African American woman, has the highest risk for dying. The Hispanic male is at a lower risk due to his age and gender. The white woman is at a lower risk due to her age and race. The Asian man is at a lower risk due to his age, race, and gender. The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize? 3 Tobacco exposure, including secondhand smoke, reduces coronary blood flow; causes vasoconstriction, endothelial dysfunction, and thickening of the vessel wall; increases carbon monoxide; and decreases oxygen. Because it is highly addicting, beginning smoking in the teen years may lead to decades of exposure. Teens are not likely to experience metabolic syndrome from obesity but are very likely to use tobacco. The risk for smoking outweighs the risk for alcohol use. Avoiding stress is a lesser modifiable risk factor, which is less likely to cause heart disease in teens. Which is the most suitable body temperature for cardiopulmonary bypass? 3 During cardiopulmonary bypass, the body temperature should be between 95° F and 98° F, so, 96° F is the most suitable body temperature during bypass from the options provided. Although cooling decreases the rate of metabolism and demand for oxygen, keeping the heart "warm" decreases the postoperative complications which are more common when cold cardioplegia is used. Temperatures below 95° F and above 98° F may increase the amount of postoperative complications, so 90° F, 95° F, and 102° F are not suitable temperature options for cardiopulmonary bypass. What
should a patient do if he has new-onset angina at home? 1 A patient with new-onset angina at home is advised to chew 325 mg of aspirin, or 4 baby aspirins, 81 mg each, immediately and then call 911. Ingesting 4 baby aspirins 85 mg each; 3 baby aspirins 81 mg each; and 3 baby aspirins 85 mg each, do not meet the recommended dose requirements. The nurse finds that a patient has been refusing treatment for infection for the past month. Which type of shock does the nurse anticipate in this patient? 1 Infection can result in septic shock, if not treated on time. Septic shock occurs when an infection is not confined to a local area; it spreads into the blood stream and other body areas. Obstructive, cardiogenic, and hypovolemic shock are not caused by infection. Which laboratory result is seen in late sepsis? 2 A decreased segmented neutrophil count is indicative of late sepsis. Serum lactate is increased in late sepsis. Monocytosis is usually seen in diseases such as tuberculosis and Rocky Mountain spotted fever. An increased platelet count does not indicate sepsis; late in sepsis, platelets may decrease due to consumptive coagulopathy. Which gram-positive bacteria
may cause sepsis and septic shock? 2 Staphylococcus aureus is a gram-positive organism, which may cause sepsis and septic shock. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa are gram-negative bacteria, which may cause sepsis and septic shock. The
nurse gives a patient with acute coronary syndrome simple repeated explanations on therapies used to treat anxiety. What rationale supports this intervention? 1 Stress is a risk factor for acute coronary syndrome; therefore, this patient may need help managing stress and promote coping. Assessing the patient's level of anxiety and giving simple, repeated explanations on different therapies reduces anxiety in the patient and promotes effective coping and learning. Collaborative cardiac rehabilitation programs help increase activity tolerance in patients with acute coronary syndrome. The patient's hemodynamic status is assessed to identify and manage dysrhythmias. Surgical management of acute coronary syndrome is necessary for managing the extension of myocardial injury. What are the actions of renin in the maintenance of blood pressure? Select all that apply. 1 Renin is produced in the body as a response to low blood pressure. This enzyme helps in maintaining blood pressure by decreasing urine output and constricting peripheral blood vessels. Renin also increases sodium reabsorption in the kidney which causes further retention of water. Renin does not directly affect cardiac function or potassium levels. The nurse is explaining to a patient that the medication prescribed inhibits platelet aggregation and vasoconstriction. Which
medication is the nurse describing? 4 Acetylsalicylic acid (aspirin) decreases the likelihood of thrombosis by inhibiting both platelet aggregation and vasoconstriction. Abciximab (ReoPro) is a glycoprotein IIb/IIIa inhibitor and prevents fibrinogen from attaching to activated platelets at the site of a thrombus. Clopidogrel (Plavix) is an antiplatelet. Metoprolol (Toprol XL) is a beta-adrenergic blocking agent and decreases the size of the infarct, the occurrence of ventricular dysrhythmias, and mortality rates in patients experiencing a myocardial infarction. What is the most preferred source of omega-3 fatty acids in a patient who consumes a Western diet? 1 The preferred source of omega-3 acids is fish because it contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in direct form. Plant sources such as walnuts, canola oil, and flaxseed contain α-linolenic acid. The conversion of α-linolenic acid to EPA and DHA is not as efficient in patients who consume a typical Western diet. Which is associated with hypovolemic shock? 1 Dehydration is a symptom of hypovolemic shock. This is because in hypovolemic shock, there is a decrease in the total body fluids. Pulmonary embolus is a result of direct pump failure, which indicates cardiogenic shock. Myocardial infarction occurs due to decreased cardiac function, which causes obstructive shock. Chemical-induced sepsis is caused by fluid shift from the central vascular space. This results in distributive shock. Which are risk factors for hypovolemic shock? Select all that apply. 1 Specific risk factors for hypovolemic shock include hemophilia, malnutrition, and diuretic therapy. Hypovolemia can be caused by impaired clotting in patients with hemophilia and malnourishment. Excessive diuresis due to diuretic therapy can also cause reduction in blood volume. Patients with spinal cord injury have distributive shock in which the total blood volume is not reduced but fluid shifts from the central vascular space. In patients with myocardial infarction, cardiac function is impaired which causes cardiogenic shock. Which shock results in a
decrease of total body fluids? 4 Hypovolemic shock results in a decrease of total body fluids. Cardiogenic shock is indicated by direct pump failure. In distributive shock, the fluid shifts from the central vascular space. In obstructive shock, cardiac function is decreased due to indirect pump failure. What metabolic changes occur as a result of tissue ischemia during the compensatory stage of hypovolemic shock? Select all that apply. 1 In the compensatory (nonprogressive) stage of shock, tissue hypoxia leads to acidosis because of changes in anaerobic metabolism. Hyperkalemia occurs as well from the changes in metabolism. The patient is acidotic, not alkalotic. Hypovolemic shock is associated with vasoconstriction, not vasodilation. A patient in hypovolemic shock presents with a normal hematocrit and hemoglobin. What type of fluid should the nurse anticipate the health care provider will prescribe to restore oncotic pressure? 1 The ideal intervention for restoring osmotic pressure in a patient with normal hematocrit and hemoglobin is plasma. Plasma protein fractions and synthetic plasma expanders are used to increase fluid volume. Whole blood is suitable for replacing large blood losses in patients with a decrease in hemoglobin and hematocrit levels. Ringer's lactate does not restore oncotic pressure; it is a crystalloid that restores fluid volume and is used in instances where the patient needs volume expansion and correction of acidosis. Packed red cells are chosen for moderate blood losses when the patient needs red blood cells without added fluid volume. Where are the baroreceptors that are responsible for detection of pressure changes within the arterial system located? 1 The baroreceptors responsible for detecting pressure changes in the arterial system are located in aortic arch and carotid sinus. There are no baroreceptors located in radial sinus, brachial arch, and femoral sinus. Which stage of hypovolemic shock is a medical emergency and requires immediate intervention? 3 The progressive stage of shock is a medical emergency that requires immediate intervention because compensatory mechanisms may be unable to deliver an adequate amount of oxygen to the vital organs. If this condition is left untreated even for an hour, it will lead to multiple organ dysfunction syndrome and even death. At the initial stage, the compensatory mechanisms are efficient enough to maintain normal oxygenation and perfusion rates of the vital organs; thus, immediate interventions are not required. The refractory stage involves excessive cell damage and tissue death, because tissue perfusion is blocked at this stage due to an excessive decrease in mean arterial pressure. The nonprogressive stage is not a medical emergency. If supportive interventions are performed, a patient can remain in the nonprogressive stage for hours without any damage to the vital organs. After teaching a patient's family members about hypovolemic shock, the nurse asks
them about the early signs and symptoms that appear in the nonprogressive stage. What symptom identified by a family member requires further teaching? 1 Cyanosis appears later, in the progressive stage of hypovolemic shock. Earlier signs and symptoms of the nonprogressive stage include restlessness, increased respiratory rate, and decreased urine output. Which type of shock may result if hemorrhage in a patient is not treated in time? 4 Hemorrhage can result in hypovolemic shock, which occurs when the mean arterial pressure decreases due to loss of blood from the vascular space resulting in inadequate total body perfusion and oxygenation. A loss of blood does result in distributive, obstructive, and cardiogenic shock; therefore, these are not associated with hemorrhage. Which organ is responsible for releasing myocardial depressant factor that leads to heart damage as a result of multiple organ dysfunction syndrome (MODS)? 4 Myocardial depressant factor is secreted from the ischemic pancreas and is responsible for causing profound damage to the heart in MODS. The liver, brain, and kidneys, in addition to the heart, are severely damaged but they do not release myocardial depressant factors. Which stage of hypovolemic shock is indicated by a pulse oximetry value of 93%? 4 In the nonprogressive stage of hypovolemic shock, the pulse oximetry value ranges from 90%-95%. If the value is above 95%, it indicates the initial stage of hypovolemic shock. Any value below 70% indicates the refractory stage. In the progressive stage, the value lies between 75% and 80%. Which vasodilator drug is often helpful in managing hypovolemic
shock? 4 Sodium nitroprusside dilates the coronary arteries, enhancing myocardial perfusion and improving hypovolemic shock. Milrinone and dobutamine are both inotropic agents that act by increasing the force of heart muscle contractions. Phenylephrine is a vasoconstrictor, not a vasodilator. Which
organ can tolerate hypoxia for 1 hour without permanent damage in a patient with hypovolemic shock? 4 Kidneys can tolerate hypoxia for 1 hour without permanent damage, but beyond this time the patient is at the risk of kidney failure. The liver, brain, and heart cannot tolerate hypoxia; it will lead to organ dysfunction. What is the
component of colloid solutions that is helpful in managing hypovolemic shock through the intravenous route? 3 Colloid solutions are mainly composed of larger molecules like starches and proteins. These molecules help to maintain the oncotic pressure of the intravascular fluid and prevent fluid loss. Salts, sugars, and minerals are components of crystalloids, not colloids. Which clinical manifestation may be evident in the initial stage of hypovolemic shock? 3 The initial stage of hypovolemia can be detected only by an increase in heart and respiratory rates. Reduction in urine output is a manifestation of the nonprogressive stage. Antidiuretic hormone increases water reabsorption in the kidneys which results in decreased urine output. In the initial stage of hypovolemia, the compensatory mechanisms are efficient in maintaining cardiac output, so there is no overall decrease in cardiac output. A 2%-5% decrease in oxygen saturation indicates the nonprogressive stage of hypovolemia. The nurse is caring for postoperative patients at
risk for hypovolemic shock. Which condition represents an early symptom of shock? 4 Heart and respiratory rates increased from the patient's baseline level or a slight increase in diastolic blood pressure may be the only objective manifestation of this early stage of shock. Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal. Early in shock, the patient displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock; they are related to lack of oxygen to the heart. In acute shock, which organ has the capacity to tolerate hypoxia and anoxia for 1 hour without sustaining permanent injury? 4 In acute shock, which organ has the capacity to tolerate hypoxia and anoxia for 1 hour without sustaining permanent injury? Which are cardiovascular manifestations of hypovolemic shock? Select all that apply. 1 In hypovolemic shock, total body fluid is reduced; therefore, the difference between systolic and diastolic pressure (pulse pressure) is decreased. Blood pressure in the body drops also causing postural hypotension. The decrease in blood volume causes a simultaneous decrease in cardiac output. There is a compensatory increase in pulse rate to restore cardiac output in shock. Peripheral pulses become weak in hypovolemic shock. Which physiological
change is related to septic shock? 2 Septic shock is always due to an underlying infection. An elevated WBC count is associated with septic shock. There is a progressive organ dysfunction resulting in low blood pressure, and decreased urinary output. The respiratory rate is increased to compensate for hypoxia in the tissues. Which drug is prescribed particularly in patients with septic shock? 2 Severe sepsis may result in adrenal insufficiency. Therefore, low doses of corticosteroids are prescribed in the form of IV hydrocortisone during the treatment to prevent adrenal insufficiency. In hypovolemic shock, adrenal insufficiency may not occur. Milrinone helps in improving contractility, and its administration is not limited to septic shock. Sodium nitroprusside improves myocardial perfusion and is not limited to septic shock. Phenylephrine HCl helps in improving mean arterial pressure and therefore can be prescribed in both septic and hypovolemic patients. The primary health care provider prescribed a plasma C-reactive protein test for a
patient. Which shock does the nurse anticipate in this patient? 1 Plasma C-reactive protein test is prescribed in septic shock because it helps in detecting inflammation. As soon as an infection starts, the plasma-reactive protein is made by the liver and released into the blood. Obstructive, cardiogenic, and hypovolemic shock are not caused by infection, and may not need a C-reactive protein test. Which parameter reduction indicates the beginning of severe sepsis? 1 Reduced levels of activated protein C is an early indicator of severe sepsis even before any other manifestations emerge. Protein C is an enzyme that prevents inappropriate clot formation. It is activated when it binds to healthy vascular endothelial cells. In severe sepsis, injured endothelial cells cannot activate protein C and thousands of small clots form in the capillaries of vascular organs. Hallmarks of severe sepsis include rising serum lactate and band neutrophil levels. Hemoglobin level does not change until late in sepsis. Which medications are often used to provide adrenal support for the
patient with severe sepsis? Select all that apply. 3 During severe sepsis, the body's immune response can become self-destructive if not controlled. Drugs that provide adrenal support during severe sepsis are IV hydrocortisone and oral fludrocortisone. IV penicillin, levofloxacin, and vancomycin are antibiotics that help to kill the bacteria causing the sepsis. Which clinical symptoms in a postoperative patient indicate early sepsis with an excellent recovery rate if treated? 2 Low-grade fever and mild hypotension indicate very early sepsis, but with treatment, the probability of recovery is high. Localized erythema and edema indicate local infection. A low oxygen saturation rate and decreased cognition indicate active (not early) sepsis. Reduced urinary output and an increased respiratory rate indicate severe sepsis. Which is a risk factor for distributive shock? 3 The risk factor for distributive shock is diminished immunity response. Use of ginkgo biloba can result in hypovolemic shock. Diminished thirst reflex is a risk factor for hypovolemic shock. Presence of cardiomyopathies is a risk factor for cardiogenic shock. Which
physiological change in a patient with septic shock indicates a poor prognosis? 4 Sepsis often progresses into irreversible septic shock and is associated with a poor prognosis. Hypodynamic cardiac function in septic shock indicates deterioration. A rapid respiratory rate, low oxygen saturation, and a change in the patient's cognition are present during this stage of severe sepsis. These can be reversed with appropriate and timely treatment. Which problem places a patient at highest risk for sepsis? 3 The post- kidney transplant patient will need to take lifelong immune suppressant therapy and is at risk for infection from internal and external organisms. Pernicious anemia is related to lack of vitamin B 12, not to bone marrow failure (aplastic anemia), which would place the patient at risk for infection. Inflammation of the pericardial sac is an inflammatory condition that does not pose a risk for septic shock. Although owning pets, especially cats and reptiles, poses a risk for infection, the immune-suppressed kidney-transplant patient has a very high risk for infection, sepsis, and death. Which assessment data indicates that antibiotic therapy has been effective for treating a patient with sepsis? 3 No single laboratory test confirms the presence of sepsis, but one of the hallmarks of sepsis is an increasing serum lactate level. The return of abnormal labs to normal range and stabilization of the patient's presentation are used to evaluate treatment effectiveness. An increase in serum creatinine clearance does not indicate the effective sepsis treatment. A decrease (not increase) in serum glucose would be expected in a non-diabetic patient. The slight decrease in white blood cells does not yet signify the effectiveness of antibiotic therapy. Which finding may reflect increased cardiac output in patients with septic shock? 3 Increased cardiac output is reflected by a normal central venous pressure (CVP). Increased cardiac output is reflected by tachycardia rather than bradycardia. Increased stroke volume and a normal systolic blood pressure may also reflect increased cardiac output. A patient is receiving antineoplastic chemotherapy. Which measure does the nurse teach that will help prevent infection and sepsis? 3 Dishes should be washed in hot, soapy water or in a dishwasher to thoroughly cleanse them; there is no need to use disposable tableware. Water that has been standing longer than 15 minutes should be discarded; however, bottled water is not necessary. The patient may be in the same room as, as well as touch, the family pet (with the exception of changing a litterbox—this should not be done); however, the patient should wash the hands thoroughly with an antimicrobial soap after touching pets. The expected outcome of the sepsis resuscitation bundle for a patient with septic shock has been met when which parameter is present? 1 Effective fluid resuscitation will restore tissue perfusion, correcting lactic acidosis and meeting the goal of a lactate level of 4 mmol/L. Mean arterial pressure in septic shock should be maintained at 65 mm Hg for adequate tissue perfusion. Blood cultures may take 3 days to grow; appropriate treatment is initiated prior to culture results. The result of treatment of sepsis is to maintain a urine output of at least 20 mL/hr. Which type of shock has no loss of blood volume from the body but has toxic metabolites, which results in organ dysfunction? 1 Septic shock is a type of distributive shock in which there is no blood volume loss, but low levels of oxygen are perfused to the body tissues because of infections. Obstructive shock is caused by problems that impair the ability of the normal heart to pump effectively. Although the heart remains healthy, the conditions outside the heart prevent either adequate filling of the heart or adequate contraction of the healthy heart muscle. Cardiogenic shock occurs when the heart muscle is unhealthy and pumping is impaired. Hypovolemic shock occurs when there is too little circulating blood volume, decreasing the mean arterial pressure (MAP) because of hemorrhage, which results in inadequate total body perfusion and oxygenation. Which problem places a patient at highest risk for septic shock? 4 The skin forms the first barrier to prevent entry of organisms into the body; the patient with 40% burn injury is at very high risk for sepsis and death. Although the patient with kidney failure has an increased risk for infection, his skin is intact, unlike the patient with burn injury. Although the liver acts as a filter for pathogens, the patient with cirrhosis has intact skin, unlike the burned patient. The patient with lung cancer may be at risk for increased secretions and infection, but risk is not as high as for a patient with open skin. Which blood product is mostly preferred in
patients with septic shock? 1 A patient in septic shock may have impaired clotting, increasing the risk for bleeding. Therefore, the patient should be administered platelets to improve clotting and to prevent bleeding. The use of platelet shock is recommended over other blood products such as clotting factors, fresh frozen plasma, and packed red blood cells for a patient with septic shock to improve clotting. Which is most suitable body temperature for cardiopulmonary bypass?To minimize risk of cerebral hyperthermia, the arterial outlet and nasopharyngeal temperatures are maintained ≤37°C.
Which temperature would be appropriate for warm cardioplegia?Optimal Temperature. Most investigators have reported using warm cardioplegia at 37 °C, and others, at temperatures above 35 °C.
What is the highest amount of cholesterol a person should consume to reduce the risk for developing coronary artery disease?In general, aim for: Total cholesterol below 200 mg/dL.
Which action would a patient take if he or she has a new onset angina at home?If you have symptoms, sit down and rest, and take the first dose of nitroglycerin as directed. If your symptoms get worse or are not getting better within 5 minutes, call 911 right away.
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Which is the most suitable body temperature for cardiopulmonary bypass Quizlet
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