Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth
Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth
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Chapter 32- Disorders of Cardiac Function
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient’s health problems? | |
| A) | A 61-year-old man whose ECG was characterized by widespread T-wave inversions on admission but whose T waves have recently normalized | |
| B) | A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation | |
| C) | A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge | |
| D) | A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels | |
| Ans: | B | |
| Feedback: | ||
| S3 and S4 irregularities and irregular heart rate are not noted symptoms of pericarditis. Widespread T-wave inversions that later normalize; chest pain radiating to the neck and scapula that is worse on inspiration; and high white cells, erythrocyte sedimentation rate, and C-reactive protein levels are all indicators of pericarditis. | ||
| 2. | Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply. | |
| A) | Muffled heart tones | |
| B) | Narrowed pulse pressure | |
| C) | Low BP—84/60 | |
| D) | Heart rate 78 | |
| E) | Bounding femoral pulse | |
| Ans: | A, B, C | |
| Feedback: | ||
| Cardiac tamponade results in increased intracardiac pressure, progressive limitation of ventricular diastolic filling, and decreased stroke volume and cardiac output. This accumulation of fluid results in tachycardia, elevated CVP, jugular vein distention, fall in systolic BP, narrowed pulse pressure, and signs of shock. Heart sounds may be muffled. A pulse rate of 78 is normal (not tachycardic). With pulsus paradoxus, the arterial pulse as palpated at the carotid or femoral artery becomes weakened (not bulging) or absent with inspiration. | ||
| 3. | Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)? | |
| A) | Inadequate ventricular end-diastolic pressure | |
| B) | Use of calcium channel blocker medications | |
| C) | Increased aortic pressure | |
| D) | Ventricular atrophy | |
| Ans: | C | |
| Feedback: | ||
| An increase in aortic pressure results in a rise in afterload, wall tension, and, ultimately, MVO2. Increased, not inadequate, ventricular end-diastolic pressure would cause an increase in MVO2, and medications such as calcium channel blockers would decrease MVO2. Hypertrophy of ventricles would occur in response to prolonged wall stress and consequent oxygen demand. | ||
| 4. | As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? | |
| A) | Echocardiogram, PET scan, ECG | |
| B) | Ambulatory ECG, cardiac MRI, echocardiogram | |
| C) | Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy | |
| D) | Cardiac catheterization, cardiac CT, exercise stress testing | |
| Ans: | A | |
| Feedback: | ||
| An echocardiogram would provide an image of the client’s heart, while a PET scan reveals metabolic activity and an ECG the electrical activity. Answer B would lack data on the client’s myocardial metabolism; answer C would lack electrical and physical measurement information; answer D would lack electrical measurement of his heart. | ||
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