A patient has been diagnosed with coronary artery disease (CAD) and was told she has a small plaque in the lumen of a coronary artery. The patient is placed on an EKG monitor during her chest pain episode and develops these vital signs: BP 110/70, HR 120, RR 18. What physiologic mechanism is most likely responsible for the tachycardia?

Decrease in circulating epinephrine.

Sympathetic nervous system (SNS) activity.

Increase in circulating acetylcholine.

Parasympathetic nervous system (PNS) activity.

Answer and Explanation

The Correct Answer is B

A. A decrease in circulating epinephrine would not cause tachycardia; it would likely lead to a reduction in heart rate.

B. Sympathetic nervous system activity is responsible for the increased heart rate (tachycardia) in response to stress, pain, or decreased perfusion, especially during episodes of chest pain in CAD.

C. An increase in circulating acetylcholine, associated with parasympathetic activity, would generally result in a decreased heart rate.

D. Parasympathetic nervous system activity would lead to a decrease in heart rate and would not account for the tachycardia observed in this patient.

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Correct Answer is D

Explanation

A. While the kidneys do excrete HCO3 to help in metabolic compensation, this process is slower than respiratory compensation.

B. An increase in respiratory rate would further decrease CO2, worsening the alkalosis rather than compensating for it.

C. Creating more HCO3 would not compensate for respiratory alkalosis and would actually increase the pH further.

D. The body will decrease the respiratory rate to retain more CO2, helping to lower the pH and partially correct the alkalosis.

A. The uninjured lung will hyperinflate because of an increased respiratory rate. B. Affected lung collapses as more air is exhaled through the traumatic injury. C. Trapped air causes collapse of the lung and can reduce the cardiac output. D. More CO2 is retained because weakened alveoli blebs rupture.

Correct Answer is C

Explanation

A. While an increased respiratory rate may occur, it does not directly lead to hyperinflation of the uninjured lung due to tension pneumothorax.

B. In a tension pneumothorax, air enters the pleural space and does not exhale effectively; it is not about exhalation.

C. Trapped air in the pleural cavity increases pressure, collapsing the lung and pushing mediastinal structures (like the heart) to the opposite side, thereby reducing venous return and cardiac output.

D. Retained CO2 is not a direct cause of tension pneumothorax; the main issue is the pressure from trapped air affecting lung function and hemodynamics.

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A patient's ABG results are: pH 7.50, PCO2 25, HCO3 25, PO2 80. Which finding should the nurse expect as the body compensates for the acid-base imbalance?

Correct Answer is D

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