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. Large amounts of IV fluids are generally not used in ESRD because the kidneys cannot effectively remove excess fluids, potentially worsening fluid overload.

B. Potassium supplements are avoided, as ESRD patients often have elevated potassium levels due to reduced excretion, which can lead to dangerous cardiac complications.

C. While ESRD is serious, postmortem care is premature; many patients manage ESRD with appropriate treatment.

D. Dialysis or kidney transplantation is the standard treatment for ESRD to take over the functions that the kidneys can no longer perform, such as waste removal and fluid balance.

A. Serum creatinine (Cr.): 0.6-1.2 B. A 24-hour urine creatinine clearance test result that is higher than normal. C. A serum creatinine of 0.5. D. Casts present in the urinalysis.

Correct Answer is D

Explanation

A. Serum creatinine levels within the normal range (0.6-1.2) do not specifically indicate intra-renal AKI.

B. A high 24-hour creatinine clearance is not typically associated with intra-renal AKI, as kidney injury often leads to decreased filtration and clearance.

C. A low serum creatinine level (0.5) would generally indicate good kidney function rather than AKI.

D. Casts in the urine are indicative of damage within the kidney tubules, which is a characteristic finding of intra-renal AKI, often due to cellular injury or necrosis within the kidney itself.

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