A patient states he often has chest pain when he is exercising. The pain goes away with rest and lasts less than 15 minutes.
The nurse understands that the patient is experiencing:
Stable angina.
A myocardial infarction.
Unstable angina.
Myocarditis.
The Correct Answer is A
Choice A rationale
Stable angina is characterized by predictable chest pain that occurs during physical exertion when the myocardial oxygen demand exceeds the available supply. The hallmark of this condition is that the symptoms subside promptly with rest or the administration of nitroglycerin. The duration is typically short, usually lasting less than fifteen minutes. The underlying pathology involves a fixed atherosclerotic plaque that limits blood flow only during periods of increased cardiac workload.
Choice B rationale
A myocardial infarction involves actual necrosis or death of cardiac muscle tissue due to a prolonged lack of oxygenated blood. Unlike the scenario described, the pain from an infarction is typically severe, crushing, and does not resolve with rest or simple nitrates. It often lasts much longer than fifteen minutes and is frequently accompanied by systemic symptoms such as diaphoresis, nausea, and shortness of breath. Laboratory markers like troponin would also be elevated.
Choice C rationale
Unstable angina is a dangerous condition where chest pain occurs at rest or with minimal exertion, and the patterns are unpredictable. It often represents a transition state where a plaque has ruptured and a thrombus is partially occluding the vessel. The pain may last longer than fifteen minutes and does not follow the predictable pattern of exercise-induced symptoms. It is considered an acute coronary syndrome and requires immediate medical intervention to prevent an infarction.
Choice D rationale
Myocarditis is an inflammatory process affecting the heart muscle itself, often caused by viral infections rather than coronary artery disease. The pain associated with myocarditis is often pleuritic or persistent and is not specifically triggered by exercise or relieved by rest in the same predictable manner as angina. Patients often present with additional signs of infection, such as fever, malaise, and evidence of heart failure or arrhythmias on an electrocardiogram.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Calcification is the accumulation of calcium salts in body tissues, which can cause the tissue to harden. While calcification can occur within atherosclerotic plaques, making the arteries rigid, it is a broader biological process that can happen in heart valves, kidneys, or soft tissues. It is a secondary component of the narrowing process rather than the term for the narrowing itself caused specifically by plaque. In the context of arteries, it often signifies an advanced stage of vascular disease.
Choice B rationale
Thrombophlebitis is an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs. While it involves a blockage, it occurs in the venous system rather than the arterial system and is caused by a thrombus rather than the chronic buildup of fatty plaques. Symptoms include redness, swelling, and pain in the affected area. It is a different pathological entity from the chronic arterial narrowing described in the prompt's question.
Choice C rationale
Myocarditis is the inflammation of the heart muscle, known as the myocardium. It is most often caused by viral infections, but can also result from drug reactions or inflammatory conditions. Symptoms include chest pain, fatigue, and shortness of breath. Myocarditis affects the muscle tissue's ability to pump blood and can lead to heart failure or arrhythmias. It does not involve the narrowing of the arteries due to plaque buildup, which is a vascular rather than a primary muscular issue.
Choice D rationale
Atherosclerosis is a specific type of arteriosclerosis characterized by the buildup of fats, cholesterol, and other substances in and on the artery walls. This buildup is called plaque. Over time, these plaques can narrow the lumen of the arteries, restricting blood flow to vital organs. If a plaque ruptures, it can trigger a blood clot. This process is the underlying cause of many cardiovascular diseases, including coronary artery disease and peripheral artery disease. Risk factors include high cholesterol and smoking.
Correct Answer is A
Explanation
Choice A rationale
The motor pathways in the brain, specifically the corticospinal tract, undergo decussation or crossing over at the level of the medulla oblongata. This means that the motor neurons originating in the left hemisphere of the brain control the muscle movements on the right side of the body. When a stroke occurs in the left hemisphere, the resulting damage to these neurons manifests as contralateral weakness or paralysis on the right side.
Choice B rationale
Due to the contralateral organization of the central nervous system, injury to the left side of the brain does not typically result in isolated weakness on the same side. Ipsilateral weakness would only occur if the damage was below the point of decussation in the spinal cord. In the context of a hemispheric stroke, the physical deficits appear on the opposite side of the brain lesion. Therefore, left sided weakness would indicate a right hemisphere stroke.
Choice C rationale
A stroke involving the left hemisphere typically impacts the primary motor cortex or the internal capsule, which are essential for voluntary movement. It is medically expected that such an event will produce some level of neurological deficit unless the stroke was extremely small or located in a non functional area. Weakness or paralysis is a classic symptom of middle cerebral artery strokes. Suggesting that no side is affected ignores the basic principles of clinical neurology.
Choice D rationale
Weakness on both sides of the body, or quadriparesis, usually indicates a lesion in the brainstem or a very large bilateral injury, rather than a stroke confined to the left hemisphere. The brainstem contains the motor pathways for both sides before they fully separate or decussate. A focal stroke in one hemisphere is characterized by hemiparesis or hemiplegia, affecting only one half of the body. Bilateral weakness is not a standard expectation for a unilateral hemispheric stroke.
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