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 ["A","B","C","E"]
Explanation
Choice A rationale
The liver is the primary organ responsible for the metabolism and detoxification of exogenous substances, including medications and alcohol. Through various enzymatic pathways, such as the cytochrome P450 system, the liver chemically modifies drugs to make them more water soluble for excretion by the kidneys. This prevents the accumulation of toxic levels of substances in the bloodstream. Impaired liver function can lead to prolonged drug half lives and increased risk of drug toxicity in patients.
Choice B rationale
Bile production is a vital exocrine function of the liver. Hepatocytes synthesize bile, which is composed of water, electrolytes, bile salts, and bilirubin. Bile is essential for the emulsification and absorption of dietary fats and fat soluble vitamins in the small intestine. It also serves as a vehicle for the excretion of waste products like bilirubin and excess cholesterol. Without adequate bile production, patients experience malabsorption and steatorrhea, which is characterized by fatty stools.
Choice C rationale
The liver plays a central role in carbohydrate metabolism and blood glucose regulation. It stores excess glucose in the form of glycogen through a process called glycogenesis. When blood glucose levels drop, the liver performs glycogenolysis, breaking down stored glycogen into glucose to be released into the circulation. Additionally, the liver can create new glucose from non carbohydrate sources via gluconeogenesis. These processes ensure that the body maintains a stable blood glucose level, typically 70 to 100 mg/dL.
Choice D rationale
The liver is responsible for the synthesis, not the destruction, of most clotting factors, including fibrinogen, prothrombin, and factors VII, IX, and X. These proteins are essential for the coagulation cascade and the prevention of excessive bleeding. In liver failure, the production of these factors decreases, leading to an increased prothrombin time and a higher risk of hemorrhage. The destruction of clotting factors is generally associated with consumptive coagulopathies like disseminated intravascular coagulation, not normal liver function.
Choice E rationale
The liver is the major site of cholesterol synthesis in the body. It produces cholesterol to be used in the formation of cell membranes, the synthesis of steroid hormones, and the production of bile acids. The liver also regulates cholesterol levels by exporting it to other tissues via lipoproteins and removing it from the blood. While dietary intake contributes to cholesterol levels, endogenous production by the liver accounts for a significant portion of the total cholesterol found in the human body.
Correct Answer is C
Explanation
Choice A rationale
Multiple sclerosis is a chronic autoimmune disease that specifically targets the central nervous system, which includes the brain and spinal cord. It does not primarily affect the peripheral nervous system, which consists of the nerves outside these structures. Peripheral nerve issues are more characteristic of conditions like Guillain-Barre syndrome or peripheral neuropathy. Understanding that MS is a central nervous system disorder is vital for recognizing the types of neurological deficits and imaging findings expected during diagnosis.
Choice B rationale
There is no single definitive blood test that can confirm a diagnosis of multiple sclerosis. Diagnosis is usually based on clinical findings, magnetic resonance imaging showing lesions disseminated in time and space, and sometimes cerebrospinal fluid analysis for oligoclonal bands. Blood tests are primarily used to rule out other conditions that mimic MS, such as systemic lupus erythematosus or vitamin B12 deficiency. Relying solely on a blood test suggests a misunderstanding of the diagnostic process.
Choice C rationale
Multiple sclerosis is characterized by an immune-mediated attack on the myelin sheath, which is the protective insulation surrounding nerve fibers in the central nervous system. This process of demyelination disrupts the normal transmission of electrical impulses, leading to various neurological symptoms. By correctly identifying that the disease involves the loss of myelin within the central nervous system, the client demonstrates an accurate understanding of the underlying pathophysiology and the reason for their varied physical and cognitive symptoms.
Choice D rationale
The clinical course of multiple sclerosis is typically characterized by unpredictable relapses and remissions or a steady progression of symptoms. It is very rare for symptoms to remain exactly the same every day; instead, patients often experience fluctuations in fatigue, motor strength, and sensory perception depending on disease activity and external factors like heat or stress. Believing that symptoms will be identical daily shows a lack of awareness regarding the episodic and variable nature of MS.
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