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 ["B","D","E"]
Explanation
Choice A rationale
A high fiber diet is associated with improved digestive health and a lower risk of chronic diseases like cardiovascular disease and type 2 diabetes. While it can help lower blood pressure in hypertensive patients over the long term, it does not cause acute hypotension. Fiber primarily affects glucose absorption and cholesterol levels. It does not significantly alter the immediate hemodynamic variables such as blood volume or cardiac contractility that are necessary to cause a clinical state of low blood pressure.
Choice B rationale
Dehydration leads to a decrease in total circulating blood volume, known as hypovolemia. When the intravascular volume drops, there is less blood filling the heart, which decreases stroke volume and subsequently reduces blood pressure. The body may attempt to compensate with tachycardia, but if the fluid loss is significant, hypotension ensues. Normal fluid intake varies, but clinical signs of dehydration include dry mucous membranes and poor skin turgor. Maintaining adequate hydration is critical for maintaining a stable, normal blood pressure.
Choice C rationale
High sodium intake is a well-known risk factor for hypertension, not hypotension. Sodium causes the body to retain water, which increases the total blood volume and places more pressure on the arterial walls. Excessive sodium intake can lead to edema and strain on the cardiovascular system. Reducing sodium intake is a standard recommendation for managing high blood pressure. In contrast, hypotension is sometimes treated with increased salt intake in specific conditions like orthostatic hypotension or certain dysautonomias.
Choice D rationale
Cardiac output is the product of heart rate and stroke volume. If the heart cannot pump effectively due to heart failure, myocardial infarction, or arrhythmias, the cardiac output falls. Since blood pressure is equal to cardiac output multiplied by systemic vascular resistance, a decrease in cardiac output directly leads to a decrease in blood pressure if the resistance does not increase enough to compensate. Normal cardiac output for an adult is typically between 4 to 8 liters per minute.
Choice E rationale
Blood loss, or hemorrhage, causes a rapid decrease in the volume of blood within the circulatory system. This acute hypovolemia reduces the amount of blood returning to the heart, which lowers the preload and the resulting stroke volume. If the loss is substantial, the body can no longer maintain adequate perfusion pressure, resulting in hypotension and potentially hypovolemic shock. Hemoglobin levels normally range from 12 to 16 g/dL in women and 14 to 18 g/dL in men; significant drops indicate blood loss.
Correct Answer is B
Explanation
Choice A rationale
Hepatitis D is a unique virus that requires the presence of the Hepatitis B virus to replicate. It is transmitted through percutaneous or mucosal contact with infected blood or body fluids, similar to Hepatitis B. It is not transmitted through the ingestion of contaminated food or water. Therefore, outbreaks are usually seen in populations with high rates of Hepatitis B infection, particularly among those who use intravenous drugs or receive multiple blood transfusions.
Choice B rationale
Hepatitis A is an acute viral infection that is primarily transmitted via the fecal-oral route. This occurs when an individual consumes food or water that has been contaminated with the feces of an infected person. It is often associated with poor sanitation, lack of clean water, and improper hand hygiene in food preparation. Unlike other forms of hepatitis, it does not typically lead to chronic liver disease, but it can cause significant acute illness.
Choice C rationale
Hepatitis C is a bloodborne virus that is most commonly transmitted through the sharing of needles among injection drug users or through needle-stick injuries in healthcare settings. Before widespread screening was implemented, it was also commonly spread through blood transfusions. It is characterized by a high rate of chronic infection and is not spread through food, water, or casual contact. It requires direct blood-to-blood contact for transmission to occur effectively.
Choice D rationale
Hepatitis B is transmitted through exposure to infectious blood, semen, and other body fluids. Common routes include perinatal transmission from mother to child, sexual contact, and the use of contaminated needles. It can result in both acute and chronic infections. Like Hepatitis C, it is not an enterically transmitted virus, meaning it does not enter the body through the digestive tract via contaminated food or water sources under normal circumstances.
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