1. A patient has intermittent claudication and a history of atherosclerosis. What other
findings are most likely?
a. pitting edema of the ankles. Wrong—edema is associated with venous issues, not arterial
(everything
...
1. A patient has intermittent claudication and a history of atherosclerosis. What other
findings are most likely?
a. pitting edema of the ankles. Wrong—edema is associated with venous issues, not arterial
(everything in stem of question points to arterial: intermittent claudication = PAD, atherosclerosis =
arterial prob.)
b. jugular vein distention. Wrong—associated with RHF in which there is back up of venous blood
into jugular veins.
c. cool feet with diminished pulses. Correct—atherosclerosis blocks arterial flow to distal areas;
intermittent claudication means basically “limping because of ischemic pain,” so you link this with
PAD & diminished flow to feet.
d. S&S of increased preload. Wrong—increased volume is not a part of this scenario.
2. A patient is diagnosed with venous insufficiency. What treatment is most likely and why?
a. a clot-busting medication, because it is used to dissolve arterial clots that block off
flow. Wrong—venous insufficiency = venous prob, not arterial (“arterial clots” is in stem of
question)
b. drop the legs lower than the heart so that circulation can bypass DVTs.
Wrong—venous issues = raise feet.
c. complete bedrest, as venous stasis is the best way to prevent thrombosis. Wrong—
blood should never be static! increases risk for thrombus.
d. elevation of feet as often as possible, because it enhances venous return. Correct –
think of venous insufficiency as “insufficient ability to get venous flow back UP to the heart” (often
due to incompetent venous valves) so that blood pools in veins in the feet.
***Questions 3-7 refer to this scenario: A patient with a history of atherosclerosis and HTN is
complaining of chest pain, SOB, and pain radiating to his left arm. He is diagnosed with an MI of
his left ventricular wall.
3. What S&S would be expected and would indicate decreased CO /perfusion?
a. ankle edema and varicose veins. Wrong—atherosclerosis & HTN are arterial dzs; ankle
edema & varicose veins relate to venous issues.
b. decreased urine output and capillary refill of 4 seconds. Correct – an MI will be a
negative inotrope—it will decrease contractility of the heart muscle and thus decrease stroke volume,
which in turn decreases CO (see concept map); decreased CO means less perfusion to the
body!delayed capillary refill as well as diminishment of organ efficiency such as that of the kidneys.
c. BP of 190/90 and capillary refill of 2 seconds. Wrong—capillary refill of 2 sec. is normal.
d. strong, bounding DP & PT pulses. Wrong—with decreased CO, you are more likely to have
decreased, weaker pulses.
4. Lab work done during the MI most likely shows high blood levels of certain substances,
including:
a. troponin. Correct—increase in serum troponin almost always means cardiomyocytes injury/death,
since troponin is a substance usually only found in the heart cells.
b. BNP. Wrong—BNP is increased in HF, not MI.
c. histamine Wrong—histamine MAY be increased because of inflammatory side of MI, but it is more
subtle and not measured as lab work.
d. inotropes. Wrong—the word inotrope means having to do with contractility; it’s not usually a
measurement in terms of labs, etc.
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