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NURS 8022 EXAM 3 2025 SUMMER-FALL QUESTIONS
AND ANSWERS GRADED A+
Which of the following disorders can lead to a low V/Q mismatch?
A. Pulmonary edema
B. Pulmonary Embolism
C. Pulmonary Hypertension
D. Hypercapnia
A. Pulmonary edema
Nitric oxide, which is released by the glomerular endothelial cells, causes which physiological process to occur?
A. Vasoconstriction
B. Vasodilation
B. Vasodilation
What would be a normal physiological response in regard to osmosis be in a patient with hyperglycemia?
The patient's serum is hypertonic and the fluid will move out of the cell
How does the parasympathetic nervous system decrease heart rate?
Release of ACH from the parasympathetic system increases the permeability of K+ ions and leads to hyperpolarization of the cell.
A patient is in renal failure. The patient reports a history of severe diarrhea for several days. They also report they have not been able to eat or drink anything for the last 24 hours due to not feeling well. The NP would suspect that this patient's renal failure is a (pre/intral/post renal) and is due to (dehydration/ischemia/urinary obstruction).
Prerenal; dehydration
Which of the following cardiac alterations could lead to left sided hypertrophic cardiomyopathy?
A. Aortic stenosis
B. Pulmonary hypertension
C. Cardiac dilation
D. Amyloidosis
A. Aortic stenosis
Natriuretic peptides increase the _________ of sodium?
When reviewing the patients chart a provider reads that there is nephrotic sediment in the urine. This means there is a large presence of
Protein
AD
When reviewing the patients chart a provider reads that there is nephritic sediment in the urine. This means there is a large presence of
Blood
What are two functions of surfactant in the lungs?
-Keeps alveoli open and free of fluid
-Decreases surface tension by blocking H2O and H+ binding
If a patients has low plasma volume what is the normal physiological response?
Thirst
Which nerve innervates the diaphragm?
Phrenic nerve
Which lipid carried cholesterol to the tissues?
LDL
What three areas does gas exchange occur?
Bronchioles
Alveolar ducts
Alveoli
Gas exchange airways are served by the
A. Cardiac circulation
B. Venous circulation
C. Pulmonary circulation
C. Pulmonary circulation
Bronchi and other lung structures are served by the
A. Cardiac circulation
B. Systemic circulation
HCO3 range
22-26 mEq/L
Base excess
-2 to +
A person has atherosclerosis. Which pathophysiologic process has occurred?
Macrophages release enzymes and toxic oxygen radicals that create oxidative stress.
Why do we give patient's ACE inhibitors if they have had an MI?
To stop the conversion of angiotensin I to angiotensin II to further protect the heart
What is Dressler syndrome? When does it occur?
Delayed form of pericarditis; thought to be antigen-antibody response to necrotic myocardium
Occurs 1 week to several months later
A person with an MI is releasing angiotensin II. How should the nurse interpret this finding?
Releasing angiotensin II is beneficial or counterproductive and why?
Counterproductive; it causes the heart to work harder.
How does angiotensin II affect the heart during an MI?
It contributes to the pathogenesis of the MI. Results in systemic effects which causes peripheral vasoconstriction and fluid retention. It's returning more blood flow to the heart and increasing peripheral vascular resistance making the heart work harder
6 P's of PVD
Pallor, pulselessness, pain, paresthesia, paralysis and poikilothermia
AD
What can vascular regurgitation lead to?
Dilation and hypertrophy
(Increased volume leads to dilation; increased workload leads to hypertrophy)
Kussmaul's sign
Some causes of diastolic heart failure
Hypertrophy
Ischemia
Diabetes
Valve problems
Systolic heart failure
Ejection problem
Decreased EF of the L ventricle
Diastolic heart failure
Filling problem
Pulm congestion despite normal EF
Understand orthopnea with heart failure
Person lays down making it easier for blood to flow back to the heart, thus increasing preload and workload. A failing heart cannot handle this. Blood flows back into the lungs causing the shortness of breath.
Where is left heart failure edema?
Pulmonary
AD
Where is right heart failure edema?
Peripheral
Clinical manifestations of L heart failure
Dyspnea, orthopnea, cough of frothy sputum
Clinical manifestations of R heart failure
Jugular vein distention and hepatosplenomegaly
- Parasympathetic nervous system
- Hypothalamic pituitary adrenal axis
- Renin-angiotensin-aldosterone system (RAAS)
- Antidiuretic hormone (ADH) vasopressin aldosterone system
- Renin-angiotensin-aldosterone system (RAAS)
Atrial flutter vs atrial fibrillation
Flutter p rate 251-
Fib >
AD
Four types of heart block
First degree
Second degree Mobitz I (Wenckebacke)
Second degree Mobitz II
Third degree (complete)
Where does first degree heart block occur?
Delay at the level of AV node
Where does second degree Mobitz I heart block occur?
Level of the AV node
Where does second degree Mobitz II heart block occur?
In the bundle of His or lower in the AV conduction system
Where does third degree (complete) heart block occur?
AV node or bundle of His or purkinje fibers
Acyanotic heart defects
Left to right shunting with pulmonary congestion. CHF
Cyanotic heart defects
Right to left shunting
In a child with ventricular septal defect (VSD), blood flow is shunted from the:
- Hypercyanotic spells
- High BP in the arms with decreased pedal pulses
- Syncopal episodes with chest pain
- High BP in the arms with decreased pedal pulses
Kawasaki disease cause
Mostly unknown; ~immunologic response to infectious toxin or antigen
What is Kawasaki disease?
Acute self limiting febrile illness of early childhood characterized by vasculitis of the medium sized arteries, most noticeable in the coronary vessels
Kawasaki Stage 1
0-12 days: capillaries, venues, arterioles and heart become inflamed
Kawasaki stage 2
12-35 days: larger vessels become inflamed. Coronary aneurysms appear
Kawasaki stage 3
26-40 days: Medium sized arteries begin granulation process. Small vessel inflammation decreases
Kawasaki stage 4
40+ days: scarring of vessels. Thickening of tunica intima. Calcification. Coronary artery stenosis
Kawasaki's disease: clinical manifestations
Acute
Fever, conjunctivitis, strawberry tongue, rash and lymphadenopathy
Kawasaki's disease: clinical manifestations
Subacute
Begins when fever ends;
Coronary artery aneurysm development, desquamation of palms and soles, marked thrombocytosis
Kawasaki's disease: clinical manifestation
Convalescent
Hairlike structures
Alveoli
Primary gas exchange units
Type I alveolar cells
alveolar structure
Type II alveolar cells
surfactant production
What is surfactant?
A detergent like complex, reduces surface tension and helps keep the alveoli from collapsing.
Acinus contains
- Ciliated cells
- Goblet cells
- Alveolar ducts
- Alveolar ducts
Pulmonary circulation functions
(1) facilitates gas exchange
(2) delivers nutrients to lung tissues
(3) acts as a blood reservoir for the left ventricle
(4) serves as a filtering system that removes clots, air, and other debris from the circulation
Pulmonary circulation has (higher/lower) pressure than systemic circulation?
Lower
What two circulatory systems make up the pulmonary circulation?
Bronchial (high pressure) and pulmonary (low pressure)
Two factors that keep the lungs from collapsing
surfactant and pleural pressure
