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Which serum enzyme would elevate first after an infarction?
- A. Serum glutamic-oxaloacetic transaminase (SGOT)
- B. Lactic acid dehydrogenase (LDH)
- C. Creatine phosphokinase isoenzymes (CPK-MB)
- D. Serum glutamic-pyruvic transaminase (SGPT)
Correct Answer: C
Rationale: CPK-MB rises early after MI onset.
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How might the blood pressure be affected in a client whose body mass index (BMI) is 31 (obese)?
- A. increased
- B. decreased
- C. no change
- D. a change either way
Correct Answer: A
Rationale: Obesity is strongly associated with increased blood pressure due to factors like insulin resistance and increased vascular resistance.
Which neurotransmitter released by the parasympathetic nervous system can decrease heart rate?
- A. Acetylcholine
- B. Norepinephrine
- C. Dopamine
- D. Serotonin
Correct Answer: A
Rationale: The correct answer is A: Acetylcholine. Acetylcholine is released by the parasympathetic nervous system and acts on the heart to decrease heart rate. It binds to muscarinic receptors in the heart, leading to a decrease in heart rate through inhibition of the SA node. Norepinephrine (B) is released by the sympathetic nervous system and increases heart rate. Dopamine (C) and Serotonin (D) are not directly involved in regulating heart rate through the parasympathetic pathway.
What is a condition where the heart's valves do not function properly, leading to disrupted blood flow within the heart?
- A. Valvular heart disease
- B. Myocarditis
- C. Endocarditis
- D. Aneurysm
Correct Answer: A
Rationale: The correct answer is A: Valvular heart disease. Valvular heart disease refers to conditions where the heart's valves do not function properly, leading to disrupted blood flow within the heart. This can result in symptoms like chest pain, shortness of breath, and fatigue. Myocarditis (B) is inflammation of the heart muscle, Endocarditis (C) is an infection of the inner lining of the heart, and Aneurysm (D) is a bulge in a blood vessel. These conditions do not specifically involve malfunctioning heart valves as seen in valvular heart disease.
Two weeks ago, a 63-year-old patient with heart failure received a new prescription for carvedilol (Coreg) 3.125 mg orally. Upon evaluation in the outpatient clinic you find these symptoms. Which is of most concern?
- A. Complaints of increased fatigue and dyspnea.
- B. Weight increase of 0.5 kg in 2 weeks.
- C. Bibasilar crackles audible in the posterior chest.
- D. Sinus bradycardia, rate 50, as evidenced by ECG.
Correct Answer: D
Rationale: Bradycardia can impair cardiac output, especially in heart failure patients.
What is a severe and often sudden allergic reaction that can lead to breathing difficulties and anaphylactic shock?
- A. Anaphylaxis
- B. Allergic rhinitis
- C. Bronchospasm
- D. Asthma attack
Correct Answer: A
Rationale: The correct answer is A: Anaphylaxis. Anaphylaxis is a severe and sudden allergic reaction that can lead to breathing difficulties and anaphylactic shock due to the body's extreme immune response. Allergic rhinitis (B) is a milder allergic reaction affecting the nose and eyes. Bronchospasm (C) is a sudden constriction of the muscles in the airways, often associated with asthma. Asthma attack (D) refers to the exacerbation of asthma symptoms but does not necessarily involve anaphylactic shock.