Cardiac Vascular Nursing Exam Cardiac Vascular Nursing Exam Pathophysiology & Disease Processes 2 — Questions and Answers
Question 1: Which pathophysiological process distinguishes unstable angina from stable angina?
- Plaque rupture with partial thrombus formation without complete occlusion (Correct answer)
- Complete coronary artery occlusion with myocardial necrosis
- Coronary vasospasm only, without plaque involvement
- Increased myocardial oxygen demand with a fixed stenosis
Correct answer: Plaque rupture with partial thrombus formation without complete occlusion
Unstable angina is caused by plaque rupture and platelet aggregation forming a non-occlusive thrombus, creating unpredictable ischemia at rest or with minimal exertion.
Question 2: In peripheral arterial disease (PAD), which pathophysiological change causes claudication pain?
- Inadequate arterial blood flow creating ischemia in exercising muscles (Correct answer)
- Venous hypertension causing tissue edema and nerve compression
- Arterial embolism causing sudden complete occlusion
- Inflammatory myopathy unrelated to vascular supply
Correct answer: Inadequate arterial blood flow creating ischemia in exercising muscles
Atherosclerotic stenosis limits blood flow to limb muscles during exercise; when oxygen demand exceeds supply, ischemia causes cramping pain that resolves with rest.
Question 3: Which mechanism causes the widened pulse pressure seen in aortic regurgitation?
- High stroke volume increases systolic pressure while regurgitant backflow lowers diastolic pressure (Correct answer)
- Increased systemic vascular resistance raises both systolic and diastolic pressure
- Decreased heart rate with increased stroke volume raising systolic pressure only
- Left ventricular hypertrophy increasing contractility without valvular effect
Correct answer: High stroke volume increases systolic pressure while regurgitant backflow lowers diastolic pressure
In aortic regurgitation, large forward stroke volume raises systolic pressure, while regurgitation of blood back into the ventricle during diastole causes low diastolic pressure.
Question 4: Ventricular remodeling after myocardial infarction involves which structural change that increases risk of heart failure?
- Infarct expansion and dilation of the ventricle with thinning of the infarcted wall (Correct answer)
- Hypertrophy of the infarcted area to compensate for lost function
- Fibrosis limited to the infarct zone without chamber changes
- Increased contractility in the remote myocardium only
Correct answer: Infarct expansion and dilation of the ventricle with thinning of the infarcted wall
Post-MI remodeling involves infarct expansion, ventricular dilation, and wall thinning driven by neurohormonal activation and inflammatory mediators, increasing wall stress and heart failure risk.
Question 5: Which mechanism explains why hypertensive patients are at increased risk for both ischemic stroke and hemorrhagic stroke?
- Chronic hypertension promotes atherosclerosis causing embolic stroke and weakens small vessel walls causing rupture (Correct answer)
- Hypertension only affects large vessels, causing embolic events
- Hypertension reduces clotting factors, predisposing to bleeding only
- Hypertension causes cerebral vasospasm as the only mechanism
Correct answer: Chronic hypertension promotes atherosclerosis causing embolic stroke and weakens small vessel walls causing rupture
Chronic hypertension accelerates atherosclerosis in large cerebral arteries predisposing to embolic stroke, while also causing lipohyalinosis and microaneurysm formation in small penetrating arteries predisposing to hemorrhage.
Question 6: Pulmonary hypertension in the context of left heart disease (Group 2 PH) develops through which mechanism?
- Elevated left atrial pressure is transmitted backward, raising pulmonary venous and arterial pressures (Correct answer)
- Primary pulmonary arterial remodeling unrelated to left heart pressures
- Hypoxia-induced pulmonary vasoconstriction as the primary cause
- Increased pulmonary blood flow from left-to-right shunting
Correct answer: Elevated left atrial pressure is transmitted backward, raising pulmonary venous and arterial pressures
Left ventricular dysfunction or mitral valve disease raises left atrial pressure, which is transmitted back through pulmonary veins, increasing pulmonary capillary and arterial pressures.
Cardiac Vascular Nursing Exam Cardiac Vascular Nursing Exam Pathophysiology & Disease Processes 2
Which pathophysiological process distinguishes unstable angina from stable angina?