Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 33: Alterations of Cardiovascular FunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. What is the initiating event that leads to the development of atherosclerosis?a. Release of the inflammatory cytokinesb. Macrophages adhere to vessel walls.c. Injury to the endothelial cells that line the artery wallsd. Release of the platelet-deprived growth factorANS: CAtherosclerosis begins with an injury to the endothelial cells that line the arterial walls. Possible causes of endothelial injury include the common risk factors for atherosclerosis, such as smoking, hypertension, diabetes, increased levels of low-density lipoprotein (LDL), decreased levels of high-density lipoprotein (HDL), and autoimmunity. The remaining options occur only after the endothelial cells are injured.PTS: 1 DIF: Cognitive Level: Remembering 2. When endothelial cells are injured, what alteration contributes to atherosclerosis?a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs)b. Cells are unable to make the normal amount of vasodilating cytokines.c. Cells produce an increased amount of antithrombotic cytokines.d. Cells develop a hypersensitivity to homocysteine and lipids.ANS: BInjured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines. They do not release toxic oxygen radicals or develop hypersensitivity to homocysteine and lipids.PTS: 1 DIF: Cognitive Level: Remembering 3. Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?a. Increased norepinephrineb. Adducinc. Angiotensin IId. Insulin resistanceANS: CAngiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension. Increased SNS activity with norepinephrine leads to increases in heart rate and systemic vasoconstriction. Diabetes and glucose intolerance are risk factors for developing hypertension. Polymorphisms in some adducin proteins have been linked to hypertension but more study is needed.PTS: 1 DIF: Cognitive Level: Remembering 4. What pathologic change occurs to the kidney’s glomeruli as a result of hypertension?a. Compression of the renal tubulesb. Ischemia of the tubulec. Increased pressure from within the tubuled. Obstruction of the renal tubuleANS: BIn the kidney, ischemia causes inflammation and dysfunction of the glomeruli and tubules. This leads to increased sodium retention. Neither the renal tubules are compressed nor do they generate increased pressure. There is no obstruction.PTS: 1 DIF: Cognitive Level: Remembering 5. What effect does atherosclerosis have on the development of an aneurysm?a. Atherosclerosis causes ischemia of the intima.b. It increases nitric oxide.c. Atherosclerosis erodes the vessel wall.d. It obstructs the vessel.ANS: CAtherosclerosis is a common cause of aneurysms because plaque formation erodes the vessel wall. Atherosclerosis does not lead to ischemia of the intima, increase nitric oxide, or obstruct the vessel.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation?a. Inflammation and roughening of the endothelium of the artery are present.b. Hypertrophy and vasoconstriction of the endothelium of the artery are present.c. Excessive clot formation and lipid accumulation in the endothelium of the artery are present.d. Evidence of age-related changes that weaken the endothelium of the artery is present.ANS: AAtherosclerosis causes roughening of the intima of blood vessels, which subsequently leads to activation of the coagulation cascade. Clot promotion is not caused by vasoconstriction of the endothelium, or age-related changes that weaken the endothelium. This process occurs in the intima of the artery.PTS: 1 DIF: Cognitive Level: Remembering 7. A healthcare professional is caring for four patients. Which patient does the professional assess for pulmonary emboli (PE) as the priority?a. Deep venous thrombosisb. Endocarditisc. Valvular diseased. Left heart failureANS: APulmonary emboli originate in the venous circulation (mostly from the deep veins of the legs) or in the right heart. While any patient can develop a PE, the patients with endocarditis, valvular disease, and left heart failure do not have as big a risk as the patient with the deep vein thrombosis.PTS: 1 DIF: Cognitive Level: Understanding 8. Which factor can trigger an immune response in the bloodstream that may result in an embolus?a. Amniotic fluidb. Fatc. Bacteriad. AirANS: AAmniotic fluid displaces blood, thereby reducing oxygen, nutrients, and waste exchange; however, it also introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and the immune response in the bloodstream. Fat, bacteria, and air emboli do not trigger an immune response.PTS: 1 DIF: Cognitive Level: Remembering 9. Which statement best describes thromboangiitis obliterans (Buerger disease)?a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the handsb. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toesc. Autoimmune disorder of the large arteries and veins of the upper and lower extremitiesd. Neoplastic disorder of the lining of the arteries and veins of the upper extremitiesANS: ABuerger disease is an inflammatory disease of the peripheral arteries. Inflammation, thrombus formation, and vasospasm can eventually occlude and obliterate portions of small- and medium-size arteries. The digital, tibial, and plantar arteries of the feet and the digital, palmar, and ulnar arteries of the hands are typically affected. Vasospasm in the small arteries and arterioles of the fingers and occasionally the toes describes Raynaud disease. It does not involve larger arteries and veins and it is not a neoplastic disease.PTS: 1 DIF: Cognitive Level: Remembering 10. A patient has been diagnosed with Raynaud disease and asks for an explanation. What statement by the healthcare professional is best?a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the handsb. Neoplastic disorder of the lining of the arteries and veins of the upper
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