A patient has been diagnosed with coronary artery disease (CAD) and was told she has a small plaque in the lumen of a coronary artery. The patient is placed on an EKG monitor during her chest pain episode and develops these vital signs: BP 110/70, HR 120, RR 18. What physiologic mechanism is most likely responsible for the tachycardia?

Decrease in circulating epinephrine.

Sympathetic nervous system (SNS) activity.

Increase in circulating acetylcholine.

Parasympathetic nervous system (PNS) activity.

Answer and Explanation

The Correct Answer is B

A. A decrease in circulating epinephrine would not cause tachycardia; it would likely lead to a reduction in heart rate.

B. Sympathetic nervous system activity is responsible for the increased heart rate (tachycardia) in response to stress, pain, or decreased perfusion, especially during episodes of chest pain in CAD.

C. An increase in circulating acetylcholine, associated with parasympathetic activity, would generally result in a decreased heart rate.

D. Parasympathetic nervous system activity would lead to a decrease in heart rate and would not account for the tachycardia observed in this patient.

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Correct Answer is D

Explanation

A. Aortic atherosclerosis and mitral insufficiency could lead to some symptoms of congestion but would not fully explain jugular venous distension and liver congestion.

B. Aortic valve stenosis and left heart failure primarily affect left-sided heart function, which typically does not present with jugular venous distension or peripheral edema.

C. Bronchogenic cancer and diaphoresis do not explain the cardiovascular symptoms present in this case.

D. Pulmonic valve stenosis can lead to right heart failure, causing systemic venous congestion, which results in JVD, liver congestion, ascites, and ankle edema, thus accounting for all aspects of the patient's presentation.

A. is dehydrated; the body is compensating by "hanging onto water." B. has an acute kidney injury; the specific gravity indicates very concentrated urine. C. is developing renal tissue impairment; the kidney is not able to concentrate urine. D. has testicular cancer; the specific gravity indicates an undescended testis.

Correct Answer is C

Explanation

A. A specific gravity of 1.000 indicates very dilute urine, not concentrated. This would not be typical of dehydration, where urine would be concentrated with a high specific gravity.

B. Acute kidney injury (AKI) typically results in more concentrated urine due to retained waste products; therefore, specific gravity would likely be higher, not at the minimum level of 1.000.

C. A specific gravity of 1.000 indicates the kidney’s inability to concentrate urine, often seen in renal impairment where kidney function is compromised, leading to very dilute urine.

D. Specific gravity is unrelated to testicular cancer or an undescended testis, as it measures kidney concentration ability rather than reproductive health.

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Naxlex Comprehensive Predictor Exams

A woman presents to a clinic with JVD (jugular venous distension), liver congestion, ascites, and ankle edema. Upon auscultation of her heart, the RN notes a murmur. The etiologies that would best account for all aspects of this patient picture are

Correct Answer is D

Explanation

Correct Answer is C

Explanation

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