1. Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, “What does that mean?” The nurse willbase her answer on which of the following physiologic principles? A) “You have been exposed to an infection that wentinto your blood stream.” B) “You have a heart valve that is diseased.” C) “You heart has been pumping your blood so hard,that the pressure has damaged your valves.” D) “Your heart has enlarged, so naturally your valveshad to enlarge as well.” Ans: B Feedback: Turbulence is often accompanied by vibrations of the blood and surrounding cardiovascular structures. Some of these vibrations are in the audible rangeand can be heard using a stethoscope. For example, a heart murmur results from turbulent flow through a diseased heart valve. The other distractors are not feasible. 2. A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to “watch” for now.When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which of the following physiological principles? A) Small diameter of this vessel will cause it torupture more readily. B) The larger the aneurysm, the less tension placedon the vessel. C) As the aneurysm grows, more tension is placed onthe vessel wall, which increases the risk for rupture. D) The primary cause for rupture relates to increasein abdominal pressure such as straining to have a bowel movement. Ans: C Feedback: Because the pressure is equal throughout, the tension in the part of the balloon with the smaller radius is less than the tension in the section with thelarger radius. The same holds true for an arterial aneurysm in which the tension and risk of rupture increase as the aneurysm grows in size. Wall tension is inversely related to wall thickness, such that the thicker the vessel wall, the lower the tension, and vice versa. Although arteries have a thicker muscular wall than veins, their distensibility allows them to store some of the blood that is ejected from the heart during systole, providing for continuous flow through the capillaries as the heart relaxes during diastole. HESI ADVANCED PATHOPHYSIOLOGY V2( 100 PRACTICE QUESTIONS AND ANSWERS) ALL CORRECT. 3. A client has entered hypovolemic shock after massive blood loss in a car accident. Many of the client's peripheral blood vessels have consequently collapsed. Howdoes the Laplace law account for this pathophysiologic phenomenon? A) Blood pressure is no longer able to overcomevessel wall tension. B) Decreasing vessel radii has caused a decrease inblood pressure. C) Wall thickness of small vessels has decreased dueto hypotension. D) Decreases in wall tension and blood pressure havecaused a sudden increase in vessel radii. Ans: A Feedback: In circulatory shock, there is a decrease in blood volume and vessel radii, along with a drop in blood pressure. As a result, many of the small vessels collapse as blood pressure drops to the point where it can no longer overcome the wall tension. Decreases in vessel wall radii donot cause the decrease in blood pressure, and wall thicknessgenerally remains static. 4. Which of the following statements about vascularcompliance is accurate? A) Arteries are much more distensible than veins. B) Veins can act as a reservoir for storing largequantities of blood. C) Arteries have thick muscular walls that constricttightly, thereby ejecting blood without storing it for later use. D) A continuous flow through the capillaries occursprimarily during systole. Ans: B Feedback: The most distensible of all vessels are theveins, which can increase their volume with only slight changes in pressure, allowing them to function as a reservoirfor storing large quantities of blood that can be returned to the circulation when it is needed. Although arteries have a thicker muscular wall than veins, their distensibility allows them to store some of the blood that is ejected from the heart during systole, providing for continuous flow through the capillaries as the heart relaxes during diastole. 5. In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis?