46. A 57-year-old white man presents to his primary care physician with dyspnea. He says that he likes to maintain his yard and garden, but that he has recently had trouble doing the work, and becomes short of breath even walking up the one flight of stairs in his house. On further questioning, he says that sometimes he wakes up short of breath in the middle of the night. Physical examination demonstrates pitting ankle edema. Which of the following findings would also be expected in this patient?
(A) Decreased sympathetic outflow
(B) Decreased venous pressure
(C) Increased aldosterone secretion
(D) Increased effective arterial blood volume
47. Cardiac Nursing Questions about a 73-year-old man with a history of hypertension and type 2 diabetes mellitus who presents with the sudden onset of right-sided paralysis. An ultrasound study shows significant atherosclerosis in a major artery that is embryologically derived from one of the aortic arches. The artery that is most likely involved in this patient’s paralysis is derived from which of the following aortic arches?
(A) First aortic arch
(B) Second aortic arch
(C) Third aortic arch
(D) Fourth aortic arch
48. A 76-year-old woman who visits the emergency department complaining of increased fatigue. She states that she tires easily even with very low levels of activity. Her temperature is 36.7° C (98.1° F), heart rate is 123 beats/min, and blood pressure is 85/43 mm Hg. The woman has a history of coronary artery disease and diabetes. She also notes a recent traumatic episode when her grandson kicked her in the chest when she was picking him up. On physical examination, her doctor notices a disappearing arterial pulse on inspiration. The doctor orders an echocardiogram to confirm the diagnosis. What invasive procedure will be necessary to treat this patient?
(B) Aortic valve replacement
(C) Mitral valve replacement
49. Cardiac Nursing Questions about a 3-year-old boy who comes to the pediatrician with fever, conjunctivitis, erythema in the oral mucosa, and cervical lymphadenopathy. The boy suddenly becomes hypotensive and goes into cardiac arrest and dies shortly thereafter. Autopsy shows aneurysmal dilations of the left circumflex and right coronary arteries. The boy’s disease is characterized as a self-limiting disease that most commonly affects the coronary arteries. Which of the following diseases is the correct diagnosis?
(A) Buerger’s disease
(B) Kawasaki’s disease
(C) Polyarteritis nodosa
(D) Takayasu’s arteritis
50. A 54-year-old woman comes to the physician 3 months after a undergoing a root canal because of persistent general malaise and fever. The symptoms developed slowly over the weeks following her root canal, but have not abated. On physical examination, the patient is found to have a temperature of 38.3° C (101° F). Ophthalmic examination reveals retinal hemorrhages with clear central regions. Examination of the extremities reveals painful red nodules on her digits and dark macules on her palms and soles. On cardiac examination, a click and a systolic murmur are auscultated over the mitral valve. She tells the physician that the click is due to a mechanical valve replacement done 4 years ago due to rheumatic fever as a child. Given this history, which of the following is the most appropriate treatment for this patient?