31. A 35-year-old man with no significant medical history presents to his primary care physician with a 2-week history of progressive shortness of breath that occurs with activity. He previously exercised regularly and has never had symptoms like this before, but now he finds that he can walk only one block before becoming symptomatic. He has also noticed a 7-lb (3.2-kg) weight gain during this time. He does not smoke or use alcohol or illicit drugs and has not traveled recently. In addition, he has no family history of cardiac disease and does not have any sick contacts, but recalls having an upper respiratory infection about a month ago that improved on its own. Physical examination reveals crackles in his lungs bilaterally and an S3 gallop. X-ray of the chest reveals cardiomegaly. What is the most likely mechanism causing this patient’s heart failure?
(A) Antibodies to a variety of cardiac proteins that cause immune-mediated damage to myocytes
(B) Direct cytotoxicity via receptor-mediated entry of virus into cardiac myocytes
(C) Granulomatous inflammation of myocytes
(D) Hyperadrenergic state leading to dilated cardiomyopathy
32. Med Surg Nursing Questions about a 25-year-old pregnant woman who goes to her gynecologist for her 36-week checkup. She complains of light-headedness when she goes to bed at night. In the office, her blood pressure is 120/70 mm Hg while sitting upright and 90/50 mm Hg while lying supine. Which of the following is the most likely cause of this hypotension?
(A) Cardiogenic shock
(B) Inferior vena cava compression
(C) Neurogenic shock
(D) Third spacing of fluid
33. A 48-year-old obese man who presents to his primary care physician with complaints of lower leg pain that occurs after he walks a few city blocks and is relieved with rest. He has no other complaints. His blood pressure is 165/85 mm Hg, his pulse is 83/min, and his respiratory rate is 18/min. After further questioning, he admits to smoking two packs of cigarettes per day. Which of the following types of vessels is most likely involved in the pathologic process surrounding this patient’s symptoms?
34. Med Surg Nursing Questions about a 62-year-old breast cancer survivor who visits her physician because of weakness, fatigue, fever, and weight gain 5 years following her radiation therapy. The physician also elicits complaints about abdominal discomfort and exertional dyspnea. Physical examination reveals hepatomegaly and jugular venous distention that fails to subside on inspiration, but shows no evidence of hypotension or pulsus paradoxus. An echocardiogram shows reduced end-diastolic volumes and elevated diastolic pressures in both ventricles. Which of the following is the most likely diagnosis?
(A) Cardiac tamponade
(B) Congestive heart failure
(C) Constrictive pericarditis
(D) Dilated cardiomyopathy
35. The classic location for an abdominal aortic aneurysm is inferior to the renal arteries and extending to the bifurcation of the common iliac arteries. Repair involves resecting the diseased portion of the aorta and replacing it with a synthetic graft. Based on anatomic considerations, which of the following visceral arteries would likely be resected along with the diseased aortic tissue during the repair of an infrarenal abdominal aortic aneurysm?
(A) Gastroduodenal artery
(B) Hepatic artery
(C) Inferior mesenteric artery
(D) Left gastric artery