Mural Thrombus NCLEX Review Question

A 62-year-old man has experienced substernal chest pain upon exertion with increasing frequency over the past 6 months. An electrocardiogram shows features consistent with ischemic heart disease. He has a total serum cholesterol of 262 mg/dL. By angiography, there is 75% narrowing of coronary arteries.

In which of the following locations is a mural thrombus most likely to occur in this man?
A  Left atrium
B Left ventricle
C Right atrium
D Right ventricle

Correct Answe (B)
Rationale: The left ventricle is the major user of oxygen and nutrients and requires a good blood supply. A complication of ischemic heart disease with infarction is development of overlying mural thrombus. Such mural thrombi are likely to result from damage to the left ventricle from ischemic heart disease, either acutely with an underlying myocardial infarction, or with a left ventricular aneurysm formed following resolution of a large myocardial infarction

Mesenteric Artery Occlusion NCLEX Question with Answer and Rationale

A 63-year-old man has had insulin dependent diabetes mellitus for over two decades. The degree of control of his disease is indicated by the laboratory finding of hemoglobin A1C 10.1%. He has noted episodes of abdominal pain following meals. These episodes have worsened over the past year. On physical examination, there are no masses and no organomegaly of the abdomen, and he has no tenderness to palpation.

 Which of the following pathologic findings is most likely to be present in this man?

A Ruptured aortic aneurysm
B Hepatic infarction
C Mesenteric artery occlusion
D Acute pancreatitis

Correct Answer (C)
Rationale: He has 'abdominal angina' from diminished blood flow to the bowel as a consequence of severe atherosclerosis. Persons with diabetes mellitus may have this finding, because all branches of major arteries to the bowel are affected by atherosclerosis.

Femoral Vein Thrombosis NCLEX Question with Answer and Rationale

A 54-year-old previously healthy woman is hospitalized for pneumonia. On the 10th hospital day she is found to have swelling and tenderness of her right leg, which has developed over the past 48 hours. Raising the leg elicits pain. An ultrasound examination reveals findings suggestive of femoral vein thrombosis.

Which of the following conditions is most likely to have contributed the most to the appearance of these findings?

A Trousseau syndrome
B Protein C deficiency
C Immobilization
D Pregnancy

Correct Answer: (C)
Rationale: The immobilization while in hopsital would predispose to thrombosis of leg veins. This is the most common cause for deep venous thrombosis.