Ch.20 PrepU Quiz

• Diuretics reduce blood volume and myocardial oxygen demand. • Decrease in cardiac output causes an increase in preload. • Excessive stretch on the ventricular wall will decrease preload.

The Frank-Starling mechanism is a compensatory response to heart failure that can support cardiac output but also worsen heart failure. Which of the following statements regarding this mechanism are correct? Select all that apply.

• Frothy blood-tinged sputum • Respiratory crackles • Confusion • Rapid pulse

Acute pulmonary edema often occurs with heart failure. Which of the following signs of acute pulmonary edema should be monitored? Select all that apply.

Ability to increase cardiac output during physical exercise

Cardiac reserve refers to which of the following events?

Distributive shock

For which of the following types of shock might intravenous antibiotic therapy be indicated?

They have the same compensatory mechanisms.

Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?

"Displays of aggression, confusion and restlessness when the resident has no history of such behavior can be a sign of heart failure."

Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate?

Vasoconstriction

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Fatigue Exercise intolerance Cyanosis Malnutrition

Manifestations of heart failure are due to the decreased pumping ability of the heart. The nurse will monitor for which of the following signs and symptoms of heart failure? Select all that apply.

• Sufficient blood volume to fill the vascular compartment • Efficient cardiac pumping ability • Intact vascular system • Ability of organs to extract oxygen and nutrients from blood

Proper perfusion of vital organs requires which of the following conditions? Select all that apply.

Liver

The diagnosis is right-sided heart failure. The nurse knows that which organ is primarily affected in this type of heart failure?

Inhibition of the renin-angiotensin-aldosterone system

The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology?

90/75

The nurse is assessing the blood pressure of a client who is experiencing cardiogenic shock. Which of the following blood pressure readings is most likely?

20 mL/hour

The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:

Hypertrophy

Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?

Peripheral edema weight gain

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?

Decreased risk of infection Better wound healing

The diagnosis is septic shock. The nurse knows that administration of insulin to this patient will provide which of the following beneficial effects? Select all that apply.

Septic

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this patient most likely is experiencing which of the following types of shock?

Anaphylatic shock

A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client.

Infusion of normal saline or Ringer's lactate to maintain the vascular space.

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?

Infusion of normal saline or Ringer's lactate to maintain the vascular space

A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man?

Low blood pressure

A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?

Dry and warm skin

A 30-year-old woman presents at a hospital after fainting at a memorial service and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display?

Hypertrophy of the myocardium Sympathetic nervous stimulation Increased renin--angiotensin--aldosterone system (RAAS) function Increased preload

A 60-year-old woman has just been diagnosed with heart failure and her primary care provider is describing the concept of adaptation. Which compensatory mechanisms may have masked the client's heart failure? Select all that apply.

Ventricular dilation and wall tension are significantly lower than normal

A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?

Dry, warm skin Bradycardia

A 70-year-old woman presents at a hospital after fainting at the funeral of a loved one. She is diagnosed as being in shock. Which signs and symptoms is she most likely to display? Select all that apply.

• "Do you easily get tired?" • "Do you have swelling in your ankles?" • "Are you feeling depressed?" • "Do you get up often during the night to urinate?"

A 75-year-old patient is being evaluated for heart failure. Which questions will the nurse ask to confirm common signs and symptoms observed in older adults experiencing heart failure? Select all that apply.

Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand

A 77 year old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of, "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:

Ca2+ levels in the myocardium

A client has been diagnosed with heart failure. The client's cardiac contractility will be primarily affected by which factor?

Diastolic dysfunction

A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause.

Respiratory distress with audible crackles

A client has presented to the emergency department in distress and is being rapidly assessed by the care team. Which assessment finding would prompt the team to consider the possibility of acute heart failure?

Sepsis

A client in the intensive care unit died shortly after developing multiple organ dysfunction syndrome (MODS). Which health problem most likely preceded the client's MODS?

Relaxation of the bronchioles

A client is experiencing circulatory shock. The nurse is aware that compensation will occur with stimulation of the beta-2 (β2) receptors. The nurse anticipates the client will experience:

Anaphylactic

A client is rushed to the emergency department with symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?

Administer epinephrine (adrenaline).

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?

Obstructive shock

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing?

A cardiac glycoside

A client with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions?

Implantation of a ventricular assist device

A client with a history of heart failure has been assessed and the care team has determined that a reduction in myocardial workload would benefit his prognosis. Which intervention is most likely to meet this client's needs?

Paroxysmal nocturnal dyspnea

A client with heart failure tells the nurse that he is frustrated and is unable to get "a good night's rest." The client relates that he falls asleep and is suddenly awakened and feels as though he is having a hard time breathing and is suffocating. The nurse recognizes this assessment as:

Measurement of urine output and mental status assessment

A nurse educator on a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice?

Dyspnea, cough

A nurse in a nursing home is concerned that a resident may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?

Diuretic, ACE inhibitor, beta-blocker

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure?

Continuous measurement of urine output

A nurse is assessing a client in shock for complications of acute renal failure. The most important assessment for the nurse to obtain would be:

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?

Raising the head of the bed to a high Fowler's position

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?

has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client:

• Myocardial hypertrophy • Ischemic heart disease • Constrictive pericarditis

A patient diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which of the following are often associated with diastolic failure? Select all that apply.

Electrocardiogram (EKG) Cardiac computed tomography (CCT) Echocardiography Chest x-ray

A patient exhibits signs and symptoms of heart failure, including fatigue and shortness of breath. Which of the following tests are suggested to support a diagnosis of heart failure? Select all that apply.

Preload

A patient has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the patient's end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this?

Myocardial infarction

A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?

• Thrombotic occlusion occurs in small and midsized blood vessels. • Bleeding may accompany coagulation. • Generation of thrombin increases. • Endogenous anticoagulation mechanisms are suppressed.

A patient has developed disseminated intravascular coagulation (DIC). The nurse knows that which statements regarding DIC are true? Select all that apply.

Myocardial infarction

A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?

Diastolic dysfunction

A patient has developed pericarditis. The nurse knows that this condition will increase the risk for development of which condition?

"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."

A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?

• Beta-adrenergic blockers • Angiotensin-converting enzyme inhibitors (ACEI) • Digitalis • Diuretics

A patient is diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder? Select all that apply.

Weight gain

A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following?

Valvular regurgitation

A patient is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as which of the following?

Venous return to the heart

A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?

Epinephrine (Adrenalin).

All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?

Increased vascular stiffness

An 86-year-old male client is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?

• Organs affected include kidneys, lungs, liver, brain, and heart. • Homeostasis is disrupted. • Risk factors for development of MODS include severe trauma, hepatic dysfunction, and prolonged hypotension. • Treatment is primarily supportive of the affected organs

An acutely ill patient is developing multiple organ dysfunction syndrome (MODS). The nurse knows that which statements regarding multiple organ dysfunction syndrome are true? Select all that apply.

Vascular stiffness

An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:

blocking the conversion of angiotensin I to angiotensin II.

An elderly client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:

severity and duration of shock.

An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?

Histamine release causes massive vasodilation

Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?

Laryngeal edema

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often accompanies the vascular response in anaphylaxis?

Right-sided heart failure

Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem?

• Pyruvate converted to lactic acid • Cellular edema • Deranged sodium/potassium balance • Impaired cellular production of adenosine triphosphate (ATP)

Circulatory shock is characterized by an inability of the circulatory system to provide adequate oxygen to body tissues. Which of the following damaging effects at the cellular level can cause hypoxia? Select all that apply.

Atrial fibrillation

Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?

The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate.

Emergency Medical Technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place?

• Decreasing mean arterial pressure (MAP). • Low BP reading of 86/60. • Urine output 15 mL last hour. • Periods of confusion.

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on their left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm the client may be in the early stages of cardiogenic shock? Select all that apply.

Whole blood Packed red cells Plasma volume expanders Crystalloids

Hypovolemic shock is characterized by a loss of blood volume or extracellular fluid. Administering which of the following would manage a patient with hypovolemic shock? Select all that apply.

Neurogenic Septic Anaphylactic

In distributive shock, there are abnormalities in vascular resistance. Which of the following types of shock display the same distributive pattern? Select all that apply.

• Vasoconstriction • Increased heart rate • Activitation of the renin angiotensin system (RAAS)

In heart failure patients, the nurse knows that many compensatory mechanisms attempt to support cardiac output. Included among these mechanisms are which of the following? Select all that apply.

20 mL/hour

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion?

Vasoconstrictive drugs

In hypovolemic shock, the main purpose of treatment is correcting or controlling the underlying cause of the hypovolemia and improving the perfusion of the tissues and organs of the body. Which of the following treatments is not a primary form of therapy for hypovolemic shock?

Low cardiac output

Increased secretion of renin in heart failure is caused by which of the following events?

Call for emergency assistance utilizing hospital protocol.

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is:

Increased glomerular filtration Decreased renal reabsorption of sodium and water Inhibition of endothelin action

Natriuretic peptides (NP) are part of the compensatory response to heart failure. Which of the following are actions of NP? Select all that apply.

Heart rate slower than normal; skin warm and dry.

Neurogenic shock, or spinal shock, is a phenomenon caused by the inability of the vasomotor center in the brain stem to control blood vessel tone through the sympathetic outflow to the blood vessels. In neurogenic shock, what happens to the heart rate and the skin?

• Aortic stenosis can cause left-sided failure. • Cardiomyopathy is a common cause of heart failure. • Compensated heart failure may be clinically asymptomatic.

Regarding heart failure, the nurse knows that which of the following statements are correct? Select all that apply.

inflammatory mediators and cytokines

Select the option that best describes the mediation of the systemic inflammatory responses that occurs in disseminated intravascular clotting (DIC).

Release nitric oxide

Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis?

• Severe burns • Fifteen percent blood volume loss • Severe dehydration

The diagnosis is hypovolemic shock. The nurse knows that causes of hypovolemic shock include which of the following? Select all that apply.

decreased after load

The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is:

The condition is getting progressively worse.

The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:

Improving quality of life by relieving symptoms

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:

Cardiogenic

The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock?

Decreased cardiac output

The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:

• Causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction. • Sensitivity of beta adrenergic receptors decreases resulting in decreased ventricular contractility. • It is more difficult to diagnose because of underlying chronic diseases.

The nurse knows that advanced age is a risk factor for heart failure. Which statements regarding heart failure in older adults are true? Select all that apply.

• Preload • Afterload • Myocardial contractility

The nurse knows that factors that affect stroke volume include which of the following? Select all that apply

Decreased cardiac output

The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following?

reduced ventricular efficiency

The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?

In compensated failure, an increase in preload causes an increase in ventricular contractility.

The nurse knows that which of the following statements regarding heart failure is correct?

• Improve cardiac output • Regulate blood volume • Increase coronary perfusion • Correct pulmonary edema

The nurse must achieve which of the following objectives for a patient in cardiogenic shock? Select all that apply.

• Nitroprusside (Nitropress) • Nitroglycerin • Dobutamine (Dobutrex) • Milrinone (Primacor)

The nurse should suggest which of the following medications for a patient in cardiogenic shock? Select all that apply.

Exertional dyspnea Orthopnea Cheyne-Stokes respiration Chronic dry cough

The nurse will monitor which of the following respiratory manifestations of heart failure? Select all that apply.

Dyspnea and crackles in bilateral lung bases

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?

Respiratory dysfunction

The pathogenesis of multiorgan dysfunction syndrome (MODS) is not clearly understood at this time. Supportive management is currently the focus of treatment in this disorder. What is not a major risk factor in MODS?

compensatory mechanisms

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.

The sympathetic nervous system responds rapidly to a fall in cardiac output. The sympathetic nervous system increase in heart rate and force of contraction support cardiac output. The sympathetic nervous system increase in cardiac workload and oxygen use can cause ischemia and worsening of heart failure.

The sympathetic (adrenergic) nervous system is an important compensatory mechanism in heart failure. Which of the following statements regarding the sympathetic nervous system response to heart failure are correct? Select all that apply.

Decreased mean arterial blood pressures Increased CVP Increased extraction of o2 from hemoglobin

What are the physiologic signs and symptoms of cardiogenic shock? (Select all that apply.)

Fluid retention Fatigue

What are the signs and symptoms of heart failure? (Select all that apply.)

Elevated right heart pressure

What is the primary physiologic result of obstructive shock?

Cyanosis

Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes?

Circulatory shock Heart failure

Which of the following conditions reflect failure of the circulatory system? Select all that apply.

Myocardial hypertrophy

Which of the following health problems can contribute to diastolic dysfunction heart failure?

• Myocardial hypertrophy causes diastolic dysfunction. • Ischemic heart disease causes systolic dysfunction. • Valvular insufficiency causes systolic dysfunction.

Which of the following statements regarding causes of systolic and diastolic dysfunction are correct? Select all that apply.

Compensated congestive heart failure may be clinically asymptomatic.

Which of the following statements regarding heart failure is true?

In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.

Which of the following statements regarding heart failure is true?