Chapter 19 - Pathophysiology

Digitalis therapy may improve symptoms of CHF, but it doesn't alter survival. True/False

True

Loss of functional myocardial cells is the principal cause of heart failure. True/False

True

The most common causes of heart failure are (Select all that apply.) a. myocardial ischemia. b. hypertension. c. dilated cardiomyopathy. d. high-fat diet. e. urinary retention.

a. myocardial ischemia. b. hypertension

First-degree heart block is characterized by a. prolonged PR interval. b. absent P waves. c. widened QRS complex. d. variable PR interval.

a. prolonged PR interval.

Left-sided heart failure is characterized by a. pulmonary congestion. b. decreased systemic vascular resistance. c. jugular vein distention. d. peripheral edema.

a. pulmonary congestion.

All of the following dysrhythmias are thought to be associated with reentrant mechanisms except a. second-degree AV block. b. atrial fibrillation. c. premature ventricular complexes. d. preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome).

a. second-degree AV block.

A patient who complains of dizziness and who has absent P waves, regular QRS complexes, and a heart rate of 48 beats/min on an ECG is most likely in which rhythm? a. Third-degree heart block b. Junctional tachycardia c. Junctional escape rhythm d. Sinus bradycardia

c. Junctional escape rhythm

Cor pulmonale refers to a. biventricular failure. b. left ventricular hypertrophy secondary to lung disease. c. right ventricular hypertrophy secondary to pulmonary hypertension. d. right ventricular failure secondary to right ventricular infarction.

c. right ventricular hypertrophy secondary to pulmonary hypertension.

A laboratory test that should be routinely monitored in patients receiving digitalis therapy is a. serum sodium. b. albumin level. c. serum potassium. d. serum calcium.

c. serum potassium.

Angiotensin-converting enzyme (ACE) inhibitor therapy is avoided in heart failure because a drop in preload may reduce cardiac output. True/False

False

Lusitropic impairment refers to a. poor contractile force. b. impaired diastolic relaxation. c. altered action potential conduction rate. d. altered automaticity.

b. impaired diastolic relaxation.

After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence of a. arterial obstruction. b. isolated left-sided heart failure. c. right-sided heart failure. d. peripheral vascular disease.

c. right-sided heart failure.

Second-degree heart block type I (Wenckebach) is characterized by a. absent P waves. b. variable PR interval and dropped QRS complexes. c. constant PR interval and dropped QRS complexes. d. no correlation between P waves and QRS complexes.

b. variable PR interval and dropped QRS complexes.

Dysrhythmias are significant since they (Select all that apply.) a. are an indicator of life span. b. can indicate an underlying disorder. c. can impair venous return. d. increase the severity of heart murmurs. e. can impair cardiac output.

can indicate an underlying disorder can impair cardiac output.

Cardiac hypertrophy is stimulated by all of the following except a. angiotensin II. b. norepinephrine. c. increased myocardial wall tension. d. atrial natriuretic peptide.

d. atrial natriuretic peptide.

The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is a. afterload reduction. b. -antagonist agents. c. preload reduction. d. digitalis.

d. digitalis.

A patient with heart failure who complains of intermittent shortness of breath during the night is experiencing a. orthopnea. b. paroxysmal atrial tachycardia. c. sleep apnea. d. paroxysmal nocturnal dyspnea.

d. paroxysmal nocturnal dyspnea.

An abnormally wide (more than 1.0 msec) QRS complex is characteristic of a. paroxysmal atrial tachycardia. b. supraventricular tachycardia. c. junctional escape rhythm. d. premature ventricular complexes.

d. premature ventricular complexes.

Hypertrophy of the right ventricle is a compensatory response to a. aortic stenosis. b. aortic regurgitation. c. tricuspid stenosis. d. pulmonary stenosis.

d. pulmonary stenosis.

The majority of dysrhythmias are believed to occur because of a. triggered activity. b. enhanced automaticity. c. defective gap junctions. d. reentry mechanisms.

d. reentry mechanisms.

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells. a. aldosterone b. norepinephrine c. angiotensinogen d. renin

d. renin

Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class? a. Class I b. Class II c. Class III d. Class IV

a. Class I

A patient with forward effects of heart failure may present with which symptoms? (Select all that apply.) a. Impaired memory b. Mental fatigue c. Stupor d. Confusion e. Aggression

a. Impaired memory b. Mental fatigue d. Confusion

Which statement is true about the incidence of heart failure? (Select all that apply.) a. Heart failure affects about 2 million Americans. b. Heart failure is the fastest-growing cardiac disorder. c. There are more than 400,000 new cases of heart failure diagnosed each year in the United States. d. The increasing incidence and hospitalization rates of heart failure reflect the aging population in the United States. e. The incidence of heart failure is 10 per 1000 population after age 65.

b. Heart failure is the fastest-growing cardiac disorder d. The increasing incidence and hospitalization rates of heart failure reflect the aging population in the United States. e. The incidence of heart failure is 10 per 1000 population after age 65.

In which of the following dysrhythmias should treatment be instituted immediately? a. Asymptomatic sinus bradycardia at a heart rate of 50 beats/min b. Fever-induced tachycardia at 122 beats/min c. Premature atrial complexes occurring every 20 seconds d. Atrial fibrillation with a ventricular rate of 220 beats/min

d. Atrial fibrillation with a ventricular rate of 220 beats/min

A patient receives an ACE-inhibiting agent to manage his cardiovascular disease. Which of the following is not an expected result of ACE inhibitor therapy? a. Diuresis b. Afterload reduction c. Enhanced sodium excretion d. Increased cardiac preload

d. Increased cardiac preload

-Adrenergic blocking drugs are contraindicated in heart failure. True/False

False

An ejection fraction of 0.40 or higher is considered normal. True/False

False

A patient's ECG lacks recognizable waveforms and is deemed to be in sinus arrest. The patient's sinus arrest may be a result of (Select all that apply.) a. MI. b. electrical shock. c. electrolyte disturbance. d. acidosis. e. alkalosis.

a. MI. b. electrical shock. c. electrolyte disturbance. d. acidosis.

Oversecretion of B-type natriuretic peptide by the heart contributes to the volume overload of congestive heart failure (CHF). True/False

False

Most cases of heart failure are a consequence of coronary heart disease or systemic hypertension. True/False

True

Systolic failure is associated with a low cardiac output and low ejection fraction. True/False

True

The overall 5-year survival rate after onset of heart failure is about 50%. True/False

True

The principal difference between systolic failure and diastolic failure is the ejection fraction. True/False

True

Right-sided heart failure usually is a consequence of a. elevated right ventricular afterload. b. right ventricular infarction. c. tricuspid valve defects. d. congenital anomalies.

a. elevated right ventricular afterload.

Right-sided heart failure is usually a consequence of (Select all that apply.) a. elevated right ventricular afterload. b. right ventricular infarction. c. tricuspid valve defects. d. congenital anomalies.

a. elevated right ventricular afterload. b. right ventricular infarction.

A patient has heart failure with a normal ejection fraction. Which findings are most likely found in this patient? (Select all that apply.) a. High cardiac output b. Pulmonary congestion c. Edema d. Ejection fraction greater than 50% e. Ejection fraction less than 45%

b. Pulmonary congestion c. Edema d. Ejection fraction greater than 50%

A patient with pure left-sided heart failure is likely to exhibit a. jugular vein distention. b. pulmonary congestion with dyspnea. c. peripheral edema. d. hepatomegaly.

b. pulmonary congestion with dyspnea.

Morphine and nitrates may be used in the management of acute pulmonary edema to a. increase cardiac output. b. reduce cardiac preload. c. improve ventilation. d. decrease anxiety.

b. reduce cardiac preload

The common denominator in all forms of heart failure is a. poor diastolic filling. b. reduced cardiac output. c. pulmonary edema. d. tissue ischemia.

b. reduced cardiac output.