Chapter 27: Disorders of Cardiac Function, Heart Failure, and Circulatory Shock

A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause. A. diastolic dysfunction B. systolic dysfunction C. backward failure D. frontward failure

A. diastolic dysfunction The conditions that cause diastolic dysfunction are those that impede expansion of the ventricles (ie, pericarditis), those that increase ventricular wall thickness and reduce chamber size (ie, myocardial hypertrophy), and those that delay diastolic relaxation (ie, aging).

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: A. 20mL/hr B. 40mL/hr C. 80mL/hr D. 60mL/hr

A. 20mL/hr Urine output decreases very quickly in hypovolemic shock. Compensatory mechanisms decrease renal blood flow as a means of diverting blood flow to the heart and brain. Oliguria of 20mL/hr or less indicates inadequate renal perfusion.

What is the most common identifiable cause of secondary cardiomyopathy? A. alcohol abuse B. heart failure C. genetic abnormalities D. heart transplant

A. alcohol abuse Alcohol abuse is a cause of secondary cardiomyopathy, while the other options results in primary cardiomyopathy.

A child is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are most accurate? Select all that apply. A. congenital defects are a risk factor B. the etiology of heart failure is similar in children and adults C. symptoms include tachypnea and tachycardia D. physical activity must be discouraged E. inotropic agents such as digoxin may be used in children

A. congenital defects are a risk factor C. symptoms include tachypnea and tachycardia E. inotropic agents such as digoxin may be used in children The etiology of heart failure in children is different from that in older adults. Causes in children include congenital abnormalities and genetic cardiomyopathy. Signs and symptoms include fatigue, effort intolerance, cough, anorexia, abdominal pain, and impaired growth as well as tachypnea and tachycardia. Surgery can correct some underlying defects. Drugs such as digoxin and diuretics are used when medical management is required. Patients should be as active as their cardiac function supports.

A 75yo client is being evaluated for heart failure. Which questions should the nurse ask to confirm common signs and symptoms observed in older adults experiencing heart failure? Select all that apply. A. do you get up often during the night to urinate? B. do you easily get tired? C. are you eating more than usual? D. are you feeling depressed? E. do you have swelling in your ankles?

A. do you get up often during the night to urinate? B. do you easily get tired? D. are you feeling depressed? E. do you have swelling in your ankles? Nocturia, depression, edema in the lower extremities, and fatigue are common signs and symptoms of heart failure in older adults. Anorexia, or decreased appetite, is also a symptom.

The health care team is developing a plan of care for a client diagnosed with CHF. The primary treatment goal would be: A. improving quality of life by relieving symptoms B. placing a stent for fluid drainage from the heart C. eliminating CHF through curing the disease D. maintaining higher oxygen levels to decrease the work of breathing

A. improving quality of life by relieving symptoms A primary treatment goal for the client with CHF is to improve the quality of life through symptom management. CHF will not be cured, and maintaining a higher oxygen level will assist with dyspnea associated with CHF. A stent is not an option for treatment of CHF.

What is the most important factor in myocardial oxygen demand? A. degree of anxiety B. heart rate C. respiratory rate D. hyperthermia

B. heart rate The heart rate is the most important factor in myocardial oxygen demand since as heart rate increases, myocardial oxygen demands increase. The degree of affect the other options have on the myocardial oxygen demand is related to how much affect they have on the heart rate.

When an acute event occurs and the circulatory system can no longer provide the body with adequate perfusion of its tissues and organs, cellular hypoxia occurs and the body goes into shock. What are the causes of shock in the human body? Select all that apply. A. hypervolemia B. obstruction of blood flow C. maldistribution of blood flow D. hypovolemia E. excessive vasoconstriction

B. obstruction of blood flow C. maldistribution of blood flow D. hypovolemia Shock is not a specific disease but a syndrome that can occur in the course of many life-threatening traumatic conditions or disease states. It can be caused by an alteration in cardiac function (cardiogenic shock), a decrease in blood volume (hypovolemic shock), excessive vasodilation with maldistribution of blood flow (distributive shock), or obstruction of blood flow through the circulatory system (obstructive shock). Excessive vasoconstriction and hypervolemia are not causes of shock.

A client with a history of acute coronary syndrome asks why she needs to take aspirin 81mg every day. The most appropriate response by the nurse would be: A. aspirin prevents blood clotting by halting platelet production B. it will give you a steady relief of your chest pain C. aspirin will help prevent blood clotting D. aspirin will prevent a heart attack

C. aspirin will help prevent blood clotting Aspirin (acetylsalicylic acid) is the preferred antiplatelet agent for preventing platelet aggregation in persons with ACS. Aspirin, which acts by inhibiting synthesis of the prostaglandin thromboxane A2, is thought to promote reperfusion and reduce the likelihood of rethrombosis. This dose of aspirin is not appropriate for pain relief, and the final option does not demonstrate therapeutic communication.

The nurse is preparing to auscultate for a mitral valve stenosis murmur. Where is the best location to place the stethoscope? A. over the sternum B. over the aorta C. at the apex of the heart D. at the carotid arteries

C. at the apex of the heart The murmur of mitral valve stenosis is heard during diastole when blood is flowing through the constricted valve; it is characteristically a low-pitched, rumbling murmur best heard at the apex of the heart. The other locations would not be effective.

The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states the blood is shunted where to which part of the body? A. left lung to the right lung B. right side of the heart to the left side of the heart C. left side of the heart to the right side of the heart D. right lung to the left lung

C. left side of the heart to the right side of the heart Defects that result in a left-to-right shunt are categorized as acyanotic disorders since they do not compromise oxygenation of blood in the pulmonary circulation.

A preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following? A. scheduling regular hearing examinations B. yearly electrocardiography after the age of 50 C. blood specimen assessed for rheumatoid factor D. prompt diagnosis of streptococcal infections with a throat culture

D. prompt diagnosis of streptococcal infections with a throat culture Rheumatic heart disease is normally caused by streptococcal infections; therefore early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a patient has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and while the patient may benefit from regular hearing exams, it is not related to preventing rheumatic heart disease.

A client with a known history of IV drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection. A. kingella kingae B. eikenella corrodens C. actinobacillus actinomycetemcomitans D. staphylococcus aureus

D. staphylococcus aureus While all of these bacteria can cause infective endocarditis, staphylococcus aureus is the major offender in injection drug abusers, whereas prosthetic heart valve infective endocarditis tends to be caused by coagulase-negative staphylococci (ie, staphylococcus epidermidis)

The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this patient. A. myocardial infarction prevention B. assisting the client to return to previous lifestyle C. preventing clotting disorders D. ensuring adequate oxygenation with continuous oxygen administration

A. myocardial infarction prevention Symptom reduction for quality of life and prevention of MI are treatment goals for stable angina. The other options would not be treatment goals for stable angina.

A 62yo female client presents to the ED and is diagnosed with acute heart failure syndrome. Which assessment finding would the nurse expect? A. productive cough with frothy sputum B. slowed breathing and dehydration C. increased urination and dry skin D. shortness of breath and bradycardia

A. productive cough with frothy sputum The s/s of acute heart failure syndromes include shortness of breath and other respiratory manifestations (ie, exertion dyspnea, orthopnea), fatigue and limited exercise tolerance, fluid retention and edema, cachexia and malnutrition, and cyanosis. Acute pulmonary edema is the most dramatic symptom of AHFS. The client would have an increased heart rate as a result of the exertional process.

In distributive shock, there are abnormalities in vascular resistance. Which types of shock display the same distributive pattern? Select all that apply. A. septic B. cardiogenic C. hypovolemic D. neurogenic E. anaphylactic

A. septic D. neurogenic E. anaphylactic In distributive shock, the capacity of the vascular compartment is greatly enlarged so that a normal blood volume becomes insufficient. In neurogenic shock, sympathetic (adrenergic) control of blood vessels is lost and extreme vasodilation occurs. In anaphylactic shock, a severe allergic reaction, massive release of histamine induces extreme vasodilation. In septic shock, a response to severe infection, there is vascular dilation. Cardiogenic shock is a loss of ventricular contractility. Hypovolemic shock is a loss of blood volume.

The diagnosis is hypovolemic shock. The nurse knows that causes of hypovolemic shock include which of the following? Select all that apply. A. severe dehydration B. myocardial infarction C. excessive vasoconstriction D. 15% blood volume loss E. severe burns

A. severe dehydration D. 15% blood volume loss E. severe burns Hypovolemic shock is characterized by diminished blood volume with inadequate filling of the vascular compartment. Causes include extensive whole blood loss, severe burns with extensive loss of plasma, severe dehydration, and shifting of extracellular fluid from the circulatory system to interstitial spaces. Myocardial infarction can cause cardiogenic shock. Excessive vasoconstriction can be a compensatory mechanism in hypovolemic shock.

Which serum biomarker is highly specific for myocardial tissue? A. troponin B. creatine kinase C. C-reactive protein D. white blood cells

A. troponin The troponin assays have high specificity for myocardial tissue and have become the primary biomarker test for the diagnosis of MI. Creatine kinase is specific for muscle injury but not as focused as is troponin. White blood cells and C-reactive protein are associated with inflammation.

Exudate in the pericardial cavity is a characteristic of which cardiac condition? A. cardiac tamponade B. pericardial effusion C. constrictive pericarditis D. acute pericarditis

B. pericardial effusion Pericardial effusion, either acute or chronic, refers to the presence of an exudate in the pericardial cavity. Acute pericarditis is characterized by chest pain, ECG changes, and pericardial friction rub. Cardiac tamponade represents a life-threatening compression of the heart resulting from excess fluid in the pericardial sac. In constrictive pericarditis, scar tissue develops between the visceral and parietal layers of the serous pericardium. In time, the scar tissue contracts and interferes with cardiac filling.

Which statements regarding heart failure in older adults are true? Select all that apply. A. mechanisms of heart failure in older adults as compared to children are dissimilar B. exertion dyspnea is more prominent than in younger adults C. sensitivity of beta adrenergic receptors decreases resulting in decreased ventricular contractility D. causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction E. it is more difficult to diagnose because of underlying chronic diseases

C. sensitivity of beta adrenergic receptors decreases resulting in decreased ventricular contractility D. causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction E. it is more difficult to diagnose because of underlying chronic diseases Changes in cardiovascular function that accompany advanced age contribute to heart failure but are not in themselves sufficient to cause heart failure. Causes of heart failure in this age group include coronary heart disease, valvular dysfunction, aortic stenosis, and arrhythmias. The mechanisms of heart failure in children and adults are similar, although manifestations are often different in older adults where they are superimposed on other chronic diseases. For example, exertion dyspnea is less prominent in older adults than in younger adults; thus heart failure can be more difficult to diagnose in older adults.