Chapter 27 PrepU

A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure?

Hypertrophic cardiomyopathy

A client has developed left-sided heart failure. Which symptom might have precipitated this condition?

Myocardial infarction

What should the nurse teach the client prior to ergometry?

"This test evaluates cardiac function."

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:

20 mL/hour

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

Anaphylactic

Five hours after presenting to the emergency department with substernal chest pain, a client's laboratory results demonstrate that troponin I is elevated and the creatine kinase-myoglobin (CK-MB) levels are within normal range. What is the nurse's interpretation of these results?

Client is currently experiencing an MI.

The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?

Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation

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:

Decreased cardiac output

A client who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which manifestation alerts the nurse to a developing complication?

Decreased level of consciousness

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?

Hypertrophic cardiomyopathy (HCM)

Which statement regarding heart failure is true?

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

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

Increased vascular stiffness

A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have?

Mitral valve stenosis

The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myocardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain?

Morphine

Which client is at the greatest risk of developing rheumatic heart disease?

Teenager with untreated strep throat

Which serum biomarker is highly specific for myocardial tissue?

Troponin

A client comes to the emergency room with all the symptoms of a myocardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order?

Troponin assays

A client has undergone insertion of a drug-eluting stent. Based on clinical trials, which medications, when taken in combination, have been found effective to prevent restenosis if taken for up to 1 year after the procedure? Select all that apply.

aspirin clopidogrel

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?

beta-adrenergic blocking drugs (beta-blockers)

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

compensatory mechanisms

A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process?

infective endocarditis

A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening?

weight gain

A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which explanation is most appropriate to share?

"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."

During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?

20 to 40 minutes

A client with known pericardial effusions has developed tachycardia and a sudden drop in blood pressure. What actions should the nurse take? Select all that apply.

Assess heart sounds. Arrange for STAT echocardiogram. Palpate carotid or femoral artery.

A client is admitted to the intensive care unit suspected of having infective endocarditis. Which test is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client?

Blood culture

Implantation of a pacemaker is most likely to benefit a client with which cardiomyopathy?

Dilated cardiomyopathy (DCM)

A nurse is assessing a client with a diagnosis of acute pericarditis. The client will most likely exhibit which clinical manifestations? Select all that apply.

Fever Chest pain Pericardial friction rub Pleuritic pain

Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?

Have the client sit up and lean forward.

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 follows the vascular response in anaphylaxis?

Laryngeal edema

A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering?

Pericardial effusion

An older adult 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:

blocking the conversion of angiotensin I to angiotensin II.

A nurse is concerned that a resident of a long-term care facility may be developing left-sided heart failure. The nurse would communicate which set of manifestations as possible evidence of left-sided heart failure?

dyspnea, cough, fatigue

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?

Administer epinephrine (adrenaline).

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

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.

A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?

Vasodilating effects reducing preload and afterload

The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.

Myocardial infarction prevention