Chapter 34

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?

Valvular regurgitation

Anaphylactic shock is directly associated with:

type I hypersensitivity response.

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?

weight gain

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?

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

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?

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

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?

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:

20 mL/hour

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?

90/75

Cardiac reserve refers to which of the following events?

Ability to increase cardiac output during physical exercise

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?

Anaphylactic

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

Atrial fibrillation

Which of the following statements regarding heart failure is true?

Compensated congestive heart failure may be clinically asymptomatic.

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

Hypertrophy

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?

Low blood pressure

Which of the following health problems is associated with heart failure as a result of diastolic dysfunction?

Myocardial hypertrophy

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

Myocardial infarction

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?

Peripheral edema weight gain

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?

Right-sided heart failure

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

They have the same compensatory mechanisms.

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

Vasoconstriction

The most common causes of left-sided heart failure include:

acute myocardial infarction

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:

decreased afterload.

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.

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

A young nurse working on a cardiac floor who is working with a nursing student informs the student that there are numerous ways to evaluate coronary blood flow. Which does she identify as the most frequently used cardiovascular diagnostic procedure?

12 lead ECG

A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

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?

Cardiogenic

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).

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.

Anaphylactic shock

The health care provider is reviewing diagnostic tests that were ordered for a client diagnosed with heart failure. Select the test that would provide information about the client's ejection fraction and ventricular preload.

Cardiac computerized axial tomography (CCT)

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 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?

Dyspnea, cough

A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?

Hypovolemic

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

Hypovolemic shock due to acute intravascular volume loss

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:

Improving quality of life by relieving symptoms

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.

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?

Laryngeal edema

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?

Obstructive shock

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?

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

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?

Release nitric oxide

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?

Septic

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

Severity and duration of shock

What is the primary cause of heart failure in infants and children?

Structural heart defects

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?

Venous return to the heart

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

liver

Which of the following consequences of cardiogenic shock will the nurse monitor? Select all that apply.

• Decreased stroke volume • Decreased cardiac output • Increased afterloading

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.

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

At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply.

• Elongating the cardiac muscle cells • Decreasing the ventricular wall thickness

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.

• Fatigue • Exercise intolerance • Cyanosis • Malnutrition

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

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

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

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

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

• Preload • Afterload • Myocardial contractility

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

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