PrepU Chapter 27
Anaphylactic shock causes severe hypoxia very quickly because of which reason? a. Metabolic rate is greatly increased. b. Heart rate and contractility are reduced. c. Generalized vasoconstriction reduces venous return. d. Histamine release causes massive vasodilation.
d Anaphylactic shock, a severe allergic reaction, rapidly causes severe hypoxia as histamine release results in massive vasodilation. The volume of blood is no longer able to fill the greatly dilated vascular compartment. The other answers are not part of anaphylaxis.
Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells? a. Dysplasia b. Hyperplasia c. Hypertrophy d. Atrophy
c Myocardial hypertrophy is a compensatory mechanism in heart failure as the heart attempts to maintain adequate pumping ability. Paradoxically, hypertrophy can gradually decrease cardiac efficiency.
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. 40 mL/hour b. 60 mL/hour c. 80 mL/hour d. 20 mL/hour
d 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 20 mL/hour or less indicates inadequate renal perfusion.
A client 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: a. Valvular stenosis b. Pericardial effusion c. Infective endocarditis d. Valvular regurgitation
d When cardiac valves such as the aortic or mitral fail to close properly, blood does not efficiently exit from the left ventricle. This condition is valvular regurgitation. Valvular stenosis is a narrowing of the lumen of the valve. Pericardial effusion, an accumulation of fluid in the pericardial sac, causes obstructive shock, as it impedes ventricular filling. Infective endocarditis could trigger septic shock.
A client asks the purpose of an exercise stress test. What is the nurse's best response? a. "The test is used to measure functional status during stress." b. "This test is necessary prior to starting medication therapy for obesity." c. "This is to assess your tolerance of isometric exercise." d. "This will help you endure exercise."
a The exercise stress test is used to measure aerobic fitness. It does not help the client endure exercise or assess tolerance of isometric exercise. It is not done prior to starting medication therapy for obesity.
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be: a. History of cigarette smoking and elevated blood pressure b. Physical inactivity and high serum high-density lipoprotein cholesterol c. High serum high-density lipoprotein and diabetes d. Advanced age and low serum total and low-density lipoprotein cholesterol
a The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.
A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing: a. Onset of STEMI b. Gastroesophageal reflux disease (GERD) c. Acute respiratory distress syndrome (ARDS) d. Pneumonia
a The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin.
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output. a. compensatory mechanisms b. electrical conductivity c. aortic hypertrophy d. parasympathetic system
a The pathophysiology of heart failure involves an interaction between two factors: a decrease in pumping ability of the heart with a consequent decrease in the cardiac reserve and the compensatory mechanisms that serve to maintain the cardiac output while also contributing to the progression of heart failure. Myocardial muscle hypertrophy has an important role in long-term adaptation to hemodynamic overload. Stimulation of the sympathetic nervous system plays an important role in the compensatory response to decreased cardiac output and to the pathogenesis of heart failure. Heart failure is a muscle contractility problem, unrelated to the electrical conduction that stimulates it.
Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function? a. Pericardial effusion and cardiac tamponade b. Dilated cardiomyopathies c. Atherosclerosis and unstable angina d. Aortic valve regurgitation and aortic stenosis
c Coronary artery bypass grafting (CABG) may be the treatment of choice for people with significant coronary artery disease (CAD) who do not respond to medical treatment and who are not suitable candidates for percutaneous coronary intervention. CABG does not address valve disorders, pericardial effusion, or cardiomyopathies.
A nurse is teaching a client with newly diagnosed dilated cardiomyopathy (DCM) about associated treatments. The nurse determines that the knowledge is understood when the client correctly matches which drug category to the primary action of decreasing preload by suppressing renal reabsorption of sodium and increasing salt and water excretion? a. diuretics b. angiotensin-converting enzyme (ACE) inhibitors c. beta-blockers d. calcium channel blockers
a The treatment of DCM is directed toward relieving the symptoms of heart failure and reducing the work of the heart. Diuretics, such as the thiazides, loop diuretics, and the aldosterone antagonist (potassium-sparing) diuretics, lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing salt and water excretion), thereby decreasing preload and cardiac output. Although ACE inhibitors also lower the reabsorption of sodium and water by reducing the amount of circulating levels of aldosterone (through reducing the conversion of angiotensin 1 to angiotension 2), they also prevent vasoconstriction, so the effects on sodium and water retention is not this class of drug's only or primary effect. Calcium channel blockers prevent vasoconstriction as thier primary mechanism of actions, and beta-blockers primarily reduce cardiac output by reducing heart rate and contractility.
A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI? a. Troponin level b. Complete blood components c. Creatine kinase marker d. Calcium level
a The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction (MI). The troponin complex, which is part of the actin filament, consists of three subunits (i.e., TnC, TnT, and TnI) that regulate calcium-mediated actin-myosin contractile process in striated muscle (see Chapter 1, Fig. 1-19). TnI and TnT, which are present in cardiac muscle, begin to rise within 3 hours after the onset of MI and may remain elevated for 7 to 10 days after the event. This is especially adventitious in the late diagnosis of MI. The other blood work may be ordered, but not to confirm the diagnosis of MI.
A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have? a. Pericarditis b. Abdominal aortic aneurysm c. Myocardial infarction d. Pneumonia
a This client is demonstrating signs and symptoms of pericarditis, which includes a triad of chest pain, pericardial friction rub, and EKG changes. Other signs are that the pain is usually abrupt in onset, occurs in the pericardial area, and may radiate to the neck, back, abdomen or side. It is usually worse with deep breathing and swallowing, and the person often finds relief when sitting up and leaning forward.
Which clients are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply. a. A 70-year-old with enlarged left ventricle due to myocardial hypertrophy b. A 48-year-old client with uncontrolled hypertension c. A 57-year-old client with history of ischemic heart disease d. A marathon runner with history of chronic bradycardia whose pulse rate is 46
a, b Conditions that reduce the heart's ability to adequately fill during diastole, such as myocardial hypertrophy and tachycardia, can lead to heart failure. Hypertension remains the leading cause of diastolic dysfunction. Ischemic heart disease is associated with systolic heart failure, or impaired contractile performance. It is normal for athletes, like marathon runners, to have slow pulses.
Which statements regarding heart failure are true? Select all that apply a. In uncompensated right-sided heart failure, there is peripheral venous congestion and edema. b. In uncompensated left-sided heart failure, there is pulmonary congestion and edema. c. Pulmonary hypertension is a frequent cause of left-sided failure. d. Myocardial infarction is a frequent cause of right-sided failure. e. In compensated heart failure, cardiac output is normal.
a, b, e In compensated failure, many mechanisms are activated to support normal cardiac output. In uncompensated right-sided failure, blood backs up in the systemic circulation and causes peripheral congestion and edema. In left-sided failure, blood backs up in the pulmonary circulation and causes pulmonary edema. Myocardial infarction is a frequent cause of left-sided failure. Pulmonary hypertension causes right-sided failure.
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? a. Phosphorous b. Troponin assays c. Creatine kinase d. Potassium
b The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction. Creatine kinase is an intracellular enzyme found in muscle cells. The troponin level identifies necrosis in cardiac muscles earlier than creatine kinase. The others are not necessarily used when suspecting a myocardial infarction.
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? a. Administration of 2L of oxygen by nasal cannula b. Raising the head of the bed to a high Fowler's position c. Inserting an IV to begin a normal saline infusion d. Placing a pulse oximeter on the client to monitor oxygenation status
b Treatment measures include close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion; and the administration of oxygen, antihistamine drugs, and corticosteroids. The person should be placed in a supine position. This is extremely important because venous return can be severely compromised in the sitting position. This in turn produces a pulseless mechanical contraction of the heart and predisposes to arrhythmias. In several cases, death has occurred immediately after assuming the sitting position.
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis? a. Vertigo, headache b. Weakness, palpitations c. Peripheral edema, weight gain d. Dyspnea, cough
c In right-sided heart failure, blood backs up into the venous side of the circulatory system causing increased hydrostatic pressure in capillaries and leakage of plasma, which forms peripheral edema and becomes apparent as weight gain. The other manifestations listed are not characteristic of right-sided failure.
A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged, resulting in a pulmonary embolism. Which type of shock is this client at risk of experiencing? a. Hypovolemic shock b. Distributive shock c. Obstructive shock d. Cardiogenic shock
c Obstructive shock results from mechanical obstruction of the flow of blood through the central circulation, such as the blockage that characterizes a pulmonary embolism.
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? a. Antianxiety drugs b. Broad-spectrum antibiotic drugs c. beta-adrenergic blocking drugs (beta-blockers) d. Calcium-channel blocking drugs
c Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with the beta-adrenergic blocking drugs. None of the other types of drugs are used in the treatment of mitral valve prolapse to relieve symptoms or prevent complications.
The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason? a. That there is no definitive test used for diagnoses b.The cost associated with treating the disease c. The disabling effects that result from involvement of heart valves d. The fact that it affects young and old
c Rheumatic fever is a very important cause of heart disease and its most serious and disabling effects result from involvement of the heart valves.
A teenager is seen in the emergency room with reports of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen 3 weeks before in the clinic and treated with antibiotics for strep throat. He was better for a few days but now he seems to have gotten worse in the last 2 days. What should the nurse suspect is wrong with this client? a. Mononucleosis b. Flu c. Rheumatic fever d. Meningitis
c Rheumatic fever is an immune-mediated inflammatory disease that occurs a few weeks after a group A strep (sore throat). It can manifest as an acute, recurrent, or chronic disorder.
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client? a. cardiogenic shock b. septic shock c. neurogenic shock d. anaphylactic shock
d Anaphylactic shock is initiated through an immunologically mediated reaction to an irritant. Neurogenic shock is caused by decreased sympathetic control of blood vessel tone due to a defect in the vasomotor center in the brain stem or the sympathetic outflow to the blood vessels. Cardiogenic shock occurs when the heart fails to pump blood sufficiently to meet the body's demands. Septic shock, which is the most common type of distributive shock, is associated with the systemic immune response to severe infection.
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? a. Cardiac catherization b. Stress test c. Cardiac CT d. 12-lead ECG
d Electrocardiography or the 12-lead ECG is the most frequently used cardiovascular diagnostic procedure. The others are also used in evaluating blood flow and myocardial perfusion, but not as frequently.
In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which level indicates inadequate renal perfusion? a. 80—60 mL/hour b. 60—40 mL/hour c. 40—20 mL/hour d. 20 mL/hour
d In hypovolemia, renal vasculature is constricted in a compensatory attempt to circulate blood to more vital organs. Urinary output at 20 mL/hour or below indicates that renal perfusion is too inadequate.
Which serum biomarker is highly specific for myocardial tissue? a. Creatine kinase b. C-reactive protein c. White blood cells d. Troponin
d The troponin assays have high specificity for myocardial tissue and have become the primary biomarker tests for the diagnosis of myocardial infarction. Creatine kinase is specific for muscle injury but is not as focused as is troponin. White blood cells and C-reactive protein are associated with inflammation.