Ch Patho 27
Which lab result strongly suggests an immunologic response in the client with possible rheumatic heart disease? Elevated erythrocyte sedimentation rate (ESR) Group A (β-hemolytic) streptococcal antibodies Elevated white blood cell count High C-reactive protein levels
Group A (β-hemolytic) streptococcal antibodies Explanation: The pathology of RF does not involve direct bacterial infection of the heart. Rather, the time frame for development of symptoms relative to the onset of pharyngitis and the presence of antibodies to the GAS organism strongly suggests an immunologic response. It is thought that antibodies directed against the M-protein of certain strains of streptococci cross-react with glycoprotein antigens in the heart, joints, and other tissues to produce an autoimmune response through a phenomenon called molecular mimicry. Elevated erythrocyte sedimentation rate (ESR) is a blood test that can reveal inflammatory activity in your body. The level of CRP rises when there is inflammation throughout the body. Elevated WBC indicates an infection.
Which instructions should the nurse give to a client with a new prosthetic mitral valve? Select all that apply. "Lifelong anticoagulants are necessary to prevent blood clots." "Avoid standing close to a running engine." "Avoid drinking caffeinated beverages." "Expect to take prophylactic antibiotics for dental work." "Have cholesterol levels monitored every 6 months."
"Expect to take prophylactic antibiotics for dental work." "Lifelong anticoagulants are necessary to prevent blood clots." Explanation: Endocarditis may develop as a result of infection at the site of a prosthetic heart valve. Clients should inform dentists about the heart valve before receiving any treatment. Prosthetic valves are a risk factor for blood clots, so clients require lifelong anticoagulants. Running engines are a risk factor for pacemakers and implanted defibrillators, not heart valves. Prosthetic valves do not influence cholesterol levels. Caffeine may trigger palpitations and tachycardia, but is not contraindicated for a prosthetic heart valve.
A client with an ST elevation myocardial infarction (STEMI) receives a coronary stent in the obstructed vessel. Which instruction will the client receive for the immediate postprocedure period? "Take aspirin daily for 3 months." "Watch for bleeding at the catheter insertion site." "Keep your leg straight for the next 24 hours." "Do not raise your arms over your head for 12 hours."
"Watch for bleeding at the catheter insertion site." Explanation: A client with a stent placement will follow protocols similar to a cardiac catheterization. The leg should be kept straight for 6-8 hours. The client should monitor for bleeding at the insertion site, and the client should take a daily dose of aspirin or clopidogrel to prevent thrombosis long term.
ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI? Action increases autonomic nervous system activity. Action relieves pain and gives sense of depression. Action increases anxiety, in turn increasing metabolic demands of the heart. Action decreases metabolic demands of the heart.
Action decreases metabolic demands of the heart. Explanation: Although a number of analgesic agents have been used to treat the pain of STEMI, morphine is usually the drug of choice. It usually is indicated if chest pain is unrelieved with oxygen and nitrates. The reduction in anxiety that accompanies the administration of morphine contributes to a decrease in restlessness and autonomic nervous system activity, with a subsequent decrease in the metabolic demands of the heart. Morphine does not cause a feeling of depression to the client.
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: High serum high-density lipoprotein and diabetes Advanced age and low serum total and low-density lipoprotein cholesterol Physical inactivity and high serum high-density lipoprotein cholesterol History of cigarette smoking and elevated blood pressure
History of cigarette smoking and elevated blood pressure Explanation: 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 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 Atrial regurgitation Mitral valve prolapse Dilated cardiomyopathy
Hypertrophic cardiomyopathy Explanation: HCM is an autosomal dominant heart disease caused by mutations in the genes encoding proteins of the cardiac sarcomere. HCM is the most common cause of sudden cardiac death (SCD) in young athletes. Dilated cardiomyopathy, mitral valve prolapse, and atrial regurgitation all lead to heart failure but much later in life.
A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this? Pericarditis Heart attack Dehydration Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy Explanation: Hypertrophic cardiomyopathy is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the interventricular septum, abnormal diastolic filling, and cardiac dysrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in young athletes.
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? Myocardial infarction Cardiomyopathy Infective endocarditis Pericarditis
Infective endocarditis Explanation: Infective endocarditis is a serious and potentially life-threatening infection of the inner surface of the heart. Pericarditis involves an inflammatory response of the pericardium. Myocardial infarction is a heart attack while cardiomyopathy is a heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorders.
A client who was diagnosed with myocarditis asks the nurse what caused his disease. Which response by the nurse is most accurate? It is usually caused by a viral infection. There is no research yet on what causes this disease. You need to ask your physician. It is caused by some type of bacteria.
It is usually caused by a viral infection. Explanation: Myocarditis is inflammation of the myocardium. Although there are different causes, it is usually caused by a viral infection. Telling the client there is no research would not be true and telling him to ask the physician would not be therapeutic.
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? Distributive shock Hypovolemic shock Obstructive shock Cardiogenic shock
Obstructive shock Explanation: Obstructive shock results from mechanical obstruction of the flow of blood through the central circulation, such as the blockage that characterizes a pulmonary embolism.
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? Myocardial infarction Pericardial effusion COPD Pericarditis
Pericardial effusion Explanation: Pericardial effusion refers to the accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200 mL of fluid may raise intracardiac pressure to levels that will cause symptoms similar to right-sided heart failure. Pericarditis is inflammation of the pericardium while COPD is a respiratory disease.
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) 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 client most likely is experiencing which type of shock? Anaphylactic Septic Cardiogenic Neurogenic
Septic Explanation: Septic shock can result with the body's response to a severe infection. Neurogenic shock is a loss of sympathetic (adrenergic) control of systemic blood vessel tone. Cardiogenic shock is a loss of cardiac efficiency, and anaphylactic shock is a severe allergic reaction.
Which client is at the greatest risk of developing rheumatic heart disease? Child with impetigo on the face Young adult with viral meningitis Older adult with shingles Teenager with untreated strep throat
Teenager with untreated strep throat Explanation: Rheumatic fever is caused by group A (beta-hemolytic) streptococcal throat infection. Although the same bacteria causes the skin infection called impetigo, it is not known to cause rheumatic heart disease. Viral infections such as meningitis and shingles (herpes zoster) do not cause rheumatic heart disease.
Heart failure and circulatory shock are both conditions of circulatory system failure. Which statement regarding these conditions is correct? They have the same compensatory mechanisms. They have the same etiology. They have the same pathogenesis. They have the same remediation.
They have the same compensatory mechanisms. Explanation: Heart failure and circulatory shock have common compensatory mechanisms that attempt to support cardiac output and tissue perfusion. They do not share common pathogenesis, causes, or remediation.
Which serum biomarker is highly specific for myocardial tissue? Creatine kinase White blood cells Troponin C-reactive protein
Troponin Explanation: 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
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: promoting cardiac output through a reduction in afterload. selectively blocking the synthesis of renin in the kidneys. blocking the conversion of angiotensin I to angiotensin II. enhancing inotropy by maximizing calcium channel function.
blocking the conversion of angiotensin I to angiotensin II. Explanation: ACE inhibitors block the conversion of angiotensin I to angiotensin II. They do not directly affect renin synthesis, calcium channel function, or afterload.
Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart. contracts; friction rubs fills rapidly; compresses thickens; stretches ruptures; releases
fills rapidly; compresses Explanation: Rapid accumulation of effusion fluid or blood in the pericardial sac causes cardiac tamponade, resulting in compression of the heart. This leads to cardiac standstill or failure. Pericardial sac thickening due to inflammation can restrict the heart, rather than allow stretching. Rupture of the sac is pathologic, resulting in heart expansion. A friction rub sound (rubbing between the inflamed pericardial surfaces) is characteristic of acute pericarditis. Constrictive pericarditis causes scar tissue formation that contracts and interferes with filling.
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: maintaining higher oxygen levels to decrease the work of breathing. placing a stent for fluid drainage from the heart. eliminating CHF through curing the disease. improving quality of life by relieving symptoms.
improving quality of life by relieving symptoms. Explanation: A primary treatment goal for a 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.
A preventive measure to decrease the risk of developing rheumatic heart disease includes: prompt diagnosis of streptococcal infections with a throat culture. scheduling regular hearing examinations. blood specimen assessed for rheumatoid factor. yearly electrocardiography after the age of 50.
prompt diagnosis of streptococcal infections with a throat culture. Explanation: 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 client has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and while the client may benefit from regular hearing examinations, it is not related to preventing rheumatic heart disease.
Assessment of an older adult client reveals bilateral pitting edema of the client's feet and ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation level of 93% (0.93); and vital signs normal. What is this client's most likely health problem? right-sided heart failure cor pulmonale cardiogenic shock pericarditis
right-sided heart failure Explanation: A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and palpitations.
A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which statement demonstrates an accurate understanding of his new diagnosis? "I'm going to avoid as much physical activity as I can so that I preserve my strength." "I'm trying to think of ways that I can cut down the amount of salt that I usually eat." "I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on." "I'll be sure to take my beta-blocker whenever I feel short of breath."
"I'm trying to think of ways that I can cut down the amount of salt that I usually eat." Explanation: Salt and fluid restrictions are indicated for most clients with heart failure (HF). Beta-blockers do not address shortness of breath, and cardiac medications are not normally taken in response to acute symptoms. Clients should be encouraged to maintain—and increase, if possible—physical activity within the limits of their condition.
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." "You must be drinking way too many liquids. Your kidneys cannot filter all that you are drinking during the day." "Since your heart function is impaired, the lungs are not able to oxygenate the blood and your kidneys are wearing out." "Your heart muscle is overstretched, so it's not able to pump all the blood out. The prescribed 'water pills' help by decreasing your weight."
"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water." Explanation: In heart failure with a reduced ejection fraction, a decrease in cardiac output and renal blood flow leads to increased sodium and water retention by the kidney with a resultant increase in vascular volume and venous return to the heart and an increase in ventricular end-diastolic volume. Drinking water may increase volume but is not the physiologic reason for retention of fluid. Diuretics do decrease weight as a result of diuresis, but weight loss is not the purpose for giving diuretics. The lungs are not the primary cause of heart failure.
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? Inserting an IV to begin a normal saline infusion Raising the head of the bed to a high Fowler's position Administration of 2L of oxygen by nasal cannula Placing a pulse oximeter on the client to monitor oxygenation status
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? You Selected: Raising the head of the bed to a high Fowler's position Correct response: Raising the head of the bed to a high Fowler's position Explanation: 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.
The nurse is preparing to auscultate for a mitral valve stenosis murmur. Where is the best location to place the stethoscope? At the apex of the heart Over the sternum Over the aorta At the carotid arteries
At the apex of the heart Explanation: 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 Frank-Starling mechanism is a compensatory response to heart failure that can support cardiac output but also worsen heart failure. Which statements regarding this mechanism are correct? Select all that apply. Increased oxygen demand produces ischemia. Excessive stretch on the ventricular wall will decrease preload. Decrease in cardiac output causes an increase in preload. Diuretics reduce blood volume and myocardial oxygen demand. Increase in preload will increase ventricular wall tension and myocardial oxygen demand.
Decrease in cardiac output causes an increase in preload. Increase in preload will increase ventricular wall tension and myocardial oxygen demand. Increased oxygen demand produces ischemia. Diuretics reduce blood volume and myocardial oxygen demand. Explanation: The Frank-Starling mechanism involves increases in preloading. With heart failure, cardiac output and renal perfusion decline, leading to increased sodium and water retention and increase in blood volume. The resulting increase in preloading will support cardiac output and increase ventricular wall tension and oxygen demand. Increased myocardial oxygen use leads to ischemia, which will hinder ventricular contraction. Excessive stretch on the ventricular wall does not affect preloading, which can continue to increase and worsen heart failure. Diuretics foster excretion of body water, decrease blood volume and preloading and ventricular wall tension, and allow more efficient ventricular contraction.
A client who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which manifestation alerts the nurse to a developing complication? Symmetrical joint pain Diarrhea Hypoglycemia Decreased level of consciousness
Decreased level of consciousness Explanation: Fibrinolytic therapy is most effective in treating STEMI when administered within 30 minutes after the onset of symptoms. It can still be beneficial up to 12 hours after the onset of ischemic pain. Clients who should not receive fibrinolytic therapy are those with a history of intracranial hemorrhage or significant trauma within the preceding 3 months. The primary complication of fibrinolytic treatment is intracranial bleeding that usually occurs within the first 24 hours following treatment. This would be evident with a change in mental status or level of consciousness (LOC).
Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris? Emotional stress Abrupt change in position Exposure to heat Sedentary lifestyle
Emotional stress Explanation: Angina pectoris usually is precipitated by situations that increase the work demands of the heart, such as physical exertion, exposure to cold, and emotional stress. The pain typically is described as a constricting, squeezing, or suffocating sensation. It usually is steady, increasing in intensity only at the onset and end of the attack. Changing positions abruptly does not cause an attack of angina pectoris.
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. Have the client breathe deeply. Have the client change positions to unaffected side. Have the client swallow slowly and frequently.
Have the client sit up and lean forward. Explanation: With acute periocarditis, the pain typically is pleuritic (aggravated by inspiration and swallowing) and positional (decreases with sitting and leaning forward; increases with moving to the side) because of changes in venous return and cardiac filling.
What is the most important factor in myocardial oxygen demand? Hyperthermia Heart rate Respiratory rate Degree of anxiety
Heart rate Explanation: The heart rate is the most important factor in myocardial oxygen demand since, as heart rate increases, myocardial oxygen demands increase. The degree of effect the other options have on myocardial oxygen demand is related to how much effect they have on heart rate.
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) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) Dilated cardiomyopathy (DCM) Takotsubo cardiomyopathy
Hypertrophic cardiomyopathy (HCM) Explanation: The most frequent symptoms of HCM are dyspnea and chest pain in the absence of coronary artery disease. Syncope (fainting) is also common and is typically postexertional, when diastolic filling diminishes and outflow obstruction increases. Ventricular dysrhythmias are also common, and sudden death may occur, often in athletes after extensive exertion. Risk factors for sudden cardiac death among clients with HCM include a family history of syncope or sudden cardiac death, certain mutations, and extreme hypertrophy of the left ventricle. HCM is characterized by a massively hypertrophied left ventricle with a reduced chamber size.
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. Physical activity must be discouraged. The etiology of heart failure is similar in children and adults. Inotropic agents such as digoxin may be used in children. Symptoms include tachypnea and tachycardia. Congenital defects are a risk factor.
Inotropic agents such as digoxin may be used in children. Congenital defects are a risk factor. Symptoms include tachypnea and tachycardia. Explanation: The etiology of heart failure in children is different from that in older adults. Causes in children include congenital abnormalities and genetic cardiomopathy. 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. Clients should be as active as their cardiac function supports.
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 Bronchodilation Uterine smooth muscle relaxation Gastrointestinal relaxation
Laryngeal edema Explanation: Anaphylaxis is a clinical syndrome that represents the most severe form of systemic allergic reaction. Anaphylactic shock results from an immunologically mediated reaction in which vasodilator substances such as histamine are released into the blood. The vascular response in anaphylaxis is often accompanied by life-threatening laryngeal edema and bronchospasm, circulatory collapse, contraction of gastrointestinal and uterine smooth muscle, and urticaria (hives) or angioedema.
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? Obstructive shock Cardiogenic shock Distributive shock Hypovolemic shock
Obstructive shock Explanation: Obstructive shock results from mechanical obstruction of the flow of blood through the central circulation, such as the blockage that characterizes a pulmonary embolism.
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: Onset of STEMI Gastroesophageal reflux disease (GERD) Pneumonia Acute respiratory distress syndrome (ARDS)
Onset of STEMI Explanation: 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.
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? Pneumonia Pericarditis Abdominal aortic aneurysm Myocardial infarction
Pericarditis Explanation: 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.
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? Vertigo, headache Weakness, palpitations Peripheral edema, weight gain Dyspnea, cough SUBMIT ANSWER
Peripheral edema, weight gain Explanation: 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.
What is the primary cause of heart failure in infants and children? Hyperkalemia Reactions to medications Idiopathic heart disease Structural heart defects
Structural heart defects Explanation: Structural (congenital) heart defects are the most common cause of heart failure in children.
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response? Let's not worry about the cause as we need to focus on getting him better. The most common cause is a staph infection. Sometimes a parasite is involved. It can be attributed to drug abuse.
The most common cause is a staph infection. Explanation: Staphylococcal infections have now emerged as the leading cause of infective endocarditis, with streptococci and enterococci as the other two most common causes. Informing the client's wife about the drug abuse connection infers that you think he is a drug addict and is not therapeutic. Parasites are never the cause. Telling the client to focus on her husband also is not appropriate, as this is a genuine concern for her.