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

A client asks the purpose of an exercise stress test. What is the nurse's best response?

"The test is used to measure functional status during stress."

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?

Hypertrophic cardiomyopathy

Increased secretion of renin in heart failure is caused by which event?

Low cardiac output

What is the most important factor in myocardial oxygen demand?

Heart rate

The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition?

"I should report episodes of dizziness or fainting."

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

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."

A client in the nursing home wonders why he is having these signs and symptoms of left-sided heart failure. Which explanation will the nurse give the client?

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

What should the nurse teach the client prior to ergometry?

"This test evaluates cardiac function."

When a physician suspects a client has suffered an acute myocardial infarction, which serum biomarkers should he order? Select all that apply.

- Troponin 1 - Troponin T - Creatine kinase

Which client should most benefit from treatment with anti-thrombin agents?

57-year-old client who has recently been diagnosed with unstable angina

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hypercyanotic attack brought on by periods of stress

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).

What is the most common identifiable cause of secondary cardiomyopathy?

Alcohol abuse

The nursing instructor teaches the students that when a client is suffering from pericarditis he/she will have a friction rub. Which description best describes a friction rub?

An audible medical sign that is high-pitched and results from the rubbing and friction between the inflamed pericardial surfaces.

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

Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences?

Backflow from the left ventricle to left atrium

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)

A nurse educator explains a type of cardiac condition as "a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation and often lead to cardiovascular death or progressive heart failure." Which condition fits this definition?

Cardiomyopathy

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 is being discharged following a myocardial infarction (MI) and asks the nurse why two blood thinners are prescribed. The nurse explains that the acetylsalicylic acid (ASA) and clopidogrel are both prescribed to reduce the risk of which complication?

Deep vein thrombosis

Clients with unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) are classified as low or high risk for acute myocardial infarction and sudden death based on the severity of which characteristic?

ECG changes

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

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)

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 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 client diagnosed with septic shock who is experiencing tissue hypoxia likely will activate which pathophysiologic process?

Inflammatory mediators

A client has a diagnosis of right-sided heart failure. Which body organ should the nurse assess regularly?

Liver

A nurse is assessing for cyanosis in a child who has a congenital heart defect. Select the most important area for the nurse to assess.

Mucous membranes

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

A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing:

Pericardial effusion

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?

Pericarditis

The nurse caring for a client 12 hours after a coronary bypass graft notes a sudden decrease in the amount of chest tube drainage, a rapidly narrowing pulse pressure, paradoxical pulse, and shortened amplitude of the QRS complex on the electrocardiogram monitor. Which action should the nurse take next?

Prepare for pericardiocentesis

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?

Septic

The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock?

Septic shock

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

Structural heart defects

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

Teenager with untreated strep throat

Select the client who may be at risk for developing an increased resistance to blood flow.

The client in hypovolemic shock experiencing extreme dehydration

The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:

The condition is getting progressively worse.

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 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?

Troponin level

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

Vasoconstriction

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.

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

A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?

When the client experiences chest pain

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.

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

compensatory mechanisms

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

fills rapidly; compresses

A preventive measure to decrease the risk of developing rheumatic heart disease includes:

prompt diagnosis of streptococcal infections with a throat culture.

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

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:

see the doctor for evaluation immediately.

In an ICU setting, one assessment that would lead the nurse to suspect that shock has led to decreased blood flow to vital organs is:

urine output less than 20 mL/hour.

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 decreases metabolic demands of the heart.

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:

History of cigarette smoking and elevated blood pressure