Chapter 27

Backflow from the left ventricle to left atrium

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?

Hypertrophic cardiomyopathy (HCM)

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?

Whole blood Packed red blood cells Plasma volume expanders Crystalloids

Hypovolemic shock is characterized by a loss of blood volume or extracellular fluid. Administering which of the following would manage a client with hypovolemic shock? Select all that apply.

20 mL/hour

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?

Hypertrophic cardiomyopathy

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?

When the client experiences chest pain

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

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

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

Myocardial infarction

A client has developed cardiogenic shock. The most frequent cause of this type of shock is:

Infective endocarditis

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?

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

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?

Prompt diagnosis and treatment of streptococcal infections

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

Relaxation of the bronchioles

A client is experiencing circulatory shock. The nurse is aware that compensation will occur with stimulation of the beta-2 (β2) receptors. The nurse anticipates the client will experience which physiologic response?

Anaphylactic

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?

Pericarditis

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?

Valvular regurgitation

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:

Administer epinephrine (adrenaline).

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?

Pericardial effusion

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:

Obstructive shock

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?

Cardiac tamponade

A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment, the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?

Atherosclerosis and unstable angina

Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?

see the doctor for evaluation immediately.

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

Vasodilating effects reducing preload and afterload

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?

Fever and diaphoresis

A client with heart failure has just had an automatic defibrillator implanted. When the nurse is performing follow-up assessment the next month, which finding is most likely the result of a complication?

Orthopnea

A nurse is assessing a client diagnosed with severe mitral valve stenosis. The nurse anticipates which classic assessment finding?

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

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?

prompt diagnosis of streptococcal infections with a throat culture.

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

Rheumatic fever

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?

weight gain

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?

Vascular stiffness

An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased:

Laryngeal edema

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?

right-sided heart failure

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?

fills rapidly; compresses

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

Fixed coronary obstruction

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

Atrial fibrillation

Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is:

Vasoconstriction

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

beta-adrenergic blocking drugs (beta-blockers)

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?

Have the client sit up and lean forward.

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?

Peripheral edema, weight gain

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?

Action decreases metabolic demands of the heart.

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?

History of cigarette smoking and elevated blood pressure

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:

improving quality of life by relieving symptoms.

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:

Myocardial infarction prevention

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

"I should report episodes of dizziness or fainting."

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?

Septic shock

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

Morphine

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?

"This test evaluates cardiac function."

What should the nurse teach the client prior to ergometry?

Left anterior descending artery

When teaching about heart attacks, the nursing instructor tells the students that most heart attacks (approximately 40 to 50 percent) affect which coronary artery?

Teenager with untreated strep throat

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

Low cardiac output due to reduced pumping ability

Which description sums up the basic pathophysiology of heart failure that the nurse would include when educating a client?

Hypertrophic cardiomyopathy Left ventricular noncompaction

Which form of cardiomyopathy would be considered genetically based? Select all that apply.