Chapter 32: Disorders of Cardiac Function

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 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 Pg. 826

The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?

- Genetic Explanation: Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young athletes. It actually occurs in one person out of every 500. Pg. 814

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 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. Pg. 814

The nurse determines that teaching has been effective when a client diagnosed with chronic stable angina states:

- "Angina may result from exertional activity or emotional stress and be relieved within minutes by rest or by nitroglycerin." Explanation: Chronic stable angina is provoked by exertional activity or emotional stress and relieved within minutes by rest or by nitroglycerin. A delay of more than 5 to 10 minutes before relief is obtained suggests that the symptoms result from severe ischemia. Angina that occurs at rest, is of new onset, or is increasing in intensity or duration denotes an increased risk for myocardial infarction and should be evaluated using the criteria for ACS. Pg.812

A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:

- "Aspirin will help prevent blood clotting." Explanation: Aspirin (i.e., acetylsalicylic acid) is the preferred antiplatelet agent for preventing platelet aggregation in persons with ACS. Aspirin, which acts by inhibiting synthesis of the prostaglandin thromboxane A2, is thought to promote reperfusion and reduce the likelihood of rethrombosis. This dose of aspirin is not appropriate for pain relief, and the final option does not demonstrate therapeutic communication. Pg. 808

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:

-The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. Explanation:Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. This increases the work and volume of the chamber emptying through the narrowed valve—the left atrium in the case of mitral stenosis and the left ventricle in aortic stenosis. An incompetent or regurgitant valve permits backward flow to occur when the valve should be closed—flowing back into the left ventricle during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased. Pg. 824

During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?

- 20 to 40 minutes Explanation: If blood flow can be restored within the 20-to-40-minute time frame, loss of cell viability does not occur or is minimal. Pg. 810

ST-elevated myocardial infarction 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. 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. Pg. 807

A client comes to the emergency room with complaints of chest pain. When the nurse reads his ECG she sees changes which include T-wave inversion, ST-segment elevation, and an abnormal Q wave. What should she suspect?

- Acute myocardial infarction Explanation: An acute myocardial infarction diagnosis includes unstable angina, T-wave inversion, ST-segment elevation and abnormal Q wave on the ECG. The other diagnoses do not normally exhibit these findings on the ECG. Pg. 804

When a client develops a pericardial effusion which are considered to be factors that will influence what effects it will have on cardiac function? Select all that apply.

- Amount of fluid -Rapidity the fluid accumulates -The elasticity of the pericardium Explanation:The amount of fluid, the rapidity with which it accumulates, and the elasticity of the pericardium determine the effect the effusion has on cardiac function. The presence of an infection and the nutritional status of the client have no effect. Pg.795

Two weeks after receiving a prosthetic mitral valve, a patient presents to the emergency department with fever, anorexia, and splinter hemorrhages of the nails. Which interventions will the nurse likely implement? Select all that apply.

- Blood cultures -Antibiotics -Monitoring for emboli Explanation: Patients with infective endocarditis are at risk for emboli as the vegetations on the valves may break off and travel to other parts of the body. Patients are also at risk for heart failure. Treatment focuses on preventing emboli, preventing heart failure, and treating the infection. Activity restrictions are based on symptoms of heart failure. This patient has no symptoms, indicating a need for complete bed rest. Although a low-cholesterol diet can promote health, it is not a specific intervention for infective endocarditis. Pg. 819-821

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?

- Cardiac tamponade Explanation:Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart. It can be life-threatening and symptoms include tachycardia, elevated central venous pressure, jugular vein distention, fall in systolic blood pressure with narrowed pulse pressure. Pericarditis is inflammation of the pericardium. A myocardial infarction does not have these symptoms nor does a thrombus. Pg.795

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 Explanation: Cardiomyopathies result from genetic and/or environmental factors and will result in heart failure. MI and rheumatic diseases may lead to heart failure, but the mechanism is different. Pg. 814

The nursing student correctly identifies which are major risk factors for coronary artery disease? Select all that apply.

- Cigarette smoking -Elevated blood pressure -Elevated LDL -Diabetes -Abdominal obesity Explanation: Major risk factors for coronary artery disease include cigarette smoking, elevated blood pressure and LDL, diabetes, advanced age, abdominal obesity, and physical inactivity, just to name a few. Decreased pulse rate and elevated HDL (good cholesterol) are not contributors. Pg. 797

Which of the following describes surgical correction of tetralogy of Fallot?

- Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction Explanation: The surgical treatment of tetralogy of Fallot would include the repair of the ventricular-septal defect and relief of the ventricular outflow obstruction. An arterial switch procedure is the treatment for transposition of the great arteries. Resection of the narrowed segment of the aorta is the treatment for coarctation of the aorta. Pg.838

When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?

- Conversion from aerobic to anaerobic metabolism Explanation: The principal biochemical consequence of MI is the conversion from aerobic to anaerobic metabolism with inadequate production of energy to sustain normal myocardial function. As a result, a striking loss of contractile function occurs within 60 seconds of onset. None of the other answers occur. Pg. 805

A nurse assesses a client with normal biomarkers who reports angina. Which additional manifestations are late signs of aortic stenosis? Select all that apply.

- Dyspnea -Peripheral cyanosis -Syncope Explanation: The earliest signs of aortic stenosis are a loud systolic ejection murmur or a single or paradoxically split second heart sound. Angina, syncope, and heart failure are later signs of the disorder. Pg. 828

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 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. Pg. 812

A nurse is assessing a client with a diagnosis of acute pericarditis. The client will most likely exhibit which clinical manifestations? Select all that apply.

- Fever -Chest pain -Pericardial friction rub -Pleuritic pain Explanation:The manifestations of acute pericarditis include a triad of chest pain, an auscultatory pericardial friction rub, and electrocardiographic (ECG) changes. Nearly all persons with acute pericarditis have chest pain and fever. The pain usually is sharp and abrupt in onset, occurring in the precordial area, and may radiate to the neck, back, abdomen, or side. Pain in the scapular area may result from irritation of the phrenic nerve. The pain typically is pleuritic. Pg. 794

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

- Fixed coronary obstruction Explanation: Chronic stable angina is caused by fixed coronary obstruction that produces an imbalance between coronary blood flow and the metabolic demands of the myocardium. Endothelial relaxing factors relax the smooth muscle in the vessel wall and allow increased blood flow; treatment for chronic stable angina is with a vasodilating agent, such as nitroglycerine, that relaxes the vessels and enhances coronary blood flow. Intermittent vessel vasospasms, in conjunction with coronary artery stenosis, cause the vasospastic type of angina. Increased formation of collateral vessels is a compensatory response that allows adequate blood circulation to tissues distal to an obstruction. Pg.812

A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which of the following reasons? Select all that apply.

- For its vasodilatation effect - To relieve coronary pain Explanation: Nitroglycerine is given in the treatment of STEMI because of its vasodilating effect and its ability to relieve coronary pain. Pg. 807

A community health nurse is conducting a seminar at a local church group on health and wellness. Which of the following does she tell the group is the leading cause of death in the United States?

- Heart disease Explanation: Heart disease affects persons of all ages and all walks of life. It is the leading cause of death in the United States as well as other developed nations of the world. Pg. 793

What is the most important factor in myocardial oxygen demand?

- 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 affect the other options have on myocardial oxygen demand is related to how much affect they have on heart rate. Pg. 798

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 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. Pg. 797

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 Explanation: Hypertrophic cardiomyopathy is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the interventricular septum, abnormal diastolic filling, cardiac arrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac deat in young athletes. Pg. 814

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 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. Pg. 820

The nurse is evaluating a client who is in her last month of pregnancy and at risk for peripartum cardiomyopathy. Select the most appropriate information for the nurse to consider. Select all that apply.

- It is an acquired cardiomyopathy. -It is a disorder that can occur in the last month of pregnancy. -The incidence is greater in women with twin fetuses. Explanation: Peripartum cardiomyopathy is an acquired cardiomyopathy that that occurs in the last month of pregnancy or within 5 months after delivery. The incidence is greater in African American, multiparous, or older women and in women with twin fetuses or preeclampsia, or use of tocolytic therapy to prevent premature labor and delivery. Pg. 818

While studying the heart the nursing instructor teaches about pericarditis. Which of the following does she tell the student best defines this disease?

- It is an inflammatory process. Explanation: 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? Pg. 820

A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have?

- Mitral valve stenosis Explanation: Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole, with left atrial distention and impaired filling of the left ventricle with associated symptoms. Mitral prolapse and aortic valve disorders will lead to the development of cardiomyopathies. Pg. 825

Antibodies directed against the M protein of certain strains of streptococcal bacteria seem to cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response resulting in rheumatic fever. This occurs through what phenomenon?

- Molecular mimicry Explanation: It is thought that antibodies directed against the M protein of certain strains of streptococci cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response through a phenomenon called molecular mimicry. Pg. 822

The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?

- Morphine Explanation: Although a number of analgesic agents have been used to treat pain of myocardial infarction, morphine is the drug of choice and is usually indicated if chest pain is unrelieved with oxygen and nitrates. Pg. 807

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

- Mucous membranes Explanation: Cyanosis, a bluish color of the skin, most notable in the nail beds and mucous membranes, develops when sufficient deoxygenated blood from the right side of the heart mixes with oxygenated blood in the left side of the heart. Pg. 833

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

- Myocardial infarction prevention Explanation: Symptom reduction for quality of life and prevention of MI are treatment goals for stable angina. The other options would not be treatment goals for stable angina. Pg. 812

Which of the following patients with cardiomyopathy does the nurse identify as having the greatest risk for a complication?

- One with an ejection fraction of 25% and atrial fibrillation Explanation:Although each set of symptoms is characteristic of cardiomyopathy, the nurse determines the greatest risk occurs with the patient showing evidence of stasis in the heart that can result from a reduced ejection fraction and atrial fibrillation. This patient is most likely to experience an embolus. Pg.814-819

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. Patients 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.

- 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. Pg. 806

The nurse is caring for a group of patients from 7 am to 7 pm. Which patient should be seen first as the nurse starts the shift?

- Patient with new onset unstable angina who is scheduled for a cardiac catheterization at 2 pm Explanation: Patients with ischemic chest pain are ranked according to severity. Class I is new onset severe angina; Class II is angina at rest within the past month, but not the past 48 hours; and Class III is angina at rest with 48 hours. If the pain is from recent surgery, it is lower in priority than is cardiac ischemia. Pg. 805

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 Explanation: Pericardial effusion is the accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory reaction. It may develop with neoplasms, cardiac surgery, or trauma. Pericardial effusion exerts its effects through compression of the heart chambers. The normal pericardial space contains about 15 to 50 mL of fluid. Increases in the volume of this fluid, the rapidity with which it accumulates, and the elasticity of the pericardium determine the effect that the effusion has on cardiac function. This leads to cardiac standstill or failure. Pericardial sac thickening due to inflammation can restrict the heart, rather than to 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. Acquired cardiomyopathies include those that have their origin in the inflammatory process (e.g., myocarditis), pregnancy (peripartum cardiomyopathy), and stress (takotsubo cardiomyopathy). In congenital heart defects, in most cases, pulmonary vascular resistance is only slightly elevated during early infancy, and the major contribution to pulmonary hypertension is the increased blood flow. Pg. 795

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 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?

- Pericardial effusion Explanation: Pericardial effusion refers to the accumulation of fluid in the pericardial vacuity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200ml 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. Pg. 795

Exudate in the pericardial cavity is a characteristic of which cardiac condition?

- Pericardial effusion Explanation: Pericardial effusion, either acute or chronic, refers to the presence of an exudate in the pericardial cavity. Acute pericarditis is characterized by chest pain, ECG changes, and pericardial friction rub. Cardiac tamponade represents a life-threatening compression of the heart resulting from excess fluid in the pericardial sac. In constrictive pericarditis, scar tissue develops between the visceral and parietal layers of the serous pericardium. In time, the scar tissue contracts and interferes with cardiac filling. Pg. 795

The nurse caring for a patient 12 hours post 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 of the following should the nurse do next?

- Prepare for pericardiocentesis Explanation: Cardiac tamponade develops when cardiac filling is reduced by the accumulation of fluid in the pericardial sac. This may occur after cardiac surgery or as a result of trauma or infection. The volume and speed of fluid accumulating in the pericardial sac determines how critical the situation is. A large or rapidly developing effusion often requires pericardiocentesis to remove it. Small effusions may be treated with nonsteroidal anti-inflammatory drugs and corticosteroids. Pg. 795-796

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

- Prompt diagnosis and treatment of streptococcal infections 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 the client should have regular dental examinations. Pg. 823

A preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following?

- 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 patient has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and while the patient may benefit from regular hearing examinations, it is not related to preventing rheumatic heart disease. Pg. 823

A teenager is seen in the emergency room with complaints of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen three weeks before in the clinic and treated with antibiotics for a strep throat. He was better for a few days but now he seems to have gotten worse in the last two days. What should the nurse suspect is wrong with this client?

- Rheumatic fever Explanation: 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. Pg. 812-822

While studying the physiology of the heart, the nursing students have learned that which of the following influence the blood flow in the coronary vessels that supply the myocardium? Select all that apply.

- The aortic pressure -Autoregulatory mechanisms - Compression of the intramyocardial vessels Explanation: Blood flow in the coronary vessels that supply the myocardium is influenced by the aortic pressure, the autoregulatory mechanisms, and compression of the intramyocardial vessels by the contracting heart muscle. Pg. 797

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?

- The disabling effects that result from involvement of heart valves Explanation: Rheumatic fever is a very important cause of heart disease and its most serious and disabling effects result from involvement of the heart valves. Pg.823

Which serum biomarker is highly specific for myocardial tissue?

- 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. Pg. 804

A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?

- Troponin assays Explanation: 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. Pg. 805

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 Explanation: 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. Pg. 804-805

A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this patient about diagnosing a valvular defect?

- Valvular defects usually are detected through cardiac auscultation. Explanation: Although valvular heart disease can result from congenital defects, rheumatic heart disease, trauma and other causes, atrial stenosis is usually first diagnosed with auscultation of a loud systolic murmur or a single split second heart sound. Other tests are not used initially. Pg. 828

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

- 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. Pg. 795

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

-"I should report episodes of dizziness or fainting." Explanation: Hypertrophic cardiomyopathy is defined as unexplained thickening of the left ventricle leading to reduced cardiac output and obstructive outflow. It can cause sudden cardiac death in athletes after exertion. Treatment includes beta blockers to reduce outflow obstruction. The calcium channel blocker verapamil may be used but is avoided in patients with severe outflow obstruction. Patients should pace activity and avoid alcohol. Episodes of dizziness or fainting could indicate reduced cardiac output and should be evaluated. Pg. 814-815

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

-A teenager with untreated strep throat Explanation: Rheumatic fever is caused by group A (beta-hemolytic) streptococcal throat infection. Although the same bacteria cause 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. Pg.812-823

What can trigger myocardial ischemia even when there is adequate coronary oxygen supply? Select all that apply.

-Anemia -Carbon monoxide poisoning -Hypoxia Explanation: Myocardial oxygen supply is determined by the coronary arteries and capillary inflow, and the ability of hemoglobin to transport and deliver oxygen to the heart muscle. Even with adequate coronary blood flow, myocardial ischemia can occur in situations of hypoxia, anemia, or carbon monoxide poisoning. The other options are not relevant to myocardial ischemia. Pg. 798

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

-Atherosclerosis and unstable angina Explanation: 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. Pg. 809

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

-Cardiac tamponade Explanation: Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart. It can be life-threatening and symptoms include tachycardia, elevated central venous pressure, jugular vein distention, fall in systolic blood pressure with narrowed pulse pressure. Pericarditis is inflammation of the pericardium. A myocardial infarction does not have these symptoms nor does a thrombus. Pg. 795

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

-Constrictive pericarditis Explanation: In constrictive pericarditis, fibrous, calcified scar tissue develops between the visceral and parietal layers of the serous pericardium. Acute pericarditis is due to inflammation of the pericardium. Pleural effusion is caused by accumulation of fluid and can lead to cardiac tamponade. Pg. 796

A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?

-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. Patients 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. Pg. 807-808

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. 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. Pg.794

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 of the following disorders was the player's most likely cause of death?

-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 arrhythmias 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. Pg.814

A client is seen in the emergency room with complaints of 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 Explanation: This patient 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. Pg. 794

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?

-See the doctor for evaluation immediately. Explanation: Angina that occurs at rest, is of new onset, or is increasing in intensity or duration denotes an increased risk for myocardial infarction and should be seen immediately using the criteria for acute coronary syndrome (ACS). Pg. 812

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?

-β-Adrenergic-blocking drugs Explanation: Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with the Β-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. Pg. 827