Chp. 27

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?

Weight gain

It is known that over 100 distinct myocardial diseases can demonstrate clinical features associated with dilated cardiomyopathy (DCM). What is the most common identifiable cause of DCM in the United States?

Alcoholic cardiomyopathy

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." SUBMIT ANSWER

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." SUBMIT ANSWER

Which statements regarding causes of systolic and diastolic dysfunction are most accurate? Select all that apply.

- Myocardial hypertrophy causes diastolic dysfunction.• - Ischemic heart disease causes systolic dysfunction. - Valvular insufficiency causes systolic dysfunction.

In heart failure, what causes the increase in renal secretion of renin?

Decreased cardiac output SUBMIT ANSWER

The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?

56 old Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation

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

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

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

Atherosclerosis and unstable angina

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

Atrial fibrillation SUBMIT ANSWER

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 SUBMIT ANSWER

A client has been diagnosed with heart failure. The client's cardiac contractility will be primarily affected by which factor?

Ca2+ levels in the myocardium

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

Cigarette smoking Elevated blood pressure Elevated LDL Diabetes Abdominal obesity

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 SUBMIT ANSWER

For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve?

Compensatory mechanisms

A nurse is assessing a client in shock for complications of acute renal failure. Which assessment is priority for the nurse to obtain?

Continuously measuring urine output

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

Fixed coronary obstruction

Acute pulmonary edema often occurs with heart failure. Which signs of acute pulmonary edema should the nurse monitor their clients for? Select all that apply.

Frothy, blood-tinged sputum Respiratory crackles Confusion Rapid pulse

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

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

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 SUBMIT ANSWER

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)

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?

Hypertrophy

In a client with hypovolemic shock, which assessment findings alert the nurse that compensatory mechanisms are attempting to support cardiac output. Select all that apply.

Increased heart rate Vasoconstriction Activation of the renin-angiotensin-aldosterone system (RAAS

Which intervention will the nurse anticipate being prescribed to treat an adult admitted to the ICU with acute respiratory distress syndrome (ARDS)?

Increasing oxygen concentration in the inspired air

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

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?

Morphine

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

Myocardial infarction SUBMIT ANSWER

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 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?

Pericardial effusion SUBMIT ANSWER

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?

Peripheral edema, weight gain SUBMIT ANSWER

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

Heart failure can increase one's risk for developing manifestations related to which complications? Select all that apply.

Pulmonary congestion Systemic congestion Low cardiac outpu

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?

Raising the head of the bed to a high Fowler's position

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?

Rheumatic fever

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 SUBMIT ANSWER

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

Teenager with untreated strep throat

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 SUBMIT ANSWER

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.

A client who has progressed to late-stage heart failure is experiencing sympathetic stimulation. The nurse would correlate which manifestations with sympathetic response? Select all that apply.

VasoconstrictionArrhythmiasIncreased oxygen demand

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

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

compensatory mechanisms

Unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) is a clinical syndrome that ranges in severity between stable angina and MI. It is classified according to its risk of causing an acute MI and is diagnosed based on what assessment data? Select all that apply.

d)Serum biomarkerse)ECG pattern

A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. The results suggest that the client's end-diastolic volume is insufficient. Which parameter of cardiac performance will directly decrease as a result of this finding?

preload

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:

recording weight every day at the same time with same type of clothing.

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.

Which conditions reflect failure of the circulatory system? Select all that apply.

• Circulatory shock• Heart failure

A nurse educator is defining heart failure to a group of recent graduates who will begin providing care on a cardiac unit. The educator should describe which phenomenon?

"Heart failure is a complex syndrome resulting from any disorder of the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion." SUBMIT ANSWER

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 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

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 Compression of the intramyocardial vessels Autoregulatory mechanisms

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 SUBMIT ANSWER

A client who has just recently completed his second series of radiation therapy for lung cancer was admitted yesterday to an acute care facility with ascites. He begins to have jugular vein distention, pedal edema, and dyspnea upon exertion as well as fatigue. What should the nurse suspect?

He has developed constrictive pericarditis. SUBMIT ANSWER