HLTH 201 Exam 3

What are some causes of heart murmurs?

stenosis, regurgitation, prolapse

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."

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

Teenager with untreated strep throat

What does treatment with epinephrine do to the body?

vasoconstriction (increases resistance), increases HR and strength, increases cardiac output, increases BP, relaxes bronchiole smooth muscles

what is prolapse?

when closing, valve flips back up in other direction (will hear murmur as blood moves past valve)

The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system?

the kidneys

what is regurgitation?

valve will not close all the way and leaks when "closed" (will hear murmur of blood leaking back through valve)

primary varicose veins

valvular insufficiency of the superficial veins

Which lipoprotein is the main carrier of cholesterol?

LDLs

what is the main cause of death following MI?

cardiac dysrhythmias

A 29-year-old pregnant woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia in her second trimester. What should her care provider teach her about this change in her health status?

"We don't really understand why some women get high blood pressure when they're pregnant."

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply.

- weight reduction - dietary measures to reduce LDL levels - smoking cessation

s/s of men experiencing an MI

-Chest pain: -radiating to left arm/neck -severe crushing, constrictive or heartburn-like pain -shortness of breath

What is type III hypersensitivity reaction: immune complex characterized by?

-Free floating antigens reacting with antibodies in circulation -Immune complexes deposit on walls of blood vesseLs, activate complement system -inflammation and blood vessel damage

The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion?

140 mm Hg or higher

universal recipient and why?

AB-positive, both A and B antigens, no antibodies against A or B blood type

Which client would the nurse recognize as needing to be assessed for orthostatic hypotension?

An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom

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

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

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy

A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have on the body to consequently decrease blood pressure?

Decrease vascular volume

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?

Deep vein thrombophlebitis of the leg

A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?

Elevation of triglycerides

What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise?

Exercise can increase blood vessel growth and help to decrease symptoms

The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?

Going for a brisk walk with a friend and talking to him about continuing to exercise regularly

A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring?

HDLs

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.

Which intervention by the client will decrease overall cardiovascular risk?

Higher levels of fitness and exercise

What does HLA/MHC stand for?

Human Leukocyte Antigen (Major Histocompatibility Complex)

The student attends a health fair and has his serum cholesterol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?

It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.

universal donor and why?

O negative, no antigens

A female client tells the health care provider that she has recently been experiencing episodes of changes occurring in the color of her fingertips, especially when she experiences cold temperatures. She further states that the tips become pale, turn a bluish color, and then become reddened. The client is most likely experiencing:

Raynaud phenomenon

A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client?

Raynaud's disease

What are varicose veins ?

abnormally dilated, enlarged veins due to valves not working properly and allowing backflow

myasthenia gravis

a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles (destruction of acetylcholine receptors)

preeclampsia

a complication of pregnancy characterized by hypertension, edema, and proteinuria

what type of rejection occurs due to generation of T cells and antibodies that attack the graft?

acute

what type of transplant rejection occurs several weeks/months after transplantation when unmatched antigens cause a reaction?

acute

Type IV hypersensitivity reaction

cell-mediated delayed hypersensitivity

what type of transplant rejection occurs several months/years afterwards?

chronic or late

what is the name for this defect? -progressive cardiac dilation- heart enlarged 2 to 3x normal size -all 4 chambers involved, thinning walls (can't contract w/ as much force, can't pump out all of the blood) -s/s related to heart failure: dyspnea, orthopnea, exercise intolerance

dilated cardiomyopathy

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

fills rapidly; compresses

What is arteriosclerosis?

hardening and thickening of artery walls leading to narrowing of small arteries -general term for natural degenerative changes that occur with age

complications of acute MI

heart failure, cardiogenic shock, pericarditis, thromboemboli, rupture of heart, ventricular aneurysms

what is the name for this defect? - individual cells of heart do not have enough contractile proteins, heart muscles hypertrophy in attempt to carry out normal functioning of heart, need more oxygen and perform tasks less efficiently, prone to heart failure and sudden death during exertion- think athletes

hypertrophic cardiomyopathy

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

hypertrophy

An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?

hypotension

What is an isograft? Are immunosuppressants needed? What are the matching chances?

identical twins, no chance of rejection so no need for immunosuppressants

Type III hypersensitivity reaction

immune complex

what are some causes of orthostatic hypotension?

medications, autonomic disorders, diabetes, prolonged bed rest, volume depletion, cardiovascular disorders

The parents of a 13-year-old boy with a sore throat for a week, vomiting for two days, swollen lymph glands, and stiff achy joints is now seeking antibiotic treatment after herbal remedies were unsuccessful. Throat cultures reveal infection with group A streptococci. This child is at high risk for development of which cardiac complication?

mitral valve stenosis

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

In donors or recipients, how many HLAs need to match up?

need at least 7/8 or 9/10

modifiable risk factors for atherosclerosis?

obesity/diet, cigarette smoking, sedentary lifestyle, diabetes mellitus, hypertension

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

What is an allograft? Are immunosuppressant drugs/matching HLA/MHC's needed? What are the chance of matches?

same species, yes they are needed, not 100% matches

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

Cardiac Effusion

serous exudate accumulates slowly in pericardial cavity, few/no symptoms

What is acute coronary syndrome?

spectrum of acute ischemic heart disease ranging from unstable angina to acute MI -anything caused by a sudden reduced blood flow to heart

The nurse knows that which food is excluded from the Dietary Approaches to Stop Hypertension (DASH) diet? a.) steak b.) whole grains c.) poultry d.) nuts

steak

what is a stable plaque?

thick fibrous covering that does not easily rupture

A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

What should the nurse teach the client prior to ergometry?

"This test evaluates cardiac function."

s/s of women experiencing an MI

-Pain in the back or jaw pain -a lot of times not recognized

cardiac tamponade

-Rapid accumulation of serous exudate, chambers of heart cannot fill with blood (serous fluid is pressing on heart, difficult to inflate the heart) -Restricts heart expansion -Ventricles cannot accept enough blood

What is type IV cell-mediated delayed hypersensitivity reaction characterized by?

-Response to soluble protein in antigen, activating macrophages & helper T cells (48-72 hrs) -cytokine and lysosomal enzyme release causing inflammation -area gets thick and hard (ex. TB test)

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which has lead to a diagnosis of deep vein thrombosis (DVT). What treatment option will be of greatest benefit to prevent further thrombus formation?

Anticoagulation therapy and elevation of the leg

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement?

Apply sequential pneumatic compression devices to lower extremities.

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

A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?

Black and South Asian people

mechanism of cytotoxic hypersensitivity reaction?

IgG or IgM antibody binds antigens on cell surfaces

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

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

what is the name for this defect? -restricted cardiac filling b/c heart is "stiff" so it cannot fill properly -S/s: dyspnea, PND, orthopnea, peripheral edema -cardiac volume goes down, stroke volume goes down

Restrictive cardiomyopathy

In what type of patient do you see ST wave depression?

a patient with an incomplete coronary blockage

non-modifiable risk factors for atherosclerosis?

age, gender (males more likely, post-menopausal women more likely), genetics

what is the mechanism of type 1 hypersensitivity reaction upon subsequent exposures?

allergen attaches to IgE on mast cells (degranularization) causing release of histamine leading to inflammatory response

what is the mechanism of type 1 hypersensitivity reaction upon initial exposure?

allergen causes release of IgE antibodies from B lymphocytes which then attach to mast cells, making them "sensitized"

Type 1 hypersensitivity reaction

anaphylactic shock (hay fever, asthma, food allergies)

Graves disease

autoimmune disorder caused by hyperthyroidism and is characterized by goiter

What is a xenograft? Are immunosuppressants/matching HLA/MHC's needed? What are the matching chances?

between different species, matches not 100%, yes they are needed

what is the type of angina characterized by a fixed coronary obstruction (plaque) covered by a thick coating, an imbalance between blood flow and metabolic demands and pain when oxygen demand increases?

chronic stable angina

Primary myopathy

confined to myocardium

s/s of serum sickness

hives, patchy or generalized rash, extensive edema, fever

what type of rejection occurs immediately after transplantation when blood flow is reestablished?

hyperacute

what type of transplant rejection occurs due to preexisting antibodies in the host?

hyperacute

serum sickness

immune complex deposited in blood vessels in joints, heart, kidney tissue resulting in massive inflammation -usually results from protein from non-human sources(venom, antibodies)

secondary varicose veins

impaired flow in the deep venous channels; main cause is deep vein thrombosis

autoimmune vasculitis

inflammation and narrowing of blood vessels

additional/non traditional risk factors for atherosclerosis?

inflammation markers, increased lipoprotein A

glomerulonephritis

inflammation of the glomeruli of the kidney

What is an autograft? Are immunosuppressants needed? What are the matching chances?

one part of body to another, very low chance of rejection so immunosuppressants not needed

At 4 AM the hemodynamic monitoring for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure (MAP) is at the low end of the normal range; at 5 AM the client's MAP has fallen definitively below normal. The nurses should prioritize assessments for:

organ damage and hypovolemic shock.

Which of the following are characteristic signs of acute arterial embolism?

pain, pulselessness, pallor

what is the name for this defect? -dilated cardiomyopathy that occurs in last month of pregnancy or within 5 months after delivery -50% of women recover w/ no loss of cardiac function, 50% have persistent cardiac dysfunction

peripartum myopathy

What are these some s/s of? -Gradual onset -Pain while walking (claudication or intermittent claudication) -calf pain -vague aching feeling or numbness -Feet cool to the touch -Weak or absent pedal pulse or femoral pulse -When blood flow is severely reduced: -ischemic pain at rest -ulcerations -gangrene

peripheral artery disease (PAD)

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?

peripheral vascular resistance

eclampsia

true toxemia of pregnancy characterized by high blood pressure, albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma

Which blood vessel layer is composed primarily of smooth muscle cells?

tunica media

The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:

unknown

What is the sympathetic NS response to an MI?

-GI distress, nausea, vomiting -Tachycardia and vasoconstriction (pallor) -Fainting, intense sweating -Anxiety, restlessness, feeling of impending doom

Which diagnostic/assessment findings would be seen in a client with worsening mitral valve stenosis? Select all that apply.

-Low-pitched diastolic murmur that is increasing in duration -Sharp elevation in left atrial pressure -Decreased cardiac output

what is an unstable plaque?

A plaque prone to rupture even before it affects blood flow significantly

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 condition occurs in women who have been diagnosed with chronic high blood pressure before pregnancy, but then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy?

Chronic hypertension with superimposed preeclampsia.

What is atherosclerosis?

The build-up of fats, cholesterol, and other substances in and on the artery walls.

In what type of patient do you see ST wave elevation?

a patient found to have complete coronary blockage

The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition?

a pulsating mass in the abdomen

What are these key points describing the pathophysiology of? -complete obstruction of coronary artery leading to infarction -area becomes necrotic leading to death of myocardium, replaced by fibrous tissue(coagulative necrosis) -Myocardial cells become ischemic, resulting in damage to heart muscle. -Diseased coronary artery (atherosclerosis) leading to partially restricted blood flow to heart -Atherosclerotic plaque in arterial wall, if part of plaque ruptures, a thrombus forms which may grow and occlude the vessel. -Thrombus detaches, causing an embolism that restricts blood flow through the artery

an MI

A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client?

anaphylactic shock

Goodpasture syndrome

antibodies deposit on and destroy basement membrane in lungs and kidneys

What is one of the main consequences of an unstable plaque?

covering is very thin and can easily rupture

Type II hypersensitivity reaction

cytotoxic (complement and antibody mediated)

Which statements most accurately describe secondary hypertension? Select all that apply.

-May be caused by oral contraceptives -Is most commonly caused by kidney disease -Accounts for 5% to 10% of hypertension cases -Can be corrected or cured by surgery or specific medical treatment -Has an independent risk factor for obstructive sleep apnea

What are heart murmurs?

-extra heart sounds caused by some disruption of blood flow to the heart (TURBULENT FLOW)

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

A nurse is teaching a client with postural hypotension about effective ways to increase cardiac output while sitting and standing. Which information should be included in this education?

Slight leg movement before standing

what is an arthus reaction?

Type III hypersensitivity inflammation that is LOCALIZED (common with injections/vaccines)

what are s/s of an allergic reaction?

Vasodilation Vascular leakage Smooth muscle contraction Infiltration of tissue w/ eosinophils, tissue destruction (secondary phase)

A client is pregnant for the first time and is considered to be at high risk for preeclampsia. The care team should prioritize which intervention?

Vigilant blood pressure monitoring

what are atheromas?

plaques in blood vessel walls high in lipids, fibrin, cellular debris,

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which 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

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

what is the type of angina characterized by an unstable plaque, unexpected chest pain, usually occurring at rest, reduced blood flow to heart due to atherosclerotic build up, and can be a warning sign of an MI if intensity, frequency and duration increases?

unstable angina

what is stenosis?

valve does not open all the way, harder to force blood through it (will hear murmur of blood shooting through narrow opening)

what is the type of angina characterized by pain when coronary arteries spasm and it occurs at rest or with minimal activity?

variant/vasospastic angina

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 client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:

pulmonary embolism

A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:

tearing or ripping-type pain in the chest or back

The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading?

the client just smoked a cigarette