Patho: Disorders of cardiac function, and heart failure and circulatory shock

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.

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

structural heart defects

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

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are prescribed by the health care provider. Which intervention should the nurse complete first?

Administer epinephrine (adrenaline)

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

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

Atherosclerosis and unstable angina

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 client with mitral valve regurgitation and left heart failure reports shortness of breath and fatigue with activities of daily living. Which instructions by the nurse will be ineffective in reducing these symptoms?

Elevating legs for 20 minutes daily

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)

The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?

Kussmaul sign

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

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

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

Septic Shock

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

Teenager with untreated strep throat

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

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.

Which serum biomarker is highly specific for myocardial tissue?

Troponin

Which is a common cause(s) of left-sided heart failure?

acute myocardial infarction

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.

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the blood pressure is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

hypovolemic shock due to acute intravascular volume loss.

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

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

prompt diagnosis of streptococcal infections with a throat culture.

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 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."

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?

beta-adrenergic blocking drugs (beta-blockers)

Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

constrictive pericarditis

A client reports severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate:

myocardial infarction

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 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

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.

What should the nurse teach the pregnant woman about congenital heart defects?

Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant.

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