Patho Unit 3 PrepU with Explanations Chapter 27
A client asks the purpose of an exercise stress test. What is the nurse's best response? "This will help you endure exercise." "This is to assess your tolerance of isometric exercise." "This test is necessary prior to starting medication therapy for obesity." "The test is used to measure functional status during stress."
"The test is used to measure functional status during stress." The exercise stress test is used to measure aerobic fitness. It does not help the client endure exercise or assess tolerance of isometric exercise. It is not done prior to starting medication therapy for obesity.
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? 80—60 mL/hour 60—40 mL/hour 40—20 mL/hour 20 mL/hour
20 mL/hour In hypovolemia, renal vasculature is constricted in a compensatory attempt to circulate blood to more vital organs. Urinary output at 20 mL/hour or below indicates that renal perfusion is too inadequate.
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is: 20 mL/hour 40 mL/hour 60 mL/hour 80 mL/hour
20 mL/hour Urine output decreases very quickly in hypovolemic shock. Compensatory mechanisms decrease renal blood flow as a means of diverting blood flow to the heart and brain. Oliguria of 20 mL/hour or less indicates inadequate renal perfusion.
Blood flow in the circulatory system depends on a blood volume that is sufficient to fill the blood vessels and a pressure difference across the system that provides the force to move blood forward. What is the total blood volume in an adult? 60 to 65 mL/kg 70 to 75 mL/kg 80 to 85 mL/kg 90 to 95 mL/kg
70 to 75 mL/kg The total blood volume is a function of age and body weight, ranging from 85 to 90 mL/kg in the neonate and from 70 to 75 mL/kg in the adult.
A client with a new diagnosis of heart failure has received a new prescription. Which medication category is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions? A beta-adrenergic blocker (beta-blocker) A diuretic A cardiac glycoside An ACE inhibitor
A cardiac glycoside Cardiac glycosides improve cardiac function by increasing the force and strength of ventricular contractions. Beta-adrenergic blockers decrease left ventricular dysfunction associated with activation of the sympathetic nervous system. ACE inhibitors block the conversion of angiotensin I to II, whereas diuretics promote the excretion of fluid.
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 stressful period right after birth that occurs without evidence of cyanosis A hyperoxygenated period when the infant is at rest A hypercyanotic attack brought on by periods of stress A hyperpneic attack in which the infant loses consciousness
A hypercyanotic attack brought on by periods of stress The degree of obstruction may be dynamic and can increase during periods of stress causing hypercyanotic attacks ("tet spells"). None of the other answers occur in association with tetralogy of Fallot or tet spells.
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? Neurogenic Septic Cardiogenic Anaphylactic
Anaphylactic Signs and symptoms associated with impending anaphylactic shock include abdominal cramps; apprehension; warm or burning sensation of the skin; itching; urticaria (i.e., hives); coughing; choking; wheezing; chest tightness; and difficulty in breathing. The other types of shock do not have these clinical manifestations
A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child? Cardiac catheterization and corticosteroid therapy Implanted pacemaker and beta-adrenergic blockers (beta-blockers) Antibiotics and anti-inflammatory drugs Pain control and oxygen therapy
Antibiotics and anti-inflammatory drugs A diagnosis of rheumatic fever (RF) necessitates the use of antibiotics (usually penicillin) and anti-inflammatory drugs. These measures supersede the importance of pain control and oxygen therapy. Cardiac catheterization, corticosteroid therapy, pacemakers, and beta-adrenergic blockers are not common treatment modalities for RF.
Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function? Atherosclerosis and unstable angina Pericardial effusion and cardiac tamponade Dilated cardiomyopathies Aortic valve regurgitation and aortic stenosis
Atherosclerosis and unstable angina 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.
A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the: Tricuspid valve Pulmonic valve Bicuspid valve Aortic valve
Bicuspid valve The bicuspid valve (also called the mitral valve) controls the flow of blood between the left atria and left ventricle. The aortic valve controls flow between the left ventricle and aorta. The tricuspid controls the flow between the right atria and ventricle. The pulmonic valve controls flow between the right ventricle and pulmonary artery.
Select the correct sequence of blood return to the heart. Capillaries, venules, veins, right atrium Capillaries, arterioles, arteries, right atrium Capillaries, arterioles, veins, left atrium Capillaries, venules, veins, left atrium
Capillaries, venules, veins, right atrium The correct pathway for blood returning back to the heart is the capillaries, venules, veins, and right atrium. The other options do not support normal blood flow.
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? Heart failure Cardiomyopathy Myocardial infarction Rheumatic cardiac disease
Cardiomyopathy 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.
A client who has just been diagnosed with atrial stenosis asks his nurse what can cause a problem with heart valves. Which causes of dysfunction of the heart valves should the nurse relay to this client? Select all that apply. Congenital defects Rheumatic heart disease Trauma Ischemic heart disease Inflammation Degenerative changes
Congenital defects Rheumatic heart disease Trauma Ischemic heart disease Inflammation Degenerative changes Dysfunction of the heart valves can result from a number of disorders including congenital defects, rheumatic disease, trauma, ischemic heart disease, degenerative changes and inflammation.
In heart failure, what causes the increase in renal secretion of renin? Increased metabolic demand Decreased cardiac output Increased renal perfusion Hypertension
Decreased cardiac output Low cardiac output results in decreased renal perfusion, which activates the renin-angiotensin-aldosterone system (RAAS). The resultant vasoconstriction due to angiotensin II and the retention of sodium and water due to aldosterone attempt to support cardiac output. Hypertension and increased metabolic needs do not activate the RAAS.
The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system? Distribute oxygenated blood to the tissues Collect deoxygenated blood from the tissues Exchange gases, nutrients, and wastes Pump blood
Exchange gases, nutrients, and wastes The circulatory system consists of the heart, which pumps blood; the arterial system, which distributes oxygenated blood to the tissues; the venous system, which collects deoxygenated blood from the tissues and returns it to the heart; and the capillaries, where exchange of gases, nutrients, and waste takes place.
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. Have the client change positions to unaffected side. Have the client breathe deeply. Have the client swallow slowly and frequently.
Have the client sit up and lean forward. With acute pericarditis, 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.
What is the most important factor in myocardial oxygen demand? Heart rate Respiratory rate Degree of anxiety Hyperthermia
Heart rate The heart rate is the most important factor in myocardial oxygen demand since, as heart rate increases, myocardial oxygen demands increase. The degree of effect the other options have on myocardial oxygen demand is related to how much effect they have on heart rate.
Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability. Norepinephrine Serotonin Prostaglandins Histamine
Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Norepinephrine is a powerful vasoconstrictor. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.
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? Takotsubo cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) Hypertrophic cardiomyopathy (HCM) Dilated cardiomyopathy (DCM)
Hypertrophic cardiomyopathy (HCM) 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 dysrhythmias 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.
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another? Laminar Turbulent Crosswise Axially
Laminar Laminar blood flow reduces friction by allowing the blood layers to slide smoothly over one another, with the axial layer having the most rapid rate of flow. Axially, crosswise, and turbulent blood flow would result in increased friction. In turbulent flow, the laminar stream is disrupted and the flow becomes mixed, moving radially (crosswise) and axially (lengthwise).
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 Orthostatic hypotension Increased cardiac contractility Loss of action potential
Increased vascular stiffness Increased vascular stiffness in older adults causes a progressive increase in systolic blood pressure with advancing age, which in turn contributes to the development of left ventricular hypertrophy and altered diastolic filling. A loss of action potential does not typically accompany aging, and contractility tends to decrease as a result of cardiac stiffness. Orthostatic hypotension is neither a normal age-related change nor a cause of heart failure.
Which of the following is true regarding pulmonary circulation? The system functions with an increased arterial pressure to circulate through the distal parts of the body. It is a low-pressure system that allows for improved gas exchange. It is the larger of the two circulatory systems. It consists of the left side of the heart, the aorta, and its branches.
It is a low-pressure system that allows for improved gas exchange. The pulmonary circulation consists of the right heart and the pulmonary artery, capillaries, and veins. It is the smaller of the systems and functions at a lower pressure to assist with gas exchange.
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation? Right atrium Left atrium Right ventricle Left ventricle
Left ventricle The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.
Which description sums up the basic pathophysiology of heart failure that the nurse would include when educating a client? Low cardiac output due to reduced pumping ability Reduced tissue perfusion, especially to the kidney Activated sympathetic (adrenergic) reflexes Myocardial remodeling of scar tissue
Low cardiac output due to reduced pumping ability There are many reasons for heart failure but the basic pathophysiology is a loss of ventricular efficiency with a decrease in cardiac output. As a result, blood flow to body tissues declines, and sympathetic reflexes of vasoconstriction and increase in heart rate attempt to compensate. The renin-angiotensin-aldosterone system is activated, and aldosterone, which causes myocardial remodeling, is released.
Which related circulatory complication can result from surgical treatment for metastatic breast cancer? Lymphedema in the affected arm Hypotension upon standing Tachycardia when at rest Irregular heart rate
Lymphedema in the affected arm Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema. The other options are not related to the surgery that would have removed any affected lymph nodes.
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? Demerol Morphine Fentanyl Codeine
Morphine 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.
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 Ensuring adequate oxygenation with continuous oxygen administration Preventing clotting disorders Assisting the client to return to previous lifestyle
Myocardial infarction prevention 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.
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? Myocardial infarction Abdominal aortic aneurysm Pericarditis Pneumonia
Pericarditis This client 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.
The heart consists of four valves. Which are the semilunar valves? Select all that apply. Tricuspid Mitral Pulmonary Aortic
Pulmonary Aortic The heart's semilunar valves are the pulmonary and aortic values. The heart's atrioventricular valves are the tricuspid and the mitral.
The heart is a four-chambered pump. What is the function of the right ventricle? Receives blood returning to the heart from the systemic circulation Receives oxygenated blood from the lungs Pumps blood to the lungs Pumps blood into the systemic circulation
Pumps blood to the lungs The right ventricle pumps blood to the lungs. The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The left ventricle pumps blood into the systemic circulation.
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? Placing a pulse oximeter on the client to monitor oxygenation status Raising the head of the bed to a high Fowler's position Administration of 2L of oxygen by nasal cannula Inserting an IV to begin a normal saline infusion
Raising the head of the bed to a high Fowler's position Treatment measures include close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion; and the administration of oxygen, antihistamine drugs, and corticosteroids. The person should be placed in a supine position. This is extremely important because venous return can be severely compromised in the sitting position. This in turn produces a pulseless mechanical contraction of the heart and predisposes to arrhythmias. In several cases, death has occurred immediately after assuming the sitting position.
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? Relaxation of the bronchioles Increasingly stronger myocardial contraction Increase in heart rate Vasoconstriction of skeletal muscle
Relaxation of the bronchioles Beta-2 receptors cause vasodilation of the skeletal muscle bed and relaxation of the bronchioles. Beta-1 receptors result in an increased heart rate and stronger myocardial contraction, while vasoconstriction of skeletal muscle is affected by the alpha receptors.
The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock? Anaphylactic shock Septic shock Cardiogenic shock Hypovolemic shock
Septic shock Septic shock is a subtype of distributive shock. The treatment of sepsis and septic shock focuses on control of the causative agent and support of the circulation and the failing organ systems. The administration of antibiotics that are specific for the infectious agent is essential. Swift and aggressive fluid administration is needed to compensate for third spacing, though which type of fluid is optimal remains controversial. Equally, aggressive use of vasopressor agents, such as norepinephrine or epinephrine, is needed to counteract the vasodilation caused by inflammatory mediators.
The heart and blood vessels receive both sympathetic and parasympathetic innervation from neural control. What controls the parasympathetic-mediated slowing of the heart rate? The vasomotor center The cardioinhibitory center The medullary center The innervation center
The cardioinhibitory center The medullary cardiovascular neurons are grouped into three distinct pools that lead to sympathetic innervation of the heart and blood vessels and parasympathetic innervation of the heart. The first two, which control sympathetic-mediated acceleration of heart rate and blood vessel tone, are called the vasomotor center. The third, which controls parasympathetic-mediated slowing of heart rate, is called the cardioinhibitory center.
The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as: The condition is getting progressively worse. The client is improving. Results are not significant assessment data. The more the results continue to increase, the better outcome for the client.
The condition is getting progressively worse. Circulating levels of both ANP and BNP are elevated in persons with heart failure. The concentrations are well correlated with the extent of ventricular dysfunction, increasing up to 30-fold in persons with advanced heart disease. Assays of BNP are used clinically in the diagnosis of heart failure and to predict the severity of the condition.
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? It can be attributed to drug abuse. The most common cause is a staph infection. Sometimes a parasite is involved. Let's not worry about the cause as we need to focus on getting him better.
The most common cause is a staph infection. Staphylococcal infections have now emerged as the leading cause of infective endocarditis, with streptococci and enterococci as the other two most common causes. Informing the client's wife about the drug abuse connection infers that you think he is a drug addict and is not therapeutic. Parasites are never the cause. Telling the client to focus on her husband also is not appropriate, as this is a genuine concern for her.
A cardiac nurse is describing to a colleague the relationship between the law of Laplace and a client's peripheral vascular disease. To express the law of Laplace in an equation, the nurses need to know which values? Select all that apply. The tension that exists in the walls of a blood vessel The client's mean, resting stroke volume The thickness of a particular blood vessel The radius of a particular blood vessel The pressure that exists in the lumen of a vessel
The tension that exists in the walls of a blood vessel The radius of a particular blood vessel The pressure that exists in the lumen of a vessel The law of Laplace is determined by the equation, P = T/r, in which T is wall tension, P is the intraluminal pressure, and r is vessel radius. The client's stroke volume is not directly relevant to the equation. The thickness of a vessel will affect wall tension, but this is not an explicit component of the equation.
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply. Tricuspid Mitral Pulmonary Aortic
Tricuspid Mitral The heart's atrioventricular valves are the tricuspid and the mitral. The semilunar valves are the pulmonary and aortic.
Which blood vessel layer is made primarily of muscle? Tunica media Tunica intima Tunica externa Tunica adventitia
Tunica media The middle layer (tunica media) of a vessel is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The outermost layer of a vessel is called the tunica externa (or tunica adventitia) and is composed of loosely woven collagen fibers. The innermost layer is the tunica intima, which consists of a single layer of flattened endothelial cells.
An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased: Vascular stiffness Response to beta-adrenergic stimulation Cardiac tone and compliance Myocardial metabolism
Vascular stiffness There are four changes associated with aging that contribute to the development of heart failure in the older adults. Reduced responsiveness to beta-adrenergic stimulation limits the heart's capacity to maximally increase heart rate and contractility during an increase in activity or stress. A second major effect of aging is increased vascular stiffness; third, in addition to increased vascular stiffness, the heart itself becomes stiffer and less compliant with age. Fourth, aging alters myocardial metabolism at the level of the mitochondria.
The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole? Ventricles contract and blood is ejected from the heart. Atria contract and blood is ejected from the heart. Ventricles relax and blood fills the heart. Atria relax and blood fills the heart.
Ventricles contract and blood is ejected from the heart. Systole occurs when the ventricles contract and blood is ejected from the heart. Diastole occurs when the ventricles are relaxed and blood fills the heart.
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) Calcium-channel blocking drugs Antianxiety drugs Broad-spectrum antibiotic drugs
beta-adrenergic blocking drugs (beta-blockers) Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with the beta-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.
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to: take a second nitroglycerine. give it 5-10 minutes more to see if there is relief. see the doctor for evaluation immediately. not worry about it as this is common for someone who has already had a myocardial infarction.
see the doctor for evaluation immediately. 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).
A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy 1 year ago. What does the nurse suspect is the problem? Venous stasis Lymphedema Arteriosclerosis Deep vein thrombosis
Lymphedema The lymphatic system filters fluid at the lymph nodes and removes foreign particles such as bacteria. When lymph flow is obstructed, a condition called lymphedema occurs. Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema.
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? Cardiogenic shock Hypovolemic shock Obstructive shock Distributive shock
Obstructive shock Obstructive shock results from mechanical obstruction of the flow of blood through the central circulation, such as the blockage that characterizes a pulmonary embolism.
A client has had an acute myocardial infarction (MI). The brother of the client has a history of angina. The client asks how he will know if his brother's pain is angina or if the brother is actually having an MI. Which statement is correct? Chest pain with angina only occurs during the day; MI pain is more likely at night. Chest pain with angina only occurs at rest; MI pain occurs during a stressful time. Pain is more severe and lasts longer with angina than with an MI. Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.
Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. Rest and intake of nitroglycerin relieve chest pain with angina but not with an MI. Pain with angina and MI is a subjective symptom for each client. Pain with angina and MI can occur at a variety of times.
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? Flu Meningitis Rheumatic fever Mononucleosis
Rheumatic fever 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.
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 neurogenic shock septic shock cardiogenic shock
anaphylactic shock Anaphylactic shock is initiated through an immunologically mediated reaction to an irritant. Neurogenic shock is caused by decreased sympathetic control of blood vessel tone due to a defect in the vasomotor center in the brain stem or the sympathetic outflow to the blood vessels. Cardiogenic shock occurs when the heart fails to pump blood sufficiently to meet the body's demands. Septic shock, which is the most common type of distributive shock, is associated with the systemic immune response to severe infection.
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output. aortic hypertrophy compensatory mechanisms electrical conductivity parasympathetic system
compensatory mechanisms The pathophysiology of heart failure involves an interaction between two factors: a decrease in pumping ability of the heart with a consequent decrease in the cardiac reserve and the compensatory mechanisms that serve to maintain the cardiac output while also contributing to the progression of heart failure. Myocardial muscle hypertrophy has an important role in long-term adaptation to hemodynamic overload. Stimulation of the sympathetic nervous system plays an important role in the compensatory response to decreased cardiac output and to the pathogenesis of heart failure. Heart failure is a muscle contractility problem, unrelated to the electrical conduction that stimulates it.
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: "Pull your blood from the right side of the heart and run it through a machine to oxygenate it better, and then return it to your body." "Measure the pressures inside your heart continuously to asses pumping ability of your left ventricle." "Have a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." "This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure." Refractory heart failure reflects deterioration in cardiac function that is unresponsive to medical or surgical interventions. Ventricular assist devices (VADs) are mechanical pumps used to support ventricular function. VADs are used to decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure. This decreases the workload on the ventricle and allows it to rest and recover. The rest of the distractors relate to the monitoring in an ICU of cardiac functioning. Invasive hemodynamic monitoring may be used for assessment in acute, life-threatening episodes of heart failure. With the balloon inflated, the catheter monitors pulmonary capillary pressures (i.e., pulmonary capillary wedge pressure or pulmonary artery occlusion pressure), which reflect pressures from the left ventricle. The pulmonary capillary pressures provide a means of assessing the pumping ability of the left ventricle. One type of pulmonary artery catheter is equipped with a thermistor probe to obtain thermodilution measurements of cardiac output.
Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is: Atrial fibrillation Ventricular fibrillation Atrioventricular heart block Nodal tachycardia
Atrial fibrillation In heart failure, atrial fibrillation is the most frequently occurring dysrhythmia. Occasionally, ventricular fibrillation causes sudden death in clients with heart failure. Atrioventricular heart block and nodal tachycardia are not characteristic of heart failure.
A nurse is concerned that a resident of a long-term care facility may be developing left-sided heart failure. The nurse would communicate which set of manifestations as possible evidence of left-sided heart failure? diarrhea, nausea, vomiting dyspnea, cough, fatigue fatigue, headache, weight loss weakness, slowed heart rate, confusion
dyspnea, cough, fatigue In left-sided heart failure, dyspnea and cough, especially when lying supine (orthopnea), results from increased pulmonary capillary pressures contributing to pulmonary congestion. Fatigue is common due to reduced cardiac output and inadequate tissue perfusion. A slowed heart rate, or bradycardia is not expected. Often the heart rate increases to compensate for the decrease in cardiac output. Weight gain due to fluid retention from the activation of renin-angiotensin-aldosterone is expected rather than weight loss. Although some gastrointestinal fullness may be experienced by some clients with heart failure, vomiting and diarrhea is not expected.
Which sequence is the correct pathway for blood flow through the heart? right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta left atrium - tricuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein - right atrium - mitral valve - right ventricle - aorta left atrium - bicuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein - right atrium - tricuspid valve - right ventricle - aorta right atrium - bicuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - tricuspid valve - left ventricle - aorta
right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta The correct pathway for blood flow through the heart is the right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta.
The nurse is caring for a group of clients from 7 am to 7 pm. Which client should be seen first as the nurse starts the shift? Client with new onset unstable angina who is scheduled for a cardiac catheterization at 2 PM Client with a redo coronary artery bypass grafting postoperative day 6, reporting incisional pain rated 6 on a scale from 0 to 10 Client 3 days post-myocardial infarction who is scheduled for a cardiac rehabilitation evaluation this this morning Client 4 days post-valve replacement, with a pulse of 90/min, blood pressure of 112/60 mm Hg, respiration 16/min, and temperature of 99.1°F (37.3°C)
Client with new onset unstable angina who is scheduled for a cardiac catheterization at 2 PM Clients 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.
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? Potassium Phosphorous Troponin assays Creatine kinase
Troponin assays 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.
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? Creatine kinase marker Complete blood components Calcium level Troponin level
Troponin level 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. 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.
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as: Tunica media Tunica adventitia Tunica externa Tunica intima
Tunica media The tunica media, the middle layer, is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The tunica externa, also known as the tunica adventitia, refers to the outermost layer of a vessel. The tunica intima refers to the innermost layer that prevents platelet adherence and blood clotting.
