Pathophysiology Ch 34: Heart Failure and Circulatory Shock

Which of the following statements regarding heart failure is true?

Compensated congestive heart failure may be clinically asymptomatic.

The nurse must achieve which of the following objectives for a patient in cardiogenic shock? Select all that apply.

Correct pulmonary edema Increase coronary perfusion Improve cardiac output Regulate blood volume

A 70-year-old woman presents at a hospital after fainting at the funeral of a loved one. She is diagnosed as being in shock. Which signs and symptoms is she most likely to display? Select all that apply.

Dry, warm skin Bradycardia

At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply.

Elongating the cardiac muscle cells Decreasing the ventricular wall thickness

A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?

Myocardial infarction

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

Hypertrophy

Anaphylactic shock is directly associated with:

type I hypersensitivity response.

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

Anaphylatic shock

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements 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."

A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?

"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."

What are the physiologic signs and symptoms of cardiogenic shock? (Select all that apply.)

- Rise in central venous pressure (CVP) - Increased extraction of O2 from hemoglobin - Decrease in mean arterial blood pressures

The sympathetic (adrenergic) nervous system is an important compensatory mechanism in heart failure. Which of the following statements regarding the sympathetic nervous system response to heart failure are correct? Select all that apply.

- The sympathetic nervous system responds rapidly to a fall in cardiac output. - The sympathetic nervous system increase in cardiac workload and oxygen use can cause ischemia and worsening of heart failure. - The sympathetic nervous system increase in heart rate and force of contraction support cardiac output.

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion?

20 mL/hour

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

Regarding heart failure, the nurse knows that which of the following statements are correct? Select all that apply.

Aortic stenosis can cause left-sided failure. Cardiomyopathy is a common cause of heart failure. Compensated heart failure may be clinically asymptomatic.

The diagnosis is septic shock. The nurse knows that administration of insulin to this patient will provide which of the following beneficial effects? Select all that apply.

Decreased risk of infection Better wound healing

An 86-year-old male client is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?

Increased vascular stiffness

A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?

Low blood pressure

A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?

Myocardial infarction

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing?

Obstructive shock

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

Structural heart defects

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Vasoconstriction

A client who has progressed to late-stage heart failure is experiencing sympathetic stimulation. The nurse would assess the client for: Select all that apply.

Vasoconstriction Arrhythmias Increased oxygen demand

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:

Improving quality of life by relieving symptoms

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."

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF 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 patient most likely is experiencing which of the following types of shock?

Septic

The nurse is assessing the blood pressure of a client who is experiencing cardiogenic shock. Which of the following blood pressure readings is most likely?

90/75

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).

A client is rushed to the emergency department with symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?

Anaphylactic

Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?

Atrial fibrillation

The health care provider is reviewing diagnostic tests that were ordered for a client diagnosed with heart failure. Select the test that would provide information about the client's ejection fraction and ventricular preload.

Cardiac computerized axial tomography (CCT)

The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock?

Cardiogenic

The nurse will monitor which of the following respiratory manifestations of heart failure? Select all that apply.

Exertional dyspnea Orthopnea Cheyne-Stokes respiration Chronic dry cough

A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?

Hypovolemic

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 BP 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

The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by: Select all that apply.

Impaired gas exchange Accumulation of fluid in the alveoli and airways Lung stiffness

A patient diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which of the following are often associated with diastolic failure? Select all that apply.

Ischemic heart disease Constrictive pericarditis Myocardial hypertrophy

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 accompanies the vascular response in anaphylaxis?

Laryngeal edema

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?

Peripheral edema weight gain

Heart failure can have which of the following consequences? Select all that apply.

Pulmonary congestion Systemic congestion Low cardiac output

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

Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem?

Right-sided heart failure

Which of the following does the nurse know can lead to right-sided heart failure?

Severe pneumonia

Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?

They have the same compensatory mechanisms.

A patient is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as which of the following?

Valvular regurgitation

An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:

Vascular stiffness

In hypovolemic shock, the main purpose of treatment is correcting or controlling the underlying cause of the hypovolemia and improving the perfusion of the tissues and organs of the body. Which of the following treatments is not a primary form of therapy for hypovolemic shock?

Vasoconstrictive drugs

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

Weighing every day at the same time with same type of clothing

A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following?

Weight gain

An elderly 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.