porth patho chapt 20

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

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."

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 pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences?

"You'll find that in pediatric patients pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."

Vasoconstriction Arrhythmias Increased oxygen demand

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.

Myocardial hypertrophy Ischemic heart disease Constrictive pericarditis

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.

Cardiac reserve refers to which of the following events?

Ability to increase cardiac output during physical exercise

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).

The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following?

Decreased cardiac outputp. 490.

A 77 year old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of, "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:

Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand. p. 490.

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is:

Call for emergency assistance utilizing hospital protocol.

The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:

Decreased cardiac output

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure?

Diuretic, ACE inhibitor, beta-blocker

A nurse in a nursing home is concerned that a resident may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?

Dyspnea, cough

All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?

Epinephrine (Adrenalin). p. 506.

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

Hypertrophy

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

The nurse knows that which of the following statements regarding heart failure is correct?

In compensated failure, an increase in preload causes an increase in ventricular contractility.

Which of the following statements regarding heart failure is true?

In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.

Select the option that best describes the mediation of the systemic inflammatory responses that occurs in disseminated intravascular clotting (DIC).

Inflammatory mediators and cytokines

Increased secretion of renin in heart failure is caused by which of the following events?

Low cardiac output

A nurse educator on a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice?

Measurement of urine output and mental status assessment

Which of the following health problems can contribute to diastolic dysfunction heart failure?

Myocardial hypertrophy

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

Myocardial infarction

Increased glomerular filtration Decreased renal reabsorption of sodium and water Inhibition of endothelin action

Natriuretic peptides (NP) are part of the compensatory response to heart failure. Which of the following are actions of NP? Select all that apply.

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

The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?

Reduced ventricular efficiency p. 486.

Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis?

Release nitric oxide

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

When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents:

The amount of blood the heart pumps each minute

Exertional dyspnea Orthopnea Cheyne-Stokes respiration Chronic dry cough

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

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

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

Vasoconstriction p. 490

A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?

Venous return to the heart, p. 487.

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

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

compensatory mechanisms

the nurse working in the ICU knows that chronic elevation of left ventricular end diastolic pressure will result in the pt displaying which of the following clinical manifestations?

dyspnea and crackles in bilateral lung bases

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client:

has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

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.

A patient is diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder? Select all that apply.

• Beta-adrenergic blockers • Angiotensin-converting enzyme inhibitors (ACEI) • Digitalis • Diuretics

The nurse knows that advanced age is a risk factor for heart failure. Which statements regarding heart failure in older adults are true? Select all that apply.

• Causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction. • Sensitivity of beta adrenergic receptors decreases resulting in decreased ventricular contractility. • It is more difficult to diagnose because of underlying chronic diseases.

A patient has developed disseminated intravascular coagulation (DIC). The nurse knows that which statements regarding DIC are true? Select all that apply.

• Thrombotic occlusion occurs in small and midsized blood vessels. • Bleeding may accompany coagulation. • Generation of thrombin increases. • Endogenous anticoagulation mechanisms are suppressed.

In heart failure patients, the nurse knows that many compensatory mechanisms attempt to support cardiac output. Included among these mechanisms are which of the following? Select all that apply.

• Vasoconstriction • Increased heart rate • Activitation of the renin angiotensin system (RAAS)

Cardiac output is which of the following per minute? Select all that apply.

• Volume of blood pumped • Heart rate X stroke volume

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

Atrial fibrillation

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

The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology?

Inhibition of the renin-angiotensin-aldosterone system

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.