SPC Level 2 Exam 3- Heart Failure Adaptive Quiz

Which respiratory rate would the nurse anticipate when assessing a patient who is developing pulmonary edema? -10 to 14 breaths/min -16 to 20 breaths/min -22 to 24 breaths/min -32 to 36 breaths/min

-32 to 36 breaths/min A respiratory rate higher than 30 breaths/min is often found in patients with pulmonary edema. A patient experiences dyspnea and orthopnea as a result of the accumulation of edematous fluid in the lung tissues, which affects the patient's respiratory rate. Respiratory rates in the ranges of 10 to 24 breaths/min indicate normal respiration.

A patient is diagnosed with paroxysmal nocturnal dyspnea. Which clinical manifestation would the nurse expect the patient to report? -Decreased attention span -Breathlessness on exertion -Shortness of breath when lying down -Awakening with a feeling of suffocation

-Awakening with a feeling of suffocation Paroxysmal nocturnal dyspnea occurs when the patient is asleep. The patient awakes in a state of panic with a feeling of suffocation and has a strong desire to sit or stand up. Breathlessness on exertion is called dyspnea. Shortness of breath when lying down, that is, orthopnea, often accompanies dyspnea. A decreased attention span is a behavioral change that may be a result of poor gas exchange or worsening heart failure.

A patient is prescribed an angiotensin-converting enzyme (ACE) inhibitor for the treatment of heart failure (HF). Which mechanism will this medication block? -Secretion of aldosterone -Conversion of pro-renin to renin -Conversion of angiotensin I to angiotensin II -Conversion of angiotensinogen to angiotensin I

-Conversion of angiotensin I to angiotensin II Angiotensin I is subsequently converted to angiotensin II by the ACE found in the lungs. When renal blood flow is reduced, the juxtaglomerular cells secrete renin into the circulation. Renin carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin II also stimulates the secretion of the hormone aldosterone; it causes the reabsorption of sodium and water into the blood, which increases the BP.

A patient develops unexplained heart failure (HF) that remains unresponsive to usual therapy. For which diagnostic test would the nurse prepare the patient? -Chest x-ray -Echocardiogram -Cardiac catheterization -Electrocardiogram (ECG)

-Echocardiogram An echocardiogram provides information on the ejection fraction (EF). It also provides information on the structure and function of the heart valves. Heart chamber enlargement or stiffness can also be assessed. An ECG and chest x-ray are also useful but are not as specific. Heart catheterization, such as coronary angiography, is performed to determine the EF and blockages.

An echocardiogram for a patient indicates enlarged ventricles of the heart. Which condition could be the cause of the cardiac dilation? -Increased heart rate -Increased muscle thickness -Elevated pressure in the ventricles -Increased release of catecholamine

-Elevated pressure in the ventricles Cardiac dilation is an enlargement of the heart chambers, usually the ventricles; it occurs when pressure in the heart chambers is elevated over time. Hypertrophy is an increase in the muscle mass and thickness of the cardiac wall in response to overwork and strain. When the sympathetic nervous system activation is increased, there is an increased release of catecholamines, which results in an increased heart rate.

Paroxysmal nocturnal dyspnea is indicative of which more serious problem? -Chronic obstructive pulmonary disease (COPD) -Asthma -Bronchitis -Heart failure

-Heart failure A classic symptom of left-sided heart failure is paroxysmal nocturnal dyspnea, which awakens the patient after several hours of sleep. Although a patient with COPD, asthma, or bronchitis may experience shortness of breath, these symptoms do not usually manifest while the patient is sleeping.

Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply. -Hypertension -Hyperthyroidism -Cardiomyopathy -Rheumatic heart disease -Coronary artery disease (CAD)

-Hypertension -Cardiomyopathy -Coronary artery disease (CAD) Primary causes of heart failure linked to specific genes and gene mutations include hypertension, cardiomyopathy, and CAD. Hyperthyroidism and rheumatic heart disease are primary causes of heart failure that are not linked to specific genes and gene mutations.

Which items in a patient's medical history are risk factors for heart failure (HF)? Select all that apply. -Cirrhosis -Hypertension -Multiple sclerosis -Marfan's syndrome -Metabolic syndrome

-Hypertension -Metabolic syndrome Hypertension and coronary artery disease (CAD) are the primary risk factors for HF. Other co-morbidities, such as diabetes, metabolic syndrome, advanced age, tobacco use, and vascular disease, contribute to the risk of the development of HF. Cirrhosis, multiple sclerosis, and Marfan's syndrome are not precipitating causes of HF.

Which effect would be expected from a medication that acts to increase chronotropy? -Increased heart rate -Increased stroke volume -Increased cardiac output -Increased myocardial contractility

-Increased heart rate Increased heart rate is a positive chronotropic effect. Increases in myocardial contractility, stroke volume, and cardiac output are positive inotropic effects.

Which assessment finding is consistent with right-sided heart failure (HF)? -Jugular venous distention (JVD) -Presence of S3 and S4 heart sounds -Paroxysmal nocturnal dyspnea (PND) -Displacement of the point of maximal impulse (PMI)

-Jugular venous distention (JVD) JVD is a sign of right-sided HF. Presence of S3 and S4 heart sounds, PND, and displacement of the PMI are all signs/symptoms of left-sided HF.

Which term is used to describe difficulty breathing when lying down? -Dyspnea -Orthopnea -Bradypnea -Paroxysmal nocturnal dyspnea (PND)

-Orthopnea Orthopnea refers to dyspnea when recumbent (lying down). Dyspnea refers to difficulty breathing. Bradypnea is the term for abnormally slow breathing. PND is episodic sudden dyspnea that wakes a patient at night.

A patient is diagnosed with left-sided heart failure. Which assessment finding would the nurse expect? -Orthopnea -Low BP -Pulsating neck veins -Edema in the lower extremities

-Orthopnea Orthopnea, difficulty breathing except when sitting or standing, is a symptom of advanced heart failure, especially left-sided failure. When the heart fails as a pump, blood backs up into the lungs, causing fluid to leak from the alveolar membrane. As this process continues, pulmonary edema may develop. Patients may experience hypotension or hypertension, depending on the severity of the disease. Pulsating neck veins and edema in the lower extremities are characteristics of right-sided heart failure.

Which finding would the nurse monitor in the patient who has left-sided heart failure? -Pedal edema -Hepatomegaly -Splenomegaly -Pulmonary congestion

-Pulmonary congestion The most common form of heart failure is left-sided heart failure. It results from left ventricular dysfunction. This prevents normal, forward blood flow and causes blood to back up into the left atrium and pulmonary veins. There would be fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli; this manifests as pulmonary congestion and edema. Right-sided heart failure, which occurs when the right ventricle fails to contract effectively, causes pedal edema, hepatomegaly, and splenomegaly.

Which condition causes cor pulmonale? -Liver disease -Renal disease -Pulmonary disease -Preexisting heart disease

-Pulmonary disease 4 Preexisting heart disease Cor pulmonale is a cardiac condition in which a disease of the pulmonary system causes an increase in right ventricular pressure. This increased right ventricular pressure causes right ventricular failure, which may eventually lead to heart failure. This term is not used for heart disease caused by liver, kidney, or preexisting heart disease.

Which area of the body would best show accumulation of edema in a patient with heart failure (HF) who spends most of the time in bed? -Feet -Lungs -Sacrum -Abdomen

-Sacrum In patients with HF who spend a great deal of time in bed, it would be important to assess the sacral area for edema. Edema related to HF may also be found in the feet, lungs, and abdomen. But in this patient, given the history of bed rest, the sacrum will be the most accurate area to assess.

A patient is diagnosed with heart failure. Which factors may influence the patient's cardiac output (CO)? Select all that apply. -Stroke volume -Portal pressure -Respiratory rate -Ventricular filling -Myocardial contractility

-Stroke volume -Ventricular filling -Myocardial contractility CO depends on various factors, such as stroke volume, filling of the ventricles, and myocardial contractility. Stroke volume × heart rate = CO. Decreased filling of the ventricles decreases CO. Impaired myocardial contractility decreases CO. Respiratory rate and portal pressure do not alter CO.

Which condition causes the symptoms of right-sided heart failure? -Decreased preload -Increased cardiac output -Fluid congestion in the lungs -Systemic venous congestion

-Systemic venous congestion The symptoms of right-sided heart failure are caused by the backup of blood into the venous system. Preload in right-sided heart failure is increased. Cardiac output is decreased in right-sided heart failure. Fluid congestion in the lungs is a symptom of left-sided heart failure

Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO) in heart failure? Select all that apply. -Ventricular dilation -Ventricular hypertrophy -Production of endothelin -Release of renin by the kidneys -Activation of the sympathetic nervous system (SNS)

-Ventricular dilation -Ventricular hypertrophy -Activation of the sympathetic nervous system (SNS) Increased contraction as a result of dilation initially leads to increased CO and maintenance of BP and perfusion. The increased contractile power of the heart's muscle fibers as a result of hypertrophy initially leads to an increase in CO and maintenance of tissue perfusion. The SNS responds by releasing catecholamines (epinephrine and norepinephrine), which enhance peripheral vasoconstriction and cause an increase in the heart rate and myocardial contractility. Initially, this compensatory mechanism is beneficial, with a result of increased CO. Endothelin is a potent vasoconstrictor; it contributes to the development of heart failure. The release of renin by the kidneys starts a cascade of events, which results in further water and sodium retention in an already-overloaded state.

Which classification of acute decompensated heart failure includes a normal cardiac output (CO), increased pulmonary artery wedge pressure (PAWP), dyspnea, edema, and orthopnea? -Dry-cold -Wet-cold -Dry-warm -Wet-warm

-Wet-warm Normal CO, increased PAWP, and symptoms of congestion (dyspnea, edema, orthopnea) would be classified as wet-warm. A dry-cold profile would include a decreased or normal PAWP, decreased CO, edema, hypotension, and cool extremities. A wet-cold profile would have increased PAWP, decreased CO, altered mental status, decreased O2 saturation, reduced urine output, and shock. A dry-warm profile would be reflected by normal PAWP and CO and no signs or symptoms.