Cardiac Quiz
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 of the following consequences? A. Backflow from the left ventricle to the left atrium B. Backflow from the right ventricle to the right atrium during systole C. Inhibition of the SA nod's normal action potential D. Backup of blood from the right atrium into the superior vena cava
A. Backflow from the left ventricle to the left atrium Response Feedback: The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility.
A client is admitted with dilated cardiomyopathy with left ventricular dysfunction. The nurse should assess for which of the following clinical manifestations? Select all that apply. A. Extreme fatigue with activity B. Dyspnea C. Fainting D. Orthopnea E. Excess abdominal fluid
A. Extreme fatigue with activity B. Dyspnea D. Orthopnea Response Feedback: The most common clinical manifestations of DCM are those related to heart failure, such as dyspnea, orthopnea, and reduced exercise capacity. Hypertrophic cardiomyopathy (HCM) is characterized by myocardial thickening and abnormal diastolic filling. They experience fainting/syncope. Restrictive cardiomyopathy, in which there is excessive rigidity of the ventricular wall, increases the work of ventricular emptying and causes cardiac hypertrophy. These clients experience excess abdominal fluid (ascites).
Which of the following lab results strongly suggest an immunologic response in the client with possible rheumatic heart disease? A. Group A (β-hemolytic) streptococcal antibodies B. High C-reactive protein levels C. Elevated white blood cell count D. Elevated erythrocyte sedimentation rate (ESR)
A. Group A (β-hemolytic) streptococcal antibodies Response Feedback: The pathology of RF does not involve direct bacterial infection of the heart. Rather, the time frame for development of symptoms relative to the onset of pharyngitis and the presence of antibodies to the GAS organism strongly suggests an immunologic response. It is thought that antibodies directed against the M-protein of certain strains of streptococci cross-react with glycoprotein antigens in the heart, joints, and other tissues to produce an autoimmune response through a phenomenon called molecular mimicry. Elevated erythrocyte sedimentation rate (ESR) is a blood test that can reveal inflammatory activity in your body. The level of CRP rises when there is inflammation throughout the body. Elevated WBC indicates an infection.
One of the principal mechanisms by which the heart compensates for increased workload is: A. Myocardial hypertrophy B. Sodium and water retention C. Ventricular wall tension increase D. Endothelin vasoconstrictors
A. Myocardial hypertrophy Response Feedback: The development of myocardial hypertrophy constitutes one of the principal mechanisms by which the heart compensates for an increase in workload. There are at least two types of endothelin receptors, and it is thought that the peptide may play a role in mediating noncompensatory pulmonary hypertension in persons with heart failure. One effect of a lowered cardiac output in heart failure is a noncompensatory reduction in renal blood flow and glomerular filtration rate, which leads to salt and water retention. Because increased wall tension increases myocardial oxygen requirements, it can produce noncompensatory ischemia and further impairment of cardiac function.
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes? A. Peripheral vascular resistance B. Rigidity of the ventricular walls C. Electrical impulses in the heart D. Release of stress hormones
A. Peripheral vascular resistance Response Feedback: The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.
A father experienced the onset of chest pain and dies suddenly. The family asks, "What caused him to die so suddenly?" The health care provider's reply that is most appropriate would be, "There's a high probability that your loved one developed an acute heart attack and experienced: A. High troponin levels." B. Acute ventricular arrhythmia. C. Hypertrophic cardiomyopathy." D. Acute myocarditis."
B. Acute ventricular arrhythmia. Response Feedback: Sudden death from an acute myocardial infarction in an adult is usually caused by fatal (ventricular) arrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in the young, since the disorder can be inherited as an autosomal dominant trait. Troponin is normally present in cardiac muscle; serum levels of troponin enzymes are diagnostic and will elevate within 3 hours of the acute event. Myocarditis is inflammation of the heart muscle and conduction system without evidence of myocardial infarction.
Which of the following is a non-modifiable risk factor for the development of primary hypertension? A. High salt intake B. African American race C. Obesity D. Smoking
B. African American race Response Feedback: Hypertension not only is more prevalent in blacks than whites, but also is more severe, tends to occur earlier, and often is not treated early enough or aggressively enough. Blacks also tend to experience greater cardiovascular and renal damage at any level of pressure. High salt intake and obesity are modifiable risk factors for hypertension. Male gender is not identified as a risk factor for hypertension.
The most important complication of atherosclerosis that may cause occlusion of small heart vessels is: A. Ulceration B. Thrombosis C. Fatty streaks D. Fibrous plaque
B. Thrombosis Response Feedback: Thrombus formations on complicated atherosclerotic lesions are the result of sluggish blood flow and turbulence in the ulcerated plaque region. Fatty streaks are preatherosclerotic plaque changes in vessels. Fibrous plaque is part of the atherosclerosis formation, not a complication of it.
Which of the following clients should most likely be assessed for orthostatic hypotension? A 78-year-old woman who has begun complaining of frequent headaches unrelieved by over-the-counter analgesics B.An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom C.A 65-year-old client whose vision has become much less acute in recent months and who has noticed swelling in her ankles D. A 42-year-old client who has a history of poorly controlled type 1 diabetes
B.An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom Response Feedback: Dizziness and syncope are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.
Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, "What does that mean?" The nurse will base her answer on which of the following physiologic principles? A. "You heart has been pumping your blood so hard, that the pressure has damaged your valves." B. "Your heart has enlarged, so naturally your valves had to enlarge as well." C. "You have a heart valve that is diseased." D. "You have been exposed to an infection that went into your bloodstream."
C. "You have a heart valve that is diseased." Response Feedback: Turbulence is often accompanied by vibrations of the blood and surrounding cardiovascular structures. Some of these vibrations are in the audible range and can be heard using a stethoscope. For example, a heart murmur results from turbulent flow through a diseased heart valve. The other distractors are not feasible.
Which of the following clients would be at high risk for developing primary varicose veins? Select all that apply. A. A new peritoneal dialysis client who has been utilizing a home machine and performing dialysis every evening beginning at 8 PM B. A Marathon runner who has completed three marathons in the past 3 months C. A 47-year-old waitress who works 12-hour shifts three or four times/week D. A 56-year-old male who has been immobile due to back surgery and has developed a deep vein thrombosis E. A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week
C. A 47-year-old waitress who works 12-hour shifts three or four times/week E. A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week Response Feedback: Prolonged standing and increased intra-abdominal pressure are important contributing factors in the development of primary varicose veins. Because there are no valves in the inferior vena cava or common iliac veins, blood in the abdominal veins must be supported by the valves located in the external iliac or femoral veins. Immobility may cause DVTs (a secondary cause of varicose veins). Peritoneal dialysis has no effect on the development of varicose veins.
If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? A. Complete cardiac standstill B. Heart rate 150 beats/minute, labeled as supraventricular tachycardia C. Slowing of heart rate to below 60 beats/minute D. Disorganized ventricular fibrillation
C. Slowing of heart rate to below 60 beats/minute Response Feedback: Acetylcholine, the parasympathetic neurotransmitter released during vagal stimulation of the heart, slows down the heart rate by decreasing the slope of phase 4. The catecholamines, the sympathetic nervous system neurotransmitters epinephrine and norepinephrine, increase the heart rate by increasing the slope or rate of phase 4 depolarization. Fibrillation is the result of disorganized current flow within the ventricle (ventricular fibrillation). Fibrillation interrupts the normal contraction of the atria or ventricles. In ventricular fibrillation, the ventricles quiver but do not contract. Thus, there is no cardiac output, and there are no palpable or audible pulses (i.e., cardiac standstill).
When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents: A. The amount of blood pumped out of the heart with each beat B. Strength of the right ventricular pump to move blood\ C. The amount of blood the heart pumps each minute D. The volume of blood stretching the heart muscle at the end of diastole
C. The amount of blood the heart pumps each minute Response Feedback: Cardiac output, which is the major determinant of cardiac performance, reflects how often the heart beats each minute (heart rate) and how much blood it ejects with each beat (stroke volume). Preload reflects the volume of blood that stretches the ventricle at the end of diastole, just before the onset of systole.
A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client: A. "Your ventricular muscle is getting too stiff to beat normally." B. "You need to increase the amount of exercise you do to get your heart muscle back in shape." C. "This means you have a lot of pressure built-up inside your heart." D. "This means your heart is not pumping as much blood out of the heart with each beat."
D. "This means your heart is not pumping as much blood out of the heart with each beat." Response Feedback: Ejection fraction is the percentage of diastolic volume ejected from the heart [left ventricle] during systole. Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level.
The most common causes of left-sided heart failure include: A. Tricuspid valve regurgitation B. Chronic pulmonary disease C. Impaired renal blood flow D. Acute myocardial infarction
D. Acute myocardial infarction Response Feedback: The most common causes of left-sided heart failure are acute myocardial infarction and hypertension. Acute or chronic pulmonary disease can cause right heart failure, referred to as cor pulmonale. The causes of right-sided heart failure include stenosis or regurgitation of the tricuspid or pulmonic valves, right ventricular infarction, and cardiomyopathy. Manifestations (rather than causes) of heart failure reflect the physiologic effects of the impaired pumping ability of the heart, including decreased renal blood flow.
The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the mid calf area. He has many of the manifestations of: A. Stasis ulcerations B. Arterial insufficiency C. Primary varicose veins D. Deep vein thrombosis
D. Deep vein thrombosis Response Feedback: Venous insufficiency with deep vein thrombus formation is characterized by discoloration, edema, pain, tenderness, and warmth most commonly in the mid- or lower calf area of the legs. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present.
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 of the following disorders was the player's most likely cause of death? A. Takotsubo cardiomyopathy B. Dilated cardiomyopathy (DCM) C. Arrhythmogenic right ventricular cardiomyopathy-dysplasia (ARVC/D) D. Hypertrophic cardiomyopathy (HCM)
D. Hypertrophic cardiomyopathy (HCM) Response Feedback: 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 arrhythmias 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.
Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by: A. Left ventricle hypertrophy B. Myocardial inflammation C. Chronic atrial fibrillation D. Vegetative valve destruction
D. Vegetative valve destruction Response Feedback: Murmurs are sounds produced by blood flow through incompetent valves. Both infective endocarditis and carditis of rheumatic heart disease are characterized by growth of vegetation on valve leaflets, causing destruction, regurgitation, and murmur. Atrial fibrillation is a conduction disorder that impairs atrial emptying rather than valve function. Myocardial inflammation is present but does not cause murmurs. Valve dysfunctions can chronically decrease emptying and lead to left ventricular hypertrophy.
A male client with a history of angina has presented to the emergency department with uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle? A. Atrial depolarization B. Depolarization of the AV node C. Ventricular depolarization D. Ventricular repolarization
D. Ventricular repolarization Response Feedback: The T wave on electrocardiography (ECG) corresponds to ventricular repolarization. Atrial depolarization is represented by the P wave and ventricular depolarization by the QRS complex. The isoelectric or zero line between the P wave and the Q wave represents depolarization of the AV node, bundle branches, and Purkinje system.
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 of the following explanations is most appropriate to share? A. "Since your heart function is impaired, the lungs are not able to oxygenate the blood and your kidneys are wearing out." B."Your heart muscle is overstretched, so it's not able to pump all the blood out. The prescribed 'water pills' help by decreasing your weight." C. "You must be drinking way too many liquids. Your kidneys cannot filter all that you are drinking during the day." D."Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."
D."Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water." Response Feedback: In heart failure with a reduced ejection fraction, a decrease in cardiac output and renal blood flow leads to increased sodium and water retention by the kidney with a resultant increase in vascular volume and venous return to the heart and an increase in ventricular end-diastolic volume. Drinking water may increase volume but is not the physiological reason for retention of fluid. Diuretics do decrease weight as a result of diuresis, but weight loss is not the purpose for giving diuretics. The lungs are not the primary cause of heart failure.