Chapter 24 patho

A client calls the clinic reporting that painful indigestion cannot be alleviated and asks the nurse what to do. Before answering the client, which information should the nurse consider? 1 The client may be having a myocardial infarction. 2 The client activated the parasympathetic nervous system. 3 The client probably became dehydrated from gastric distress. 4 The client needs to deep breathe to get oxygen to the tissues.

1

A client has atherosclerosis. Upon reviewing the findings (see chart), the nurse considers which goal to be the priority? 1 Control of diabetes 2 Smoking cessation 3 Hypertension management 4 Medication for total cholesterol

1

A client has deep vein thrombosis. Which action will the nurse take? 1 Administer heparin 2 Prepare for sclerotherapy 3 Prepare for vein stripping 4 Administer oral contraceptives

1

A client who is diagnosed with infective endocarditis asks the nurse, "I was told that these strange lines in my fingernails are splinter hemorrhages. How could a heart infection cause me to get splinters? I haven't been working with wood." Which information by the nurse is best? 1 Owing to the infection in your heart, little pieces of fibrin and bacteria can break off and circulate in the blood. If they land in the nail beds, they can look like splinters. 2 Sometimes an infection elsewhere in your body can move to the heart and create infective endocarditis. Splinter hemorrhages are a sign of fingernail infection. 3 Because you have infective endocarditis, your immune system has been activated and can attack your nail beds inappropriately. That makes them look like you have splinters. 4 Having a heart infection can cause people to be restless from lack of oxygen. Maybe you have been rubbing your fingers on the underside of the table without realizing it.

1

A nurse administered a medication that will reduce preload in a client with left-sided heart failure. Which medication classification did the nurse give? 1 Diuretics 2 Beta-blockers 3 Corticosteroids 4 Calcium channel blockers

1

A nurse is caring for a client with a condition that causes the left atrium to work harder during systole. The nurse is caring for which client? 1 A client with mitral stenosis 2 A client with aortic stenosis 3 A client with tricuspid stenosis 4 A client with pulmonary stenosis

1

In a client who has coronary artery disease, which arteries are affected? 1 Heart arteries 2 Cerebral arteries 3 Capillary arteries 4 Peripheral arteries

1

In a client with mitral stenosis, cardiac catheterization findings would indicate increased pressure in which heart chamber? 1 Left atrium 2 Right atrium 3 Left ventricle 4 Right ventricle

1

Which blood pressure reading from an adult client would the nurse report as normal? 1 110/70 2 120/80 3 130/90 4 140/100

1

Which client is most at risk for multiple organ dysfunction syndrome (MODS)? 1 A woman with septic shock 2 A man with an autoimmune disease 3 A woman with a myocardial infarction 4 A man with chronic pulmonary disease

1

Which pathophysiologic change will the nurse expect in a client with left ventricular failure when the renin-angiotensin-aldosterone system (RAAS) is activated? 1 Increased plasma volume 2 Decreased cardiac oxygen demand 3 Decreased systemic vascular resistance 4 Increased pulmonary capillary permeability

1

Which piece of equipment should the nurse obtain to best monitor a client with complicated hypertension for early signs of impending renal dysfunction? 1 Urine test kit 2 Stethoscope 3 Pulse oximeter 4 Blood pressure cuff

1

Which heart valves should the nurse monitor because they are the most commonly affected in valvular dysfunction? Select all that apply. 1 Mitral 2 Aortic 3 Pulmonic 4 Tricuspid 5 Myocardium

1, 2

A nurse teaches a group of clients about the known causes of infective endocarditis. Which information indicates teaching was successful? Select all that apply. 1 Fungi 2 Parasites 3 Rickettsia 4 Autoimmunity 5 Myocardial ischemia

1, 2, 3

A client has high blood pressure. The nurse will teach the client which lifestyle modifications? Select all that apply. 1 Weight loss 2 Exercise program 3 Medication therapy 4 Dietary modifications 5 Increased sodium intake

1, 2, 4

A client develops an acute arterial occlusion in an extremity from peripheral artery disease. Which finding will the nurse observe upon assessment? 1 The limb will be swollen, reddish, warm, and numb. 2 The limb will be pale, without pulses, and severely painful. 3 The limb will be painful upon ambulation (intermittent claudication). 4 The limb will be normal except for dilated tortuous veins and aching.

2

A client had myocardial cells temporarily deprived of blood supply. Which term should the nurse use to describe this condition during report? 1 Infarction 2 Ischemia 3 Dyslipidemia 4 Peripheral artery disease

2

A client has a condition that causes blood to pool and produces distended, tortuous, and palpable vessels. Which condition will the nurse observe written on the chart? 1 Thrombus 2 Varicose veins 3 Venous stasis ulcers 4 Deep vein thrombosis

2

A client has inflammation of the myocardium. The nurse should use which term to describe this condition? 1 Carditis 2 Myocarditis 3 Pericarditis 4 Endocarditis

2

A client is diagnosed with secondary hypertension. The nurse will focus on which goal? 1 Reduction of high sodium intake 2 Management of an underlying disorder 3 Reduction of prolonged primary hypertension 4 Management of genetics plus environmental factors

2

A nurse is teaching a group of healthy people about reducing the risk of cardiovascular disease. Which information is most important? 1 Eating less meat 2 Cessation of smoking 3 Administration of blood products 4 Increasing exercise from mild to moderate

2

Which client is at risk for atherosclerosis from endothelial dysfunction? 1 A woman with anemia 2 A young man who smokes cigarettes 3 A young woman with a vitamin K deficiency 4 A man whose preferred form of exercise is contact sports

2

Which client is most predisposed to a fat embolism? 1 A client with a bacterial infection 2 A client with trauma to a long bone 3 A client undergoing labor and delivery 4 A client undergoing intravenous (IV) therapy

2

Which information indicates a nurse has an accurate understanding of a dissecting aneurysm? 1 A tear that is discovered during an autopsy 2 A tear that causes blood to enter the artery wall 3 An aneurysm that is an extravascular hematoma 4 An aneurysm that balloons out on one side of the artery

2

Which laboratory result will alert the nurse that the client is at risk for development of fatty streaks in atherosclerosis? 1 Decreased levels of highly sensitive C-reactive proteins 2 Increased levels of low-density lipoproteins (LDLs) 3 Increased levels of high-density lipoproteins (HDLs) 4 Decreased levels of serum fibrinogen levels

2

A nurse is teaching a group of clients about modifiable risk factors for coronary artery disease. Which factors should the nurse include? Select all that apply. 1 Advanced age 2 Atherogenic diet 3 Cigarette smoking 4 Lack of physical activity 5 Family history of hypertension

2, 3, 4

A nurse is teaching a client with Raynaud disease to prevent vasospastic attacks. Which conditions will the nurse advise the client to avoid? Select all that apply. 1 Tropical areas 2 Cold exposure 3 Wearing gloves 4 Emotional stress 5 Warm water immersion

2, 4

A client has chronic venous insufficiency. Which intervention will the nurse implement? 1 Avoid exercising 2 Keep legs dependent 3 Apply compression stockings 4 Ambulate with tight-fitting shoes

3

A client has heart failure. Which laboratory result should the nurse check to determine the severity of the heart failure? 1 Bilirubin 2 Differential count 3 B-type natriuretic peptide 4 Lumbar puncture findings

3

A client has hypertrophic obstructive cardiomyopathy. Which piece of equipment should the nurse prepare to detect the primary cause of sudden cardiac death? 1 Reflex hammer 2 Oral thermometer 3 Electrocardiogram 4 Blood pressure cuff

3

A client has ventricular fibrillation. Which information indicates the nurse has a good understanding of the pathophysiologic effect of ventricular fibrillation? 1 This rhythm causes premature contractions. 2 This rhythm creates a heart block of the atria. 3 This rhythm results in no cardiac output from the heart. 4 This rhythm is a serious problem but is not life-threatening.

3

A client is diagnosed with aortic stenosis. Which chamber of the heart will the nurse monitor most closely? 1 Left atrium 2 Right atrium 3 Left ventricle 4 Right ventricle

3

A client with peripheral artery disease reports pain with ambulation. How should the nurse communicate this finding during shift report? 1 The client has emboli in leg vessels. 2 The client has Raynaud phenomenon. 3 The client has intermittent claudication. 4 The client has experienced a traumatic injury.

3

A coworker asks the nurse how myocardial ischemia is usually reversible within 20 minutes of interruption of coronary blood flow. What information should the nurse consider before answering? 1 The heart stores approximately 20 minutes' worth of oxygen supply in the myoglobin. 2 It takes 20 minutes for neutrophils and macrophages to arrive and activate inflammation. 3 Anaerobic metabolism maintains myocardial cell integrity for approximately 20 minutes. 4 Normal collateral blood flow to the myocardium can maintain the myocardium for 20 minutes.

3

A healthy individual stands up suddenly. What effect does the nurse expect when the baroreceptor reflex is activated? 1 Increased heart rate and vasodilation 2 Decreased heart rate and vasodilation 3 Increased heart rate and vasoconstriction 4 Decreased heart rate and vasoconstriction

3

A nurse is asked by a client about a silent myocardial infarction. What is the nurse's best response to define a silent myocardial infarction? 1 A heart attack that causes rapid death 2 A heart attack that occurs at the same time as a stroke 3 A heart attack that occurs without the person experiencing pain 4 A heart attack that occurs before the person is able to call for help

3

A nurse is caring for a client with a broken right lower tibia on which a cast will be placed in a few minutes. The client has a history of left heart failure that has been well managed with medications. Which assessment findings does the nurse recognize as a potential exacerbation of the client's left heart failure that should be communicated to the client's primary healthcare provider? 1 Pulse: 82 beats per minute; "My heart is pounding." 2 Blood Pressure: 140/80; toes warm to touch bilaterally 3 Lung sounds: crackles and moist cough; "I can't catch my breath." 4 Right ankle 3+ pitting edema; pedal pulse slightly palpable on right

3

A nurse plans to teach the staff about an embolism. Which information should the nurse include in the teaching plan? 1 The source of embolism in the veins is the heart. 2 Pulmonary emboli typically originate in the left heart. 3 Serious consequences include myocardial infarction and stroke. 4 Air, fat, and foreign matter can cause embolism, but not bacteria.

3

The nurse teaches a client about arteriosclerosis. Which information from the client indicates teaching was effective? 1 The plaque is caused by neutrophils. 2 Fatty streaks and foam cells are identical. 3 Arteriosclerosis involves thickening and hardening of the vessel wall. 4 Arteriosclerosis results from an acute process of heart muscle degeneration.

3

When teaching a client, which diagram will the nurse use (see pictures) to provide the best illustration of hypertrophic cardiomyopathy? 1 3681141543 2 3681141544 3 3681141545 4 3681141546

3

Which information indicates the nurse has an accurate understanding of multiple organ dysfunction syndrome (MODS)? 1 MODS is another term for sepsis. 2 Mortality rate for MODS is generally low. 3 An uncontrolled inflammatory response can trigger MODS. 4 MODS is the progressive dysfunction of one organ system.

3

Which information indicates the nurse has the best understanding of cardiac tamponade? 1 This is when the venous return is too low to fill the heart. 2 This is when pericardial isoenzymes cause pericardial pain and hypotension. 3 This is when the heart is compressed externally and is unable to fill adequately. 4 This is when a myocardial infarction causes death of most of the left ventricle wall.

3

Which information should the nurse include when teaching about the most frequent cause of infective endocarditis? 1 Viral infection 2 Fungal infection 3 Bacterial infection 4 Autoimmune infection

3

Which intervention is the priority for a client with Buerger disease? 1 Reduction of blood pressure 2 Administration of vasodilators 3 Cessation of cigarette smoking 4 Dependent positioning of the feet

3

Which pathophysiologic mechanism should the nurse remember when planning care for a client with neurogenic shock? 1 There is massive activation of the immune system. 2 There is decreased parasympathetic nervous stimulation. 3 There is sympathetic understimulation of vascular smooth muscle. 4 There is a release of vasodilatory mediators such as histamine into the circulation.

3

A 6-year-old client presents with polyarthritis, and the parents report no medical history except for a sore throat 4 weeks ago. On physical examination, a murmur is noted. Which diagnosis is supported by the assessment data? 1 Lyme disease 2 Reiter syndrome 3 Rheumatoid arthritis 4 Acute rheumatic fever

4

A client has chronic venous insufficiency. Which area should the nurse assess first? 1 Head 2 Trunk 3 Nervous system 4 Lower extremities

4

A client has hypertension from renal disease. Which type of hypertension should the nurse report to the oncoming shift? 1 Primary 2 Idiopathic 3 Orthostatic 4 Secondary

4

A client has left heart failure. The nurse wants to know the severity of the disease. Which laboratory result should the nurse check? 1 Bleeding time 2 Platelet count 3 White blood cell count 4 Brain natriuretic peptide

4

A client has pericardial effusion. What primary pathophysiologic process will the nurse consider while planning care? 1 This is a type of cardiomyopathy. 2 This is caused by cardiac tamponade. 3 This is inflammation of the heart valves. 4 This is collection of fluid in the pericardial sac.

4

A client presents to the clinic after eating peanuts. The nurse should monitor the client for which type of shock? 1 Septic 2 Neurogenic 3 Cardiogenic 4 Anaphylactic

4

A client presents with chest pain that occurs at rest, and abnormal vasospasm of the coronary arteries is detected. The nurse will most likely observe which diagnosis on the chart? 1 Stable angina 2 Silent ischemia 3 Angina pectoris 4 Prinzmetal angina

4

The nurse cares for a client with deep vein thrombosis (DVT) in the lower leg. Which clinical manifestation would the nurse observe upon assessment? 1 Muscle paralysis 2 Reduced pulses in the foot 3 Skin pallor near the thrombus 4 Pain and edema in the affected limb

4

The nurse plans care for a client with an elevated troponin level. Which action by the nurse is most appropriate? 1 Decrease dietary intake of troponin 2 Increase fluid volume intake to prevent hypovolemic shock 3 Elevate lower extremities to reduce the formation of edema 4 Reduce myocardial oxygen demand by having the client rest in bed

4

The nurse teaches a client about mitral valve prolapse syndrome. Which information from the client indicates teaching was effective? 1 The mitral valve is absent from birth. 2 The mitral valve is simultaneously hard and contracted. 3 The mitral valve closes prematurely, reducing blood flow. 4 The mitral valve balloons back into the left atrium during contraction.

4

Which client is at greatest risk for a pulmonary embolism? 1 A woman with varicose veins 2 A man with atherosclerosis 3 A young adult with Raynaud disease 4 An elderly client with deep vein thrombosis

4

Which client is most predisposed to superior vena cava syndrome? 1 A client with metastasis 2 A client with lymphoma 3 A client with tuberculosis 4 A client with bronchogenic cancer

4

Which condition could indicate to the nurse that the client is experiencing one sign of systemic inflammatory response syndrome (SIRS)? 1 Temperature 37°C 2 Respiratory rate 16 3 Heart rate less than 60 beats/min 4 White blood cell count greater than 12,000 cells/mm3

4

Which information should the nurse include when teaching a client about a percutaneous coronary intervention (PCI)? 1 A laser will be used to fix a heart vessel. 2 A vein from the leg will be placed in the heart. 3 A medication will be injected into the heart chamber. 4 A narrow coronary vessel will be opened up with a catheter.

4

Which type of shock should the nurse assess for in a client with uncontrolled massive bleeding? 1 Septic 2 Neurogenic 3 Cardiogenic 4 Hypovolemic

4