Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock

A client asks the purpose of an exercise stress test. What is the nurse's best response? A) "The test is used to measure functional status during stress." B) "This test is necessary prior to starting medication therapy for obesity." C) "This is to assess your tolerance of isometric exercise." D) "This will help you endure exercise."

A) "The test is used to measure functional status during stress."

The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition? A) "I should begin an aerobic exercise program." B) "I should report episodes of dizziness or fainting." C) "I should limit my daily alcohol ingestion to two drinks." D) "I should take my verapamil at the same time every day."

B) "I should report episodes of dizziness or fainting."

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: A) 60 mL/hour B) 20 mL/hour C) 80 mL/hour D) 40 mL/hour

B) 20 mL/hour

A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing: A) Acute respiratory distress syndrome (ARDS) B) Onset of STEMI C) Gastroesophageal reflux disease (GERD) D) Pneumonia

B) Onset of STEMI

The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock? A) Anaphylactic shock B) Septic shock C) Hypovolemic shock D) Cardiogenic shock

B) Septic shock

A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect? A) Reduction of cardiac refractory periods B) Increased preload C) Vasodilating effects reducing preload and afterload D) Decreased heart rate and increased stroke volume

C) Vasodilating effects reducing preload and afterload

Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: A) red thrombus. B) vessel wall injury. C) large lipid core. D) calcified lesion.

C) large lipid core.

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are prescribed by the health care provider. Which intervention should the nurse complete first? A) Complete a 12-lead electrocardiogram (ECG). B) Administer diphenhydramine. C) Start a normal saline infusion. D) Administer epinephrine (adrenaline).

D) Administer epinephrine (adrenaline).

A nurse educator explains a type of cardiac condition as "a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation and often lead to cardiovascular death or progressive heart failure." Which condition fits this definition? A) Rheumatic cardiac disease B) Myocardial infarction C) Heart failure D) Cardiomyopathy

D) Cardiomyopathy

Which of the following describes surgical correction of tetralogy of Fallot? A) Resection of the narrowed segment of the aorta and end-to-end anastomoses of healthy tissue B) An arterial switch procedure C) Redirection of systemic venous return to the pulmonary arteries D) Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction

D) Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction

In teaching a pregnant client, the nurse informs the client that fetal heart development begins during which week after conception? A) Fetal development begins immediately after conception. B) Fetal cardiac development begins in the second week. C) Fetal cardiac development begins in the fifth week. D) Fetal heart development occurs between the third and eighth week.

D) Fetal heart development occurs between the third and eighth week.

What should the nurse teach the client prior to ergometry? A) "This test evaluates cardiac function." B) "Do not eat prior to having this test." C) "You must be able to jog to do this test." D) "This is an invasive test."

A) "This test evaluates cardiac function."

Which client should most benefit from treatment with anti-thrombin agents? A) 57-year-old client who has recently been diagnosed with unstable angina B) 29-year-old client who developed endocarditis by injecting with a dirty needle C) Young client diagnosed with hypertrophic cardiomyopathy (HCM) D) Client who was thought to have had an MI but who was later diagnosed with pericarditis

A) 57-year-old client who has recently been diagnosed with unstable angina

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: A) improving quality of life by relieving symptoms. B) maintaining higher oxygen levels to decrease the work of breathing. C) eliminating CHF through curing the disease. D) placing a stent for fluid drainage from the heart.

A) improving quality of life by relieving symptoms.

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which statement demonstrates an accurate understanding of his new diagnosis? A) "I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on." B) "I'm trying to think of ways that I can cut down the amount of salt that I usually eat." C) "I'll be sure to take my beta-blocker whenever I feel short of breath." D) "I'm going to avoid as much physical activity as I can so that I preserve my strength."

B) "I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

A client awaiting a heart transplant is experiencing decompensation of the left ventricle that will not respond to medications. The health care provider (HCP) suggests placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. Which response most accurately describes the purpose of a VAD? A) "Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure." B) "Measures the pressures inside your heart continuously to asses pumping ability of your left ventricle." C) "Has a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." D) "Pulls your blood from the right side of the heart and runs it through a machine to oxygenate it better, and then return it to your body."

A) "Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

The nurse knows that mean arterial pressure is: A) 60% of diastolic pressure and 40% of systolic pressure B) Systolic pressure alone C) 50% of diastolic pressure and 50% of systolic pressure D) Diastolic pressure alone

A) 60% of diastolic pressure and 40% of systolic pressure

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 hemodynamic consequences? A) Backflow from the left ventricle to left atrium B) Inhibition of the SA node's normal action potential C) Backflow from the right ventricle to the right atrium during systole D) Backup of blood from the right atrium into the superior vena cava

A) Backflow from the left ventricle to left atrium

The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which blood pressure finding can be characteristic of this condition? A) Blood pressure in arms 20 mm Hg higher than in the legs B) Prominent femoral pulses C) Blood pressure in legs 20 mm Hg higher than in the arms D) Widened pulse pressure in the legs

A) Blood pressure in arms 20 mm Hg higher than in the legs

What should the nurse teach the pregnant woman about congenital heart defects? A) Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant. B) Congenital heart defects cannot be prevented. C) Congenital heart defects occur during conception. D) Congenial heart defects occur prior to conception as a result of exposure to toxins.

A) Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant.

A client brought to the emergency department has preeclampsia. The nurse knows that this disorder can progress to include which complications? Select all that apply. A) Hepatic failure B) Renal failure C) Disseminated intravascular coagulation (DIC) D)Elevated platelet count E) Cerebral hemorrhage

A) Hepatic failure B) Renal failure C) Disseminated intravascular coagulation (DIC) E) Cerebral hemorrhage

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells? A) Hypertrophy B) Atrophy C) Hyperplasia D) Dysplasia

A) Hypertrophy

When the electrocardiogram (ECG) of a client in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta-adrenergic blocker. Which factors in the client's history will cause the nurse to withhold medication pending discussion with physician? Select all that apply. A) Myocardial infarction caused by cocaine use B) Shock C) Hypertension D) Third-degree heart block E) Cerebrovascular accident

A) Myocardial infarction caused by cocaine use B) Shock D) Third-degree heart block

An older adult 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: A) blocking the conversion of angiotensin I to angiotensin II. B) enhancing inotropy by maximizing calcium channel function. C) selectively blocking the synthesis of renin in the kidneys. D) promoting cardiac output through a reduction in afterload.

A) blocking the conversion of angiotensin I to angiotensin II.

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by: A) recording weight every day at the same time with same type of clothing. B) taking blood pressure daily and calling the physician if it is decreased. C) measuring his or her urine output daily to check for a decrease in output. D) listening to the breath sound with a stethoscope every morning.

A) recording weight every day at the same time with same type of clothing.

A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock? A) Neurogenic B) Anaphylactic C) Septic D) Cardiogenic

B) Anaphylactic

A client who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which manifestation alerts the nurse to a developing complication? A) Diarrhea B) Decreased level of consciousness C) Symmetrical joint pain D) Hypoglycemia

B) Decreased level of consciousness

A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure? A) Dilated cardiomyopathy B) Hypertrophic cardiomyopathy C) Atrial regurgitation D) Mitral valve prolapse

B) Hypertrophic cardiomyopathy

Which statement regarding heart failure is true? A) The most common cause of congestive heart failure is angina pectoris. B) In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction. C) The most common cause of left-sided heart failure is right-sided heart failure. D) The edema of right-sided heart failure is associated with low plasma osmotic pressure.

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

A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man? A) Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility. B) Infusion of normal saline or Ringer's lactate to maintain the vascular space. C) Resolution of compensatory pulmonary edema and heart dysrhythmias. D) Administration of oxygen and epinephrine to promote perfusion.

B) Infusion of normal saline or Ringer's lactate to maintain the vascular space.

A newborn is diagnosed with Tetralogy of Fallot. Prior to surgery, which abnormality should be corrected to prevent a stroke? A) Weight of 3200 grams B) Iron deficiency anemia C) Frequent liquid-pasty stools D) Urine output 8 times/day

B) Iron deficiency anemia

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: A) Yearly electrocardiography after the age of 50 B) Prompt diagnosis and treatment of streptococcal infections C) Annual blood specimen assessed for rheumatoid factor D) Avoiding frequent dental examinations

B) Prompt diagnosis and treatment of streptococcal infections

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? A) Placing a pulse oximeter on the client to monitor oxygenation status B) Raising the head of the bed to a high Fowler's position C) Inserting an IV to begin a normal saline infusion D) Administration of 2L of oxygen by nasal cannula

B) Raising the head of the bed to a high Fowler's position

A client 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: A) Valvular stenosis B) Valvular regurgitation C) Infective endocarditis D) Pericardial effusion

B) Valvular regurgitation

Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium? A) acute pericarditis B) constrictive pericarditis C) pleural effusion D) mediastinal radiation

B) constrictive pericarditis

A client in circulatory shock may experience which damaging effect(s) at the cellular level caused by lack of oxygen supply? Select all that apply. A) decreased lysosomal enzyme release B) impaired cellular production of adenosine triphosphate (ATP) C) deranged sodium/potassium balance D) cellular edema E)pyruvate converted to lactic acid

B) impaired cellular production of adenosine triphosphate (ATP) C) deranged sodium/potassium balance D) cellular edema E)pyruvate converted to lactic acid

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response? A) "I'll teach you some strategies to minimize its effect on your life, and minor surgery to open up your blood vessels will help too." B) "This likely won't have a huge effect on your quality of life and I'll prescribe anti-clotting drugs to prevent attacks." C) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation." D) "You need to make sure you never start smoking, and most of the symptoms can be alleviated by regular physical activity."

C) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve? A) Electrical conductivity B) Parasympathetic system C) Compensatory mechanisms D) Aortic hypertrophy

C) Compensatory mechanisms

A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which reason? Select all that apply. A) To relieve anxiety B) For diuretic purposes C) For its vasodilation effect D) To relieve coronary pain

C) For its vasodilation effect D) To relieve coronary pain

The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states the blood is shunted to which part of the body? A) Left lung to the right lung B) Right side of the heart to the left side of the heart C) Left side of the heart to the right side of the heart D) Right lung to the left lung

C) Left side of the heart to the right side of the heart

Which client is at the greatest risk of developing rheumatic heart disease? A) Young adult with viral meningitis B) Child with impetigo on the face C) Teenager with untreated strep throat D) Older adult with shingles

C) Teenager with untreated strep throat

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to: A) give it 5-10 minutes more to see if there is relief. B) take a second nitroglycerine. C) see the doctor for evaluation immediately. D) not worry about it as this is common for someone who has already had a myocardial infarction.

C) see the doctor for evaluation immediately.

The nurse is preparing to auscultate for a mitral valve stenosis murmur. Where is the best location to place the stethoscope? A) At the carotid arteries B) Over the aorta C) Over the sternum D) At the apex of the heart

D) At the apex of the heart

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: A) Excessive endothelial relaxing factors B) Increased collateral circulation C) Intermittent vessel vasospasms D) Fixed coronary obstruction

D) Fixed coronary obstruction

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: A) Intermittent vessel vasospasms B) Increased collateral circulation C) Excessive endothelial relaxing factors D) Fixed coronary obstruction

D) Fixed coronary obstruction

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications? A) Antianxiety drugs B) Broad-spectrum antibiotic drugs C) Calcium-channel blocking drugs D) beta-adrenergic blocking drugs (beta-blockers)

D) beta-adrenergic blocking drugs (beta-blockers)