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

A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be: "Aspirin will help prevent blood clotting." "Aspirin prevents blood clotting by halting platelet production." "It will give you a steady relief of your chest pain." "Aspirin will prevent a heart attack."

"Aspirin will help prevent blood clotting." Aspirin (i.e., acetylsalicylic acid) is the preferred antiplatelet agent for preventing platelet aggregation in persons with ACS. Aspirin, which acts by inhibiting synthesis of the prostaglandin thromboxane A2, is thought to promote reperfusion and reduce the likelihood of re-thrombosis. This dose of aspirin is not appropriate for pain relief, and the final option does not demonstrate therapeutic communication.

A nurse educator is defining heart failure to a group of recent graduates who will begin providing care on a cardiac unit. The educator should describe which phenomenon? "Heart failure is a complex syndrome resulting from a lack of oxygen to the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion." "Heart failure is a complex syndrome resulting from any disorder of the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion." "Heart failure is a complex syndrome resulting in a structural disorder of the heart that ultimately results in pulmonary or systemic congestion." "Heart failure is a complex syndrome resulting from any functional or structural disorder of the heart that results in or increases the risk of infarction."

"Heart failure is a complex syndrome resulting from any disorder of the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion." Heart failure is a complex syndrome resulting from any functional or structural disorder of the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion. Disorders of oxygen delivery (ischemia, hypoxia) can cause MIs that will lead to HF but do not cause HF directly. Structural abnormalities will impede function but not cause failure.

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? "I'll be sure to take my beta-blocker whenever I feel short of breath." "I'm going to avoid as much physical activity as I can so that I preserve my strength." "I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on." "I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat." Salt and fluid restrictions are indicated for most clients with heart failure (HF). Beta-blockers do not address shortness of breath, and cardiac medications are not normally taken in response to acute symptoms. Clients should be encouraged to maintain—and increase, if possible—physical activity within the limits of their condition.

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 explanation is most appropriate to share? "You must be drinking way too many liquids. Your kidneys cannot filter all that you are drinking during the day." "Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water." "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." "Since your heart function is impaired, the lungs are not able to oxygenate the blood and your kidneys are wearing out."

"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water." 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 physiologic 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.

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: "Pull your blood from the right side of the heart and run it through a machine to oxygenate it better, and then return it to your body." "Measure the pressures inside your heart continuously to asses pumping ability of your left ventricle." "Have a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." "This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure." Refractory heart failure reflects deterioration in cardiac function that is unresponsive to medical or surgical interventions. Ventricular assist devices (VADs) are mechanical pumps used to support ventricular function. VADs are used to decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure. This decreases the workload on the ventricle and allows it to rest and recover. The rest of the distractors relate to the monitoring in an ICU of cardiac functioning. Invasive hemodynamic monitoring may be used for assessment in acute, life-threatening episodes of heart failure. With the balloon inflated, the catheter monitors pulmonary capillary pressures (i.e., pulmonary capillary wedge pressure or pulmonary artery occlusion pressure), which reflect pressures from the left ventricle. The pulmonary capillary pressures provide a means of assessing the pumping ability of the left ventricle. One type of pulmonary artery catheter is equipped with a thermistor probe to obtain thermodilution measurements of cardiac output.

A client who came to the emergency room and was diagnosed with ST-segment elevation myocardial infarction (STEMI) experienced "sudden death." The emergency room nurse explains sudden death from a STEMI as death that occurs within what time frame of symptom onset? 15 minutes 30 minutes 1 hour 2 hours

1 hour Sudden death from STEMI is death that occurs within one hour of symptom onset.

A client with a new diagnosis of heart failure has received a new prescription. Which medication category is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions? A beta-adrenergic blocker (beta-blocker) A diuretic A cardiac glycoside An ACE inhibitor

A cardiac glycoside Cardiac glycosides improve cardiac function by increasing the force and strength of ventricular contractions. Beta-adrenergic blockers decrease left ventricular dysfunction associated with activation of the sympathetic nervous system. ACE inhibitors block the conversion of angiotensin I to II, whereas diuretics promote the excretion of fluid.

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell? A stressful period right after birth that occurs without evidence of cyanosis A hyperoxygenated period when the infant is at rest A hypercyanotic attack brought on by periods of stress A hyperpneic attack in which the infant loses consciousness

A hypercyanotic attack brought on by periods of stress The degree of obstruction may be dynamic and can increase during periods of stress causing hypercyanotic attacks ("tet spells"). None of the other answers occur in association with tetralogy of Fallot or tet spells.

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? Start a normal saline infusion. Administer epinephrine (adrenaline). Complete a 12-lead ECG. Administer diphenhydramine.

Administer epinephrine (adrenaline). Treatment includes immediate discontinuation of the inciting agent or institution of measures to decrease its absorption; close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion. Epinephrine is given in an anaphylactic reaction because it constricts blood vessels and relaxes the smooth muscle in the bronchioles, thus restoring cardiac and respiratory function.

A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child? Cardiac catheterization and corticosteroid therapy Implanted pacemaker and beta-adrenergic blockers (beta-blockers) Antibiotics and anti-inflammatory drugs Pain control and oxygen therapy

Antibiotics and anti-inflammatory drugs A diagnosis of rheumatic fever (RF) necessitates the use of antibiotics (usually penicillin) and anti-inflammatory drugs. These measures supersede the importance of pain control and oxygen therapy. Cardiac catheterization, corticosteroid therapy, pacemakers, and beta-adrenergic blockers are not common treatment modalities for RF.

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? Backup of blood from the right atrium into the superior vena cava Backflow from the right ventricle to the right atrium during systole Inhibition of the SA node's normal action potential Backflow from the left ventricle to left atrium

Backflow from the left ventricle to left atrium 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 to the intensive care unit suspected of having infective endocarditis. Which test is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client? ECG Blood culture Echocardiogram CBC

Blood culture The blood culture remains the most definitive diagnostic procedure and is essential to guide treatment. An echo, ECG, clinical findings, and lab information are also used to help in the diagnosis.

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

Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction The surgical treatment of tetralogy of Fallot would include the repair of the ventricular-septal defect and relief of the ventricular outflow obstruction. An arterial switch procedure is the treatment for transposition of the great arteries. Resection of the narrowed segment of the aorta is the treatment for coarctation of the aorta.

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

Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant. Congenital heart defects occur during the 3rd week as the heart is the first functional organ system to develop. This may be before a woman realizes she is pregnant. Congenital heart defects can, to some degree, be prevented. They do not occur prior to conception or during conception, but during the growth of the fetus.

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium? Acute pericarditis Constrictive pericarditis Pleural effusion Mediastinal radiation

Constrictive pericarditis In constrictive pericarditis, fibrous, calcified scar tissue develops between the visceral and parietal layers of the serous pericardium. Acute pericarditis is due to inflammation of the pericardium. Pericardial effusion is caused by accumulation of fluid and can lead to cardiac tamponade.

When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI? Conversion from aerobic to anaerobic metabolism Overproduction of energy capable of sustaining normal myocardial function Conversion from anaerobic to aerobic metabolism Inadequate production of glycogen with mitochondrial shrinkage

Conversion from aerobic to anaerobic metabolism The principal biochemical consequence of MI is the conversion from aerobic to anaerobic metabolism with inadequate production of energy to sustain normal myocardial function. As a result, a striking loss of contractile function occurs within 60 seconds of onset.

What are the physiologic clinical manifestations of cardiogenic shock? Select all that apply. Decrease in mean arterial blood pressures Increased urine output related to increased renal perfusion Rise in central venous pressure (CVP) Hypercapnic lips and nail beds Increased extraction of O2 from hemoglobin

Decrease in mean arterial blood pressures Rise in central venous pressure (CVP) Increased extraction of O2 from hemoglobin Signs and symptoms of cardiogenic shock include indications of hypoperfusion with hypotension, although a preshock state of hypoperfusion may occur with a normal blood pressure. The lips, nail beds, and skin may become cyanotic because of stagnation of blood flow and increased extraction of oxygen from the hemoglobin as it passes through the capillary bed. Mean arterial and systolic blood pressures decrease due to poor stroke volume, and there is a narrow pulse pressure and near-normal diastolic blood pressure due to arterial vasoconstriction. Urine output decreases due to lower renal perfusion pressures and the increased release of aldosterone. Elevation of preload is reflected in a rise in CVP and pulmonary capillary wedge pressure. Neurologic changes, such as alterations in cognition or consciousness, may occur due to low cardiac output and poor cerebral perfusion. The other physiologic occurrences are not signs or symptoms of shock.

In heart failure, what causes the increase in renal secretion of renin? Increased metabolic demand Decreased cardiac output Increased renal perfusion Hypertension

Decreased cardiac output Low cardiac output results in decreased renal perfusion, which activates the renin-angiotensin-aldosterone system (RAAS). The resultant vasoconstriction due to angiotensin II and the retention of sodium and water due to aldosterone attempt to support cardiac output. Hypertension and increased metabolic needs do not activate the RAAS.

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

Fixed coronary obstruction Chronic stable angina is caused by fixed coronary obstruction that produces an imbalance between coronary blood flow and the metabolic demands of the myocardium. Endothelial relaxing factors relax the smooth muscle in the vessel wall and allow increased blood flow; treatment for chronic stable angina is with a vasodilating agent, such as nitroglycerine, that relaxes the vessels and enhances coronary blood flow. Intermittent vessel vasospasms, in conjunction with coronary artery stenosis, cause the vasospastic type of angina. Increased formation of collateral vessels is a compensatory response that allows adequate blood circulation to tissues distal to an obstruction.

What is the most important factor in myocardial oxygen demand? Heart rate Respiratory rate Degree of anxiety Hyperthermia

Heart rate The heart rate is the most important factor in myocardial oxygen demand since, as heart rate increases, myocardial oxygen demands increase. The degree of effect the other options have on myocardial oxygen demand is related to how much effect they have on heart rate.

Anaphylactic shock causes severe hypoxia very quickly because of which reason? Generalized vasoconstriction reduces venous return. Metabolic rate is greatly increased. Histamine release causes massive vasodilation. Heart rate and contractility are reduced.

Histamine release causes massive vasodilation. Anaphylactic shock, a severe allergic reaction, rapidly causes severe hypoxia as histamine release results in massive vasodilation. The volume of blood is no longer able to fill the greatly dilated vascular compartment. The other answers are not part of anaphylaxis.

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? Hypertrophic cardiomyopathy Dilated cardiomyopathy Mitral valve prolapse Atrial regurgitation

Hypertrophic cardiomyopathy HCM is an autosomal dominant heart disease caused by mutations in the genes encoding proteins of the cardiac sarcomere. HCM is the most common cause of sudden cardiac death (SCD) in young athletes. Dilated cardiomyopathy, mitral valve prolapse, and atrial regurgitation all lead to heart failure but much later in life.

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 disorder was the player's most likely cause of death? Takotsubo cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) Hypertrophic cardiomyopathy (HCM) Dilated cardiomyopathy (DCM)

Hypertrophic cardiomyopathy (HCM) 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 dysrhythmias 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.

A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process? Pericarditis Myocardial infarction Infective endocarditis Cardiomyopathy

Infective endocarditis Infective endocarditis is a serious and potentially life-threatening infection of the inner surface of the heart. Pericarditis involves an inflammatory response of the pericardium. Myocardial infarction is a heart attack while cardiomyopathy is a heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorders.

A client diagnosed with septic shock who is experiencing tissue hypoxia likely will activate which pathophysiologic process? Inflammatory mediators Anaphylactic response Preexisting coagulation disorder Aerobic metabolism

Inflammatory mediators In sepsis and septic shock, tissue hypoxia produces continued production and activation of inflammatory mediators, resulting in further increases in vascular permeability, impaired vascular regulation, and altered hemostasis. Anaerobic metabolism is caused by tissue hypoxia, not aerobic. The other options do not facilitate the process.

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? Resolution of compensatory pulmonary edema and heart dysrhythmias. Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility. Infusion of normal saline or Ringer's lactate to maintain the vascular space. Administration of oxygen and epinephrine to promote perfusion.

Infusion of normal saline or Ringer's lactate to maintain the vascular space. Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock and can be achieved in the short term through intravenous administration of saline solution or Ringer's lactate. Resolution of pulmonary edema and heart dysrhythmias and infusion of vasodilators are associated with treatment of cardiogenic shock, while oxygen and epinephrine would address anaphylactic shock.

Increased secretion of renin in heart failure is caused by which event? Hypertension Increased renal blood flow Low cardiac output Dysrhythmias

Low cardiac output Low cardiac output reduces renal blood flow, which activates the renin-angiotensin-aldosterone system (RAAS). This system produces the vasoconstrictor angiotensin-ll and aldosterone, which increases sodium and water retention. Both of these actions attempt to increase renal perfusion. Hypertension and dysrhythmias do not activate RAAS.

A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have? Aortic valve prolapse Mitral valve prolapse Mitral valve stenosis Aortic valve stenosis

Mitral valve stenosis Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole, with left atrial distention and impaired filling of the left ventricle with associated symptoms. Mitral prolapse and aortic valve disorders will lead to the development of cardiomyopathies.

The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myocardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain? Demerol Morphine Fentanyl Codeine

Morphine Although a number of analgesic agents have been used to treat pain of myocardial infarction, morphine is the drug of choice and is usually indicated if chest pain is unrelieved with oxygen and nitrates.

A client has developed cardiogenic shock. The most frequent cause of this type of shock is: Hypertension Heart failure Myocardial infarction Allergic reaction

Myocardial infarction Cardiogenic shock is a loss of cardiac pumping ability. The most frequent cause of this shock is myocardial infarction, as ischemic damage greatly reduces left ventricular contractility.

In distributive shock, there are abnormalities in vascular resistance. Which types of shock display the same distributive pattern? Select all that apply. Neurogenic Cardiogenic Septic Hypovolemic Anaphylactic

Neurogenic Septic Anaphylactic In distributive shock, the capacity of the vascular compartment is greatly enlarged so that a normal blood volume becomes insufficient. In neurogenic shock, loss of sympathetic (adrenergic) control of blood vessels is lost and extreme vasodilation occurs. In anaphylactic shock, a severe allergic reaction, massive release of histamine induces extreme vasodilation. In septic shock, a response to severe infection, there is vascular dilation. Cardiogenic shock is a loss of ventricular contractility. Hypovolemic shock is a loss of blood volume.

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged, resulting in a pulmonary embolism. Which type of shock is this client at risk of experiencing? Cardiogenic shock Hypovolemic shock Obstructive shock Distributive shock

Obstructive shock Obstructive shock results from mechanical obstruction of the flow of blood through the central circulation, such as the blockage that characterizes a pulmonary embolism.

A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering? Pericarditis Myocardial infarction Pericardial effusion COPD

Pericardial effusion Pericardial effusion refers to the accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200 mL of fluid may raise intracardiac pressure to levels that will cause symptoms similar to right-sided heart failure. Pericarditis is inflammation of the pericardium while COPD is a respiratory disease.

A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have? Myocardial infarction Abdominal aortic aneurysm Pericarditis Pneumonia

Pericarditis This client is demonstrating signs and symptoms of pericarditis, which includes a triad of chest pain, pericardial friction rub, and EKG changes. Other signs are that the pain is usually abrupt in onset, occurs in the pericardial area, and may radiate to the neck, back, abdomen or side. It is usually worse with deep breathing and swallowing, and the person often finds relief when sitting up and leaning forward.

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis? Vertigo, headache Weakness, palpitations Dyspnea, cough Peripheral edema, weight gain

Peripheral edema, weight gain In right-sided heart failure, blood backs up into the venous side of the circulatory system causing increased hydrostatic pressure in capillaries and leakage of plasma, which forms peripheral edema and becomes apparent as weight gain. The other manifestations listed are not characteristic of right-sided failure.

A nurse is caring for a client with a new diagnosis of rheumatic fever. What is the highest priority goal of treatment during the acute phase? Prevent cardiac complications Reduce inflammation Eliminate the infection Promote nutrition

Prevent cardiac complications Rheumatic fever poses great risk to the client for long-term heart disease. Interventions to prevent cardiac complications include anti-inflammatories and antibiotics. Adequate nutrition is appropriate for healing but is not the highest priority goal.

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

Raising the head of the bed to a high Fowler's position Treatment measures include close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion; and the administration of oxygen, antihistamine drugs, and corticosteroids. The person should be placed in a supine position. This is extremely important because venous return can be severely compromised in the sitting position. This in turn produces a pulseless mechanical contraction of the heart and predisposes to arrhythmias. In several cases, death has occurred immediately after assuming the sitting position.

A teenager is seen in the emergency room with reports of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen 3 weeks before in the clinic and treated with antibiotics for strep throat. He was better for a few days but now he seems to have gotten worse in the last 2 days. What should the nurse suspect is wrong with this client? Flu Meningitis Rheumatic fever Mononucleosis

Rheumatic fever Rheumatic fever is an immune-mediated inflammatory disease that occurs a few weeks after a group A strep (sore throat). It can manifest as an acute, recurrent, or chronic disorder.

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock? Septic Neurogenic Cardiogenic Anaphylactic

Septic Septic shock can result with the body's response to a severe infection. Neurogenic shock is a loss of sympathetic (adrenergic) control of systemic blood vessel tone. Cardiogenic shock is a loss of cardiac efficiency, and anaphylactic shock is a severe allergic reaction.

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

Septic shock Septic shock is a subtype of distributive shock. The treatment of sepsis and septic shock focuses on control of the causative agent and support of the circulation and the failing organ systems. The administration of antibiotics that are specific for the infectious agent is essential. Swift and aggressive fluid administration is needed to compensate for third spacing, though which type of fluid is optimal remains controversial. Equally, aggressive use of vasopressor agents, such as norepinephrine or epinephrine, is needed to counteract the vasodilation caused by inflammatory mediators.

What is the primary cause of heart failure in infants and children? Idiopathic heart disease Structural heart defects Hyperkalemia Reactions to medications

Structural heart defects Structural (congenital) heart defects are the most common cause of heart failure in children.

The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes: T-wave changes Significant ST-segment elevation Deep Q waves Peaked T waves

T-wave changes Unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) is a clinical syndrome of myocardial ischemia ranging from angina to myocardial infarction. The ECG pattern associated with NSTEMI may display normal or ST-segment depression (or transient ST-segment elevation) and T-wave changes. The degree of ST-segment deviation from baseline is an important measure of ischemia and indicator of prognosis. Abnormal Q waves occur with ACS.

While studying the physiology of the heart, the nursing students have learned that which of the following influence the blood flow in the coronary vessels that supply the myocardium? Select all that apply. The aortic pressure Autoregulatory mechanisms Hypothalamus Compression of the intramyocardial vessels Thyroid gland

The aortic pressure Autoregulatory mechanisms Compression of the intramyocardial vessels Blood flow in the coronary vessels that supply the myocardium is influenced by the aortic pressure, the autoregulatory mechanisms, and compression of the intramyocardial vessels by the contracting heart muscle.

A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this client about diagnosing a valvular defect? An ECG can be done to rule out this disease. Blood work can help to diagnose a valvular defect. An MRI, which is more expensive, can be helpful in this diagnosis. Valvular defects usually are detected through cardiac auscultation.

Valvular defects usually are detected through cardiac auscultation. Although valvular heart disease can result from congenital defects, rheumatic heart disease, trauma and other causes, atrial stenosis is usually first diagnosed with auscultation of a loud systolic murmur or a single-split second heart sound. Other tests are not used initially.

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

Vasoconstriction Endothelins are secreted by many cell types, including the endothelial lining of the circulatory system. Clients with heart failure may have increased blood levels of endothelins as the body tries to compensate for a decrease in cardiac output. However, most actions of endothelins—for example, vasoconstriction and sodium and water retention—are counterproductive in heart failure.

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? Vasodilating effects reducing preload and afterload Decreased heart rate and increased stroke volume Increased preload Reduction of cardiac refractory periods

Vasodilating effects reducing preload and afterload Nitroglycerin produces its effects by releasing nitric oxide in vascular smooth muscle of the target tissues, resulting in relaxation of this muscle and increased blood flow. Nitroglycerin's effect on the vessels decreases venous return (reduce preload) and arterial blood pressure (reduce afterload). This drug does not decrease heart rate. Because it vasodilates, it decreases preload. Nitroglycerine does not affect cardiac refractory periods.

A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening? Weight gain Copious urination Shortness of breath Decreased blood pressure

Weight gain In right-sided heart failure, blood backs up into the venous system and increased capillary hydrostatic pressure forces plasma out of the circulatory system, resulting in edema. The accumulation of fluid is evidenced by rapid weight gain. Shortness of breath and decreased renal perfusion and output are characteristic of left-sided failure.

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? beta-adrenergic blocking drugs (beta-blockers) Calcium-channel blocking drugs Antianxiety drugs Broad-spectrum antibiotic drugs

beta-adrenergic blocking drugs (beta-blockers) Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with the beta-adrenergic blocking drugs. None of the other types of drugs are used in the treatment of mitral valve prolapse to relieve symptoms or prevent complications.

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: selectively blocking the synthesis of renin in the kidneys. blocking the conversion of angiotensin I to angiotensin II. enhancing inotropy by maximizing calcium channel function. promoting cardiac output through a reduction in afterload.

blocking the conversion of angiotensin I to angiotensin II. ACE inhibitors block the conversion of angiotensin I to angiotensin II. They do not directly affect renin synthesis, calcium channel function, or afterload.

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output. aortic hypertrophy compensatory mechanisms electrical conductivity parasympathetic system

compensatory mechanisms The pathophysiology of heart failure involves an interaction between two factors: a decrease in pumping ability of the heart with a consequent decrease in the cardiac reserve and the compensatory mechanisms that serve to maintain the cardiac output while also contributing to the progression of heart failure. Myocardial muscle hypertrophy has an important role in long-term adaptation to hemodynamic overload. Stimulation of the sympathetic nervous system plays an important role in the compensatory response to decreased cardiac output and to the pathogenesis of heart failure. Heart failure is a muscle contractility problem, unrelated to the electrical conduction that stimulates it.

A nurse is teaching a client with newly diagnosed dilated cardiomyopathy (DCM) about associated treatments. The nurse determines that the knowledge is understood when the client correctly matches which drug category to the primary action of decreasing preload by suppressing renal reabsorption of sodium and increasing salt and water excretion? diuretics angiotensin-converting enzyme (ACE) inhibitors calcium channel blockers beta-blockers

diuretics The treatment of DCM is directed toward relieving the symptoms of heart failure and reducing the work of the heart. Diuretics, such as the thiazides, loop diuretics, and the aldosterone antagonist (potassium-sparing) diuretics, lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing salt and water excretion), thereby decreasing preload and cardiac output. Although ACE inhibitors also lower the reabsorption of sodium and water by reducing the amount of circulating levels of aldosterone (through reducing the conversion of angiotensin 1 to angiotension 2), they also prevent vasoconstriction, so the effects on sodium and water retention is not this class of drug's only or primary effect. Calcium channel blockers prevent vasoconstriction as thier primary mechanism of actions, and beta-blockers primarily reduce cardiac output by reducing heart rate and contractility.

A nurse is concerned that a resident of a long-term care facility may be developing left-sided heart failure. The nurse would communicate which set of manifestations as possible evidence of left-sided heart failure? diarrhea, nausea, vomiting dyspnea, cough, fatigue fatigue, headache, weight loss weakness, slowed heart rate, confusion

dyspnea, cough, fatigue In left-sided heart failure, dyspnea and cough, especially when lying supine (orthopnea), results from increased pulmonary capillary pressures contributing to pulmonary congestion. Fatigue is common due to reduced cardiac output and inadequate tissue perfusion. A slowed heart rate, or bradycardia is not expected. Often the heart rate increases to compensate for the decrease in cardiac output. Weight gain due to fluid retention from the activation of renin-angiotensin-aldosterone is expected rather than weight loss. Although some gastrointestinal fullness may be experienced by some clients with heart failure, vomiting and diarrhea is not expected.

The nurse is assessing a client involved in a motor vehicle collision who has bruising across the sternum from seat belt pressure. The nurse notes muffled heart sounds, and the client's blood pressure is 100/85 mm Hg. The nurse notifies the health care provider to present these findings as evidence of which condition? cardiomyopathy pericarditis pulmonary hypertension pericardial effusion

pericardial effusion Pericardial effusion is the accumulation of fluid in the pericardial cavity and may develop with neoplasms, cardiac surgery, or trauma. Pericardial effusion presents with tachycardia, jugular venous distention, a fall in systolic blood pressure, narrowed pulse pressure (little difference between systolic and diastolic blood pressure), muffled heart sounds, and if tamponade develops, signs of circulatory shock. A friction rub (a sound resulting from rubbing between the inflamed pericardial surfaces) rather than muffled heart sounds is characteristic of acute pericarditis. Cardiomyopathy has many causes, but trauma is not one of them. Also, it does not result in muffled breath sounds or a narrow pulse pressure. Pulmonary hypertension results from respiratory or congenital disorders and is not associated with trauma and does not alter pulse pressure.

Assessment of an older adult client reveals bilateral pitting edema of the client's feet and ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation level of 93% (0.93); and vital signs normal. What is this client's most likely health problem? right-sided heart failure pericarditis cardiogenic shock cor pulmonale

right-sided heart failure A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and palpitations.

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

see the doctor for evaluation immediately. Angina that occurs at rest, is of new onset, or is increasing in intensity or duration denotes an increased risk for myocardial infarction and should be seen immediately using the criteria for acute coronary syndrome (ACS).