CHP. 27 Disorders of Cardiac Function, and Heart Failure and Circulatory Shock

What causes cyanosis? A shunting of blood from left to right A shunting of blood from right to left Any congenital heart defect Smoking during pregnancy

A shunting of blood from right to left A shunting of the blood from right to left results in decreased oxygen, producing cyanosis.

Cardiogenic shock causes pulmonary edema. T/F

False

More people die of cardiovascular disease than of any other pathology in the United States each year.

True

The body is able to initiate numerous mechanisms that can compensate for heart failure. T/F

True

The key components of the blood work used to diagnose myocardial infarction are the troponin assays. T/F

True

A nurse is administering a beta blocker to a patient who has heart failure. Which statement may be part of the nurse's patient education? "This medication will help your heart beat faster." "This medication will help your symptoms only." "This medication will improve your survival and symptoms of heart failure." "This medication helps get rid of the extra fluid in your body."

"This medication will improve your survival and symptoms of heart failure." Beta blockers improve symptoms of heart failure and extend survival. Beta blockers lower heart rates and help do more than managing symptoms. Diuretics may be used to get rid of extra fluid in the body.

What is the overall mortality rate during the first year after discharge from treatment of myocardial infarction? 10% 15% 20% 25%

20%

What is the meaning of the word cyanosis? A bluish discoloration of the skin and nail beds A decrease in peripheral circulation A grayish discoloration around the lips A yellowish discoloration of the nail beds

A bluish discoloration of the skin and nail beds Cyanotic means a bluish discoloration of the skin caused by decreased oxygen to tissues.

What physical finding would be associated with someone who is acyanotic A bluish discoloration of the skin and nail beds A decrease in peripheral circulation An increase in peripheral circulation A pink or reddish discoloration of the nail beds

A pink or reddish discoloration of the nail beds Acyanotic means 'no cyanosis' and refers to normal color.

A 4-month-old male infant is brought into the pediatric clinic by his mother. She reports that she noted over the past several weeks that her baby's lips and mouth and his fingernails and toenails have become a bluish gray color. She also states that he seems to tire easily and that even nursing seems to wear him out. Lately, he has had several spells where he has suddenly turned blue, has had difficulty breathing, and has been very irritable. During one of these spells, he turned limp and seemed to have passed out for a short time. An echocardiogram reveals a thickening of the right ventricular wall with overriding of the aorta, a large subaortic VSD, and narrowing of the pulmonary outflow with stenosis of the pulmonary valve. A. What is this infant's probable diagnosis? B. Describe the shunting of blood that occurs with this disorder and its relationship to the development of cyanosis. C. The surgical creation o

A. The infant's symptoms, including cyanosis (bluish-gray color of lips, mouth, fingernails, and toenails), easy fatigability, difficulty breathing, irritability, and episodes of turning blue and limp, along with echocardiogram findings of right ventricular wall thickening, overriding aorta, large subaortic ventricular septal defect (VSD), and pulmonary outflow stenosis, strongly suggest a diagnosis of Tetralogy of Fallot. B. In Tetralogy of Fallot, there is a large ventricular septal defect (VSD) that allows blood to flow between the right and left ventricles. Due to the obstruction of the pulmonary outflow tract (pulmonary stenosis) and the thickening of the right ventricular wall, the pressure in the right ventricle often exceeds that in the left ventricle. This causes deoxygenated blood from the right ventricle to be shunted through the VSD to the left ventricle and then into the systemic circulation via the overriding aorta. This right-to-left shunt leads to a mixing of oxygen-poor blood with oxygen-rich blood, resulting in less oxygen being delivered to the tissues and causing cyanosis. The degree of cyanosis depends on the extent of the pulmonary stenosis and the amount of blood shunted from right to left. C. The surgical creation of a shunt between the aorta and the pulmonary artery, often referred to as a Blalock-Taussig shunt, is a palliative procedure aimed at increasing blood flow to the lungs. By connecting the systemic circulation (aorta) to the pulmonary circulation (pulmonary artery), this shunt allows more oxygen-poor blood to reach the lungs where it can be oxygenated. This procedure helps bypass the obstructed pulmonary outflow tract, increasing the volume of blood that gets oxygenated and subsequently reducing the symptoms of cyanosis and improving oxygen delivery to the body. This palliative measur

A 45-year-old man presents in the emergency department complaining of substernal chest pain that is also felt in his left shoulder. He is short of breath and nauseated. His blood pressure is 160/90 mm Hg, and his HR is 100 beats/minute. His ECG shows an ST-segment elevation in leads II, III, and aVF. He is given oxygen, aspirin, and nitroglycerin. Blood tests reveal elevated CK-MB and TnI. A. What is the probable cause of the man's symptoms? B. What is the significance of the ST-segment changes? C. What is the significance of elevated CK-MB and TnI? D. Relate the actions of aspirin, nitroglycerin, and oxygen to the treatment of this man's condition.

A. The man's symptoms of substernal chest pain radiating to his left shoulder, shortness of breath, nausea, elevated blood pressure, and heart rate, along with the ST-segment elevation in leads II, III, and aVF on his ECG, strongly suggest an acute myocardial infarction (MI), specifically affecting the inferior wall of the heart. B. The ST-segment elevation in leads II, III, and aVF indicates an acute ST-elevation myocardial infarction (STEMI) involving the inferior part of the heart. This suggests a complete blockage of a coronary artery, leading to myocardial ischemia and injury. C. Elevated levels of creatine kinase-MB (CK-MB) and troponin I (TnI) are biomarkers indicating myocardial damage. CK-MB is specific to heart muscle, and elevated levels suggest myocardial infarction. Troponin I is highly specific and sensitive for myocardial injury, and its elevated levels confirm the diagnosis of an acute MI. D.Aspirin acts as an antiplatelet agent by inhibiting cyclooxygenase-1 (COX-1), reducing the formation of thromboxane A2, and preventing further platelet aggregation and clot growth. This helps maintain blood flow in the affected coronary artery and reduces the risk of further occlusion. Nitroglycerin, a vasodilator, reduces myocardial oxygen demand by dilating coronary arteries, improving blood flow to the ischemic myocardium, and alleviating chest pain. It also reduces preload and afterload, decreasing the workload on the heart. Supplemental oxygen increases the amount of oxygen available to the ischemic myocardial tissue, potentially reducing the extent of myocardial injury and relieving symptoms of hypoxia and shortness of breath. Together, these treatments aim to stabilize the patient, relieve symptoms, and limit myocardial damage during an acute myocardial infarction.

A 21-year-old man is admitted to the emergency department with excessive blood loss after an automobile injury. He is alert and anxious, his skin is cool and moist, his HR is 135, and his blood pressure is 100/85. He is receiving IV fluids, which were started at the scene of the accident by an emergency medical technician. He has been typed and cross-matched for blood transfusions, and a urinary catheter has been inserted to monitor his urinary output. His urinary output has been less than 10 mL since admission, and his blood pressure has dropped to 85/70. Efforts to control his bleeding have been unsuccessful, and he is being prepared for emergency surgery. A. Use information regarding the compensatory mechanisms in circulatory shock to explain this man's presenting symptoms, including urinary output. B. The treatment of hypovolemic shock is usually directed at maintaining the circulatory volume through fluid resu

A. The man's symptoms, including tachycardia (HR 135), cool moist skin, anxiety, decreased urinary output, and dropping blood pressure, indicate hypovolemic shock due to significant blood loss. The body compensates with tachycardia to maintain cardiac output and peripheral vasoconstriction to direct blood to vital organs, causing cool skin. Anxiety is due to increased sympathetic activity. The kidneys conserve fluid via the renin-angiotensin-aldosterone system, resulting in reduced urine output (less than 10 mL). Initially, vasoconstriction maintains his blood pressure at 100/85, but as blood loss continues, his pressure drops to 85/70, indicating worsening shock and insufficient perfusion. B. In hypovolemic shock, the priority is restoring blood volume and improving perfusion, making fluid resuscitation essential. Blood loss decreases volume, so IV fluids or blood products increase preload, cardiac output, and blood pressure, ensuring vital organ perfusion. Vasoactive medications raise blood pressure by constricting vessels but don't replace lost volume and can worsen tissue hypoperfusion without adequate fluids. Thus, fluid resuscitation is crucial to restore volume and improve perfusion, with vasoactive drugs used supportively if necessary.

A 50-year-old woman presents with complaints of paroxysmal nocturnal dyspnea and orthopnea, palpitations, and fatigue. An echocardiogram demonstrates a thickened, immobile mitral valve with anterior and posterior leaflets moving together, slow early diastolic filling of the ventricle, and left atrial enlargement. A. What is the probable cause of this woman's symptoms? B. Explain the pathologic significance of the slow early diastolic filling, distended left atrium, and palpitations. C. Given the echocardiographic data, what type of cardiac murmur would you expect to find in this woman? D. Which circulation (systemic or pulmonary) would you expect to be affected as this woman's mitral valve disorder progresses?

A. The woman's symptoms of paroxysmal nocturnal dyspnea, orthopnea, palpitations, and fatigue, along with the echocardiographic findings of a thickened, immobile mitral valve with abnormal leaflet movement, slow early diastolic filling of the ventricle, and left atrial enlargement, suggest mitral stenosis as the probable cause. Mitral stenosis restricts blood flow from the left atrium to the left ventricle, leading to increased pressure in the left atrium and pulmonary circulation. B. The slow early diastolic filling indicates that the narrowed mitral valve restricts blood flow into the left ventricle during diastole, leading to prolonged filling time. The distended left atrium results from the increased pressure and volume load due to the obstruction at the mitral valve, which causes blood to back up into the atrium. This can lead to atrial enlargement and eventually atrial fibrillation, contributing to the patient's palpitations. Palpitations are often due to atrial arrhythmias, like atrial fibrillation, which are common in patients with mitral stenosis because of the structural and electrical remodeling of the left atrium. C. Given the echocardiographic findings of mitral stenosis, you would expect to hear a diastolic murmur. This murmur is typically low-pitched and best heard at the apex of the heart with the patient in the left lateral decubitus position. It is often preceded by an opening snap due to the sudden tensing of the stenotic mitral valve leaflets. D. As the mitral valve disorder progresses, the pulmonary circulation would be primarily affected. The obstruction at the mitral valve causes increased pressure in the left atrium, which then transmits back into the pulmonary veins and capillaries, leading to pulmonary congestion and hypertension. This can result in symptoms like shortness of breath, paroxysma

A 75-year-old male with long-standing hypertension and angina due to coronary heart disease presents with ankle edema, nocturia, increased shortness of breath with activity, and a chronic nonproductive cough. He has a past history of smoking two packs/day and drinking, but he says he now does not smoke and is now sober. His blood pressure is 170/80 and his HR is 100. ECG and chest radiography indicate the presence of LV hypertrophy. A. Relate the presence of uncontrolled hypertension and CAD to the development of heart failure in this man. B. Explain the significance of LV hypertrophy in terms of both a compensatory mechanism and a pathologic mechanism in the progression of heart failure. C. Explain the management and treatment for this diagnosis.

A. Uncontrolled hypertension and coronary artery disease (CAD) significantly contribute to heart failure. Long-standing hypertension increases the workload on the left ventricle (LV), leading to hypertrophy as the heart muscle thickens to pump against higher resistance. CAD exacerbates this by reducing blood flow to the myocardium, causing ischemia and damage. Together, these conditions impair the heart's pumping ability, resulting in heart failure symptoms like ankle edema, nocturia, shortness of breath, and chronic cough. B. LV hypertrophy initially acts as a compensatory mechanism by enabling the heart to maintain cardiac output despite increased pressure demands from hypertension. However, it becomes pathologic over time as the thickened myocardium demands more oxygen and becomes stiffer, leading to diastolic dysfunction. This stiffness impairs ventricular filling, increasing pressures in the left atrium and pulmonary circulation, worsening heart failure symptoms and reducing cardiac efficiency. C. Management of heart failure in this patient includes controlling blood pressure with medications such as ACE inhibitors, ARBs, beta-blockers, and diuretics. Beta-blockers also reduce heart rate, lowering myocardial oxygen demand. Diuretics help alleviate fluid overload symptoms like edema and nocturia. Lifestyle modifications, such as continued abstinence from smoking and alcohol, a low-sodium diet, regular exercise, and weight management, are essential. CAD management involves aspirin, statins, and possibly revascularization procedures to improve myocardial perfusion. Regular follow-up with a cardiologist, symptom monitoring, and therapy adjustments are crucial for effective long-term management, aiming to improve symptoms, prevent further heart function deterioration, and enhance quality of life.

A patient is diagnosed with hypovolemic shock. What does the nurse anticipate being included in the plan of care? Administration of broad-spectrum antibiotics Administration of blood products and intravenous fluids Administration of vitamin K Administration of protamine sulfate

Administration of blood products and intravenous fluids Hypovolemic shock requires blood products and/or fluids. Antibiotics are indicated for septic shock, and vitamin K and protamine sulfate are antidotes for warfarin and heparin. They will not help unless anticoagulants are the cause.

Identify clinical findings that may indicate an impending myocardial infarction? Angina of increasing frequency, severity, or duration Feeling of impending doom Fatigue Nausea Vomiting Fever Shortness of breath Systemic edema Cool extremities Diaphoresis Anxiety Restlessness Hypotension Hypertension

All, but fever and systemic edema

Which serum lab value can assist in diagnosing heart failure? Brain natriuretic peptide (BNP) Blood urea nitrogen (BUN) Blood pressure Cardiac catheterization

BNP A BNP level over 100 suggests heart failure. BUN is not specific to heart failure, and blood pressure and cardiac catheterization are not serum lab values.

What is happening in the compensatory stage of shock? The organs are failing and death is imminent. The heart is unable to meet oxygen demands. Blood is being shunted to vital organs to maintain nearly normal vital signs. The patient is asymptomatic but basic cellular changes have started.

Blood is being shunted to vital organs to maintain nearly normal vital signs. During the compensatory stage of shock, the sympathetic nervous system is stimulated, and the body experiences the fight-or-flight response. The body shunts blood to vital organs, including the heart, brain, and lungs. Blood pressure and heart rate may be normal or show subtle changes. Organs fail during the irreversible stage. The heart is unable to meet oxygen demands during the progressive stage. The patient is asymptomatic with basic cellular changes during the initial stage.

Which are anticipated vital signs for a patient with neurogenic shock? Blood pressure 84/67 mm Hg and heart rate 112 bpm Blood pressure 120/80 mm Hg and heart rate 80 bpm Blood pressure 188/101 mm Hg and heart rate 125 bpm Blood pressure 74/42 mm Hg and heart rate 48 bpm

Blood pressure 74/42 mm Hg and heart rate 48 bpm A patient in neurogenic shock is expected to be hypotensive and hypovolemic due to the unopposed parasympathetic nervous system. Their blood pressure would be low, as in a reading of 74/42 mm Hg, and their heart rate would also be low, as in a reading of 48 bpm.

Which factors should be assessed prior to administering a loop diuretic? Select all that apply. Blood pressure Heart rate Potassium level Sodium level Respiratory rate

Blood pressure, Potassium level Blood pressure and potassium level need to be assessed to determine if the patient is at risk for hypotension or hypokalemia. Heart rate, sodium level, and respiratory rate may also be assessed at the same time, but this is not in relation to the administration of a loop diuretic.

A nurse is examining a newborn infant with a right-to-left blood shunt. Which finding would the nurse expect? Yellowing of whites of eyes Pinkish nail beds Bluish lips Scarlet cheeks

Bluish lips Infants with cyanotic heart defects have deoxygenated blood flowing to the body, so skin color and nail beds appear a dusky or bluish tint. Yellowing of the eye white indicates jaundice. Scarlet cheeks indicate increased blood flow, such as from fever.

Dislodging of mural thrombi may result in which condition? Extension of the original infarction Cerebral or pulmonary emboli Ventricular aneurysms Restlessness

Cerebral or pulmonary emboli When a mural thrombus is dislodged from a myocardial injury site, it may travel to the brain or lungs and form an embolus (blood clot), where it can completely restrict blood flow. Extension of the original infarction would result from additional localized hypoxia. Ventricular aneurysms result from weakened tissue in the ventricular wall. Restlessness is a symptom of an impending myocardial infarction.

Which description defines myocardial contractility? The force that the contracting heart muscle must generate to eject blood from the ventricles Contractile performance of the heart Volume of blood that stretches the ventricle at end diastole Volume of blood ejected from the ventricle with each contraction

Contractile performance of the heart

Obstruction or narrowing of the pulmonary outflow channel—including pulmonic valve stenosis, and/or decrease in the size of the pulmonary trunk, or both—is a result of what type of defect? Cyanotic defect Acyanotic defect

Cyanotic defect Obstruction or narrowing of pulmonary outflow channel causes cyanosis, a lack of oxygen in the blood.

Which condition is not an indication for a loop diuretic? Heart failure Diabetes mellitus Hypertension Fluid overload

Diabetes mellitus

A 55-year-old patient presents to the emergency room with chest pain that worsens when lying down and with deep inspirations; it is relieved with forward leaning and sitting. A friction rub is heard most clearly at the left lower sternal border. The patient reported having recent flu symptoms. They have a history of type 2 diabetes mellitus and treatment for prostate cancer 2 years prior. A 12-lead echocardiogram (ECG) shows ST-segment elevation in all leads. Myocardial infarction is ruled out, and the patient is diagnosed with pericarditis.Which are likely causes of this patient's condition? Select all that apply. Diabetes Atherosclerosis Viral infection Friction rub

Diabetes, Viral infection Diabetes complications (uremia) and viral infection (flu) can cause the symptoms of dyspnea and chest pain relieved by forward leaning and sitting. Atherosclerosis involves plaque buildup and wouldn't be relieved with repositioning. A friction rub (creaky or scratchy sound) is a symptom rather than a cause of heart inflammation. The prior treatment for prostate cancer is likely not a factor.

A patient is diagnosed with cardiogenic shock. Which medication will the RN expect to be prescribed? Dopamine Dobutamine Desmopressin Diazepam

Dobutamine Dobutamine is a medication used to improve contractility and is the drug of choice for cardiogenic shock. Dopamine, desmopressin, and diazepam are not indicated for improving contractility.

A nurse working in the intensive care unit (ICU) knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which clinical manifestation(s)? Increased urinary output Dyspnea and bilateral crackles Petechia and spontaneous bleeding Muscle cramping and cyanosis in the feet

Dyspnea and bilateral crackles Although it may preserve the resting cardiac output, the resulting chronic elevation of left ventricular end-diastolic pressure is transmitted to the atria and the pulmonary circulation, causing pulmonary congestion which manifests in dyspnea and bilateral crackles. Skin discoloration or hemorrhaging is not a sign of left-sided heart failure. Increased urinary output is not a sign of left-sided failure. The patient would have decreased urinary output.

Patient: 17-year-old female Symptoms: Acute streptococcal pharyngitis (i.e., strep throat) Peptic ulcer Which heart disease has this patient been diagnosed with? Endocarditis Pericarditis Neither

Endocarditis A streptococcal infection is a common cause of endocarditis

A 21-year-old female patient is admitted to the hospital with a temperature of 104°F, beginning 2 days ago. The patient complains of extreme fatigue. She had her tongue and nose pierced 6 weeks ago. A drug screen is negative. She presents with tricuspid insufficiency (regurgitation) murmur grade II. Her body mass index (BMI) is 18.2 and she has a history of anorexia. Which inflammatory heart disease might this patient have? Endocarditis Pericarditis Myocarditis

Endocarditis One of the most common causes of infectious endocarditis is infection. This infection most likely resulted from the oral and nasal piercing.

Patient: 28-year-old male Symptoms: Untreated tooth abscess History of intravenous drug usage Which heart disease has this patient been diagnosed with? Endocarditis Pericarditis Neither

Endocarditis Oral lesions and contaminated needles can introduce bacteria into the bloodstream, producing conditions for endocarditis.

Patient: 2-week-old female Symptoms: Pulmonary artery stenosis Infant respiratory distress syndrome (IRDS) Fever 103° Which heart disease has this patient been diagnosed with? Endocarditis Pericarditis Neither

Endocarditis The fever indicates an infection, which has put this patient with a congenital heart defect at risk for developing endocarditis.

Which layer covers the heart valves? Endocardium Pericardium Myocardium Tunica intima

Endocardium The endocardium is the innermost layer of the heart and covers the valves. The pericardium is the sac-like outer layer of the heart. The myocardium is the muscle layer of the heart. The tunica intima is the inner layer of blood vessels.

A 3-year-old child with right-sided heart failure has been admitted for worsening of the condition. Which finding would be considered one of the earliest signs of systemic venous congestion in this patient? Breathlessness with activity Excessive crying Enlargement of the liver Increased urine output

Enlargement of the liver With right ventricle function impaired, systemic venous congestion develops. Hepatomegaly due to liver congestion is often one of the first signs of systemic venous congestion in infants and children.

Blood flow that has been lost as a result of myocardial infarction cannot be reestablished. T/F

False

Septic shock is far less common in the past, given advances in prevention and treatment. T/F

False

Overall, neonates with cyanotic congenital heart defects receive fewer interventions than those with acyanotic congenital heart defects. T/F

False In general, cyanotic heart defects cause greater risks and complications then acyanotic congenital heart defects.

Of the following compensatory mechanisms, which two are the first to respond when the heart stops meeting the metabolic needs of the body? Frank-Starling mechanism Sympathetic nervous system Renin-angiotensin-aldosterone Natriuretic peptides Myocardial hypertrophy

Frank-Starling mechanism, Sympathetic nervous system The Frank-Starling mechanism increases cardiac output by increasing stroke volume, and the sympathetic nervous system increases heart rate which also increases cardiac output.

Patient: 79-year-old male Symptoms: Lung cancer (recently diagnosed; untreated) Obese Which heart disease has this patient been diagnosed with? Endocarditis Pericarditis Neither

Neither This patient likely does not have pericarditis or endocarditis because hypertension and obesity do not directly cause them. Though the patient has a cancer affecting the chest, he has not undergone radiation treatment yet.

A patient is ordered furosemide. What is a potential complication of this medication? Hypertension Hypotension Bradycardia Decreased SpO2

Hypotension A patient on furosemide is at risk for hypotension related to volume loss. This could also cause the patient to become tachycardic, not bradycardic. Furosemide would not decrease SpO2 but could increase it if fluid is removed from the lungs.

Which is not a common cause of heart failure? Coronary artery disease (CAD) Myocardial infarction (MI) Hypertension Hypothyroidism

Hypothyroidism

__________ shock results from acute blood loss

Hypovolemic

What is the preferred route to administer epinephrine during anaphylactic shock? Subcutaneously Orally Intramuscularly Intravenously

IM Epinephrine is given intramuscularly during anaphylactic shock. It is given intravenously when the patient does not have a pulse. It is never given orally or subcutaneously.

What is the definition of myocardial infarction? The invasion of the endocardium by pathogens that produce vegetative lesions on the endocardial surface Accelerated form of angina that is caused by subtotal or intermittent coronary occlusion Ischemic death of myocardial tissue A progressive arterial disease characterized by the formation of fibrofatty plaques

Ischemic death of myocardial tissue Myocardial infarction is the death of myocardial tissue. The invasion of the endocardium by pathogens that produce vegetative lesions on the endocardial surface refers to a disease process of the endocardium. An accelerated form of angina that is caused by subtotal or intermittent coronary occlusion is the definition of Prinzmetal angina. A progressive arterial disease characterized by the formation of fibrofatty plaques is the definition of atherosclerosis.

Which of the following is true of the blood regarding acyanotic defects? It is adequately oxygenated by the lungs before circulation in the body. It has a mix of deoxygenated blood and oxygenated blood for circulation in the body. It involves right-to-left shunts. It is recirculated through the heart and lungs before circulation in the body.

It is adequately oxygenated by the lungs before circulation in the body. In all acyanotic defects, there is plenty of oxygen in the blood, but more blood goes to the lungs and less blood goes to the body.

Which type of heart failure is more common? Right-sided failure Left-sided failure

Left-sided failure

A 21-year-old female patient is admitted to the hospital with a temperature of 104°F, beginning 2 days ago. The patient complains of extreme fatigue. She had her tongue and nose pierced 6 weeks ago. A drug screen is negative. She presents with tricuspid insufficiency (regurgitation) murmur grade II. Her body mass index (BMI) is 18.2 and she has a history of anorexia. Which patient data are most likely related to the patient's fever? BMI of 18.2 Anorexia Oral and nasal piercing Tricuspid insufficiency

Oral and nasal piercing The patient had her tongue and nose pierced 6 weeks ago, which could facilitate infection leading to high fever. An underweight BMI, anorexia, and insufficiency are not causes of fever.

Patient: 4-year-old male Symptoms: Hand, foot, and mouth disease Latex and food allergies Which heart disease has this patient been diagnosed with? Endocarditis Pericarditis Neither

Pericarditis Hand, foot, and mouth disease is a coxsackle virus known to cause pericarditis. This patient also has hypersensitivities and possibly autoimmune issues.

Patient: 62-year-old female Symptoms: Rheumatoid arthritis Diagnosed with breast cancer 2 years prior Which heart disease has this patient been diagnosed with? Endocarditis Pericarditis Neither

Pericarditis Rheumatoid arthritis (an autoimmune disease) and prior chest radiation make this patient susceptible to pericarditis.

Which is the outer sac-like layer of the heart? Endocardium Pericardium Myocardium Tunica intima

Pericardium The pericardium is the sac-like outer layer of the heart. The heart is covered by the pericardium. The endocardium is the inner most layer of the heart. The myocardium is the muscle layer of the heart. The tunica intima is the inner layer of blood vessels.

Which areas of the heart might a myocardial infarction affect? Select all that apply. Pericardium Myocardium Endocardium

Pericardium, Myocardium, Endocardium The main injury occurs in myocardium tissue, but complications such as inflammation or fluid buildup may affect the pericardium. Rupture of the atrial or ventricular septum, ventricular wall, or valves may affect the endocardium.

A nurse will be providing care for a patient who has a diagnosis of heart failure characterized as primarily right-sided. Which description of the patient's presentation would the nurse anticipate? Distended bladder, facial edema, and nighttime difficulty breathing Dyspnea and adventitious breath sounds on auscultation Pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain Cyanotic lips and extremities, low urine output, and low blood pressure

Pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain Right-sided failure is associated with peripheral edema, fatigue, and occasionally upper right quadrant pain. Abdominal distention can occur with right-sided failure when the liver becomes engorged. Facial edema, pulmonary edema, peripheral cyanosis, low urine output, and low blood pressure are not associated with right-sided failure. Left-sided failure is primarily associated with pulmonary signs and symptoms like dyspnea, pulmonary edema, frothy pink sputum, and respiratory congestion.

Which defects are involved when blood from the left and right ventricles are able to directly mix? Select all that apply. Atrial septal defect Tetralogy of Fallot Transposition of the great vessels Endocardial cushion defect Ventricular septal defect

Tetralogy of Fallot, Endocardial cushion defect, Ventricular septal defect Tetralogy of Fallot, endocardial cushion defect, and ventricular septal defect involve a small or larger hole in the ventricles, allowing blood to mix. Atrial septal defect allows blood mixing in the atrium. Transposition of the great vessels involves the aorta and pulmonary artery connected to the wrong ventricles.

Which correctly describes the blood flow through the heart? Right atrium, mitral valve, right ventricle, aorta, aortic valve, left ventricle, pulmonary artery Right atrium, tricuspid valve, right ventricle, pulmonic valve pulmonary, artery left ventricle, aortic valve, aorta Right atrium, tricuspid valve, right ventricle, aorta, aortic valve, left ventricle, pulmonary artery Right atrium, right ventricle, left atrium, left ventricle, pulmonary artery

Right atrium, tricuspid valve, right ventricle, pulmonic valve pulmonary, artery left ventricle, aortic valve, aorta

Which describes the normal progression of the electrical conduction system of the heart? Bundle of His, right bundle branch, left bundle branch, Purkinje fibers SA node, AV node, bundle of His, right bundle branch, left bundle branch, Purkinje fibers SA node, Purkinje fibers, right bundle branch, bundle of His, left bundle branch AV node AV node, SA node, bundle of His, left bundle branch, Purkinje fibers

SA node, AV node, bundle of His, right bundle branch, left bundle branch, Purkinje fibers

Which may occur from a myocardial infarction? Select all that apply. Scar tissue Dead tissue Regenerated tissue Weakened tissue

Scar tissue, dead tissue, Weakened tissue Scar tissue may form around the myocardium restricting contractibility. During a myocardial infarction, tissue dies from ischemia and is not able to regenerate. Weakened tissue near the infarction site may cause complications, such as ventricular aneurisms or noncompliance of the left ventricle. A myocardial infarction would not result in regenerated tissue.

Which statement defines preload? The force that the contracting heart muscle must generate to eject blood from the ventricles The amount of blood the heart must pump with each beat Volume of blood that stretches the ventricle at end diastole Volume of blood ejected from the ventricle with each contraction

The amount of blood the heart must pump with each beat Preload represents the amount of blood that the heart must pump with each beat. It is largely determined by the venous return to the heart and the accompanying stretch of the cardiac muscle fibers.

Which description best defines afterload? The force that the contracting heart muscle must generate to eject blood from the ventricles Contractile performance of the heart Volume of blood that stretches the ventricle at end diastole Volume of blood ejected from the ventricle with each contraction

The force that the contracting heart muscle must generate to eject blood from the ventricles

A patient has an ejection fraction (EF) of 35%. What does this indicate? The patient has an optimally functioning heart. The patient is in diastolic heart failure. The patient is in systolic heart failure. The patient is at risk for developing heart failure.

The patient is in systolic heart failure. An EF less than 40% indicates decreased cardiac output and pump failure, which means they have systolic heart failure. EF is preserved in diastolic heart failure. The heart is not optimally functioning, and the patient has already developed heart failure.

Upon assessment, the nurse notes a patient has crackles and dyspnea. What does this indicate? The patient's right side of the heart is affected. The patient's left side of the heart is affected. The patient has systolic heart failure. The patient has diastolic heart failure.

The patient's left side of the heart is affected. Crackles and dyspnea result from a poorly functioning left side of the heart. If the right side is affected, fluid will back up into the rest of the body leading to an enlarged liver and spleen, ascites, and dependent edema. Crackles and dyspnea do not indicate if heart failure is systolic or diastolic.

A patient is prescribed a loop diuretic. What will happen to the potassium level when this medication is administered? The potassium level will increase. The potassium level will decrease. The potassium level will remain unchanged. The potassium level will only drop if it was high prior to administration.

The potassium level will decrease. Loop diuretics are potassium-wasting drugs. The potassium will decrease when this medication is administered, and it will do so regardless of what the level was prior to administration.

Why do loop diuretics need to be pushed slowly when administered via intravenous (IV) push? To prevent nephrotoxicity To prevent neuroplasticity To prevent ototoxicity To prevent retinopathy

To prevent ototoxicity When given via IV push, loop diuretics must be pushed slowly to reduce the risk of ototoxicity and potential deafness. Pushing loop diuretics too quickly does not put the patient at risk for nephrotoxicity, neuroplasticity, or retinopathy.

With systolic heart failure, an insufficient amount of blood gets pumped out for systemic circulation, eventually causing backup into the pulmonary circulation. T/F

True Systolic heart failure results in insufficient blood getting pumped out for systemic circulation, eventually causing backup into the pulmonary circulation.

A 21-year-old female patient is admitted to the hospital with a temperature of 104°F, beginning 2 days ago. The patient complains of extreme fatigue. She had her tongue and nose pierced 6 weeks ago. A drug screen is negative. She presents with tricuspid insufficiency (regurgitation) murmur grade II. Her body mass index (BMI) is 18.2 and she has a history of anorexia.What will an echocardiogram likely reveal? Cardiac tamponade Tricuspid valve not opening Scar tissue surrounding the myocardium Vegetation on the tricuspid valve

Vegetation on the tricuspid valve An invading organism accumulates on the endocardium, usually on those with valves or areas that are deformed where the organism can 'stop and grow.' Infection sets in, causing clusters of platelets, fibrin, blood cells, and microorganisms that cluster and appear as vegetations on the valve. An echocardiogram may show a tricuspid valve not closing. Drug toxicity, cardiac tamponade, excessive fluid, and scar tissue are causes of inflammation of the tissue surrounding the outside of the heart rather than the valve covering.

Which are etiologies of inflammatory heart diseases? (Select all that apply.) Viral Bacteria Fibrosarcoma Cysts

Viral, Bacteria Viruses and bacteria are the two most common causes of inflammatory heart diseases. Fibrosarcoma is a disease related to connective tissue. Cysts are not related to inflammatory heart disease.

Which best describes stroke volume? The force that the contracting heart muscle must generate to eject blood from the ventricles Contractile performance of the heart Volume of blood that stretches the ventricle at end diastole Volume of blood ejected from the ventricle with each contraction

Volume of blood ejected from the ventricle with each contraction

What are the three areas of damage in a myocardial infarction? Zone of injury, zone of ischemia, zone of necrosis Right atrium, left atrium, left ventricle, Zone of ischemia, zone of cyanosis, zone of death Pericardium, myocardium, endocardium

Zone of injury, zone of ischemia, zone of necrosis In myocardial infarction, the damage of the myocardium is described as zones of decreased oxygenation, which include injury, ischemia, and necrosis.

Congenital defects that result in shunting of blood from the right side of the heart to the left are known as __________ disorders.

cyanotic

Coronary artery disease is often subdivided into chronic __________ heart disease and acute coronary syndrome.

ischemic

The lungs, GI system, and __________ are most susceptible to damage as a result of shock.

kidneys

Cardiac __________ is characterized by compression of the heart because of the accumulation of fluid, pus, or blood in the pericardial sac.

tamponade