Davis Advantage Ch. 17 : Left and right heart failure

A nurse is reviewing how decreased perfusion to the kidneys can result in increased blood volume. Please place the following steps in order.

1. Juxtaglomerular cells secrete renin. 2. Renin activates angiotensinogen. 3. Angiotensin I is converted to angiotensin II. 4. Aldosterone is released. 5. sodium and water reabsorption is increased. Rationale: With decreased renal perfusion, the juxtaglomerular cells will secrete renin. Renin will stimulate angiotensinogen. Angiotensin I will be converted to angiotensin II, which will stimulated aldosterone release. Aldosterone will increase sodium and water reabsorption, increasing blood volume and blood pressure.

Which of the following are classes of medications used in management of heart failure? Select all that apply.

ACE inhibitors diuretics inotropic agents Beta blockers

A patient is given an angiotensin-converting enzyme (ACE) inhibitor medication. Which of the following steps does this medication work on? Angiotensin to aldosterone Renin to angiotensinogen Angiotensin I to angiotensin II Angiotensinogen to renin

Angiotensin I to angiotensin II Rationale: ACE stands for angiotensin-converting enzyme, which converts angiotensin I to angiotensin II.

The level of brain natriuretic peptide (BNP) is often measured in states of congestive heart failure. A patient asks a nurse why this factor is released during congestive heart failure. What is the appropriate association for the nurse to make? BNP increases heart rate. BNP helps to elevate blood pressure. BNP increases the heart's ability to contract. BNP helps to alleviate the fluid overload on the heart.

BNP helps to alleviate the fluid overload on the heart. Rationale: BNP increases urine output, reducing fluid load on the heart.

Which of the following has likely occurred that led to this image? Forward effects of left heart failure Backward effects of left heart failure Forward effects of right heart failure Backward effects of right heart failure

Backward effects of left heart failure Rationale: The image shows pulmonary congestion, more common with left ventricular failure.

A patient presents with peripheral edema, hepatosplenomegaly, and jugular vein distention. What do these signs and symptoms represent? Select all that apply.

Backward effects of right ventricular failure and total heart failure

In the following image, what is this test measuring? Forward effects of left-side heart failure Backward effects of lef-sidet heart failure Forward effects of right-side heart failure Backward effects of right-side heart failure

Backward effects of right-side heart failure The image shows jugular vein distention, which is a backwards effect of right-side heart failure.

A patient with severe pulmonary issues develops right-side heart failure due to these issues. What is an appropriate term for the nurse to use? Cor pulmonale High-output heart failure Pulmonary edema Pneumocystis

Cor pulmonale Cor pulmonale develops when pulmonary disorders cause right ventricle failure.

Which of the following is incorrectly matched?

Diastolic dysfunction - Difficulty ejecting blood

A patient has severe hypertension and enlargement and distention of the left ventricle making filling very difficult. What type of heart failure may the patient display ? Systolic heart failure Diastolic heart failure High-output heart failure Cor pulmonale

Diastolic heart failure Rationale: Systolic heart failure occurs when the heart cannot eject blood properly. Diastolic heart failure manifests when the heart cannot be filled properly. High-output failure occurs when the heart cannot meet excessive demands.

In left ventricular failure, which factors may be reduced? Select all that apply. Ejection fraction Heart rate Blood pressure Fluid volume Pulmonary capillary wedge pressure (PCWP)

Ejection fraction Blood pressure If the left ventricle is failing, then ejection fraction is reduced. In heart failure, the left ventricle can not maintain blood pressure.

The edema present in Howard's lungs and extremities indicates the presence of excess fluid in the body. Which of the following signals are associated with retention of fluid? Select all that apply.

Fluid retention results from the activation of the RAAS and the release of ADH. Thus, increased renin, increased angiotensin, and increased aldosterone either directly or indirectly contribute to fluid retention. Natriuretic peptide increases urine output and reduced blood volume.

Which of the following are expected in response to left ventricular failure?

Increased anti-diuretic hormone Increased angiotensin II

Which of the following are backward effects of right ventricular failure? Select all that apply. Pulmonary edema Jugular vein distention Decreased arterial blood pressure Hepatomegaly Paroxysmal nocturnal dyspnea

Jugular vein distention Hepatomegaly Jugular vein distension occurs in right-side heart failure as fluid backs up into the veins. If the right side of the heart fails, then fluid may back up in the liver, causing hepatomegaly. Paroxysmal nocturnal dyspnea is more common with left-side heart failure. Pulmonary edema occurs with left-side heart failure.

Which of the following signs and symptoms, although not present in Howard's initial examination, are also associated with right-side heart failure? Select all that apply.

Jugular vein distention (JVD) and hepatosplenomegaly are common signs of right-side heart failure, as blood backs up in the large veins delivering blood to the heart, causing the veins and organs to enlarge. The other answers listed are associated with left-side heart failure.

Which of the following are correct statements regarding the body's attempts to compensate for heart failure? Select all that apply.

Left-side heart failure results in a fall in blood pressure that is detected by the baroreceptors. These receptors activate the sympathetic nervous system to increase heart rate to compensate for the pressure loss. Another means by which the body attempts to compensate for heart failure is to retain fluid. An increase in blood volume results in an increase in pressure. However, excess fluid in the body increases the likelihood of edema.

Which of his signs and symptoms are associated with left-side heart failure? Select all that apply.

Left-side heart failure results in fluid back up in the pulmonary system, as well as decreased perfusion of systemic tissues. Headache and memory loss can result from decreased perfusion of the brain. Orthopnea, paroxysmal nocturnal dyspnea, pulmonary crackles, and pulmonary edema are all signs of the left ventricle failing to pump the blood forward and the backward effects of fluid accumulation in the lungs developing.

A nurse is reviewing high-output heart failure. Which of the following is the correct association? Most common type of heart failure Develops in response to poor heart filling Develops due to decreased venous return to the heart May occur in conditions such as thyrotoxicosis

May occur in conditions such as thyrotoxicosis Rationale: High-output failure results from extreme demands on the heart. This can occur with hormones released in thyrotoxicosis. High-output failure is rare.

A patient is displaying increased pulmonary capillary wedge pressure due to coronary issues. What else may the nurse expect to see? Increased jugular vein distention Paroxysmal nocturnal dyspnea Decreased left ventricular size Hepatomegaly

Paroxysmal nocturnal dyspnea Rationale: Increased pulmonary capillary wedge pressure indicates left-side heart failure. Jugular vein distention is right-side failure. Increased pulmonary capillary wedge pressure indicates left-side heart failure. This may also cause paroxysmal nocturnal dyspnea. Increased pulmonary capillary wedge pressure indicates left-side heart failure. This will normally cause enlargement of the left ventricle. Hepatomegaly normally occurs with right-side heart failure.

Where would fluid accumulate in a patient due to the increased level of hydrostatic pressure caused by left ventricular failure?

Pleural cavity

A patient is to receive digitalis. Which of the following laboratory serum values should a nurse be concerned about? Potassium Magnesium Sodium Calcium

Potassium Digitalis toxicity can develop with low potassium levels

Howard undegoes further testing. Which of the following values may provide further evidence that Howard has left ventricular failure?

Pulmonary capillary wedge pressure (PCWP) estimates the pressure in the left atria. In left ventricular pressure, as fluid backs up in the left side of the heart, PCWP increases. Increased CVP, or central venous pressure, is the measurement used to evaluate right-side heartfailure.

When left ventricular failure occurs, which of the following signs and symptoms relate to the backward effects of heart failure?

Pulmonary edema Paroxysmal nocturnal dyspnea

What are the causes of left ventricular failure?

Reduced forward pumping strength of the ventricle muscle Increased stiffness of ventricle muscle Reduced relaxation of ventricle muscle

A patient is experiencing a decrease in blood pressure with myocardial infarction. What type of heart failure is exemplified by this scenario? Diastolic heart failure High-output heart failure Systolic heart failure Cor pulmonale

Systolic heart failure : The patient is unable to maintain blood pressure due to the heart's inability to contract effectively.

Digitalis is known as a positive inotropic and negative chronotropic medication. How would the nurse interpret this information? The medication stimulates an increase in heart rate in a decrease in contractility. The medication decreases both heart rate and contractility. The medication decreases heart rate and increases contractility. The medication increases both heart rate an contractility.

The medication decreases heart rate and increases contractility. Rationale: Digitalis increases heart contractility (inotropic) while decreasing heart rate (chronotropic).

A patient states that, ever since he has had heart failure and was given a medication, he has to "pee more." Which of the following is a correct explanation from the nurse? The medication increases your urine output to reduce the fluid load on your heart. The heart failure must have damaged your kidneys. The medication must not be working. With heart failure, you want to retain as much fluid as possible. Heart failure causes constant thirst, so you are drinking and urinating more.

The medication increases your urine output to reduce the fluid load on your heart. Rationale: A diuretic will increase urination because it reduces fluid overload on the heart

Which of his signs and symptoms are associated with right-side heart failure? Select all that apply.

When the right side of the heart fails, fluid backs up into the systemic venous system. Thus, ascites and peripheral pitting edema occur, as the fluid in the capillaries increases causing edema in these areas. The other signs and symptoms listed are not specific to right-side heart failure.

In response to hypertension, the left ventricle may undergo hypertrophy, reducing filling volume of the left ventricle. This is an example of _____________.

diastolic dysfunction

Baroreceptors detect ______________ and respond by increasing __________.

low blood pressure, heart rate

The backward effect of left heart failure may cause __________________. Select all that apply.

pulmonary edema pulmonary crackles paroxysmal nocturnal dyspnea JVD