Patho Chapter 17 Cardiac Function and Assessment
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 If the left ventricle is failing , then ejection fraction is reduced -Blood pressure In heart failure, the left ventricle can not maintain blood pressure
A patient has end-diastolic volume of 120 ml and end-systolic volume of 60 ml. What is the patient's stroke volume for that beat in ml/beat? Enter numeral only.
60
Which of the following responses are instituted by the body to compensate for low blood pressure? Select all that apply. Increased urine output Increased afterload Activation of the renin-aldosterone-angiotensin system Decreased sodium and water retention Increased blood volume
Activation of the renin-aldosterone-angiotenstion system Increased blood volume
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 ACE stands for angiotensin-converting enzyme, which converts angiotensin I to angiotensin II
Howard, age 58, presents to the emergency department with a variety of signs and symptoms. Howard has a history of cardiac difficulties, including a myocardial infarction 5 years ago. Since that time, Howard has continued to struggle with lifestyle modifications, such as diet and exercise, to reduce his risk of future cardiac events.As the first clinician to see Howard, you record the following signs and symptoms: headache and memory loss; cyanosis; heart rate of 100 bpm; BP of 100/70 mm Hg; ascites; orthopnea; paroxysmal nocturnal dyspnea; pulmonary crackles and edema; peripheral edema; and cool, pale extremities.Which of his signs and symptoms are associated with right-sided heart failure? Select all that apply. Ascites Headache and memory loss Cyanosis Peripheral edema Cool, pale extremities
Ascites Peripheral edema When the right side of the heart fails, fluid backs up into the systemic venous system. Ascites and peripheral edema occur, as the fluid in the capillaries increases. The other signs and symptoms listed are not specific to right-side heart failure.
Which term refers to the heart's force of contraction? Preload Chronotropic function Afterload Contractility
Contractility
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
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 develops when pulmonary disorders causes right ventricular failure.
If blood volume decreases, then blood pressure may Decrease
Decrease Blood volume and blood pressure are closely related. Without enough fluid in the circulatory system, pressure will fall.
A patient suffers severe kidney damage and the juxtaglomerular cells are disrupted. Which of the following manifestations does the nurse expect? Elevated blood pressure (BP) Decreased renin secretion Decreased antidiuretic hormone Increased angiotensin
Decreased renin secretion
A young patient has suffered a significant amount of blood loss in an auto accident. Which of the following would you expect to observe in this patient? Select all that apply. Decreased urine output Increased renin secretion Decreased anti-diuretic hormone Hypertension Increased heart rate
Decreased urine output Hypertension Increased heart rate
If afterload increases, then stroke volume Increases Decreases
Decreases Afterload is the resistance the heart must work against. The greater the resistance, the less blood the heart is able to eject each beat.
If angiotensin II is inhibited, then vasoconstriction Increases Decreases
Decreases Angiotensin II, part of the RAAS, is a potent vasoconstrictor.
In response to hypertension, the left ventricle may undergo hypertrophy, reducing filling volume of the left ventricle. This is an example of _____________. systolic dysfunction diastolic dysfunction total heart failure backward effects
Diastolic dysfunction
Which of the following pairs are incorrectly matched? Low-output failure - Decreased venous return Systolic dysfunction - Difficulty contracting and pumping effectively High-output failure - Elevated demands on the heart Diastolic dysfunction - Difficulty ejecting blood
Diastolic dysfunction - Difficultycontracting and pumping effectively
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
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 Diastolic heart failure occurs when the heart cannot be filled properly
Given Howard's current health status, what are some medication options? Select all that apply. Diuretics Beta blockers Agents to reduce heart contractility Positive inotropic agents ACE agonists Check Answer
Diuretics Beta blockers Positive inotropic agents Diuretics reduce the fluid overload that occurs in heart failure, while beta blockers reduce the work load of the heart. Positive inotropic agents stimulate more effective heart contractility. Agents to reduce heart contractility would be determinantal in someone suffering heart failure, as would ACE agonists. ACE inhibitors are usually prescribed to reduce fluid overload and vasoconstriction.
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
Based on assessment findings and mixed signs and symptoms, you suspect total heart failure.Which of the following are correct statements regarding the body's attempts to compensate for heart failure? Select all that apply. Heart rate elevates in response to parasympathetic activation. Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume. Pale, cool extremities result from increased blood flow to the skin in attempt to divert excess blood away from the heart. Baroreceptors detect falling blood pressure and initiate increased heart rate to compensate. Peripheral vasodilation is the primary cause of the peripheral pitting edema.
Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume Baroreceptors detect failing blood pressure and initiate increased heart rate to compensate 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 and compensate for the pressure loss. The body also retains fluid to compensate for heart failure. 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 the forward effects of left-side heart failure? Select all that apply. Headache Decreased blood pressure Increased heart rate Pulmonary crackles Pulmonary edema
Headache Decreased blood pressure Increased heart rate Forward effects of left-side heart failure result from an inability of ventricle to adequately pump blood into systemic circulation, resulting in decreased blood pressure and increased heart rate to compensate. Headache may occur due to poor perfusion of the brain. Pulmonary crackles and pulmonary edema are due to backward effects of LV failure.
A nurse is given a patient's heart rate and stroke volume. How would she calculate the cardiac output? Heart rate times stroke volume Heart rate divided by stroke volume Heart rate plus stroke volume Stroke volume divided by heart rate
Heart rate time stroke volume
Which of the following may adversely affect heart performance? Select all that apply. Increased calcium levels in the heart Increased contractility Increased afterload Decreased blood volume Decreased preload
Hypertension Increased angiotensin
If preload increases within a normal range, then stroke volume INCREASES DECREASES
INCREASES Preload refers to the volume of blood filling the heart before it contracts. To a certain point, the more the heart is filled with blood, the more blood is ejected with each stroke.
If blood pressure decreases, then the ADH levels Increases Decreases
Increase Low blood pressure stimulates the release of ADH, which decreases urine output and increases water retention. Increasing fluid volume in the body helps to maintain blood pressure.
If blood pressure decreases, then compensatory measures cause heart rate to Increases Decreases
Increase The baroreceptors in the aorta and carotids monitor blood pressure. When they detect a fall in blood pressure, they activate the sympathetic nervous system, which in turn stimulates heart rate to compensate for the pressure drop.
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. Decreased ADH Increased aldosterone Decreased angiotensin Increased natriuretic peptide Increased renin Check Answer
Increased aldosterone Increased renin Fluid retention results from the activation of the renin-angiotensin-aldosterone system (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 reduces blood volume.
A patient's blood pressure is falling due to hemorrhage. Which of the following are appropriate compensations by the body? Select all that apply. Decreased heart rate Increased antidiuretic hormone (ADH) Increased aldosterone Decreased peripheral vasoconstriction Increased fluid retention
Increased antidiuretic hormone (ADH) Increased aldosterone Increased fluid retention
Which of the following may adversely affect heart performance? Select all that apply. Increased calcium levels in the heart Increased contractility Increased afterload Decreased blood volume Decreased preload
Increased calcium levels in the heart Increased contractility Decreased blood volume ***NONE WERE CORRECT
Following the development of left ventricular failure, a patient develops pulmonary edema. Which of the following factors accounts for the formation of this edema? Increased hydrostatic pressure in the pulmonary capillaries Increased oncotic pressure in the pulmonary capillaries Decreased hydrostatic pressure in the pulmonary capillaries Decreased pulmonary capillary permeability
Increased hydrostatic pressure in the pulmonary cappillaries
A patient has a fluid volume overload due to congestive heart failure. Which of the following compensations will the body attempt to address the fluid volume overload? Increased renin Increased natriuretic peptide Increased angiotensinogen Increased aldosterone
Increased natriuretic peptide
If angiotensin II increases, then aldosterone Increases Decreases
Increases Angiotensin II stimulates the adrenal cortex to release aldosterone.
If nitric oxide increases, then vasodilation Increases Decreases
Increases Nitric oxide is a potent vasodilator. Nitroglycerin tablets may be used to dilate coronary arteries when the individual experiences chest pain.
Heart failure may result from which of the following? Select all that apply. Ischemic injury to the heart Dysrhythmias Increased contractility Chronic hypoxia Hypertension
Ischemia injury to the heart Dysrhythmias Chronic hypoxia Hypertension
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 Orthopnea Enlarged liver and/or spleen Crackles in the lungs Pulmonary edema
Jugular vein distention Enlarged liver and/or spleen Jugular vein distention (JVD) and hepatosplenomegaly (enlarged liver or spleen) are common signs of right-side heart failure. With this condition, blood backs up in the large veins that deliver 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 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
A nurse is reviewing how decreased perfusion to the kidneys can result in increased blood volume. Please place the following steps in order. Aldosterone is released. sodium and water reabsorption is increased. Renin activates angiotensinogen. Angiotensin I is converted to angiotensin II. Juxtaglomerular cells secrete renin.
Juxtaglomerular cells secrete renin. Renin activates angiotensinogen. Angiotensin I is converted to angiotensin II. Aldosterone is released. sodium and water reabsorption is increased.
A nurse it talking to a patient who has hypertension. The nurse states that it is not only the heart that is involved in maintaining blood pressure. What other organ is the nurse most likely referring to? Liver Stomach Spleen Kidney
Kidney
Baroreceptors detect ______________ and respond by increasing __________. high blood pressure, heart rate increased heart rate, blood pressure decreased heart rate, blood pressure low blood pressure, heart rate
Low blood pressure, heart rate
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 High-output failure results from extreme demands on the heart. This can occur with hormones released in thyrotoxicosis.
A nurse needs to record the stroke volume (SV) for a patient. Which of the following units would be the proper one for stroke volume? Beats per minute Percentage Liters per minute Milliliters per beat
Milliliters per beat
Which of his signs and symptoms are associated with the backward effects of left-side heart failure? Select all that apply. Headache and memory loss Orthopnea Paroxysmal nocturnal dyspnea Pulmonary crackles Pulmonary edema
Orthopnea Paroxysmal nocturnal dyspnea Pulmonary crackles Pulmonary edema Backward effects of left-side heart failure results in fluid back up on the pulmonary system. Orthopnea, paroxysmal nocturnal dyspnea, pulmonary crackles, and pulmonary edema are all signs of the left ventricle failing to pump blood forward and backward effects of fluid accumulation in the lungs developing.
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
When left ventricular failure occurs, which of the following signs and symptoms relate to the backward effects of heart failure? Select all that apply. Increased ejection fraction Pulmonary edema Jugular vein distension Hypotension Paroxysmal nocturnal dyspnea
Pulmonary edema Paroxysmal noctunral dyspnea
Where would fluid accumulate in a patient due to the increased level of hydrostatic pressure caused by left ventricular failure? Jugular veins Pulmonary interstitial spaces Kidneys Hepatic portal veins
Pulmonary interstitial spaces
A patient appears with hypotension. Which of the following may contribute to hypotension? Increased sodium and water reabsorption Increased cardiac output Reduced blood volume Activation of the renin-angiotensin-aldosterone system
Reduced blood volume
What are the causes of left ventricular failure? Select all that apply. Increased pressure within the venous system Increased stiffness of ventricle muscle Reduced relaxation of ventricle muscle Reduced forward pumping strength of the ventricle muscle Decreased pulmonary arterial blood flow
Reduced relaxation of ventricle muscles Reduced forward pumping strength of the 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
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 hearts inability to contract effectively.
A patient is assessed and found to have a left ventricle ejection fraction (LVEF) of 35%. What interpretation of this result would be correct for the nurse to make? The LVEF is normal. The LVEF represents a high-functioning heart. The LVEF is reduced compared to normal values. The LVEF is incorrect and should not be expressed as a percentage.
The LVEF is reduced compared to normal values
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
angiotension I to angiotension II
A trauma patient is experiencing a decrease in urine output. The patient has experienced significant blood loss. Which is one factor that accounts for the decrease in urine output? Decreased aldosterone secretion Suppression of the renin-angiotensin-aldosterone system (RAAS) Decreased sodium and water reabsorption Increased antidiuretic hormone (ADH)
increased antifdiuretic hormone (ADH)
The backward effect of total heart failure may cause __________________. Select all that apply. jugular vein distension hypertension paroxysmal nocturnal dyspnea pulmonary edema pulmonary crackles
Paroxysmal nocturnal dyspnea Pulmonary edema Pulmonary crackles
A patient is to receive digitalis. Which of the following laboratory serum values should a nurse be concerned about? Potassium Magnesium Sodium Calcium
Potassium
A nursing student writes in her notes, "When the heart is filled with more blood, the heart is able to eject more blood." What term would best fit this description? Cardiac output Afterload Preload Stroke volume
Preload
Everett has experienced increasing blood pressure over the past 2 years. Which cardiac factor indicates the increased work experienced by Everett's heart? Preload Afterload Stroke volume Contractility``
Preload
Which term indicates the volume of blood entering the heart at the end of diastole? Contractility Ejection fraction Afterload Preload
Preload
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 Occurs in right-side heart failure as fluid backs up into the veins -Hepatomegaly If the right side of the heart fails then fluid may back up in the liver, causing hepatomegaly.
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
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. BNP increases urine output reducing fluid load on the heart.
Which of the following has likely occurred that led to this image? ***congestive heart failure x-ray** 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 The image shows pulmonary congestion more common with left ventricular failure.
In the following image, what is this test measuring? Forward effects of left-side heart failure Backward effects of lef-side 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 show jugular vein distention, which is a backwards effect of right-side heart failure.
A patient presents with peripheral edema, hepatosplenomegaly, and jugular vein distention. What do these signs and symptoms represent? Backward effects of right ventricular failure Forward effects of right ventricular failure Forward effects of left ventricular failure Backward effects of left ventricular failure
Backwards effect of the right ventricular failure
Which of the following are classes of medications used in management of heart failure? Select all that apply. Beta blockers Hormone replacement therapy Diuretics Inotropic agents ACE inhibitors
Beta blockers Diuretics Inotroic agents ACE inhibitors
Which of the following statements are true? Select all that apply. Cardiac output= heart rate/stroke volume Heart failure and cardiac arrest are synonymous. Increased hydrostatic pressure increases the risk of edema. Chronotropic agents affect HR. Cardiac output is influenced by the sympathetic nervous system.
Cardiac output= heart rate/stroke volume Increased hydrostatic pressure increases the risk of edema. Cardiac output is influenced by the sympathetic nervous system. **DONT KNOW IF CORRECT
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
Which of the following are expected in response to left ventricular failure? Select all that apply. Increased anti-diuretic hormone Decreased heart rate Decreased sodium and water reabsorption Increased angiotensin II Increased urine output
Increased anti-diuretic homrone Increased angiotension II
Following the development of left ventricular failure, a patient develops pulmonary edema. Which of the following factors accounts for the formation of this edema? Increased hydrostatic pressure in the pulmonary capillaries Increased oncotic pressure in the pulmonary capillaries Decreased hydrostatic pressure in the pulmonary capillaries Decreased pulmonary capillary permeability Hopelessness r/t perceived lack of support and ability to change the present situation Explains to visitors everything is okay, he really was fortunate it wasn't worse than it could have been, 'he will be fine', tells everyone to go home (doesn't want visitors now).
Increased hydrostatic pressure in the pulmonary cappillaries
Howard undergoes further testing. Which value may provide further evidence that Howard has left ventricular failure? Increased pulmonary capillary wedge pressure (PCWP) Increased albumin Decreased PAP Increased JVD
Increased pulmonary capillary wedge (PCWP) Pulmonary capillary wedge pressure (PCWP) testing 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 heart failure.
Please place the following sequences in order as to how exercise can result in increased cardiac output. Increased skeletal muscle contraction Increased compression of the veins Increased stroke volume Increased preload Increased venous return
Increased skeletal muscle contraction Increased compression of the veins Increased venous return Increased preload Increased stroke volume
If aldosterone is released, then blood volume Increases Decreases
Increases Aldosterone stimulates sodium and water retention, increasing blood volume.
If capillary hydrostatic pressure increases, then the likelihood of edema Increases Decreases
Increases Capillary hydrostatic pressure is the fluid pressure within a capillary. As capillaries are "leaky," higher fluid pressure inside the capillary results in more fluid leaking out of the capillary.
If kidney perfusion decreases, then renin release Increases Decreases
Increases Renin is released by the juxtaglomerular (JG) cells of the kidney in response to low blood flow and pressure to the kidneys.
If venous return increases, then preload Increases Decreases
Increases Venous return is the amount of blood returning to the heart. The more blood returning to the heart, the more the heart is filled, a quantity known as preload.
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 Increased pulmonary capillary wedge pressure indicates left-sided heart failure. This may also cause enlargement of the left ventricle.
A patient with left ventricular failure is completing a cardiac assessment. Which of the following results would be concerning to a clinician? Left ventricular ejection fraction (LVEF) of 35% Resting cardiac output of 5.2 liters per minute Low to normal central venous pressure Blood pressure (BP) of 130/82 mm Hg
Left ventricular ejection fraction (LVEF) of 35%
If all people are assumed to have cardiac output of 5 L/min at rest, with a resting heart rate (HR) of 70 beats per minute (bpm), and an athlete has a resting HR of 58 bpm, which of the following likely applies? The athlete has a higher resting stroke volume. The athlete has higher afterload. The athlete has a significantly reduced ejection fraction. The athlete has higher resting blood pressure.
The athlete has a higher resting stroke volume
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 contracility
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. Digitalis increases heart contractility (inotropic) while decreasing heart rate (chronotropic)
A patient is given an angiotensin receptor blocker. As the nurse with the discharge instructions, which of the following would you tell the patient is the effect of this medication? The medication increases heart rate. The medication decreases pulmonary congestion. The medication decreases the constriction and resistance of your blood vessels. The medication increases urine output.
The medication decreases the constriction and resistance of your blood vessels
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
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. A diuretic will increase urination because it reduces fluid overload on the heart.
