Patho Chapter 20- Heart Failure and Circulatory Shock
7. From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply. A) A 48-year-old client with uncontrolled hypertension B) A marathon runner with history of chronic bradycardia whose pulse rate is 46 C) A 57-year-old client with history of ischemic heart disease D) A 70-year-old with enlarged left ventricle due to myocardial hypertrophy
A) A 48-year-old client with uncontrolled hypertension D) A 70-year-old with enlarged left ventricle due to myocardial hypertrophy
11. The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by: Select all that apply. A) Accumulation of fluid in the alveoli and airways B) Lung stiffness C) Worsening renal failure D) Myocardial muscle necrosis E) Impaired gas exchange
A) Accumulation of fluid in the alveoli and airways B) Lung stiffness E) Impaired gas exchange
8. The most common causes of left-sided heart failure include: A) Acute myocardial infarction B) Chronic pulmonary disease C) Impaired renal blood flow D) Tricuspid valve regurgitation
A) Acute myocardial infarction
6. At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply. A) Elongating the cardiac muscle cells B) Thickening of the individual myocytes C) Replicating the myofibrils D) Decreasing the ventricular wall thickness E) Symmetrically widening and lengthening the hypertrophy
A) Elongating the cardiac muscle cells D) Decreasing the ventricular wall thickness
25. In the ICU setting, clients who develop shock need thorough head-to-toe assessments. Which of the following clinical manifestations would alert the health care provider that the client may be developing ischemia associated with gastrointestinal redistribution of blood flow? A) Gastric bleeding B) Nausea and vomiting C) Irritable bowel syndrome D) Copious high-volume diarrhea
A) Gastric bleeding
18. Electrical burns over a large surface area of a client's body have resulted in hypovolemic shock after the loss of large amounts of blood and plasma. Following physical assessment, which findings lead the nurse to believe the client's body is compensating for this fluid loss? Select all that apply. A) Increased heart rate B) Vasodilation with warm extremities C) Diuresis with output of 100 mL/hour D) The client complaining of extreme thirst E) Deep, rapid respirations
A) Increased heart rate D) The client complaining of extreme thirst E) Deep, rapid respirations
16. An 86-year-old male client is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure? A) Increased vascular stiffness B) Orthostatic hypotension C) Increased cardiac contractility D) Loss of action potential
A) Increased vascular stiffness
3. One of the principal mechanisms by which the heart compensates for increased workload is: A) Myocardial hypertrophy B) Sodium and water retention C) Endothelin vasoconstrictors D) Ventricular wall tension increase
A) Myocardial hypertrophy
9. Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem? A) Right-sided heart failure B) Pericarditis C) Cardiogenic shock D) Cor pulmonale
A) Right-sided heart failure
10. While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by: A) Weighing every day at the same time with same type of clothing B) Measuring all of the client's urine output daily to check for a decrease in output C) Listening to the breath sound with a stethoscope every morning D) Take blood pressure daily and call doctor if it is decreased E) Impaired gas exchange
A) Weighing every day at the same time with same type of clot B) Measuring all of the client's urine output daily to check for a decrease in outputhing E) Impaired gas exchange
4. 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 of the following explanations is most appropriate to share? A) "You must be drinking way too many liquids. Your kidneys cannot filter all that you are drinking during the day." B) "Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water." C) "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." D) "Since your heart function is impaired, the lungs are not able to oxygenate the blood and your kidneys are wearing out."
B) "Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."
23. For which of the following types of shock might intravenous antibiotic therapy be indicated? A) Obstructive shock B) Distributive shock C) Cardiogenic shock D) Hypovolemic shock
B) Distributive shock
20. A client has arrived in the emergency department in cardiogenic shock. Which of the following assessment findings confirm this diagnosis? Select all that apply. A) Bright red color noted in the nail beds and lips B) Less than 5 mL dark, concentrated urine in the past hour C) BP reading of 80/65 D) Difficult to arouse with changes in level of consciousness E) Diminished breath sounds in the bases, bilaterally
B) Less than 5 mL dark, concentrated urine in the past hour C) BP reading of 80/65 D) Difficult to arouse with changes in level of consciousness
22. A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which of the following clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply. A) Incontinent of urine B) Severe bronchospasm C) Wheezing sound on inspiration D) Hives over entire body E) Swelling around the lips and eyes
B) Severe bronchospasm C) Wheezing sound on inspiration D) Hives over entire body E) Swelling around the lips and eyes
1. When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents: A) Strength of the right ventricular pump to move blood B) The amount of blood the heart pumps each minute C) The amount of blood pumped out of the heart with each beat D) The volume of blood stretching the heart muscle at the end of diastole
B) The amount of blood the heart pumps each minute
19. In an ICU setting, one assessment that would lead the nurse to suspect shock has resulted in decrease blood flow to vital organs is: A) Warm legs with peripheral vasodilation B) Urine output less than 20 mL/hour C) Blood pressure staying in the 98/72 range for the past hour D) Sleepiness and difficulty to arouse without using painful stimuli
B) Urine output less than 20 mL/hour
14. A client with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions? A) A β-adrenergic blocker B) A diuretic C) A cardiac glycoside D) An ACE inhibitor
C) A cardiac glycoside
5. The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology? A) Water retention B) Increased tubular sodium reabsorption C) Inhibition of the renin-angiotensin-aldosterone system D) Sympathetic nervous stimulation
C) Inhibition of the renin-angiotensin-aldosterone system
21. A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing? A) Cardiogenic shock B) Hypovolemic shock C) Obstructive shock D) Distributive shock
C) Obstructive shock
2. A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the client's end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this? A) Inotropy B) Cardiac contractility C) Preload D) Afterload
C) Preload
13. A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis? A) "I'll be sure to take my beta blocker whenever I feel short of breath." B) "I'm going to avoid as much physical activity as I can so that I preserve my strength." C) "I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on." D) "I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
D) "I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
15. 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: A) "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." B) "Measure the pressures inside your heart continuously to asses pumping ability of your left ventricle." C) "Have a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." D) "This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
D) "This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
12. While in the ICU, a client's status changes. The health care providers suspect heart failure. Which of the following diagnostic procedures would give the staff information about pulmonary capillary pressures, which will lead to the most appropriate interventions? A) Echocardiography B) Radionuclide ventriculography C) Cardiac magnetic resonance imaging D) Hemodynamic monitoring
D) Hemodynamic monitoring
17. A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of: A) Pulmonary embolism due to development of deep vein thrombosis B) Side effects from versed administration causing excessive vasoconstriction C) Renal failure due to an overdose of medication D) Hypovolemic shock due to acute intravascular volume loss
D) Hypovolemic shock due to acute intravascular volume loss
24. Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by: A) Hyperventilation B) Excessive surfactant C) Hyperinflated alveolar sacs D) Ventilation-perfusion mismatch
D) Ventilation-perfusion mismatch
