PREP U CARDIAC FUNCTION STUDY GUIDE

A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening?

Weight gain

A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:

"Aspirin will help prevent blood clotting."

Knowing the high incidence and prevalence of heart failure among older adults, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which teaching point is most accurate?

"Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure."

A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which explanation is most appropriate to share?

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

What are 3 clinical manifestations of NSTEMI/UA?

1. Occurs at rest, lasting more than 20 minutes 2. severe and described as frank pain and of new onset 3. more severe, prolonged, or frequent than previously experienced

What are the 5 phases of UA/NSTEMI

1. unstable plaque ruptures or erodes with non-occulusive thrombosis 2. Obstruction due to spasm, constriction, dysfunction, or adrenergic stimuli 3. Severe narrowing of the coronary lumen 4. Inflammation 5. Physiologic state causing ischemia related to decreased oxygen supply

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which level indicates inadequate renal perfusion?

20 mL/hour

How much fluid usually accumulates during pericardial effusion?

200mL

Which individual is likely experiencing the manifestation of acute coronary syndrome (ACS)?

A client who occasionally experiences persistent and severe chest pain when at rest

A patient comes into the ER with chest pain, changes in their ECG, and pericardial friction rub. The patient describes their pain as abrupt and sharp and gets worse with deep breathing. What is most likely to be causing these symtpoms?

Actue Pericarditis

What is a prominent early finding in constrictive percarditis?

Ascites with pedal edema, dyspnea on exertion, and fatigue

Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences?

Backflow from the left ventricle to left atrium

A patient comes into the ER and presents with tachycardia, decreased systolic BP, jugular vein distention, muffled heart sounds and signs with circulatory shock. What is most likely causing these symptoms?

Cardiac tamponade

What is the triad of clinical manifestations for acute percarditis?

Chest pain pericardial friction rub ECG changes

The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:

Decreased cardiac output

A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this?

Hypertrophic cardiomyopathy

Which statement regarding heart failure is true?

In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction.

An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure?

Increased vascular stiffness

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

Infective endocarditis

What is the most common cause of acute percarditis?

viral infections

Exudate in the pericardial cavity is a characteristic of which cardiac condition?

Pericardial effusion

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

Pericarditis

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

Prompt diagnosis and treatment of streptococcal infections

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

Rheumatic fever

ST segment elevation is only present in what?

STEMI

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

Septic shock

Unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) is a clinical syndrome that ranges in severity between stable angina and MI. It is classified according to its risk of causing an acute MI and is diagnosed based on what assessment data? Select all that apply.

Serum biomarkers ECG pattern

What is the primary cause of heart failure in infants and children?

Structural heart defects

A 60-year-old woman has just been diagnosed with heart failure and her primary care provider is describing the concept of adaptation. Which compensatory mechanisms may have masked the client's heart failure? Select all that apply.

Sympathetic nervous stimulation Hypertrophy of the myocardium Increased renin-angiotensin-aldosterone system (RAAS) function Increased preload

Which client is at the greatest risk of developing rheumatic heart disease?

Teenager with untreated strep throat

A neonate is born with a congenital heart defect. The nurse realizes this defect most likely originated during which week of development?

The third week of development

Which serum biomarker is highly specific for myocardial tissue?

Troponin

Acute Coronary Syndrome includes:

Unstable angina, NSTEMI, and STEMI

An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased:

Vascular stiffness

what is the portal of entry for infective endocariditis?

bacterial infection in the blood from dental or surgical procedures

What is relieved by rest and nitroglycerin?

chronic stable angina

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.

compensatory mechanisms

what is the pain described as during chronic stable angina?

constricting, squeezing, or suffocating

Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

constrictive pericarditis

What is the principal biochemical consequence for ST elevation?

conversion from aerobic metabolism to anaerobic metabolism

When there is scar tissue present in the pericardial sac, what does the scar tissue interfere with?

diastolic filling, cardiac output, and cardiac reserve becoming fixed

A nurse is concerned that a resident of a long-term care facility may be developing left-sided heart failure. The nurse would communicate which set of manifestations as possible evidence of left-sided heart failure?

dyspnea, cough, fatigue

What is the pathophysiology of chronic stable angina?

fixed coronary obstruction and the blood does not meet the demands of the heart

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

pericardial effusion

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 blood pressure is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

hypovolemic shock due to acute intravascular volume loss.

The nursing student has learned in his class that coronary artery disease (CAD) is heart disease caused by:

impaired coronary blood flow.

what are the hemodynamic factors that can trigger plaque disruption?

increased BP, increased HR, increased cardiac contractility, and increased coronary blood flow

Women are more likely to complain of what rather than chest pain?

indigestion

infarction leads to...

ischemic necrosis

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

right-sided heart failure

Elderly individuals are more likely to complain of what rather than chest pain?

shortness of breath

plaque that has a small lipid pool with an extremely thick fibrous capsule, while obstructing blood flow is what kind of plaque?

stable

what is the most common cause of infective endocarditis?

staphylococcal infections

plaque that has a large lipid pool with a thin capsule that can rupture and lead to adhesion and thrombus formation is what kind of plaque?

unstable

An IV drug abuser has been diagnosed with infective endocarditis. He is in the emergency department reporting increasing shortness of breath, rapid breathing, chest pain that worsens with breathing, and coughing up blood. The health care provider recognizes this may be caused by:

vegetative emboli traveling in the blood stream to the lungs.