PrepU chpt 27 Disorders of Cardiac function, and heart failure and circulatory shock
Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
constrictive pericarditis
Which instructions should the nurse give to a client with a new prosthetic mitral valve? Select all that apply.
"Expect to take prophylactic antibiotics for dental work." "Lifelong anticoagulants are necessary to prevent blood clots."
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."
A client asks the purpose of an exercise stress test. What is the nurse's best response?
"The test is used to measure functional status during stress."
ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?
Action decreases metabolic demands of the heart.
The nursing student, when studying about coronary artery disease, learns that it is commonly divided into different types of disorders. Which disorders would be included? Select all that apply.
Acute coronary syndrome Chronic ischemic heart disease
A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock?
Anaphylactic
A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child?
Antibiotics and anti-inflammatory drugs
Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?
Atherosclerosis and unstable angina
What should the nurse teach the pregnant woman about congenital heart defects?
Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant.
Which description sums up the basic pathophysiology of heart failure that the nurse would include when educating a client?
Low cardiac output due to reduced pumping ability
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:
History of cigarette smoking and elevated blood pressure
Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often follows the vascular response in anaphylaxis?
Laryngeal edema
A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:
Onset of STEMI
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
The nurse caring for a client 12 hours after a coronary bypass graft notes a sudden decrease in the amount of chest tube drainage, a rapidly narrowing pulse pressure, paradoxical pulse, and shortened amplitude of the QRS complex on the electrocardiogram monitor. Which action should the nurse take next?
Prepare for pericardiocentesis
A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?
Raising the head of the bed to a high Fowler's position
While studying the physiology of the heart, the nursing students have learned that which of the following influence the blood flow in the coronary vessels that supply the myocardium? Select all that apply.
The aortic pressure Autoregulatory mechanisms Compression of the intramyocardial vessels
A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?
Troponin level
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?
Vasoconstriction
A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?
Vasodilating effects reducing preload and afterload
A preventive measure to decrease the risk of developing rheumatic heart disease includes:
prompt diagnosis of streptococcal infections with a throat culture.
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
A nurse educator explains a type of cardiac condition as "a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation and often lead to cardiovascular death or progressive heart failure." Which condition fits this definition?
Cardiomyopathy
Which client with cardiomyopathy does the nurse identify as having the greatest risk for a complication?
Client with an ejection fraction of 25% and atrial fibrillation
Acute pulmonary edema often occurs with heart failure. Which signs of acute pulmonary edema should the nurse monitor their clients for? Select all that apply.
Frothy, blood-tinged sputum Respiratory crackles Confusion Rapid pulse
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock?
Septic
The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?
The disabling effects that result from involvement of heart valves
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:
The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
Heart failure and circulatory shock are both conditions of circulatory system failure. Which statement regarding these conditions is correct?
They have the same compensatory mechanisms.
The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by which physiologic response(s)? Select all that apply.
accumulation of fluid in the alveoli and airways lung stiffness altered gas exchange
An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:
blocking the conversion of angiotensin I to angiotensin II.
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
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:
see the doctor for evaluation immediately Explanation: Angina that occurs at rest, is of new onset, or is increasing in intensity or duration denotes an increased risk for myocardial infarction and should be seen immediately using the criteria for acute coronary syndrome (ACS).
Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?
Hypertrophic cardiomyopathy (HCM)
Select the client who may be at risk for developing an increased resistance to blood flow.
The client in hypovolemic shock, experiencing extreme dehydration Explanation: The viscosity of a liquid is largely related to its thickness or number of particles that it contains. The blood of the client who is extremely dehydrated will be more viscous and increase resistance to flow.
A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as:
Valvular regurgitation
