Adv Patho Unit 5: Cardio

Heart muscle differs from skeletal muscle tissue by being able to generate:

Action potentials

From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply.

A 48-year-old client with uncontrolled hypertension A 70-year-old with enlarged left ventricle due to myocardial hypertrophy

The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)?

A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation

When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which of the following statements are accurate? Select all that apply.

A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. When there is an AV block, impulses from the atria and ventricles beat independently of each other so, the heart rhythm is usually chaotic and not regular.

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 cardiac glycoside

A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to "watch" for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which of the following physiological principles?

As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture.

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 of the following consequences?

Backflow from the left ventricle to the left atrium

A client has entered hypovolemic shock after massive blood loss in a car accident. Many of the client's peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon?

Blood pressure is no longer able to overcome vessel wall tension.

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

Fixed coronary obstruction

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?

Hemodynamic monitoring

Which of the following would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL?

High-calorie diet

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?

I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

In addition to direct invasion of the vascular wall by an infectious agent, this pathogenic mechanism is a common cause of vasculitis?

Immune-mediated inflammation

Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a:

Large lipid core

One of the principal mechanisms by which the heart compensates for increased workload is:

Myocardial hypertrophy

When explaining a new diagnosis of complete heart block to a client/family, the nurse should include which of the following statements?

One consequence of this type of block is a very slow heart rate that limits circulation to the brain.

A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo:

Percutaneous transluminal angioplasty and stent placement

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?

Preload

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?

Right-sided 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 of the following explanations 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.

The plaques in a client's coronary arteries are plentiful, and most have small-to-moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses?

Stable angina

When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents:

The amount of blood the heart pumps each minute

The most important complication of atherosclerosis that may cause occlusion of small heart vessels is:

Thrombosis

Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by:

Vegetative valve destruction

Which of the following statements about vascular compliance is accurate?

Veins can act as a reservoir for storing large quantities of blood

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:

Weighing every day at the same time with same type of clothing

Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, "What does that mean?" The nurse will base her answer on which of the following physiologic principles?

You have a heart valve that is diseased.

A client asks, "Why do I have clogged arteries but my neighbor has higher 'bad cholesterol' levels and yet he is just fine?" The health care provider bases the reply on which of the following physiological principles about lipoprotein?

You more than likely have small, dense type of 'bad cholesterol' (LDL).

If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern?

· Slowing of heart rate to below 60 beats/minute

Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)?

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

Because of its location, the presence of an abdominal aortic aneurysm may first be manifested as:

A pulsating mass

The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by: Select all that apply.

Accumulation of fluid in the alveoli and airways Lung stiffness Impaired gas exchange

The most common causes of left-sided heart failure include:

Acute myocardial infarction

On the 3rd day following an acute myocardial infarction, the client is being discharged home. The nurse is explaining how the heart tissue heals following an MI. "Since today is your 3rd day after your heart attack, the tissue is:

Acutely inflamed.

Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease?

C-reactive protein

Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is:

Calf pain

Clients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant:

ECG changes

At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply.

Elongating the cardiac muscle cells Decreasing the ventricular wall thickness

In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis?

Endocarditis

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?

Inhibition of the renin-angiotensin-aldosterone system

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes?

Peripheral vascular resistance

A health care provider was asked by a client, "Why do my hands turn blue when I drive my car in the winter without gloves?" Which of the following is the best response?

Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen.