Cardiac Review Chapters 19-25 (ish) Exam 4-- Set 4, Cardiac Review Chapters 19-25 (ish) Exam 4-- Set 3
A physician is teaching a group of medical students about the physiological basis for damage to the circulatory and neurological system that can accompany hypotension. Which of the following responses by a student would warrant correction by the physician?
"Tension and vessel thickness increase proportionately."
What enters during the Plateau of the Conducting System?
Ca2+
A client has been diagnosed with heart failure. The client's cardiac contractility will be primarily affected by which factor?
Ca2+ levels in the myocardium p. 487.
*Which class of heart failure is when you have slight limitation of physical activity; comfortable at rest, but ordinary physical activity causes fatigue/palpitation/dyspnea?*
Class 2- mild
A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure?
Diuretic, ACE inhibitor, beta-blocker
A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure?
Diuretic, ACE inhibitor, beta-blocker p. 489.
A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regiment is most suggested that the patient has a diagnosis of heart failure?
Diuretic, ace inhibitor, beta blocker
A patient is diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder? Select all that apply.
Diuretics Digitalis Beta-adrenergic blockers Angiotensin-converting enzyme inhibitors (ACEI)
A patient is diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder? Select all that apply.
Diuretics Digitalis Beta-adrenergic blockers Angiotensin-converting enzyme inhibitors (ACEI) p. 497.
g infected with coccidioidomycosis and has been admitted to the hospital with fever, cough, pleuritic chest pain, and skin lesions.
Do you work in construction and dig soil?
The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?
Exchange gases, nutrients and wastes
A 72 year old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds:
Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.
*What does the drug DIGOXIN do?*
Helps with systolic heart failure *Decrease* HR BUT.....*Increase* ejection fraction (get more blood out, which we want)
A nurse educator in a geriatric medicine unit of the hospital is teaching a group of new grad specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurse prioritize and their practice?
Measurement of urine output in mental status assessment
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?
Increased vascular stiffness, p. 499.
The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion (p.405)
_________ receives blood from the coronary sinus.
Right Atrium
A 68-year-old male complains to his nurse practitioner that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also occasionally had lightheadedness and a recent syncopal episode. What is this patient's most likely diagnosis and the phenomenon underlying it?
Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias
Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include which of the following?
Stasis of blood, hypercoagulability, vessel wall injury
*Females with onset of MI typically have what other sx's?*
Sx's in shoulders, neck, jaw, back, abdomen *PROFOUND FATIGUE*
A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relate to these health problems?
The client is 89 years old and takes a diuretic medication for his congestive heart failure. p. 433.
The heart wall becomes thickened in hypertrophic cardiomyopathy secondary to what ?
Secondary to heart being in *prolonged isometric contraction* -can be caused by uncontrolled sympathetic activity; mostly genetic causes
college student being treated for a kidney infection developed a temperature of 104ºF 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 patient most likely is experiencing which of the following types of shock?
Septic
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF 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 patient most likely is experiencing which of the following types of shock?
Septic p. 506.
A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis?
Septic shock
Lysosomes
cell organelle filled with enzymes needed to break down certain materials in the cell
Eukatyote
an organism made up of cells that have a nucleus and membrane-bound organelles
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client?
anaphylatic shock
The function of the chordae tendinae is to
anchor the AV valve flaps and prevent backflow of blood into the atria
which of the following influence the blood flow in the coronary vessels that supply the myocardium?
aortic pressure, the autoregulatory mechanisms, and compression of the intramyocardial vessels b
A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client:
has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.
factors that affect stroke volume include which of the following?
preload, myocardial contractility, afterload
partial pressue
pressure exerted by a single gas in the mixture
preventing collapse
some air remains in the alveoli of the lower portion of the lungs
One of the important differences between skeletal muscle tissue and cardiac muscle tissue is that cardiac muscle tissue is
striated involuntary muscle
The amount of blood pumped out of each ventricle during a single beat is the
stroke volume
A client is visiting the primary physician and appears extremely nervous. The intake nurse does his vital signs and notes an increase in both his heart rate and blood pressure. In an effort to better understand the client's presenting signs and symptoms the nurse asks the client about his concerns and the client states that the person who performed his pre-visit told him that he had an arrhythmia. Which is the most therapeutic response about cardiac arrhythmias that the nurse can make?
they can occur in diseased or healthy hearts.
myocardium
thick middle muscle layer of the heart; pumps blood through the circulatory system
Parasympathetic stimulation
through the vagus nerve, that is responsible for slightly constricted smooth muscle tone in the normal resting lung.
conducting airways
through which air moves as it passes between the atmosphere and the lungs
Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart. It can be life-threatening and symptoms include
tachycardia, elevated central venous pressure, jugular vein distention, fall in systolic blood pressure with narrowed pulse pressure.
*Ischemic threshold aka anginal threshold is what?*
the *HR* at which the patient gets chest pain
The volume of blood in the L. ventricle is at its lowest when
the AV valve opens
systole
to contract; period in the cardiac cycle when the heart is in contraction and blood is ejected through the aorta and pulmonary artery
Main function of the heart is
to push blood
The left and right atrium beat _______.
together
The left and right ventricle beat ______.
together
EDV: End Diastolic Volume
the amount of blood in the ventricle immediately before a contraction a.k.a. the end of ventricular diastole
When the pressure within the L. ventricle becomes greater than the pressure within the aorta
the aortic semilunar valve is forced open
endocardium
the membrane that lines the cavities of the heart and forms part of the heart valves
During most of the ventricular diastole
the pressure in the L. ventricle is slightly lower than the pressure in the L. atrium
Which chamber receives blood from the superior and inferior vena cavae?
the right atrium receives unoxygenated blood from the systemic circuit.
*The good thing about working with patients with stable angina is that....*
you can predict the level of exertion (which is precipitated by exertion, stress, emotions, and heavy meals) pain usually lasts about several minutes and relieved by rest
The venous system is a low pressure system that returns blood to the heart. What is the normal right atrial pressure?
0mm Hg
A client who came to the emergency room and was diagnosed with ST-segment elevation myocardial infarction (STEMI) experienced "sudden death." The emergency room nurse explains sudden death from a STEMI as death that occurs within what time frame of symptom onset?
1 hour
*What are the 4 lab values used for MIs?*
1. Creatine kinase (CPK), MB band 2. Troponin I (TNI) - a little better test than CPK 3. Myoglobin (not used so much anymore...) 4. Lactate dehydrogenase (LDH) - used more now
There are 3 different types of cardiomyopathies: what are they?
1. Dilated cardiomyopathy 2. Hypertrophic cardiomyopathy 3. Restrictive cardiomyopathy
What 4 things describe Metabolic syndrome aka Syndrome X?
1. HTN 2. High blood sugar 3. High cholesterol 4. Obesity
How can you increase Cardiac Output? (2 ways)
1. Increase HR 2. Increase SV
*It is safe to keep stable angina patients how many beats below ischemic threshold?*
10 beats below ischemic threshold
Conducting System-Step 3
100-msec delay at the AV node, atrial contraction begins
The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.
140 Systolic hypertension is a consistent systolic pressure of 140 mm Hg or higher with near normal diastolic pressure.
A client is having blood work done. What percentage of red blood cells represents the formed elements of the blood?
40 - 45%
*Ischemia is:* a. temporary blood loss b. occluded vessel c. cell death
A
Which of the following patients is at greatest risk for orthostatic hypotension?
A 66-year-old post-surgery patient on bed rest
In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?
A client is helped out of bed and stands up During a change in body position, blood is rapidly relocated from the central circulation (when the client is recumbent) to the lower extremities (when the client stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.
admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering
A corticosteroid.
A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment? A. Coma B. Delirium C. Vegetative state D. Brain death
A. Coma
Which of the following phenomena would be least likely to result in activation of the complement system?
Activation of Toll-like receptors (TLRs) on complement proteins
A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?
Administer epinephrine (adrenaline).
Select the priority of care for the medical management of a client with a dissecting aortic aneurysm.
Administration of sodium nitroprusside and β-adrenergic blocking medications Page 419
pressure difference
Air moves between the atmosphere and the lungs because of this
A client has been diagnosed with atrial flutter. What assessment finding does the nurse expect?
An atrial heart rate above 240 beats per minute
A 66-year-old patient's echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart. What is this patient's most likely diagnosis?
Aortic valve stenosis
An elderly client recently had a cerebrovascular accident that resulted in dysphagia. Which of the following is the nurse's greatest concern while feeding this client?
Aspiration
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?
At the apex of the heart
*Injury is:* a. temporary blood loss b. occluded vessel c. cell death
B
*Which type of angina is when ischemic cardiac pain always occur at rest?* a. unstable b. stable c. prinzmetal
C. Prinzmetal's angina - may be associated with acute MI and cardiac arrthymias
*Can we treat patients with myocarditis?*
CANNOT TREAT UNTIL THEY ARE BETTER
*Myocarditis causes what two cardiac conditions?*
CHF & CMD (cardiac muscle dysfunction)
client has clubbing of the fingertips. Which is the best intervention?
Check the patient's O2 saturation level.
When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?
Conversion from aerobic to anaerobic metabolism
*If a patient comes into your clinic with stable angina, how would he likely describe his symptoms?*
Described as pressure, heaviness, tightness over middle of chest (substernal) sometimes over the heart, shoulders, arm, throat jaw or teeth *never sharp or shooting pain* -- need to differentiate between chest wall pain due to musculoskeletal issues and true anginal pain*
ension pneumothorax would be suspected in which of the following physical assessment findings?
Deviated trachea
A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause.
Diastolic dysfunction p. 492.
What is the most important factor in myocardial oxygen demand?
Heart rate
What is an example of a secondary cause of cardiomyopathy?
Hormones ex: "broken heart" syndrome
A patient has developed atherosclerosis. The nurse knows that a major cause for this disorder is which of the following?
Hypertension (p. 409)
Why does the drug DIGOXIN make diastolic heart failures worse?*
If the heart already has trouble re-filling, you don't want to make it worse by increasing ejection fraction
The nursing student has learned in his class that coronary artery disease (CAD) is heart disease caused by which of the following?
Impaired coronary blood flow
ronary artery disease (CAD) is heart disease caused by which of the following?
Impaired coronary blood flow
diagnosed with a tension pneumothorax. The priority intervention would be:
Insertion of a large-bore needle or chest tube
internodal pathways
Interconnect the SA Node with the AV Node, conducts impulses throught to the atrial working cells.
*What are the 3 I's in the evolution of an MI?*
Ischemia -- Injury -- Infarct
The nurse practitioner's examination of a client reveals xanthomas along the client's tendons. Which of the following tests will the practitioner order?
LDL level
The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states that blood is shunted from the:
Left side of the heart to the right side of the heart
Increased secretion of renin in heart failure is caused by which event?
Low cardiac output
Antibodies directed against the M protein of certain strains of streptococcal bacteria seem to cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response resulting in rheumatic fever and rheumatic heart disease. This occurs through what phenomenon?
Molecular mimicry
ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?
Most ECG-detected ischemic events are clinically silent. Persons with acute coronary syndrome are at risk for developing extension of an infarcted area, ongoing myocardial ischemia, and life-threatening arrhythmias. Research has revealed that 80% to 90% of ECG-detected ischemic events are clinically silent. Thus, ECG monitoring is more sensitive than a client's report of symptoms for identifying transient ongoing myocardial ischemia. Other answers are incorrect
Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?
Nitric oxide
The nurse should suggest which of the following medications for a patient in cardiogenic shock? Select all that apply.
Nitroprusside (Nitropress) Nitroglycerin Dobutamine (Dobutrex) Milrinone (Primacor) p. 498.
*When does Prinzmetal's angina occur?*
Often times, first thing in the morning.... Possibly due to: - more viscous blood in the morning *OR* from arterial spasm-ing
A nurse assesses a patient with normal biomarkers who reports angina. Which of the following additional manifestations are late signs of aortic stenosis? Select all that apply.
One with an ejection fraction of 25% and atrial fibrillation
severe mitral valve stenosis.
Orthopnea
Bloodflow from lungs
Pulmonary Veins> L Atrium> L Ventricle> Aortic Valve> Aorta> Tissues
EDV-ESV=
SV
SA node
Sino-atrial node; the pace-maker of the heart; where the impulse conduction of the heart usually starts; located in the top of the right atrium
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 type of angina is relieved by rest or nitroglycerine?*
Stable
Conducting System-Step 2
Stimulus spreads across the atrial surfaces and reaches the AV node
bacterial pneumonia and is admitted to the hospital. The nurse obtains sputum cultures upon admission.
Streptococcus pneumoniae
The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:
Stroke volume × heart rate
_________ receives blood from the upper trunk of the body.
Superior vena cava
Bloodflow from body
Superior/Inferior Vena Cava> R Atrium> Pulmonary Valve> Pulmonary Trunk> R & L Pulmonary Artery> Lungs
The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes:
T-wave changes
alveoli
Terminal air sacs that constitute the gas exchange surface of the lungs.
*What happens in systolic heart failure?*
The ejection fraction falls below 50% (severe: below 35%) Pulmonary edema / Dyspnea
coronary sinus
The great, middle, and small cardiac veins all empty into here, which in turn empties into the right atrium.
diastole
The stage of the heart cycle in which the heart muscle is relaxed, allowing the chambers to fill with blood.
Which serum biomarker is highly specific for myocardial tissue?
Troponin
An 82-year-old resident of a long-term care facility with a recent history of repeated urinary tract infections and restlessness is suspected of having urinary retention. Which of the following actions by the care team is most appropriate?
Ultrasound bladder scanning to determine the residual volume of urine after voiding
*What is acute coronary syndrome?*
Umbrella term used to cover any group of clinical symptoms that's like an acute MI (CAD, ischemia, coronary heart disease)
Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?
Ventricular fibrillation
A patient with an ST elevation myocardial infarction (STEMI) receives a coronary stent in the obstructed vessel.
Watch for bleeding at the catheter insertion site.
A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?
When the client experiences chest pain
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?
Will prevent the conversion of angiotensin I to angiotensin II
*If a patient has anginal pain at rest, can you treat or no?*
YOU *CANNOT* TREAT
During isovlumertric contraction, pressure is highest in the
aorta
Blood is carried away from the heart by the
arteries
A client who has suffered a myocardial infarction is being treated in the emergency room. His pain remains severe even though he was given nitrates and oxygen. The physician now orders morphine for the pain. What method should the nurse to administer the morphine? a) By mouth in a liquid b) Subcutaneous c) Intravenous d) By mouth in pill form
c) Intravenous Morphine is given intravenously when a patient is in the emergency room suffering a myocardial infarction. It is given intravenously because of the rapid onset of action, and it does not elevate enzyme levels
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.
compensatory mechanisms
following consequences of cardiogenic shock will the nurse monitor
decrease stroke volume, decrease cadiac output, increased afterloading
alveolar ventilation
exchange of gases within gas exchange portion of the lungs
Myocardial infarction
heart attack
cardiomyopathy
heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorder
hyaline cartilage
horseshoe or c-shaped rings that supports the walls of the trachea and prevent collapsing when the pressure in the thorax becomes negative
Anaphylactic shock
is initiated through an immunologically mediated reaction to an irritant.
RNA
later used to direct the synthesis of proteins in the cytoplasm.
Inotrophy
myocardial contractility
The pulmonary veins carry __________ blood to the __________ atrium.
oxygenated; left
A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. The results suggest that the client's end-diastolic volume is insufficient. Which parameter of cardiac performance will directly decrease as a result of this finding?
preload
Ribosomes
site of protein synthesis
What will will decrease cardiac output?
stimulation of the vagus nerve
The difference between the end-distolic volume (EDV) and the end systolic volume (ESV) is the
stroke volume
Blood from systemic circulation is returned to the right atrium by the
superior and inferior vena cava
Type II pneumocytes
synthesize surfactant
The right coronary artery supplies blood to
the right atrium, portions of the conducting system of the heart, portions of the right and left ventricles
pulmonary ventilation
total exchange of gases between the atmosphere and the lungs
Parietal Pericardium
tough, fibrous serous membrane *lining the thoracic cavity*, posterior to ribs and sternum
Microtubules
transport along the axon of neuronal cells takes place along the primary cytoskeletal component
The QRS complex of the ECG appears as the
ventricles depolarize
respiratory tissues
where gas exchange takes place
A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which of the following reasons? Select all that apply.
• For its vasodilatation effect • To relieve coronary pain
Increased secretion of renin in heart failure is caused by which of the following events?
Low cardiac output p. 490.
***HAVE TO KNOW CLASSIFICATION OF FATIGUE, DYSPNEA OR ANGINA***
*Class 1* = patient with asymptomatic heart disease *Class 2* = sx's occur on exertion but patient able to manage ADLs *Class 3* = sx's develop when doing simple housework *Class 4* = sx's occur at rest
A client has suffered chest injuries following a automobile accident. The chest injury has resulted in an increase in intrathoracic pressure. There can be a transient shift from the pulmonary to the systemic circulation of how much blood?
250 mL
The heart is actually (one, two, or three) pumps?
2; Yes, the right side of the heart pumps to/from the lungs (pulmonary circuit) and the left side of the heart pumps to/from the rest of the body (the systemic circuit).
Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?
51-year-old man who has been diagnosed with glomerulonephritis
The nurse knows that mean arterial pressure is determined as which of the following?
60% of diastolic pressure and 40% of systolic pressure(p. 420)
Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow?
A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM
In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems?
A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history or atrial fibrillation
At the start of the atrial systole, the ventricles are filled to around
70% of capacity
Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?
A hypercyanotic attack brought on by periods of stress
*What is the primary issue in systolic heart failure?*
Decrease in contractility Decreased ejection fraction **forward failure**
primary physiologic result of obstructive shock?
Elevated right heart pressure
endured a severe head injury. Which of the following statements best captures expected clinical manifestations and treatments for his immediate condition?
Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.
A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?
Increased heart rate and increased contractility
_________ receives blood from the lower portion of the body.
Inferior vena cava
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which of the following lipoproteins is the main carrier of cholesterol?
LDL p. 404.
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?
Laminar
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?
Laminar Laminar blood flow reduces friction by allowing the blood layers to slide smoothly over one another, with the axial layer having the most rapid rate of flow. Axially, crosswise, and turbulent blood flow would result in increased friction. In turbulent flow, the laminar stream is disrupted and the flow becomes mixed, moving radially (crosswise) and axially (lengthwise).
When teaching about heart attacks, the nursing instructor tells the students that most heart attacks (approximately 40 to 50 percent) affect which coronary artery?
Left anterior descending artery
What are the causes of dilated cardiomyopathy?
Long-term alcohol abuse Systemic HTN Infections Smoking Pregnancy Chemo
Increased secretion of renin in heart failure is caused by which of the following events?
Low cardiac output
Which client will the nurse assess first?
The client with premature ventricular contractions
Prokaryote
unicellular organism that lacks a nucleus
dx infective endocarditits, what caused it?
The most common cause is a staph infection.
Infective endocarditis
a serious and potentially life-threatening infection of the inner surface of the heart.
Emergency Medical Technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place?
The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate.
If the SA node or internodal pathways are damaged, what will happen?
The heart will continue to beat bc in the absence of commands from the SA node, the AV node will generate impulses at a rate of 40-60 beats per minute.
Conducting System-Step 5
The impulse is distributed by Purkinje fibers and relayed throughout the ventricular myocardium. Atrial contraction is completed and ventricular contraction begins.
The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following?
The kidneys
A definitive test for cystic fibrosis is
The sweat test
aortic stenosis
The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?
Vasoconstriction p. 490.
circulatory shock, the adrenergic (or sympathetic) nervous system is activated. The nurse knows that stimulation of beta-2 adrenergic receptors will result in which responses?
Vasodilation of the skeletal muscle vascular bed,Dilation of the bronchioles
A pediatrician is teaching a group of medical students about some of the particularities of heart failure and children as compared with older adults. Which is a physicians following statements best captures an aspect of these differences?
You'll find that in pediatric patients pulmonary edema is more often interstitial rather than alveolar so you want to hear crackles
minute volume
amount of air that is exchanged in one minute.
inspiratory capacity
amount of air that you can draw into your lungs after you have completed a quiet respiratory cycle
Atrioventricular valves prevent backflow of blood into the _______; semilunar valves prevent backflow into the _________
atria; ventricles
The P wave of a normal electrocardiogram indicates
atrial depolarization
Blood flows from the left atrium into the left ventricle through the ________ valves
bicuspid, L. atrioventricular, mitral
An elderly 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.
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.
Isovolumetric relaxation and ventricular filling (two phases of the cardiac cycle) take place during __________.
both occur during ventricular diastole when the ventricles are not actively contracting and ejecting blood.
Normally, the only electrical connection between the atria and the ventricles is the
bundle of HIS
During the plateau phase of the cardiac action potential, which ion is entering the cardiac muscle cell?
calcium
ECGs are useful in detecting and diagnosing abonormal patterns of cardiac activity called
cardiac arrhythmias
The events between the start of one hearbeat and the start of the next is called the
cardiac cycle
The amount of blood ejected by the left ventricle per minute is the
cardiac output
The P wave of the electrocardiogram is closely followed by __________.
contraction of both atria
Perioxisomes
contains a special enzyme that degrades perioxides
AV node
delay the impulses from the SA node, allowing the heart to relax
developed community-acquired pneumonia and is being treated at home. What does the nurse recognize are the methods in the diagnosis of community-acquired pneumonia
depends on age, coexisting health problems, and the severity of illness.
When a chamber of the heart fills with blood and prepares for the start of the next beat the chamber is in
diastole
CHAP 19
disorders of cardiac function
Carbon dioxide is transported in the blood in 3 forms as
dissolved Co2, attached to hemoglobin, and as bicarb
Cardiac muscle tissue
does not require nerve activity to stimlate a contraction
Septic shock
e most common type of distributive shock, is associated with the systemic immune response to severe infection
The auricle is the __________.
ear-like extension of the atrium
The nurse will monitor which of the following respiratory manifestations of heart failure?
exertional dyspnea, orthopnea (SOB while lying down) , Cheye-Stokes respiration, chronic dry cough
Acute pulmonary edema often occurs with heart failure. Which of the following signs of acute pulmonary edema should be monitored
frothy blood-tinges sputum, respiratory cracles, cofusion, rapid pulse
Blood transports
gases between the lungs and other body tissues
chap 20
heart failure and cirulatory shock
An excessively large QRS complex often indicates that the
heart has become enlarged
pH, Carbon dioxide, and temperature
hemoglobin's affinity for oxygen is influenced by pH, CO2 concentration, and body temperature.
Which of the following statements regarding heart failure are true? Select all that apply
in uncompenstated left heart failure= pulmonary congestion and edema. In compenstated heart failure, cardiac output is normal. In uncompensated right heart failure= peripheral venous congestion and edema
Obstructive shock
inability of the heart to fill or empty properly.
vital capacity
inspiratory reserve volume + tidal volume + expiratory reserve volume and is the amount of air that can be exhaled from the point of maximal inspiration.
cardiac tamponade
low bp, narrow pulse pressure,muffled heart tones
A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His cervical lymph nodes are swollen, and he moves stiffly because his joints hurt. Throat cultures show infection with group A streptococci. This child is at high risk for:
mitral valve stenosis.
autonomic nervous system
nerves that carry involuntary impulses to smooth muscle, cardiac muscle, and various glands
which of the following medications for a patient in cardiogenic shock?
nitroprusside (Nitropess), Nitroglycerin, Dobutamine (Dobutrex), Milrione (Primacor)
Oxygenated blood from the systemic arteries flows into
peripheral tissue capillaries
gas exchange
primary function of the respiratory system
Blood flowing in the vena cava will next enter the __________.
right atrium
Cardiac veins empty their blood into the __________.
right atrium
The great cardiac vein drains blood from the heart muscle to the
right atrium
hilum
slit in the primary bronchus of the lungs which allows for pulmonary arteries, veins, and lymph vessels to enter.
After the SA node is depolarized and the impulse spreads through the atria, there is a slight delay before the impulse spreads to the ventricles. The reason for this delay is to allow
the atria to finish contracting
The dicrotic wave indicates a brief rise in the aortic pressure. The rise in pressure is due to
the closure of the semilunar valve
The epicardium is also known as the __________.
visceral pericardium
Brachycardia
when heartbeat is < 60
Hypovolemic shock is characterized by a loss of blood volume or extracellular fluid. Administering which of the following would manage a patient with hypovolemic shock?
whole blood, Packed red cells, plasma volume expanders, crstalloids
Dilated cardiomyopathy is seen in: a. Systolic heart failure b. Diastolic heart failure
with left ventricular cavity dilation
oxygen binds cooperatively
with the heme groups on the hemoglobin molecule
An elderly client is admitted with the diagnosis of severe aortic regurgitation. Which of the following client reports support this diagnosis? Select all that apply.
• Exertional dyspnea • Orthopnea • Paroxysmal nocturnal dyspnea • Palpitations
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply
• Mitral • Tricuspid
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.
• Mitral • Tricuspid
A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography?
55% - 75%
The semilunar valves of the heart open at the onset of the ejection period. Approximately what percentage of the stroke volume is ejected during the first quarter of systole?
60%
The nurse is preparing to auscultate for a mitral valve stenosis murmur. Where is the best location to place the stethoscope?
At the apex of the heart
the the main cause of CAD?
Atherosclerosis
Which of the following conditions reflect failure of the circulatory system? Select all that apply.
Circulatory shock Heart failure p. 486.
*Which class on classification of fatigue, dyspnea or angina is when symptoms develop when doing simple housework?*
Class 3
*Which class on classification of fatigue, dyspnea or angina is when symptoms occur at rest?*
Class 4
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?
Hypertrophy p. 488.
diagnosed with congestive heart failure has an arterial blood oxygen level (PaO2) of 89%. Which of the following terms should the nurse use to document a reduced oxygenation of arterial blood?
Hypoxemia
A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points to the physician include in his explanation of the man's new diagnosis?
I'm going to start you on a low-dose aspirin and it will help greatly if you can lose weight and keep exercising
As a consequence of long-standing lung disease, a patient is in a chronic state of hypoxia. Which of the following phenomena would the patient's nurse practitioner be most justified in anticipating? Select all that apply:
Increased erythropoietin production, Hyperventilation, Personality changes
A child possesses a trait that is the result of the interaction of two different genes, neither of which could have produced the trait independently. Which of the following explanations best captures the genetic explanation for this?
The outcome is the result of the interaction between collaborative genes.
Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which of the following characteristics most likely applies to his tumor?
The well-differentiated neoplastic cells are clustered together in a single mass.
A nurse is monitoring a patient with sick sinus syndrome who is experiencing lightheadedness, dizziness, and syncope. Which of the following treatments will the nurse anticipate for this patient?
Insertion of a pacemaker The most common manifestations of sick sinus syndrome are lightheadedness, dizziness, and syncope. These symptoms are related to the bradyarrhythmias. Treatment depends on the rhythm problem and frequently involves implantation of a permanent pacemaker.
Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?
It documents only current cardiac function. The resting ECG is the first approach to the clinical diagnosis of disorders of cardiac rhythm and conduction, but it is limited to events that occur during the period the ECG is being monitored. The other options are not accurate statements regarding an ECG.
Which one of the following is characteristic of a thrombus?
It forms on the wall of a vessel. (p. 418)
While studying the heart the nursing instructor teaches about pericarditis. Which of the following does she tell the student best defines this disease?
It is an inflammatory process.
elderly female client reveals the presence of bilateral pitting edema of feet,ankles, pedal pulses that are difficult to palpate. Auscultation of 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 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
Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms?
Water
*In an infarct, the Q wave represents what?*
Full thickness MI
ft player to ER afer collapsing, unconsious and ECG was abnormal, he died after arresting in ER
Hypertrophic cardiomyopathy (most common cause of sudden cardiac deat in young athletes.)
Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?
Hypertrophy
What is the pathology of diastolic heart failure?
Decreased wall compliance associated with hypertrophic cardiomyopathy --> *results in diminished stroke volume sec. to decreased EDV*
A 77 year old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of, "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:
Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand. p. 490.
When increasing SV, why does increasing the heart rate work for a limited amount of time?
Because the EDV and filling time will decrease. Meaning the amount of blood in the ventricle after ventricular diastole will be decreased bc there is not enough filling time between strokes.
*What meds did we learn in pharm can be used to treat cardiomyopathies?*
Beta blockers! *increase relaxation of heart ; control sympathetics*
A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:
Bicuspid valve
A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which of the following characteristics of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle?
The cells have a poorly defined sarcoplasmic reticulum.
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
What cardiac condition is a disease in which the contraction and relaxation of myocardial muscle fibers are impaired?
Cardiomyopathy
pulmonary artery
Carries deoxygentated blood from the heart to the lungs
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 client arrives at the doctor's office complaining of severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate which of the following?
Myocardial infarction
A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?
Myocardial infarction
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema weight gain
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema weight gain p. 492.
Select the correct sequence of blood return to the heart.
Capillaries, venules, veins, right atrium The correct pathway for blood returning back to the heart is the capillaries, venules, veins, and right atrium. The other options do not support normal blood flow.
diagnostic tests that were ordered for a client diagnosed with heart failure. Select the test that would provide information about the client's ejection fraction and ventricular preload.
Cardiac computerized axial tomography (CCT)
If you know both the heart rate and stroke volume, you can calculate the __________.
Cardiac output
A critical care nurse is carefully monitoring a client's mean arterial pressure. Which combination of factors is responsible for mean arterial blood pressure?
Cardiac output multiplied by systemic vascular resistance (p. 420)
*Variant, atypical angina is known as?*
Prinzmetal's angina
As part of his diagnostic workup, a 77-year-old man's nurse practitioner has ordered blood work that includes ferritin levels. The man is very interested in the details of his health care and is unfamiliar with ferritin and its role. He asks his nurse practitioner to explain the significance of it and the rationale for testing it. Which of the following explanations by the nurse practitioner is most accurate?
"Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills."
A nurse educator is defining heart failure to a group of recent graduates who will begin providing care on a cardiac unit. The educator should describe which phenomenon?
"Heart failure is a complex syndrome resulting from any disorder of the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion."
In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion?
20 mL/hour p. 504.
treatment of a common cold.
Antipyretic medications and rest
Left ventricular filling occurs __________.
The AV valve allows blood to flow in one direction - from the atrium to the ventricle. Because the ventricle is filled with blood from the atrium, this valve must be open to fill the ventricle.
A nurse is assessing a client in shock for complications of acute renal failure. The most important assessment for the nurse to obtain would be:
Continuous measurement of urine output
client in shock for complications of acute renal failure. The most important assessment for the nurse to obtain would be:
Continuous measurement of urine output
dilated cardiomyopathy asks the nurse what caused the conditio
Genetic abnormalities
Which condition does the nurse know can lead to right-sided heart failure?
Severe pneumonia
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?
Tunica media
What causes the aortic semilunar valve to close?
backflow of blood in the aorta (towards the left ventricle) closes the aortic semilunar valve.
Angiogenesis
formation of new blood vessels
*What is myocarditis?*
inflammation of the myocardium (middle layer) results in reduced heart pumping function and irregular rhythms (viral infection most common)
A patient who will be undergoing a Holter monitor examination would be given which of the following instructions?
"Keep a diary of your activities and symptoms throughout the examination." During the period of a patient wearing a Holter monitor (usually 48 hours), the patient will be instructed to maintain a diary of activities and symptoms so that the recorded electrocardiographic reading can be correlated with the diary events. The other options are not instructions appropriate for a Holter monitor examination
The patient gets worried and asks, "What does this mean?"
"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."
The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which of the following teaching points is most justifiable?
"Research has shown that viruses may actually be a factor in many children's asthma."
*What does R ventricular failure lead to? (consequences)*
*Increased* R ventricular EDV Jugular vein distension (JVD) Liver engorgement (swelling) Ascites (high BP in the veins) Peripheral edema
*Aggressive or not aggressive for patients with subendocardial MI?* *Aggressive or not aggressive for patients with full thickness MI?*
*Subendocardial MI* = Must be LESS aggressive with these patients *Full thickness MI* = Must be aggressive with these patients to shrink size of scar (sec. to inc. BF)
A client is experiencing circulatory shock. The nurse is aware that compensation will occur with stimulation of the beta-2 (β2) receptors. The nurse anticipates the client will experience:
Relaxation of the bronchioles p. 501
Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis?
Release nitric oxide
A local athlete is getting prepared for the upcoming national track and field championships. Since this athlete is performing extreme exercise, what would be the most probable cardiac output?
16 to 36 L/minute
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
Type II alveolar cells produce surfactant and they usually develop at how many weeks gestation?
24-28 weeks
The stroke volume is the amount of blood ejected with every contraction of the ventricle. It is broken down into quarters. What is the approximate amount of the stroke volume per quarter?
60%, 20%, 20%, and little blood
Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?
A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F
Frank-Starling Mechanism
A mechanism by which the stroke volume of the heart is increased by increasing the venous return of the heart (thus stretching the ventricular muscle).
The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in:
A reading that is too high The width of the bladder should be at least 40% of arm circumference and the length at least 80% of arm circumference. Undercuffing (using a cuff with a bladder that is too small) can cause an overestimation of blood pressure. This is because a cuff that is too small results in an uneven distribution of pressure across the arm, such that a greater cuff pressure is needed to occlude blood flow. Likewise, overcuffing (using a cuff with a bladder that is too large) can cause an underestimation of blood pressure.
A nurse practitioner employed in a hospitalist notices that a patient is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the patient's muscle cells?
A reduction of skeletal muscle use secondary to the traction treatment
Which of the following types of aortic aneurysms is the most common?
Abdominal aortic p. 418.
cardiac reserve
Ability to increase cardiac output during increased activity
A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient's diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring?
Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.
The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating?
Acid-base imbalances
When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate?
Activated cells that release free radical oxidize LDL which is harmful to the lining of your blood vessels. Page 411
When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate?
Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.
It is known that over 100 distinct myocardial diseases can demonstrate clinical features associated with dilated cardiomyopathy (DCM). What is the most common identifiable cause of DCM in the United States?
Alcoholic cardiomyopathy
A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the care team's initial differential diagnosis most likely be?
Alport syndrome
inspiratory reserve volume
Amount of air that can be forcefully inhaled after a normal tidal volume inhalation
When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?
An ejection fraction of 40% This ejection fraction is below normal (normal is about 55 to 75 percent) and indicates a poor prognosis. This low ejection fraction is a result of the complications of long-standing hypertension
Rough Endoplasmic Reticulum
An internal membrane system with ribosomes on its surface where proteins are assembled
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 client is rushed to the emergency department with symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?
Anaphylactic
What can trigger myocardial ischemia even when there is adequate coronary blood flow? Select all that apply.
Anemia Carbon monoxide poisoning Hypoxia
14. All of the following interventions are ordered stat. for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first? A) Epinephrine (Adrenalin) B) Normal saline infusion C) Dexamethasone (Decadron) D) Diphenhydramine (Benadryl)
Ans: A
20. Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate? A) "Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure." B) "Heart failure will often first show up with persistent coughing and lung crackles." C) "Residents in early heart failure will often be flushed and have warm skin and a fever." D) "Complaints of chest pain are actually more often related to heart failure than to myocardial infarction."
Ans: A
15. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis? A) Hypovolemic shock B) Septic shock C) Neurogenic shock D) Obstructive shock
Ans: B
A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could A) decrease renal perfusion and result in the development of ascites. B) be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. C) desensitize the -adrenergic receptors leading to increase in norepinephrine levels. D) prolong the electrical firing from the SA node resulting in the development of a heart block.
Ans: B
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? A) Chest pain and intermittent ventricular tachycardia B) Dyspnea and crackles in bilateral lung bases C) Petechia and spontaneous bleeding D) Muscle cramping and cyanosis in the feet
Ans: B
17. A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler? A) Breathlessness with activity B) Excessive crying C) Enlargement of the liver D) Increased urine output
Ans: C
A 30-year-old woman presents at a hospital after fainting at a memorial service, and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display? A) Faster than normal heart rate B) Pain C) Dry and warm skin D) Increased thirst
Ans: C
19. Which of the following changes associated with aging contributes to heart failure development in older adults? Select all that apply. A) Increased incidence of mitral stenosis B) Sludge buildup in the kidneys C) Elevated diastolic BP D) Increased vascular stiffness E) Inflammation in the joints due to arthritis
Ans: C, D
7. Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to A) have medical supply department bring up suction equipment. B) apply oxygen via nasal cannula at 3 lpm. C) page the respiratory therapist to come give him a breathing treatment. D) call for emergency assistance utilizing hospital protocol.
Ans: D
The nurse knows that acute regulation of blood pressure involves which physiologic processes? Select all that apply.
Arterial chemoreceptors Vagal nerve impulses Adrenergic (sympathetic) stimulation Carotid baroreceptors
The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?
Arterioles (P. 420)
The nurse is assessing a client for early signs of constrictive pericarditis. The most likely manifestation would be:
Ascites
The nurse is assessing a client for early signs of constrictive pericarditis. The most likely manifestation would be: a) Weight loss b) Muscle wasting c) Exercise intolerance d) Ascites
Ascites Ascites is an early finding in constrictive pericarditis, along with pedal edema, dyspnea on exertion, and fatigue. The other options are late signs of constrictive pericarditis.
auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?
At the apex of the heart
The nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD?
Atherosclerosis
Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is:
Atrial fibrillation
Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?
Atrial fibrillation
he dysrhythmia that occurs most frequently in heart failure is which of the following?
Atrial fibrillation
Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?
Atrial fibrillation p. 495
*Infarct is:* a. temporary blood loss b. occluded vessel c. cell death
C
The efficiency of the heart as a pump often is measured in the amount of blood the heart pumps per minute. Which is the correct formula to figure out the cardiac output?
CO = SV x HR
Which of the following most likely had the greatest impact on development of the lung cancer?
Cigarette smoke
A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect?
Coarctation of the aorta p. 428.
The nurse obtains a blood pressure reading of 150/96 mm Hg from a patient at the clinic. What instructions for follow-up does the nurse anticipate giving to this patient?
Confirm within 2 months
The heart valves control the direction of blood flow. What is the function of the pulmonic valve?
Controls the direction of blood flow from the right side of the heart to the lungs
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 p. 488.
Which of the following consequences of cardiogenic shock will the nurse monitor? Select all that apply.
Decreased stroke volume Decreased cardiac output Increased afterloading p. 504.
A client is admitted to the emergency department after experiencing a motor vehicle accident and sustaining multiple injuries with significant blood loss. The nurse predicts that the client will display which of the following?
Decreased urinary output
A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?
Defibrillate the patient
Select the statement that best describes Buerger disease.
Disease of young, heavy cigarette smokers occurring before the age of 35.
Increase the SV, by increasing the _____.
EDV
EDV-SV=
ESV
Manifestations of heart failure are due to the decreased pumping ability of the heart. The nurse will monitor for which of the following signs and symptoms of heart failure? Select all that apply.
Fatigue Exercise intolerance Cyanosis Malnutrition p. 492.
The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?
Genetic
leading cause of death in the United States
Heart disease
The nurse knows that which statement regarding heart failure is most accurate?
In compensated failure, an increase in preload causes an increase in ventricular contractility.
Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)?
Increased aortic pressure
A nurse is monitoring a client with a resting heart rate of 120 beats/minute who has been diagnosed with sinus tachycardia, which can result from a change in which characteristic of cardiac cells?
Increased automaticity
Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis?
Injured cells tend to accumulate calcium.
Great coronary vein drains most of the _____ and some of the ______.
Left ventricle; Right ventricle
About 3 weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea, and vomiting. After ruling out more common health problems, his care provider eventually makes a diagnosis of histoplasmosis. Which of the following processes is most likely taking place?
Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them.
A nurse educator on a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice?
Measurement of urine output and mental status assessment p. 494.
hemoglobin
Oxygen carrying pigment in red blood cells
A monitored hospitalized patient with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which of the following forms of AF is this?
Paroxysmal AF is characterized as rapid disorganized atrial activation and uncoordinated contraction by the atria. It is classified into three categories: paroxysmal, persistent, and permanent. Paroxysmal AF self-terminates and lasts no longer than 7 days, whereas persistent lasts greater than 7 days and usually requires intervention such as a cardioversion. AF is classified as permanent when attempts to terminate are failed and the the person remains in AF. The symptoms of chronic AF vary. Some people have minimal symptoms, and others have severe symptoms, particularly at the onset of the arrhythmia.
Exudate in the pericardial cavity is a characteristic of which cardiac condition?
Pericardial effusion
diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema weight gain
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema, weight gain
A 71-year-old male patient with a history of myocardial infarction and peripheral vascular disease has been advised by his nurse practitioner to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the nurse practitioner's suggestion?
Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.
A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her?
Platelet count, serum creatinine, and liver enzymes
Resistance to flow is determined by the diameter of the blood vessels and the blood vessel itself. An equation has been developed for understanding the relationship between the diameter of the blood vessel, the viscosity of the blood, and resistance. What is the equation called?
Poiseuille law
An intensive care nurse is assessing a client just admitted from the emergency room status-post myocardial infarction (MI) and notes that the client's cardiac rhythm is a sinus bradycardia with a rate in the low 50s. The nurse is concerned that the client may have which of the following?
Poor prognosis Sinus bradycardia following a myocardial infarction is a sign that the infarction may have damaged the SA or AV nodes and the heart is not beating fast enough to meet the body's needs. If the bradycardia is hemodynamically significant, a temporary or permanent pacemaker may need to be inserted. The other options are incorrect because the rhythm, sinus bradycardia, was given in the question.
Persons with hypertension secondary to hyperaldosteronism may be treated with which of the following drugs?
Potassium-sparing diuretics Persons with hyperaldosteronism will exhibit hypokalemia as aldosterone stimulates renal sodium for potassium exchange. Potassium sparing diuretics such as spironolactone will inhibit this action of aldosterone and will increase sodium excretion and mitigate the loss of potassium. ACEI will not alter the excessive level of aldosterone, which emanates directly from an overactive adrenal gland or an adenoma. Alpha or beta antagonists will not affect the excessive sodium and water retention induced by aldosterone.
A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure?
Prehypertension
Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects?
Rapidly proliferating cells
The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium
Receives blood returning to the heart from the systemic circulation
The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?
Receives blood returning to the heart from the systemic circulation
The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?
Receives blood returning to the heart from the systemic circulation The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.
An older adult client has been diagnosed with orthostatic hypotension. When planning the client's subsequent care, the nurse should prioritize which diagnosis?
Risk for falls
Which of the following is the site of chylomicron synthesis?
Small intestine
The NP is providing care for a 21-year-old female patient with gas gangrene of a compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a patient with a diagnosis of gas gangrene?
Spreading edema
Bacterial
Sputum samples from a patient with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This pneumonia is most likely:
A nurse is administering medication to treat hypercholesterolemia. Which of the following medications reduces or blocks the hepatic synthesis of cholesterol?
Statins Inhibitors of HMG CoA reductase (e.g., atorvastatin, rosuvastatin, simvastatin), a key enzyme in the cholesterol biosynthetic pathway, can reduce or block the hepatic synthesis of cholesterol and are the cornerstone of low-density lipoprotein (LDL)-reducing therapy. Statins also reduce triglyceride levels and increase high-density lipoprotein (HDL) levels. Statin therapy has been shown to reduce the risk for acute coronary syndromes and stroke in secondary prevention.
A nurse is administering medication to treat hypercholesterolemia. Which of the following medications reduces or blocks the hepatic synthesis of cholesterol?
Statins p. 408
Which of the following is the difference between the end-diastolic and end-systolic volumes?
Stroke volume Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Ejection fraction is the volume ejected from the left ventricle. Cardiac reserve is determined by cardiac output. (less)
"
Structural changes with current or previous symptoms of failure
What is the primary cause of heart failure in infants and children?
Structural heart defects
primary cause of heart failure in infants and children?
Structural heart defects
*What happens in subendocardial MI?*
Subtotal occlusion of blood flow to endocardial layer (still some distal blood flow, but *limited*)
The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system?
Sympathetic
A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?
Sympathetic nervous system
And IV drug abuser walks into the ED telling the nurse that he is sick. He looks feverish and flushed, moist skin; dehydrated with dry lips mucous membranes; and fatigued. Yes that's what reveals a loud murmur. And echocardiogram was ordered that shows a large vegetation growth and his mitral valve. The patient has an ear to the ICU. The nurse will be assessing the patient for which possible life-threatening complication?
Systemic emboli, Especially to the brain
A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which reason accounts for this lack of change in the diastolic pressure?
Systemic vasoconstriction maintained the diastolic pressure.
A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which of the following accounts for this lack of change in the diastolic pressure?
Systemic vasoconstriction maintained the diastolic pressure.(p.420)
The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes: a) T-wave changes b) Significant ST-segment elevation c) Peaked T waves d) Deep Q waves
T-wave changes Unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) is a clinical syndrome of myocardial ischemia ranging from angina to myocardial infarction. The ECG pattern associated with in NSTEMI may display normal or ST-segment depression (or transient ST-segment elevation) and T-wave changes. The degree of ST-segment deviation from baseline is an important measure of ischemia and indicator of prognosis. Abnormal Q waves occur with ACS.
After a long bout with vomiting and diarrhea, a patient is suspected to be in hypovolemic shock. Which of the following signs and symptoms will the nurse evaluate to substantiate this diagnosis? Select all that apply.
Tachycardia Acidosis Apprehension
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:
Tearing or ripping-type pain in the chest or back A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated.
A client reporting a headache is diagnosed with giant cell arteritis. The nurse is aware that the vessels most commonly affected are the
Temporal (p. 414)
A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall (i.e., vasculitis). These disorders are common pathways for tissue and organ involvement in many different disease conditions. What is the most common of the vasculitides?
Temporal arteritis Temporal arteritis (i.e., giant cell arteritis), the most common of the vasculitides, is a focal inflammatory condition of medium-sized and large arteries. It predominantly affects branches of arteries originating from the aortic arch, including the superficial temporal, vertebral, ophthalmic, and posterior ciliary arteries. Neither polyarteritis nodosa nor Raynaud disease are the most common of the vasculitides. Varicose veins are not vasculitides.
How can the health care provider determine if the client has "aerobic fitness"?
Tests help to determine aerobic fitness by measuring heart rate while under the stress of exercise.
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
The one-way nature of the left AV valve prevents blood flow from _________.
The atrioventricular valves are one-way valves that allow blood to flow into the ventricle but prevent blood flow back into the atrium. This maintains the movement of blood forward, toward the systemic circulation.
Select the client who may be at risk for developing an increase in resistance to blood flow.
The client admitted to the intensive care unit for extreme dehydration 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. Being treated for anaphylactic shock, being hypertensive, or receiving intravenous fluids at a rate of 100 mL/hour will decrease resistance to blood flow.
Select the client who may be at risk for developing an increased resistance to blood flow.
The client in hypovolemic shock experiencing extreme dehydration
The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading?
The client just smoked a cigarette. p. 408.
A client with coccidioidomycosis has developed a severe headache with neck stiffness, has a fever, and states he feels very ill. What does the nurse recognize these symptoms may indicate?
The client might have meningitis, which is the most common cause of death.
The post-operative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which of the following assessments would be a concern for the nurse?
The client states his hand is numb. Arterial spasm caused by arterial cannulation can be a cause of acute arterial occlusion. Occlusion in an extremity causes sudden onset of acute pain, numbness, tingling, weakness, pallor, and coldness of the affected limb. Pulses are absent below the level of the occlusion.
highest risk for the development of atelectasis
The client who is postop total knee replacement and receiving client-controlled analgesia
Which client will the nurse prioritize to assess first?
The client with sinus arrest The client with sinus arrest refers to failure of the SA node to discharge and results in an irregular pulse. An escape rhythm develops as other pacemakers take over, but it may result in prolonged periods of asystole and other abnormal rhythms. The client may need further interventions such as a pacemaker. The other clients need monitoring; however, their rhythm is not placing them in need of immediate assistance.
The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:
The condition is getting progressively worse. p. 490.
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner. The patient's nurse practitioner would anticipate that which of the following phenomena is most likely occurring?
The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring?
The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.(p426.)
A researcher is involved in the production of insulin through recombinant DNA technology. Which of the following statements could the researcher best provide as a rationale for her work?
The gene fragment responsible for insulin production can be isolated and reproduced.
why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?
The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs.
A client presents to the physician's office with a chronic cough, shortness of breath, and wheezing that has gotten progressively worse, with recent episodes of hemoptysis.
The lesion has eroded blood vessels in the lungs.
Which of the following assessment findings in a newly admitted 30-year-old male patient would be most likely to cause his nurse practitioner to suspect polyarteritis nodosa?
The man's blood pressure is 178/102 and he has abnormal liver function tests.
Emergency Medical Technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place?
The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate. p. 487.
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response?
The most common cause is a staph infection
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response?
The most common cause is a staph infection.
Why is the wall of the L Ventricle thicker than the R Ventricle?
The muscle tissue of the L Ventricle has to push harder to get the blood to the tissues. The muscle tissue of the R Vntricle has to only push hard enough to get to the lungs.
Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?
The plaques it builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge self in a vessel
Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease?
The pulse decreases rather than increases in amplitude.
The decrease in left ventricular pressure at the end of ventricular systole causes __________.
The semilunar valve closes when left ventricular pressure drops below aortic pressure. This occurs at the end of ventricular systole and marks the end of ventricular ejection. Blood in the aorta collects in the cusps of the semilunar valve and holds the valve shut while pressure in the ventricle continues to decrease and ventricular diastole begins.
*Based on the 3 criteria of diagnosing an MI, which is the best one to use?*
The subjective story!!! Patient is the best resource
A group of nurses is taking a critical care course in cardiac electrophysiology. The instructor is reviewing action potential and the risk of arrhythmias and states that if an electrical impulse fires just after the relative refractory period, during the supernormal excitatory period, cardiac arrhythmias could result. Locate the supernormal excitatory period on the first complex on the rhythm strip.
The supernormal excitatory period, which occurs during the "T" wave on the ECG, is a vulnerable time during the cardiac action potential when even a weak stimulus can initiate potentially lethal cardiac arrhythmias. The ability to accurately evaluate cardiac rhythms and identify potential rhythm concerns may prevent the development of arrhythmias and improve client outcomes.
The sympathetic (adrenergic) nervous system is an important compensatory mechanism in heart failure. Which of the following statements regarding the sympathetic nervous system response to heart failure are correct? Select all that apply.
The sympathetic nervous system responds rapidly to a fall in cardiac output. The sympathetic nervous system increase in heart rate and force of contraction support cardiac output. The sympathetic nervous system increase in cardiac workload and oxygen use can cause ischemia and worsening of heart failure. p. 489
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
clinic with a cough, fever, and chest discomfort and is diagnosed with community-acquired pneumonia. What education does the nurse anticipate providing prior to discharging the client from the clinic?
The use of antibiotics
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.
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The mostappropriate response would be:
The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
A tourist presented to a primary care health clinic complaining of malaise, fever, and headache. She has subsequently been diagnosed with Rocky Mountain spotted fever, a pathology caused by Rickettsiaceae. Which of the followed statements best captures a characteristic trait of Rickettsiaceae?
They have both RNA and DNA.
As part of an orientation to a genetic counseling practice, a group of medical students is differentiating between autosomal recessive disorders and autosomal dominant disorders. Which of the following statements is true of autosomal recessive disorders?
They tend to have a more uniform symptomatology than autosomal dominant disorders.
*What is the complication with hypertrophic cardiomyopathy?*
Thick AND stiff walls of the ventricles do not relax appropriately to allow the heart chambers to fill with blood. - becomes more severe when the heart beats quickly (as during exercise) because there is then even *less time for the heart to fill.* - Heart does not fill properly --> pumps less blood (sometimes leading to death b/c no blood flow out the heart) *can be seen in athletes*
endocardium
This is the innermost layer of the heart and lines the inner chambers & heart valves
A 28-year-old client, who is a heavy smoker, tells the practitioner that he has been experiencing pain in his feet and lower legs for several months. The practitioner notes that pulses in the feet are diminished and believes the client may have which of the following?
Thromboangiitis obliterans
The nurse knows that systolic hypertension carries risk for which of the following cardiovascular events? Select all that apply.
Thrombosis Damage to elastic elements of blood vessel walls Atherosclerosis Risk for aneurysm (p. 426)
developed disseminated intravascular coagulation (DIC). The nurse knows that which statements regarding DIC are true?
Thrombotic occlusion occurs in small and midsized blood vessels.Bleeding may accompany coagulation.Generation of thrombin increases.Endogenous anticoagulation mechanisms are suppressed.
Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?
Transcutaneous
Which serum biomarker is highly specific for myocardial tissue? a) C-reactive protein b) White blood cells c) Creatine kinase d) Troponin
Troponin The troponin assays have high specificity for myocardial tissue and have become the primary biomarker tests for the diagnosis of myocardial infarction. Creatine kinase is specific for muscle injury but is not as focused as is troponin. White blood cells and C-reactive protein are associated with inflammation.
A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order?
Troponin assays
myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?
Troponin assays
*True/False. As much as 50% blockage in a coronary artery does not produce symptoms at all!.*
True :O *severe ischemia can produce significant sx's in some and none in others!*
An elderly client admitted to the hospital with tuberculosis becomes cyanotic, tachycardic, and develops a fever and cough. Chest x-ray reveals pus in the pleural space. Which of the following is the most likely diagnosis?
Tuberculous empyema due to primary progressive tuberculosis
Which of the following blood vessel layers is composed primarily of smooth muscle cells?
Tunica media The tunica media consists primarily of circumferentially arranged layers of smooth muscle cells. The tunica externa is composed of loose connective tissue and the tunica intima of endothelial cells. The endothelium is the lining of the vascular system and is composed of endothelial cells.
Which of the following vessel layers is made primarily of muscle?
Tunica media The outermost layer of a vessel is called the tunica externa or tunica adventitia. The middle layer is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The innermost layer is the tunica intima.
The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following?
Unknown
The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following?
Unknown Essential or primary hypertension has no identifiable cause, although there are many risk factors. The other options are causes of secondary hypertension, for which a cause can be identified and often treated.
*Which type of angina reveals plaque rupture, ulceration or hemorrhage with thrombus formation?*
Unstable
dx with ST-segment elevation myocardial infarction (STEMI) experienced "sudden death." The emergency room nurse explains sudden death from a STEMI as death that occurs within what time frame of symptom onset?
1 hour
*What is the treatment for systolic heart failure?* (3)
1. *ACE inhibitors!* - drug of choice 2. Diuretics 3. Digoxin (dec. HR, but increase EF)
**What are the 4 causes of L ventricular CHF?**
1. Intrinsic heart disease 2. Increased workload on heart 3. Cardiac arrthymias 4. Iatrogenic damage (medical rx errors)
*What are the causes of Right ventricular failure/CHF?*
1. L ventricular failure 2. Mitral valve disease 3. Pulmonary hypertension 4. Pulmonary disease (Cor pulmonale)
Cardiac Cycle
1. Relaxation of Ventricles and atria. 2. Blood enters atria from veins returning to heart 3. Atria fill with blood 4. Atria contract (atrial systole) 5. Blood passes into ventricles 6. Through atrioventricilar valves 7. Atrioventricular valves shut to prevent backflow back into atria 8. Ventricles contract (ventricular systole) 9. Blood passes out into arteries leaving the heart through open semilunar valves 10. Semilunar valves shut to prevent backflow.
*What are the 3 criteria in diagnosing an MI?* *which gives you the most info?*
1. Subjective story 2. ECG 3. Cardiac enzymes *subjective story*
**Excessive afterload in L ventricular failure leads to what consequences?**
1. Systolic ventricular dysfunction 2. *Decreased* stroke volume/ejection fraction 3. *Increased* L ventricular EDV (pre-load) 4. *Increased* L atrial volume 5. *Increased* L atrial/pulmonary vein pressures 6. Pulmonary edema
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below which of the following?
140/90 The main objective of hypertension management is to achieve a pressure of 140/90, although persons with renal disease or diabetes are advised to aim for 130/80 or lower. Persons with blood pressure between 140/90 and 120/80 are considered to be prehypertensive and should be monitored at regular intervals to detect any rise in pressure.
By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood pressure of ____ mm Hg or higher.
140; 90 Hypertension is a consistent systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body?
1800
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
In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion?
20 mL/hour
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:
20 mL/hour
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is.
20 mL/hour p. 504
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:
20 mL/hour p. 504.
During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?
20 to 40 minutes
A client is lying in a recumbent position. In this patient approximately how much total blood volume is in the central circulation?
25% - 30%
*Onset of chest pain until the time patients reach hospital is usually how long?*
4 hours
patient with a history of cor pulmonale will likely be exhibiting which of the following clinical manifestations of right heart failure?
4+ pitting edema in lower extremities, JVD, altered LOC
A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography?
55% - 75% The normal left ventricular ejection fraction is usually 55 percent to 75 percent when determined by angiocardiography.
Which client should most benefit from treatment with antithrombin agents?
57-year-old client who has recently been diagnosed with unstable angina
The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:
64 mm Hg
The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:
64 mm Hg The difference between the systolic and diastolic pressure is called the pulse pressure (approximately 40 mm Hg). The pulse pressure is calculated by deducting the diastolic pressure (82) from the systolic pressure (146). The difference is the pulse pressure.
A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminary Lee indicative of myocardial infarction. Which of the following client is least likely to have an ST segment myocardial infarction or STEMI?
71-year-old man who has my skin, fever, and chest pain is excruciating when he moves but relieved when he rest
Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction?
80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose
assessing the blood pressure of a client who is experiencing cardiogenic shock. Which of the following blood pressure readings is most likely?
90/75
6. A patient in the intensive care unit with ADHF complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to a. administer IV morphine sulfate 2 mg. b. give IV diazepam (Valium) 2.5 mg. c. increase dopamine (Intropin) infusion by 2 mcg/kg/min. d. increase nitroglycerin (Tridil) infusion by 5 mcg/min.
A Rationale: Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output but will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea. Cognitive Level: Analysis Text Reference: pp. 828-829 Nursing Process: Implementation NCLEX: Physiological Integrity
21. A patient with ADHF who is receiving nesiritide (Natrecor) asks the nurse how the medication will work to help improve the symptoms of dyspnea and orthopnea. The nurse's reply will be based on the information that nesiritide will a. dilate arterial and venous blood vessels, decreasing ventricular preload and afterload. b. improve the ability of the ventricular myocardium to contract, strengthening contractility. c. enhance the speed of impulse conduction through the heart, increasing the heart rate. d. increase calcium sensitivity in vascular smooth muscle, boosting systemic vascular resistance.
A Rationale: Nesiritide, a recombinant form of BNP, causes both arterial and venous vasodilation, leading to reductions in preload and afterload. Inotropic medications, such as dopamine and dobutamine, may be used in ADHF to improve ventricular contractility. Nesiritide does not increase impulse conduction or calcium sensitivity in the heart. Cognitive Level: Application Text Reference: p. 829 Nursing Process: Implementation NCLEX: Physiological Integrity
19. An outpatient who has developed heart failure after having an acute myocardial infarction has a new prescription for carvedilol (Coreg). After 2 weeks, the patient returns to the clinic. The assessment finding that will be of most concern to the nurse is that the patient a. has BP of 88/42. b. has an apical pulse rate of 56. c. complains of feeling tired. d. has 2+ pedal edema.
A Rationale: The patient's BP indicates that the dose of carvedilol may need to be decreased because the mean arterial pressure is only 57. Bradycardia is a frequent adverse effect of -Adrenergic blockade, but the rate of 56 is not as great a concern as the hypotension. -adrenergic blockade will initially worsen symptoms of heart failure in many patients, and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs. Cognitive Level: Application Text Reference: p. 832 Nursing Process: Assessment NCLEX: Analysis
1. A patient with a history of chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. The patient has pitting edema in both ankles, blood pressure (BP) of 170/100, an apical pulse rate of 92, and respirations 28. The most important assessment for the nurse to accomplish next is to a. auscultate the lung sounds. b. assess the orientation. c. check the capillary refill. d. palpate the abdomen.
A Rationale: When caring for a patient with severe dyspnea, the nurse should use the ABCs to guide initial care. This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) is occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patient's volume status and should also be accomplished rapidly, but detection (and treatment) of fluid-filled alveoli is the priority. Cognitive Level: Application Text Reference: pp. 824-825 Nursing Process: Assessment NCLEX: Physiological Integrity
A nurse practitioner student is familiarizing herself with the overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as being least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history?
A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use
Which of the following patients would be considered to have a significant risk of developing the prerenal form of acute renal failure?
A 22-year-old male who has lost a large amount of blood following a workplace injury
The nurse knows that which of the following persons is at greatest risk for malignant hypertension?
A 25-year-old African-American man Malignant hypertension is a sudden extreme elevation in both systolic and diastolic pressure, producing life-threatening complications. Persons most at risk include young African-American men, women with toxemia of pregnancy, and persons with renal or collagen disease.
Which of the following individuals is at the highest risk for developing a urinary tract infection (UTI)?
A 30-year-old obese woman with poorly controlled diabetes mellitus
Which of the following patients of a primary care nurse practitioner would not require extra screening for cancer?
A 38-year-old female with Down syndrome and congenital scoliosis
Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?
A 51-year-old male who has been diagnosed with glomerulonephritis p. 427.
The lymph nodes involved are located in a large number of locations in the lymphatic system.
A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma?
A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor?
A 61-year-old man who has a heart valve infection and recurrent fever
Which of the following patients is at greatest risk for orthostatic hypotension?
A 66-year-old post-surgery patient on bed rest Post-surgery patients who have been immobile are at greatest risk for developing othostatic hypotension. The 70-year-old female may also be at some risk: age is a risk factor, as is administration of some antihypertensive medications.
Which of the following individuals are displaying identified risk factors for the development of lower urinary tract obstruction?
A 68-year-old man who has been diagnosed with benign prostatic hyperplasia (BPH)
A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention?
A 69-year-old woman who has entered ventricular fibrillation.
A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)?
A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest
A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)?
A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest
In which of the following patient situations would a nurse practitioner be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems?
A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation
Splenomegaly and hepatomegaly
A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for?
In which of the following situations would blood be most likely to be rapidly relocated from central circulation to the lower extremities?
A client is helped out of bed and stands up.
A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the patient about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium?
A membranous sac that encloses the heart
Which of the following situations would be most deserving of a pediatrician's attention?
A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting.
An infant who is four days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders?
A particular defect can be caused by mutations at one of several different loci.
Some viruses are capable of transforming normal host cells into malignant cells.
A patient has been admitted to an inpatient medical unit of a hospital with an acute viral infection. The health care team providing care for the patient would recognize which of the following statements as an accurate description of the role of viruses in human infections?
Neutrophils
A patient presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus cellulitis. The patient's nurse practitioner has ordered a complete blood count and white cell differential. Which of the following blood components would the nurse practitioner most likely anticipate to be elevated?
Which of the following patients are NOT displaying known risk factors for the development of pulmonary emboli?
A patient who is immobilized following orthopedic surgery Postsurgical immobility, smoking, and the use of oral contraceptives are all identified risk factors for the development of pulmonary emboli. Impaired Cl- and Na+ regulation are associated with cystic fibrosis, while amiodarone and radiation therapy are linked to interstitial lung diseases.
The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which of the following initial signs of this condition?
A pulsating mass in the abdomen Most abdominal aortic aneurysms are asymptomatic. Because an aneurysm is of arterial origin, a pulsating mass in the abdomen may provide the first evidence of the disorder. The other options are signs and symptoms of aortic dissection.
The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which of the following initial signs of this condition?
A pulsating mass in the abdomen p. 418
A client recovered from influenza two days ago and informs the nurse that she is feeling better but now has a fever, chills, pain when breathing, and a productive cough. What complication does the nurse anticipate the client will be treated for?
A secondary bacterial pneumonia
A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has:
A severe bacterial infection
Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development?
A single-capillary network exists and the lungs are capable of respiration.
Which statement describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
A slow depolarization occurs because of the particular permeability of the cellular membranes.
A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm what does the nurse report the client has?
A symptomatic bradyarrhythmia
A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm what does the nurse report the client has?
A symptomatic bradyarrhythmia This client is suffering from a symptomatic bradyarrhythmia as evidenced by a heart rate of 46 with normal P waves before every QRS, normal PR interval and symptoms of dizziness and syncope. Bradyarrhythmias can decrease oxygen delivery to the brain, along with other vital organs, causing symptoms such as dizziness, lightheadedness, fatigue and syncope
Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly?
A woman who has herpes simplex and recently recovered from endocarditis
13. Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node? A) A slow depolarization occurs because of the particular permeability of the cellular membranes. B) The cells are capable of responding to a greater-than-normal stimulus before the resting membrane potential is reached. C) The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity. D) The sodium-potassium pump transports sodium into the cell to help maintain the resting membrane potential.
A) A slow depolarization occurs because of the particular permeability of the cellular membranes.
18. A nurse is monitoring a patient with a resting heart rate of 120 bpm. The patient has been diagnosed with sinus tachycardia, which is the result of an increase of which of the following characteristics of cardiac cells? A) Automaticity B) Excitability C) Conductivity D) Refractoriness
A) Automaticity
A 68-year-old man complains to his family physician that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times he feels that his heart is racing, and it also seems to pause at times. The man has also had occasionally lightheadedness and a recent syncopal episode. What is this client's most likely diagnosis and the phenomenon underlying it? A) Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias B) Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation C) Torsades de pointes as a result of disease of the bundle of His D) Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process
A) Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias
A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was "so fast I couldn't even count it." The child was determined to be in atrial flutter, and his mother is seeking an explanation from the health-care team. Which of the following points should underlie an explanation to the mother? A) The child is experiencing a reentry rhythm in his right atrium. B) The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions. C) The child is likely to have a normal ECG apart from the rapid heart rate. D) The boy's atria are experiencing abnormal sympathetic stimulation.
A) The child is experiencing a reentry rhythm in his right atrium.
A nurse who provides care on a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive beta-adrenergic blocking medications, such as metoprolol. Which of the following statements best conveys an aspect of the use of beta blockers? A) They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential. B) They inhibit the potassium current and repolarization, extending the action potential and refractoriness. C) They counteract arrhythmias and tachycardias by increasing vagal stimulation. D) They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions.
A) They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential.
A nursing student having trouble moving his head from side to side is likely experiencing a problem with which type of neurons? A. Pharyngeal efferent neurons B. Preganglionic neurons C. General visceral efferent neurons D. Parasympathetic postganglionic neurons
A. Pharyngeal efferent neurons Pharyngeal efferent neurons innervate brachial arch skeletal muscles, muscles of mastication and facial expression, and muscles of the pharynx and larynx. They also innervate muscles responsible for moving the head. General visceral efferent neurons and preganglionic neurons (same) innervate smooth and cardiac muscle and glandular cells of the body, most of which are in the viscera. Parasympathetic postganglionic neurons have no effect in moving the head.
*Which type of angina can PTs typically work with?* a. stable b. unstable c. prinzmetal
A. Stable
*Which of the 3 types of angina is one that occurs with less exertion, lasts longer and becomes less responsive to meds?* a. Unstable angina b. Stable angina c. Prinzmetal angina
A. Unstable Angina
What is the treatment for diastolic heart failures?
ACE inhibitors Diuretics Decreased salt intake (<2 gms/day) *NOTE: Digoxin makes diastolic heart failures worse*
*What is the drug of choice for systolic heart failures?* a. digoxin b. beta blockers c. ACE inhibitors d. calcium channel blockers
ACE inhibitors!
If the SA node or internodal pathways are damaged, the
AV node assumes command
An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short term and long term compensatory Mechanisms are least likely to decrease the symptoms of his heart failure?
AV node pacemaking activity and vagal nerve suppression
An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure?
AV node pacemaking activity and vagal nerve suppression
If the papillary muscles fail to contract, the
AV valves will not close properly
Cardiac reserve refers to which of the following events?
Ability to increase cardiac output during physical exercise p. 487.
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.
ST-elevated myocardial infarction 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.
ST-elevated myocardial infarction 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? a) Action decreases metabolic demands of the heart. b) Action increases anxiety increasing metabolic demands of the heart. c) Action relieves pain and gives sense of depression. d) Action increases autonomic nervous system activity.
Action decreases metabolic demands of the heart. Although a number of analgesic agents have been used to treat the pain of STEMI, morphine is usually the drug of choice. It usually is indicated if chest pain is unrelieved with oxygen and nitrates. The reduction in anxiety that accompanies the administration of morphine contributes to a decrease in restlessness and autonomic nervous system activity, with a subsequent decrease in the metabolic demands of the heart. Morphine does not cause a feeling of depression to the client.
A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure?
Activation of the renin-angiotensin-aldosterone mechanism
A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient's increased blood pressure?
Activation of the renin-angiotensin-aldosterone mechanism The largest single cause of secondary hypertension is renal disease. The reduced renal blood flow that occurs with renovascular disease causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II and raising blood pressure. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta.
A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient's increased blood pressure?
Activation of the renin-angiotensin-aldosterone mechanism(p. 427.)
A client comes to the emergency room with complaints of chest pain. When the nurse reads his ECG she sees changes which include T-wave inversion, ST-segment elevation, and an abnormal Q wave. What should she suspect?
Acute myocardial infarction
A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What is this patient's most likely diagnosis?
Adenocarcinoma
in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?
Administer epinephrine (adrenaline).
A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?
Administer epinephrine (adrenaline). p. 506.
The nurse is providing care for a client who has a recent history of visual disturbances, facial pain and erythema in the region of the temporal artery. Which aspect of care is most appropriate?
Administration of corticosteroids as ordered
What is the most common identifiable cause of secondary cardiomyopathy?
Alcohol abuse
most common cause of hypercapnia?
Alterations in respiratory rate
*What makes Prinzmetal's angina so "spontaneous?"*
Always fluctuating - sometimes symptoms improve with exertion
Exiratory Reserve Volume
Amount of air that can be exhaled in excess of a normal tidal volume
For patients are admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experience myocardial infarction?
An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST segment elevation with inverted T-wave and abnormal keyways; levels of cardiac markers of secretly rose.
Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction?
An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose
Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction? a) A 33-year-old male whose pain started at 7 a.m. during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable b) A 61-year-old man whose pain started at 9 a.m. during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened c) An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose d) A 67-year-old female whose pain started at 2 a.m. while she was asleep and which responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable
An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart. The other patients have angina of varying severity.
Which of the following patients on a medical unit of a hospital is most likely to be experiencing health problems that may be attributable to kidney disease?
An 81-year-old female patient with osteoporosis and anemia
Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?
An 81-year-old male who has a productive cough and recurrent respiratory infections
Which of the following individuals would be considered to be at risk for the development of edema?
An 81-year-old man with right-sided heart failure and hypothyroidism
The nursing instructor teaches the students that when a client is suffering from pericarditis he/she will have a friction rub. The student asks the instructor what a friction rub is.
An audible medical sign that is high-pitched and results from the rubbing and friction between the inflamed pericardial surfaces.
When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?
An ejection fraction of 40%
A nurse is caring for four patients. Which of the following patients is most at risk for atrial fibrillation (AF)?
An elderly male who is 2 days postcoronary artery bypass surgery AF can be seen in people without any apparent disease, or it may occur in people with coronary artery disease, mitral valve disease, ischemic heart disease, hypertension, myocardial infarction, pericarditis, congestive heart failure, digitalis toxicity, and hyperthyroidism. AF is the most common chronic arrhythmia, with an incidence and prevalence that increase with age. The incidence of AF increases with age. For example, it occurs in less than 0.5% of the population aged less than 50 years and increases by 2% at ages 60-69 years old. The prevalence is also greater in men than in women.
Which of the following patients should most likely be assessed for orthostatic hypotension?
An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom
Which of the following patients should most likely be assessed for orthostatic hypotension?
An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom. Dizziness and syncope are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.
symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?
Anaphylactic
A client is rushed to the emergency department with symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?
Anaphylactic p. 506.
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client.
Anaphylatic shock
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client.
Anaphylatic shock p. 506.
*What is the classical symptom of a stable angina?*
Angina pectoris (ischemic chest pain)
A patient taking an antihypertensive drug for several months comes to the physician's office with a dry, persistent cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors inhibit bradykinin degradation in the lungs, which can cause a common side effect of a dry, nonproductive cough.
10. Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place? A) The man's - and -adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate. B) Hemolysis and blood pooling are taking place in the man's peripheral circulation. C) Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism. D) Intracellular potassium and extracellular sodium levels are rising as a result of sodium-potassium pump failure.
Ans: A
18. A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences? A) "You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." B) "Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young patients." C) "Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate." D) "Fever is a sign of heart failure in children that you are unlikely to see in older adults."
Ans: A
6. A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? A) Measurement of urine output and mental status assessment B) Pupil response and counting the patient's apical heart rate C) Palpation of pedal (foot) pulses and pain assessment D) Activity tolerance and integumentary inspection
Ans: A
8. A female older adult client has presented with a new onset of shortness of breath, and her physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of blood work? A) BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology. B) BNP is an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure. C) BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. D) BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.
Ans: A
11. Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be in the early stages of cardiogenic shock? Select all that apply. A) Decreasing mean arterial pressure (MAP) B) Low BP reading of 86/60 C) Urine output of 15 mL last hour D) Low pulmonary capillary wedge pressure (PCWP) E) Periods of confusion
Ans: A, B, C, E
16. A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows that which of the following complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply. A) Profound dyspnea due to acute respiratory distress syndrome B) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces C) Formation of plaque within vessels supplying blood to the heart causing muscle damage and chest pain D) Acute renal failure due to decreased/impaired renal perfusion as a result of low BP E) Flushed skin and pounding headache that coincides with each heart beat
Ans: A, B, D
9. A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? A) Antihypertensive, diuretic, antiplatelet aggregator B) Diuretic, ACE inhibitor, beta-blocker C) Anticoagulant, antihypertensive, calcium supplement D) Beta-blocker, potassium supplement, anticoagulant
Ans: B
12. A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? A) Resolution of compensatory pulmonary edema and heart arrhythmias B) Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility C) Infusion of normal saline or Ringer lactate to maintain the vascular space D) Administration of oxygen and epinephrine to promote perfusion
Ans: C
A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client A) has a distended bladder, facial edema, and nighttime difficulty breathing. B) complains of dyspnea and has adventitious breath sounds on auscultation (listening). C) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. D) has cyanotic lips and extremities, low urine output, and low blood pressure.
Ans: C
A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? A) His resting blood pressure is normally in the range of 150/90, and an echocardiogram indicates his ejection fraction is 30%. B) His end-diastolic volume is higher than normal, and his resting heart rate is regular and 82 beats/minute. C) He is presently volume overloaded following several days of intravenous fluid replacement. D) Ventricular dilation and wall tension are significantly lower than normal.
Ans: D
An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure? A) An increase in preload via the Frank-Starling mechanism B) Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine C) Activation of the renin-angiotensin-aldosterone system and secretion of brain natriuretic peptide (BNP) D) AV node pacemaking activity and vagal nerve suppression
Ans: D
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
A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child's recurrent infections?
Antibody production by plasma cells is compromised because of impaired communication between B and T cells.
A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this client?
Anticoagulation therapy and elevation of the leg Anticoagulants, immobilization, and elevation of the affected extremity are used in the treatment of DVT. Interventions that are used to prevent DVT (ambulation; compression stockings; compression devices) may be harmful when a DVT is present. Surgery is not normally required, and massage has the potential to dislodge a DVT.
The NP is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the NPs advice?
Antioxidants inhibit the actions of reactive oxygen species (ROS).
dead space
Any portion of the airway that does contain air and cannot participate in gas exchange, such as the trachea and bronchi.
Regarding heart failure, the nurse knows that which of the following statements are correct? Select all that apply.
Aortic stenosis can cause left-sided failure. Cardiomyopathy is a common cause of heart failure. Compensated heart failure may be clinically asymptomatic. p. 486.
Regarding the various forms of heart failure, the nurse knows that which statements are correct? Select all that apply.
Aortic stenosis can cause left-sided failure. Cardiomyopathy is a common cause of heart failure. Compensated heart failure may be clinically asymptomatic.
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:
Apply sequential pneumatic compression devices to lower extremities
The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?
Arterioles Arterioles can constrict or dilate selectively and control the resistance to blood flow into capillaries.
early signs of constrictive pericarditis. The most likely manifestation would be:
Ascites
A client presents with sinus bradycardia. What is the nurse's best action?
Assess the client's history The nurse needs to assess the client's history before determining if action is necessary. Sinus bradycardia is most often benign unless it is associated with a myocardial infarction, post resuscitation, or associated with hemodynamic decompensation. It is normal in an athlete, or someone who is well conditioned. After assessing the client's history the nurse can determine if other action is necessary
A client presents with sinus tachycardia. What is an appropriate nursing action? Select all that apply.
Assess the client's temperature Assess the client's pain level Assess the client's vital signs
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope? a) At the carotid arteries b) Over the aorta c) At the apex of the heart d) Over the sternum
At the apex of the heart The murmur of mitral valve stenosis is heard during diastole when blood is flowing through the constricted valve; it is characteristically a low-pitched, rumbling murmur best heard at the apex of the heart. The other locations would not be effective.
The nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD? a) Excessive use of dairy products b) Atherosclerosis c) Defect in the DNA d) Excessive exercise
Atherosclerosis In most cases, coronary artery disease is caused by atherosclerosis. Exercise is good for people and excessive use of dairy is not related nor is it a defect in DNA. Risk factors can predispose someone to coronary artery disease such as cigarette smoking, high cholesterol, diabetes, advancing age, etc
Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?
Atherosclerosis and unstable angina
A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plan listed below?
Atherosclerotic occlusive disease necessitating thrombolytic therapy
A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. What would his care provider's preliminary diagnosis and anticipated treatment most likely be?
Atherosclerotic occlusive disease necessitating thrombolytic therapy
Question 3 See full question A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plan listed below
Atherosclerotic occlusive disease necessitating thrombolytic therapy p. 415.
The purpose of a cardioversion device is the treatment of which of the following cardiac disorders?
Atrial fibrillation Explanation: Synchronized cardioversion and defibrillation are two reliable methods for treating ventricular tachycardia, and cardioversion is the definitive treatment for atrial fibrillation. The discharge of electrical energy that is synchronized with the R wave of the electrocardiogram is referred to as synchronized cardioversion, and unsynchronized discharge is known as defibrillation
A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which of the following assessments should the nurse complete?
Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves
The NP is working with a family whose daughter has been recently diagnosed with the chromosomal disorder Turner syndrome. The NP would recognize that which of the following statements about the characteristics of human chromosomes is accurate?
Autosomes contain the determination of an individual's sex.
14. The nurse identifies the collaborative problem of potential complication: pulmonary edema for a patient in ADHF. When assessing the patient, the nurse will be most concerned about a. an apical pulse rate of 106 beats/min. b. an oxygen saturation of 88% on room air. c. weight gain of 1 kg (2.2 lb) over 24 hours. d. decreased hourly patient urinary output.
B Rationale: A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require rapid nursing actions, but the low oxygen saturation rate requires the most immediate nursing action. Cognitive Level: Analysis Text Reference: pp. 829-830 Nursing Process: Assessment NCLEX: Physiological Integrity
22. A patient who is receiving dobutamine (Dobutrex) for the treatment of ADHF has all of the following nursing actions included in the plan of care. Which action will be best for the RN to delegate to an experienced LPN/LVN? a. Teach the patient the reasons for remaining on bed rest. b. Monitor the patient's BP every hour. c. Adjust the drip rate to keep the systolic BP >90 mm Hg. d. Call the health care provider about a decrease in urine output.
B Rationale: An experienced LPN/LVN would be able to monitor BP and would know to report significant changes to the RN. Teaching patients and making adjustments to the drip rate for vasoactive medications are RN-level skills. Because the health care provider may order changes in therapy based on the decrease in urine output, the RN should call the health care provider about the decreased urine output. Cognitive Level: Application Text Reference: pp. 827-829 Nursing Process: Planning NCLEX: Safe and Effective Care Environment
5. When the nurse is developing a teaching plan to prevent the development of heart failure in a patient with stage 1 hypertension, the information that is most likely to improve compliance with antihypertensive therapy is that a. hypertensive crisis may lead to development of acute heart failure in some patients. b. hypertension eventually will lead to heart failure by overworking the heart muscle. c. high BP increases risk for rheumatic heart disease. d. high systemic pressure precipitates papillary muscle rupture.
B Rationale: Hypertension is a primary cause of heart failure because the increase in ventricular afterload leads to ventricular hypertrophy and dilation. Hypertensive crisis may precipitate acute heart failure is some patients, but this patient with stage 1 hypertension may not be concerned about a crisis that happens only to some patients. Hypertension does not directly cause rheumatic heart disease (which is precipitated by infection with group A -hemolytic streptococcus) or papillary muscle rupture (which is caused by myocardial infarction/necrosis of the papillary muscle). Cognitive Level: Application Text Reference: p. 822 Nursing Process: Planning NCLEX: Health Promotion and Maintenance
8. A patient admitted to the hospital with an exacerbation of chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse can best document this assessment information as a. pulsus alternans. b. paroxysmal nocturnal dyspnea. c. two-pillow orthopnea. d. acute bilateral pleural effusion.
B Rationale: Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period. Cognitive Level: Comprehension Text Reference: p. 825 Nursing Process: Assessment NCLEX: Physiological Integrity
11. When developing a plan to decrease preload in the patient with heart failure, the nurse will include actions such as a. administering sedatives to promote rest and decrease myocardial oxygen demand. b. positioning the patient in a high-Fowler's position with the feet horizontal in the bed. c. administering oxygen per mask or nasal cannula. d. encouraging leg exercises to improve venous return.
B Rationale: Positioning the patient in a high-Fowler's position with the legs dependent will reduce preload by decreasing venous return to the right atrium. The other interventions may also be appropriate for patients with heart failure but will not help in decreasing preload. Cognitive Level: Application Text Reference: pp. 827-828 Nursing Process: Planning NCLEX: Physiological Integrity
7. Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to adjust the Nipride rate if the patient develops a. a drop in heart rate to 54 beats/min. b. a systolic BP <90 mm Hg. c. any symptoms indicating cyanide toxicity. d. an increased amount of ventricular ectopy.
B Rationale: Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. After 48 hours of continuous use, cyanide toxicity is a possible (though rare) adverse effect. Reflex tachycardia (not bradycardia) is another adverse effect of this medication. Nitroprusside does not cause increased ventricular ectopy. Cognitive Level: Application Text Reference: p. 828 Nursing Process: Evaluation NCLEX: Physiological Integrity
10. The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient a. says that the nitroglycerin patch will be used for any chest pain that develops. b. calls when the weight increases from 124 to 130 pounds in a week. c. tells the home care nurse that furosemide (Lasix) is taken daily at bedtime. d. makes an appointment to see the doctor at least once yearly.
B Rationale: Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 pounds in 2 days or 5 pounds in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an "as necessary" basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. Heart failure is a chronic condition that will require frequent follow-up rather than an annual health care provider examination. Cognitive Level: Application Text Reference: pp. 826, 833-834, 838 Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance
15. While admitting an 80-year-old patient with heart failure to the medical unit, the nurse obtains the information that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." The nurse makes a note that discharge planning for the patient will need to include a. transfer to a dementia care service. b. referral to a home health care agency. c. placement in a long-term-care facility. d. arrangements for around-the-clock care.
B Rationale: The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patient's home situation and help the patient to develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as dementia care, long-term-care, or around-the-clock home care. Cognitive Level: Application Text Reference: pp. 836-837 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance
Which of the following statements most accurately conveys an aspect of lymphatic system activity?
B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.
8. A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention? A) A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia B) A 69-year-old woman who has entered ventricular fibrillation C) A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation D) A 60-year-old woman who has just been diagnosed with a first-degree AV block
B) A 69-year-old woman who has entered ventricular fibrillation
6. A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate? A) Immediate cardioversion followed by surgery to correct the atrial defect B) Anticoagulants, beta blockers, and possibly digitalis C) Antihypertensives and constant cardiac monitoring in a high acuity unit D) Diuretics, total bed rest, and cardioversion if necessary
B) Anticoagulants, beta blockers, and possibly digitalis
A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart? A) Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation. B) Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells. C) The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions. D) The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.
B) Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
16. You are interpreting an electrocardiogram of a 65-year-old woman. Which of the following represents ventricular depolarization? A) The P wave B) The QRS complex C) the T wave D) The ST segment
B) The QRS complex
An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG? A) The electrical potential recorded by a lead on an extremity will vary significantly depending on where the lead is placed on the extremity. B) The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane. C) Limb leads measure the electrical activity of the heart indirectly through the activity of adjacent skeletal muscle. D) A total of 12 chest leads is necessary to attain the most accurate ECG.
B) The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.
A patient is admitted to the outpatient diagnostic unit for further testing to identify the cause of the uncontrolled secondary hypertension. In preparation, the nurse should anticipate that which of the following diagnostic procedures will provide the most definitive diagnosis? A. Echocardiography B. Renal arteriography C. Serum creatinine level D. Routine ultrasound of kidney
B. Renal arteriography with the dominant role that the kidney assumes in blood pressure regulation, it is not surprising that the largest single cause of secondary hypertension is renal disease. Renal arteriography remains the definitive test for identifying renal artery disease. Ultrasound, CT, and MRA are other tests that can be used to screen for renovascular hypertension.
Transient ischemic attacks (TIAs) are characterized by ischemic cerebral neurologic deficits that: A. indicate aneurysm leakage. B. resolve within one hour of onset. C. cause minor residual deficits. D. affect diffuse cerebral functions.
B. resolve within one hour of onset.
Hypertrophic cardiomyopathies are seen in:* a. Systolic heart failure b. Diastolic heart failure
B. Diastolic HF
Which type of cardiomyopathy is the most common? a. Hypertrophic b. Dilated c. Restrictive
B. Dilated cardiomyopathy
A female adult older client has presented with new onset of shortness of breath and her physician has ordered measurement of her BNP levels along with other diagnostic test. What is the most accurate rationale for the physicians choice of blood work?
BNP is released as a compensatory mechanism during heart failure and measuring it can differentiate the clients dyspnea from a respiratory pathology
An older adult female patient has presented with a new onset of shortness of breath, and the patient's nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner's choice of blood work?
BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient's dyspnea from a respiratory pathology.
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
25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms
Barrel chest
A 45-year-old patient who experienced exposure to radiation during an industrial accident several years prior is being assessed. Which of the following phenomena may underlie the genetic changes that have been noted in the patient?
Base pairs may have been rearranged by the radiation exposure.
It's 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with rapid heart rate and a feeling of impending doom. Based on the pathophysiologic principles, the nurse knows the rapid heart rate could
Be a result of catecholamines released from SNS that could increase the myocardial oxygen demand
A 77 year old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of, "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:
Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand.
history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of, "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:
Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand.
The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as:
Berry aneurysm
A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:
Bicuspid valve The bicuspid valve, (also called the mitral) controls the flow of blood between the left atria and left ventricle. The aortic valve controls flow between the left ventricle and aorta. The tricuspid controls the flow between the right atria and ventricle. The pulmonic valve controls flow between the right ventricle and pulmonary artery
A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?
Blacks and South Asians A 2006 Canadian study showed that the ethnic groups consisting of South Asians (30%) and blacks (31%) in Canada are more likely to have hypertension in comparison to the primarily Caucasian population (21%) and East Asians are the least likely to have hypertension (19%).
An 81-year-old female patient of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the patient's condition?
Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.
A client is admitted to the intensive care unit suspected of having infective endocarditis. Which of the following tests is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client?
Blood culture
A nurse who works on pediatric cardiology unit of the hospital is providing care for an infant with diagnosis of tetralogy of fallot. Which of the following pathophysiologic results should the nurse anticipate
Blood outflow into the pulmonary circulation is restricted by Pulmonic valve stenosis.
A nurse who works on a pediatric cardiology unit of a hospital is providing for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate?
Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.
A nurse who works on a pediatric cardiology unit of a hospital is providing for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate? a) There is a break in the normal wall between the right and left atria that results in compromised oxygenation. b) The right ventricle is atrophic as a consequence of impaired myocardial blood supply. c) Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis. d) The aortic valve is stenotic, resulting in increased afterload.
Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis. Tetralogy of Fallot is marked by obstruction or narrowing of the pulmonary outflow channel, including pulmonic valve stenosis, a decrease in the size of the pulmonary trunk, or both. The characteristic septal defect is ventricular, not atrial. Aortic valve stenosis and right ventricular atrophy are not associated with the diagnosis.
In pregnancy, which of the following data are diagnostic for pre-eclampsia and eclampsia?
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Pre-eclampsia and eclampsia are defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (≥300 in 24 hours) developing after 20 weeks of gestation.
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Preeclampsia-eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing after 20 weeks of gestation.
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy(p. 430)
A patient is diagnosed with gestational hypertension. The nurse recognizes which of the following as characteristic of this condition? Select all that apply.
Blood pressure greater than 140/90 Development after 20th week of pregnancy Blood pressure back to normal by 12 weeks postpartum (p. 431)
The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which of the following blood pressure findings can be characteristic of this condition?
Blood pressure in arms 20 mm Hg higher than in the legs(p.428)
At which of the following locations in the nephron would a nurse practitioner first expect blood to be largely free of plasma proteins?
Bowman Space
infant who was born prematurely and developed respiratory distress syndrome was placed on mechanical ventilation for several weeks.
Bronchopulmonary dysplasia
Which diuretic acts by inhibiting sodium chloride reabsorption in the thick ascending limb of the loop of Henle?
Bumetanide (Bumex)
A patient with chronic heart failure who has been following a low-sodium diet tells the nurse at the clinic about a 5-pound weight gain in the last 3 days. The nurse's first action will be to a. ask the patient to recall the dietary intake for the last 3 days because there may be hidden sources of sodium in the patient's diet. b. instruct the patient in a low-calorie, low-fat diet because the weight gain has likely been caused by excessive intake of inappropriate foods. c. assess the patient for clinical manifestations of acute heart failure because an exacerbation of the chronic heart failure may be occurring. d. educate the patient about the use of diuretic therapy because it is likely that the patient will need medications to reduce the hypervolemia.
C Rationale: The 5-pound weight gain over 3 days indicates that the patient's chronic heart failure may be worsening; it is important that the patient be immediately assessed for other clinical manifestations of decompensation, such as lung crackles. A dietary recall to detect hidden sodium in the diet and teaching about diuretic therapy are appropriate interventions but are not the first nursing actions indicated. There is no evidence that the patient's weight gain is caused by excessive dietary intake of fat or calories, so the answer beginning "instruct the patient in a low-calorie, low-fat diet" describes an inappropriate action. Cognitive Level: Application Text Reference: p. 826 Nursing Process: Assessment NCLEX: Physiological Integrity
20. An elderly patient with a 40-pack-year history of smoking and a recent myocardial infarction is admitted to the medical unit with acute shortness of breath; the nurse need to rule out pneumonia versus heart failure. The diagnostic test that the nurse will monitor to help in determining whether the patient has heart failure is a. 12-lead electrocardiogram (ECG). b. arterial blood gases (ABGs). c. B-type natriuretic peptide (BNP). d. serum creatine kinase (CK).
C Rationale: BNP is secreted when ventricular pressures increase, as with heart failure, and elevated BNP indicates a probable or very probable diagnosis of heart failure. 12-lead ECGs, ABGs, and CK may also be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP. Cognitive Level: Application Text Reference: p. 827 Nursing Process: Assessment NCLEX: Physiological Integrity
16. A home health care patient has recently started taking oral digoxin (Lanoxin) and furosemide (Lasix) for control of heart failure. The patient data that will require the most immediate action by the nurse is if the patient's a. weight increases from 120 pounds to 122 pounds over 3 days. b. liver is palpable 2 cm below the ribs on the right side. c. serum potassium level is 3.0 mEq/L after 1 week of therapy. d. has 1 to 2+ edema in the feet and ankles in the morning.
C Rationale: Hypokalemia potentiates the actions of digoxin and increases the risk for digoxin toxicity, which can cause life-threatening dysrhythmias. The other data indicate that the patient's heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium level. Cognitive Level: Application Text Reference: pp. 832-833 Nursing Process: Assessment NCLEX: Physiological Integrity
During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. incompetent jugular vein valves. c. elevated right atrial pressure. d. jugular vein atherosclerosis.
C Rationale: The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle reflects elevated right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume; it is not caused by incompetent jugular vein valves or atherosclerosis. Cognitive Level: Comprehension Text Reference: p. 825 Nursing Process: Assessment NCLEX: Physiological Integrity
9. During a visit to an elderly patient with chronic heart failure, the home care nurse finds that the patient has severe dependent edema and that the legs appear to be weeping serous fluid. Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to venous congestion. b. disturbed body image related to massive leg swelling. c. impaired skin integrity related to peripheral edema. d. impaired gas exchange related to chronic heart failure.
C Rationale: The patient's findings of severe dependent edema and weeping serous fluid from the legs support the nursing diagnosis of impaired skin integrity. There is less evidence for the nursing diagnoses of activity intolerance, disturbed body image, and impaired gas exchange, although the nurse will further assess the patient to determine whether there are other clinical manifestations of heart failure to indicate that these diagnoses are appropriate. Cognitive Level: Application Text Reference: p. 836 Nursing Process: Diagnosis NCLEX: Physiological Integrity
5. A nurse educator is teaching a group of nurses at a long-term-care facility about atrial fibrillation in light of its prevalence in older adults. Which of the following statements by the nurses would the educator most want to correct? A) "The electrical impulses go in chaotic directions, so the atria can't contract properly." B) "An ECG of someone in atrial fibrillation would be almost random in appearance." C) "The contraction of the ventricles and the atria can range from 400 to 600 beats per minute." D) "It can be hard to measure at the bedside because not all ventricular beats make a palpable pulse."
C) "The contraction of the ventricles and the atria can range from 400 to 600 beats per minute."
9. A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The man's nurse has been educating him on his diagnosis and treatment and answering the numerous questions he has about his health problem. Which of the following teaching points should the nurse include in this patient teaching? A) "This is almost certainly a condition that you were actually born with, but that is just now becoming a serious problem." B) "Because the normal electrical communication in lacking, the bottom parts of your heart are beating especially fast to compensate for inefficiency." C) "The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently." D) "If left untreated, this would have put you at great risk of stroke or heart attack."
C) "The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently."
15. Assuming that they have not responded to drug therapy, which of the following clients is likely to be the best candidate for surgical cardiac ablation? A) A 62-year-old woman with peripheral vascular disease who has experienced multiple episodes of torsades des pointes B) A 75-year-old man with diabetes but no previous heart disease who suddenly develops ventricular tachycardia C) A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long Q-T syndrome D) A 22-year-old woman with an atrial septal defect who has recurrent paroxysmal supraventricular tachycardia
C) A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long Q-T syndrome
10. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the client's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 25 hours. Which of the following statements best captures an aspect of Holter monitoring? A) A Holter monitor is preferable to standard ECG because of its increased sensitivity to cardiac electrical activity. B) The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. C) Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording. D) Holter monitors are normally set to record electrical activity of the heart at least once per hour.
C) Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording.
17. During a class on cardiac disorders, a nurse educator is explaining the numerous diagnostic methods used in the care of cardiac patients. Which of the following could best diagnose sick sinus syndrome? A) Chemical stress test B) Exercise stress test C) ECG D) Cardiac ultrasound
C) ECG
The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?
C-reactive protein p. 409.
Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply. A. A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa B. A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia C. An 81-year-old man with right-sided heart failure and hypothyroidism D. A 34-year-old industrial worker who has suffered extensive burns in a job-related accident E. A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus
C. An 81-year-old man with right-sided heart failure and hypothyroidism D. A 34-year-old industrial worker who has suffered extensive burns in a job-related accident A. A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa
An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition? A. Peripheral dilation is associated with decreased stroke volume and ejection fraction. B. Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. C. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. D. Heart valves are not capable of preventing backflow in cases of atrial congestion.
C. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. Because there are no valves at the entry points to the atria, congestion can result in engorgement of the jugular veins, which are proximal to the heart. Increased cardiac demand is not associated with engorgement of vessels or peripheral dilation.
A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? A. Activity tolerance and integumentary inspection B. Measurement of urine output and mental status assessment C. Pupil response and counting the patient's apical heart rate D. Palpation of pedal (foot) pulses and pain assessment
C. Pupil response and counting the patient's apical heart rate
Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is:
Call for emergency assistance utilizing hospital protocol.(p. 497)
Mr. V has been admitted for exacerbation of his chronic heart failure. When the nurse walks into his room he is sitting on the edge of the bed gasping for air and his lips are dusty blue. Vital signs reveal a heart rate of 112 respiratory rate of 36 and pulse ox reading of 81%. He starts coughing up pink frothy sputum. The priority intervention is to
Call from urgency assistant utilizing hospital protocol
A community health nurse practitioner is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that which of the following items underlies the rationale for this teaching?
Cancer of the uterine cervix develops incrementally at a cellular level.
Which of the following blood vessels function without the benefit of having walls comprised of three muscular layers
Capillaries
Which of the following blood vessels function without the benefit of having walls comprised of three muscular layers?
Capillaries
Select the correct sequence of blood return to the heart.
Capillaries, venules, veins, right atrium
A nurse is planning a community education program on hypertension. Which of the following parameters should be included to explain the regulation of arterial blood pressure?
Cardiac output and systemic vascular resistance
A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?
Cardiac tamponade
diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled.
Cardiac tamponade
A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make? a) Myocardial infarction b) Pericarditis c) Thrombosis d) Cardiac tamponade
Cardiac tamponade Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart. It can be life-threatening and symptoms include tachycardia, elevated central venous pressure, jugular vein distention, fall in systolic blood pressure with narrowed pulse pressure. Pericarditis is inflammation of the pericardium. A myocardial infarction does not have these symptoms nor does a thrombus
The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock?
Cardiogenic
The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock?
Cardiogenic p. 504.
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 type of cardiac patients need cardiac transplants?*
Cardiomyopathy patients!
Which statements regarding heart failure in older adults are true? Select all that apply.
Causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction. Sensitivity of beta-adrenergic receptors decreases, resulting in decreased ventricular contractility. It is more difficult to diagnose because of underlying chronic diseases.
The nurse practitioner working in occupational health has been asked to speak to a group of factory workers about the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which of the following characteristics of cell membranes underlies the nurse's teaching?
Cell membranes are impermeable to all but lipid-soluble substances.
Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma?
Chemical mediators are released from presensitized mast cells.
A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl's persistent sore throat and malaise. Which of the following facts revealed in the girl's history and examination would lead the nurse practitioner to rule out infectious mononucleosis?
Chest auscultation reveals crackles in her lower lung fields bilaterally.
diagnosed with pulmonary embolism. Which of the following symptoms would most likely be present?
Chest pain and dyspnea
A 56-year-old male patient has been diagnosed with hypercholesterolemia. Which of the following are the lab results that support this diagnosis?
Cholesterol 250 mg/dL and HDL 32 mg/dL A diagnosis of hypercholesterolemia would be made based on a cholesterol level greater than 200 mg/dL and an HDL of greater than 30 mg/dL.
A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his nurse practitioner. Which of the following aspects of hyperlipidemia would the nurse practitioner most likely take into account when teaching the patient?
Cholesterol is a metabolic waste product that the liver is responsible for clearing.
*Which class on classification of fatigue, dyspnea or angina is when symptoms occur on exertion but patient is able to manage usual tasks of life?*
Class 2
*Which class of heart failure is when you have marked limitation of physical activity; less than ordinary physical activity causes fatigue/palpitation/dyspnea; don't really do well with exercise?*
Class 3- moderate
*Which class of heart failure is when you are unable to carry out any physical activity; sx's of cardiac insufficiency even at rest?*
Class 4- severe :(
The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?
Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation
What causes the Plateau of the Conducting System to end?
Closure of the slow calcium channels K+ open
A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect?
Coarctation of the aorta
The distensibility of the blood vessel is the major factor in which of the vessel's characteristics?
Compliance
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.
The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
Constrictive pericarditis
The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
Constrictive pericarditis
A patient diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which of the following are often associated with diastolic failure? Select all that apply.
Constrictive pericarditis Myocardial hypertrophy Ischemic heart disease
A client diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which conditions are often associated with diastolic failure? Select all that apply.
Constrictive pericarditis Myocardial hypertrophy Ischemic heart disease
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which of the following topics should be included in the teaching plan? Select all that apply.
Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. Limit alcohol consumption.
A client has been admitted after being resuscitated from a cardiac arrest. The client is stated to be in Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client?
Continuous cardiac monitoring
A client has been admitted after being resuscitated from a cardiac arrest. The client is stated to be in Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client?
Continuous cardiac monitoring The American Heart Association has published practice standards for electrocardiogram monitoring in hospital settings. The rating system has three categories. Class I clients require cardiac monitoring consistently. Class II clients may need monitoring but it is not essential. Class III clients do not have monitoring indicated.
A nurse is assessing a client in shock for complications of acute renal failure. Which assessment is priority for the nurse to obtain?
Continuously measuring urine output
The heart controls the direction of blood flow. What is the role of the aortic valve?
Controls the direction of blood flow from the left side of the heart to the systemic circulation
A client with primary lung disease has developed right heart failure. The health care provider would document this as:
Cor pulmonale
client with primary lung disease has developed right heart failure.
Cor pulmonale
*Endocarditis can lead to what?*
Coronary emboli Abscess formation Purulent pericardial effusions
Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes?
Cyanosis
Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes?
Cyanosis p. 492.
The nurse practitioner is providing care for a patient with a diagnosis of cirrhosis, and he notes that the patient's sclerae are jaundiced. The nurse practitioner recalls that jaundice is caused by excess accumulation of bilirubin, a pigment that can accumulate in which part of the cell?
Cytoplasm
17. Following an acute myocardial infarction, a previously healthy 67-year-old patient develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. digitalis preparations, such as digoxin (Lanoxin). b. calcium-channel blockers, such as diltiazem (Cardizem). c. -adrenergic agonists, such as dobutamine (Dobutrex). d. angiotensin-converting enzyme (ACE) inhibitors, such as captopril (Capoten).
D Rationale: ACE-inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other medications such as ACE-inhibitors, diuretics, and -adrenergic blockers is insufficient. Calcium-channel blockers are not generally used in the treatment of heart failure. The -adrenergic agonists such as dobutamine are administered through the IV route and are not used as initial therapy for heart failure. Cognitive Level: Application Text Reference: p. 832 Nursing Process: Implementation NCLEX: Physiological Integrity
The nurse is caring for a patient receiving IV furosemide (Lasix) 40 mg and enalapril (Vasotec) 5 mg PO bid for ADHF with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is a. weight loss of 2 pounds overnight. b. improvement in hourly urinary output. c. reduction in systolic BP. d. decreased dyspnea with the head of the bed at 30 degrees.
D Rationale: Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in crackles. The other assessment data also may indicate that diuresis or improvement in cardiac output have occurred but are not as useful in evaluating this patient's response. Cognitive Level: Application Text Reference: p. 825 Nursing Process: Evaluation NCLEX: Physiological Integrity
23. A hospitalized patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about captopril, which statement by the patient indicates that teaching has been effective? a. "I will need to include more high-potassium foods in my diet." b. "I will expect to feel more short of breath for the next few days." c. "I will be sure to take the medication after eating something." d. "I will call for help when I need to get up to the bathroom."
D Rationale: Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose. The ACE inhibitors are potassium sparring, and the nurse should not teach the patient to increase sources of dietary potassium. Increased shortness of breath is expected with initiation of -blocker therapy for heart failure, not for ACE-inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating. Cognitive Level: Application Text Reference: p. 832 Nursing Process: Evaluation NCLEX: Physiological Integrity
13. The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin), hydrochlorothiazide (HydroDIURIL), and a potassium supplement. Appropriate instructions for the patient include a. avoid dietary sources of potassium because too much can cause digitalis toxicity. b. take the pulse rate daily and never take digoxin if the pulse is below 60 beats/min. c. take the hydrochlorothiazide before bedtime to maximize activity level during the day. d. notify the health care provider immediately if nausea or difficulty breathing occurs.
D Rationale: Difficulty breathing is an indication of acute decompensated heart failure and suggests that the medications are not achieving the desired effect. Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. Digoxin toxicity is potentiated by hypokalemia, rather than hyperkalemia. Patients should be taught to check their pulse daily before taking the digoxin and, if the pulse is less than 60, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption. Cognitive Level: Application Text Reference: p. 835 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance
18. A 55-year-old patient with inoperable coronary artery disease and end-stage heart failure asks the nurse whether heart transplant is a possible therapy. The nurse's response to the patient will be based on the knowledge that a. heart transplants are experimental surgeries that are not covered by most insurance. b. the patient is too old to be placed on the transplant list. c. the diagnoses and symptoms indicate that the patient is not an appropriate candidate. d. candidacy for heart transplant depends on many factors.
D Rationale: Indications for a heart transplant include inoperable coronary artery disease and refractory end-stage heart failure, but other factors such as coping skills, family support, and patient motivation to follow the rigorous post-transplant regimen are also considered. Heart transplants are not considered experimental; rather, transplantation has become the treatment of choice for patients who meet the criteria. The patient is not too old for a transplant. The patient's diagnoses and symptoms indicate that the patient may be an appropriate candidate for a heart transplant. Cognitive Level: Comprehension Text Reference: p. 837 Nursing Process: Planning NCLEX: Health Promotion and Maintenance
12. When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. eggs and other high-cholesterol foods. b. canned and frozen fruits. c. fresh or frozen vegetables. d. milk, yogurt, and other milk products.
D Rationale: Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses, have very high levels of sodium and are not appropriate for a 2000-mg sodium diet. The other foods listed have minimal levels of sodium and can be eaten without restriction. Cognitive Level: Application Text Reference: p. 833 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance
19. A nurse educator is explaining normal cardiac conduction and action potentials to a nursing cohort. When she uses the term "calcium current" a student stops her and asks for clarification. Which is the best response? A) "The calcium current provides for the entrance of calcium for the repolarization of electrical activity with muscle contraction." B) "The calcium current provides for the entrance of calcium needed for muscle contraction." C) "The calcium current provides for the entrance of calcium for the fast depolarization of the myocardium." D) "The calcium current provides for the entrance of calcium for the excitation- contraction mechanism that couples the electrical activity with muscle contraction."
D) "The calcium current provides for the entrance of calcium for the excitation- contraction mechanism that couples the electrical activity with muscle contraction."
7. A 63-year-old male client has been diagnosed with a bundle branch block. How will this client's care team most likely expect his condition to be expressed diagnostically? A) His AV node will be performing the primary pacemaker role due to inadequacy of the SA node. B) His ECG will show a flattened P wave as a result of impaired atrial depolarization. C) Conduction from the Purkinje fibres to the bundle branches is compromised by inadequate conduction. D) His ECG will show an inordinately wide QRS complex because impulses are bypassing normal conduction tissue.
D) His ECG will show an inordinately wide QRS complex because impulses are bypassing normal conduction tissue.
14. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? A) Signal-averaged ECG B) Exercise stress testing C) Electrophysiologic study D) Holter monitoring
D) Holter monitoring
20. A physician is explaining to the evening nurse the underlying cause of a patient's sudden death. While explaining the contractile failure, she states that the cause of death originated from currents "that reduce the magnitude of outward repolarizing potassium currents, enhance the magnitude of the inward depolarizing sodium and calcium currents, or both. Thus, there is delayed repolarization of the ventricles with development of early depolarizing afterpotentials that initiate the arrhythmia" resulting in sudden cardiac failure. What condition is she explaining? A) Cardiomyopathy B) Myocardial infarction C) Long QT syndrome D) Premature ventricular contractions
D) Premature ventricular contractions
12. A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment? A) Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role. B) Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker. C) Defibrillation must be coincided with the R wave of the ECG in order to be successful. D) The goal is to depolarize the entire heart during the passage of current.
D) The goal is to depolarize the entire heart during the passage of current.
A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds, A. "Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve is just had to work too hard and it is weakening." B. "Aortic stenosis is commonly seen in elderly patients. Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow." C. "This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends." D. "Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur."
D. "Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur."
Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome? A. Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium, and disruption of the sodium-potassium pump B. Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response C. Increased serum creatinine and troponin I as a result of enzyme release from damaged cells D. Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation
D. Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation
Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to A. apply oxygen via nasal cannula at 3 lpm. B. have medical supply department bring up suction equipment. C. page the respiratory therapist to come give him a breathing treatment. D. call for emergency assistance utilizing hospital protocol.
D. call for emergency assistance utilizing hospital protocol. Mr. V. is experiencing acute pulmonary edema. This is a life-threatening condition. The person is seen sitting and gasping for air. The pulse is rapid, the skin is moist, and the lips/nail beds are cyanotic. Dyspnea and air hunger are accompanied by productive cough with frothy and often blood-tinged sputum (pink). The patient needs the emergency responder team (including ICU nurses, physicians, respiratory therapist, etc.) to intervene. Applying O2 by mask will not increase his oxygen level fast enough, and he is probably mouth breathing (gasping for air). Suction equipment may be needed, but getting a physician to give orders for diuretics and inotropic medications is the priority. Of course respiratory therapist will arrive with the emergency assistance team.
A 66-year-old client echocardiogram report reveals a hyper trophy left ventricle. The healthcare provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client had aortic stenosis? Select all that apply
Decrease in exercise tolerance, exertional dyspnea, syncope
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have to decrease blood pressure?
Decrease vascular volume
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have to decrease blood pressure?
Decrease vascular volume Diuretics, such as the thiazides, loop diuretics, and the aldosterone antagonist (potassium-sparing) diuretics, lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing salt and water excretion) and cardiac output.
A nurse practitioner employed in the emergency department admits a patient who has experienced severe frostbite to his hands and toes after becoming lost on a ski trail. The NP recognizes that which of the following phenomena has caused the tissue damage?
Decreased blood flow has induced hypoxia.
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
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
The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following?
Decreased cardiac outputp. 490.
A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation?
Decreased erythropoietin levels
*What decreases in subendocardial MI?*
Decreased filling phase (diastolic pressure) - sometimes blood doesn't even get to the endocardial layer
While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?
Decreased heart rate as a result of parasympathetic innervation of the heart
A client who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which manifestation alerts the nurse to a developing complication?
Decreased level of consciousness
A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?
Decreased level of consciousness
ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?
Decreased level of consciousness
A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication? a) Hypoglycemia b) Diarrhea c) Symmetrical joint pain d) Decreased level of consciousness
Decreased level of consciousness Fibrinolytic therapy is most effective in treating STEMI when administered within 30 minutes after the onset of symptoms. It can still be beneficial up to 12 hours after the onset of ischemic pain. Patients who should not receive fibrinolytic therapy are those with a history of intracranial hemorrhage or significant trauma within the preceding 3 months. The primary complication of fibrinolytic treatment is intracranial bleeding that usually occurs within the first 24 hours following treatment. This would be evident with a change in mental status.
Following coronary artery bypass graft or CABG surgery for a massive myocardial infarction located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be an early stages of cardiogenic shock? Select all that apply
Decreasing mean arterial pressure or map, low blood pressure reading of 86/60, urine output of 15 mls last hour, periods of confusion
From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?
Deep vein thrombophlebitis of the leg p. 439.
The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the midcalf area. He has many of the manifestations of:
Deep vein thrombosis Venous insufficiency with deep vein thrombus formation is characterized by discoloration, edema, pain, tenderness, and warmth most commonly in the mid- or lower calf area of the legs. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present.
A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?
Defibrillate the patient Immediate defibrillation using a nonsynchronized, direct-current electrical shock is mandatory for ventricular fibrillation and for ventricular flutter that has caused loss of consciousness.
The shape of the QRS complexes on the ECG is determined by the direction of the electrical impulse in relation to the placement of the electrode on the chest wall. QRS complexes greater than 0.12 second could indicate which of the following?
Delayed conduction in the bundle branches A bundle branch block (BBB) is an interruption in the electrical impulse's ability to travel through the bundle of His at the normal rate, which would result in QRS complexes of 0.08 to 0.12 second. The physiologic consequence of a bundle branch block is that one ventricle contracts before the other because the impulse must travel through the cardiac muscle rather than the bundle of His.
When explaining to a patient why they only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to:
Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually.
What is the pathology of hypertrophic cardiomyopathy?
Diastolic dysfunction which impairs filling of ventricles during diastole Increased LV EDV eventually *increases* left atrial, pulmonary artery, and pulmonary capillary pressures --> all lead to hyper contractility of LV
What is the pathology of restrictive cardiomyopathy?
Diastolic dysfunction which impairs filling of ventricles during diastole (like hypertrophic cardiomyopathy)
Decreased ejection fraction + dilated cavity = what?* a. Hypertrophic cardiomyopathy b. Dilated cardiomyopathy c. Restrictive cardiomyopathy
Dilated cardiomyopathy
Which type of cardiomyopathy is when heart muscle fibers are stretched and chambers enlarged? *What causes it?*
Dilated cardiomyopathy End result of myocardial damage produced by toxins, metabolic or infectious agents (alcohol and smoking)
A patient with persistent primary hypertension is unhappy with the adverse effects of his current antihypertensive regimen. The nurse will tell the patient that there are several types of antihypertensive drugs having different mechanisms of action and different adverse effect profiles. The physician can vary regimens until an acceptable one is found. Which of the following are antihypertensive medications which the physician might select to use? Select all that apply.
Direct acting vasodilators Alpha adrenergic blockers Centrally acting adrenergic agonists
Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long-term care home as organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points 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
medication regimens is most suggestive that the patient has a diagnosis of heart failure?
Diuretic, ACE inhibitor, beta-blocker
A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly matches which of the following drug categories to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion?
Diuretics
The nurse knows that which group of antihypertensive drugs is usually the least expensive and is well tolerated?
Diuretics Diuretics are usually the least expensive, and are usually well tolerated by most patients.
An elderly patient is diagnosed with orthostatic hypotension. For which of the following clinical manifestations should the nurse assess?
Dizziness and fainting Orthostatic or postural hypotension is an abnormal drop in blood pressure on assumption of the standing position The presence of orthostatic symptoms (e.g., dizziness, syncope) is more relevant to the diagnosis that the actual blood pressure readings.
A 30-year-old woman present to a hospital after fainting out of memorial service, and she Is diagnosed as being a neurogenic shock. Which of the following signs and symptoms is she most likely to display?
Dry and warm skin
after fainting at a memorial service and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display?
Dry and warm skin
An older adult woman presents arrives in the emergency department after fainting at the funeral of a loved one. She is diagnosed with shock as a result of impaired sympathetic outflow based on which clinical manifestations? Select all that apply.
Dry, warm skin Bradycardia
The nurse practitioner working in an overnight sleep lab assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?
During apneic periods the patient experiences hypoxemia which stimulates chemoreceptors to induce vasoconstriction.
Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant? a) During feeding b) During sleep c) During bathing d) During burping
During feeding Heart failure manifests itself as tachypnea or dyspnea at rest or on exertion. For the infant, this most commonly occurs during feeding. The other answers are incorrect.
Brugada syndrome, an autosomal dominant disorder, manifests in adulthood as ST-segment elevation, right bundle branch block, and susceptibility to ventricular tachycardia. In Brugada syndrome, the timing of cardiac events is significant. When do these cardiac events typically occur?
During sleep or rest
**What are the manifestations of L ventricular failure?**
Dyspnea Dry cough Orthopnea (pt. can't sleep flat) Paraoxysmal nocturnal dyspnea (PND) Fatigue, weakness Pulmonary crackles ("cardiac asthma") S3 ventricular gallop L ventricular dysfunction (LVD)
*What are anginal equivalents?*
Dyspnea (SOB) Light-headedness Belching brought on by exercise/stress Fullness in the throat/jaw Desire to cough
The nurse working in the ICU knows a chronic elevation of left ventricular end diastolic pressure will result in a patient displaying which of the following clinical manifestations?
Dyspnea and crackles in bilateral lung bases
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?
Dyspnea and crackles in bilateral lung bases.
A nurse in a nursing home is concerned that a resident may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?
Dyspnea, cough
may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?
Dyspnea, cough
A nurse assesses a patient with normal biomarkers who reports angina. Which of the following additional manifestations are late signs of aortic stenosis?
Dyspnea,Peripheral cyanosis, syncope
As part of the diagnostic work out for a mail client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of test is most likely to provide the needed data for diagnosis and care?
Echocardiogram, PET Scan, ECG
As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?
Echocardiogram, PET scan, ECG
A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The healthcare team wants to rule out endocarditis as a diagnosis. Stafford apartment one W. realistically anticipate which of the following sets of diagnostics?
Echocardiogram, blood cultures and temperature
A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics?
Echocardiogram, blood cultures, temperature
A patient exhibits signs and symptoms of heart failure, including fatigue and shortness of breath. Which of the following tests are suggested to support a diagnosis of heart failure? Select all that apply.
Electrocardiogram (EKG) Cardiac computed tomography (CCT) Echocardiography Chest x-ray p. 496.
Which of the following statements provided blood work results and rationale that would be most closely associated with acute coronary syndrome?
Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation
"
Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation.
Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome?
Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation.
Which of the following changes associated with aging contributes to Hartville your development an older adults,? Select all that apply
Elevated diastolic blood pressure, increased vascular stiffness
A patient with mitral valve regurgitation and left heart failure reports shortness of breath and fatigue with activities of daily living. Which of the following instructions by the nurse will be ineffective in reducing these symptoms?
Elevating legs for 20 minutes daily
A client has been diagnosed with diabetes mellitus. Which of the following lab results would the practitioner expect?
Elevation of triglycerides (p. 407)
Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?
Emotional stress
Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris? a) Exposure to heat b) Abrupt change in position c) Sedentary lifestyle d) Emotional stress
Emotional stress Angina pectoris usually is precipitated by situations that increase the work demands of the heart, such as physical exertion, exposure to cold, and emotional stress. The pain typically is described as a constricting, squeezing, or suffocating sensation. It usually is steady, increasing in intensity only at the onset and end of the attack. Changing positions abruptly does not cause an attack of angina pectoris.
A three-year-old child with right sided heart failure has been admitted for worsening in his condition. Which of the following assessment would be considered one of the earlier side of systemic venous congestion in his toddler?
Enlargement of the liver
child is having trouble breathing. The child is rushed to the emergency department. Upon assessment, the child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward. The parent states that the child just developed a sore throat and fever today. The health care provider determines that the child is experiencing:
Epiglottitis
All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?
Epinephrine (Adrenalin).
All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?
Epinephrine (Adrenalin). p. 506.
All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention with a nurse administer first
Epinephrine (adrenaline)
The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?
Exchange gases, nutrients and wastes The circulatory system consists of the heart which pumps blood, the arterial system which distributes oxygenated blood to the tissues, the venous system which collects deoxygenated blood from the tissues and returns it to the heart, and the capillaries where exchange of gases, nutrients and waste takes place.
The nurse will monitor the client for which possible respiratory manifestations of heart failure? Select all that apply.
Exertional dyspnea Orthopnea Cheyne-Stokes respiration Chronic, dry cough
A nurse practitioner is educating a patient with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the cell in order to provide energy for the patient. The nurse practitioner knows that which of the following processes allows glucose to enter body cells
Facilitated diffusion
A 35-year-old man presents to the emergency department complaining of chest pain for the last 2 hours. He describes the pain as crushing, like a huge weight is on his chest. He also states that the pain goes up into his neck and down his left arm. An acute myocardial infarction (MI) is diagnosed. When taking his history, the following things are noted: ● Hyperlipoproteinemia for past 7 years ● Family history of early MI ● Cholesterol deposits along the tendons (diagnosed 1 year ago) ● Atherosclerosis (diagnosed 6 months ago) ● Diabetes mellitus (type 1) diagnosed at age 16 The nurse suspects which of the following diagnoses will be made?
Familial hypercholesterolemia (type 2A)
A client with heart failure has just had an automatic defibrillator installed in her chest wall. When the nurse is performing follow-up assessments in the coming months, which finding is most likely the result of a complication?
Fever and diaphoresis
AV bundle
Fibers in the heart that relay a nerve impulse from the AV node to the ventricles; also known as the Bundle of His
The nursing instructor when teaching about disorders of cardiac function informs the students that all people presenting with ST-segment elevation myocardial infarction (STEMI) should be assessed for reperfusion therapy as quickly as possible. Reperfusion therapy includes which of the following? Select all that apply.
Fibrinolytic therapy Percutaneous coronary intervention (PCI) Coronary artery bypass grafting (CABG)
ST-segment elevation myocardial infarction (STEMI) should be assessed for reperfusion therapy as quickly as possible. Reperfusion therapy includes which of the following?
Fibrinolytic therapy,Percutaneous coronary intervention (PCI), Coronary artery bypass grafting (CABG)
The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as which of the following?
Fibrous atheromatous plaque (p. 410)
Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in which of the following?
Fingers
Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in which of the following?
Fingers Raynaud disease is a disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes.
Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:
Fixed coronary obstruction
What are the signs and symptoms of heart failure? (Select all that apply.)
Fluid retention Fatigue p. 494.
A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient's most likely diagnosis?
Fluid volume excess
Increased thrombopoietin levels
Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team?
A 14-year-old boy who appears to be intoxicated is brought to the emergency department by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy's room. Which of the following is likely to be used to treat the patient's symptoms?
Fomepizole
A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which of the following reasons? Select all that apply.
For its vasodilatation effect To relieve coronary pain
A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which reason? Select all that apply.
For its vasodilation effect To relieve coronary pain
Type I pneumocytes
Form part of respiratory membrane
he health care provider suspects a newly admitted client may have a hemothorax. The client most likely experienced:
Fractured or dislocated ribs
*According to Ingenito, how do most people get Kawasaki syndrome?*
From water parks!!! :O ewwwwww
The client's ultrasound shows a true aneurysm that involves the entire circumference of the vessel and has a gradual and progressive dilation of the vessel. The provider tells the client the aneurysm is which of the following form?
Fusiform (p. 417.)
The client with pancreatitis is noted to have a high triglyceride count. Which of the following medications could the practitioner initiate to decrease this level?
Gemfibrozil The fibrates (e.g. fenofibrate and gemfibrozil) decrease the synthesis of VLDL by the liver, but also enhance the clearance of triglycerides. Cholestyramine, a bile acid-binding resin, is used as an adjunct to statin therapy to reduce LDL and increase HDL. Simvastatin, an inhibitor of HMG CoA reductase, can reduce or block the hepatic synthesis of cholesterol. These drugs are cornerstones of LDL-reducing therapy.
What are some causes of hypertrophic cardiomyopathy?
Genetically transmitted as an autosomal-dominant trait Genetic abnormal configuration of interventricular septum Abnormal sympathetic stimulation Subendocardial ischemia Abnormal calcium ion dynamics *basically genetic genetic genetic*
The nurse is teaching a class on reduction of cardiovascular disease. Which of the following demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?
Going for a brisk walk with a friend and talking to him about continuing to exercise regularly
The nurse is teaching a class on reduction of cardiovascular disease. Which of the following demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?
Going for a brisk walk with a friend and talking to him about continuing to exercise regularly The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes. Therapeutic lifestyle changes include an increased emphasis on physical activities such as walking and exercise. Dietary measures to reduce LDL levels include decreasing the use of saturated fats and transfats. Testing for al hypercholesterolemia is not a modifiable risk factor.
Pregnancy-induced hypertension is a serious condition affecting between 5% and 10% of pregnant women. The most serious classification of hypertension in pregnancy is preeclampsia-eclampsia. It is a pregnancy-specific syndrome that can have both maternal and fetal manifestations. What is a life-threatening manifestation of the preeclampsia-eclampsia classification of pregnancy-induced hypertension?
HELLP syndrome Liver damage, when it occurs, may range from mild hepatocellular necrosis with elevation of liver enzymes to the more ominous hemolysis, elevated liver function tests, and low platelet count (HELLP) syndrome that is associated with significant maternal mortality.
A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized by being primarily right sided. Which of the following statements best describes a presentation that the nurse would anticipate? The client
Has pitting edema to ankles and feet bilaterally, decreased activity tolerance, and occasional right upper quadrant pain. (Right sided failures associated with peripheral Adema fatigue and on occasion upper right quadrant)
Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?
Have the client sit up and lean forward.
A client who has just recently completed his second series of radiation therapy for lung cancer was admitted yesterday to an acute care facility with ascites. He begins to have jugular vein distention, pedal edema, and dyspnea upon exertion as well as fatigue. What should the nurse suspect?
He has developed constrictive pericarditis.
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
Headache and confusion
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
Headache and confusion Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms
Headache and confusion p. 430.
*In restrictive cardiomyopathy, what is the major problem?*
Heart cannot relax and re-fill with blood, which leads to *increased* atrial pressure, which leads to *enlargement* of both atria! :( - R ventricle more affected than L ventricle
A community health nurse is conducting a seminar at a local church group on health and wellness. Which of the following does she tell the group is the leading cause of death in the United States?
Heart disease
The nursing instructor, while teaching the physiology of the heart, informs the students that there are 3 major determinants of myocardial oxygen demand, which include the heart rate, left ventricular contractility, and systolic pressure. Which does she tell them is the most important factor in myocardial oxygen demand?
Heart rate
A health care provider suspects a client has heart failure. Which diagnostic procedure would give the staff information about pulmonary capillary pressures, which will lead to the most appropriate interventions?
Hemodynamic monitoring
A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the patient's diagnosis? hi
Hemoglobin 9.9 g/dL
A 31-year-old African-American female who is in her 30th week of pregnancy has been diagnosed with para part of cardio myopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy?
Her diagnoses might be attributable to a disorder immune response, nutritional factors, or infectious process
A 31-year-old African-American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy?
Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.
best captures an aspect of peripartum cardiomyopathy?
Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.
A 77-year-old female with a diagnosis of chronic obstructive pulmonary disease is experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate. Which of the following phenomena would her care team most realistically anticipate?
Her kidneys will adapt with an increase in plasma HCO3- and her pH will decrease.
A female patient is requiring supplementary oxygen by facemask due to her reduced lung compliance. Which of the following pathophysiologic processes is most likely to be a contributor to her low lung compliance?
Her thoracic cage is less flexible than when she was healthy.
A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?
High afterload because of backpressure against the left ventricle
A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress syndrome (RDS). Which of the following is the most likely contributor to the infant's present health problem?
High inspired oxygen concentration and injury from positive-pressure ventilation
A student nurse practitioner asks her preceptor about the origins of different tissues, and their cellular origins during the process of development. Which of the following statements by the preceptor best describes the process of cell differentiation?
"A fertilized ovum undergoes a series of divisions, yielding many different cell types."
A nurse practitioner is teaching her colleagues about the role of cytokines in a variety of pathologies. Which of the following teaching points best captures an aspect of the functions and nature of cytokines?
"A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use."
The nurse determines that teaching has been effective when a client diagnosed with chronic stable angina states:
"Angina may result from exertional activity or emotional stress and be relieved within minutes by rest or by nitroglycerin."
An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure?
"Arterial sclerosis of subcortical brain regions noted."
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.
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."
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: a) "Aspirin will help prevent blood clotting." b) "Aspirin prevents blood clotting by halting platelet production." c) "It will give you a steady relief of your chest pain." d) "Aspirin will prevent a heart attack."
"Aspirin will help prevent blood clotting." Explanation: Aspirin (i.e., acetylsalicylic acid) is the preferred antiplatelet agent for preventing platelet aggregation in persons with ACS. Aspirin, which acts by inhibiting synthesis of the prostaglandin thromboxane A2, is thought to promote reperfusion and reduce the likelihood of rethrombosis. This dose of aspirin is not appropriate for pain relief, and the final option does not demonstrate therapeutic communication.
A nurse is caring for a patient with an average heart rate of 56 beats/min. The patient has no adverse symptoms associated with this heart rate and is receiving no treatment. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate?
"Avoid bearing down while having a bowel movement."
A nurse is caring for a patient with an average heart rate of 56 beats/min. The patient has no adverse symptoms associated with this heart rate and is receiving no treatment. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate?
"Avoid bearing down while having a bowel movement." Bearing down during a bowel movement stimulates the vagus nerve and results in a slowing of the heart rate. Vagal stimulation as well as some medications decreases the firing rate of the sinoatrial node and conduction through the atrioventricular node to cause a decrease in heart rate.
The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states which of the following?
"Capillaries permit the exchange of material between the blood and interstitial fluid." Capillaries have thin walls that permit the exchange of materials between blood and interstitial fluid. Arteries have a three-layer wall with a thick tunica media. Arterioles transport blood away from the heart and help control blood pressure. Veins have internal valves.
Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points 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." p. 495.
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."
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."
instructions should the nurse give to a patient 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 nurse educator is orientating new nurses to a renal unit of a hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function?
"Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation."
A new older female patient at a long-term care facility has a diagnosis of type 1 neurofibromatosis (NF-1). As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements most accurately conveys an aspect of neurofibromatosis?
"Her diagnosis puts her at higher risk of developing a malignant neoplasm."
A nurse practitioner is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year's vaccine. Which of the following statements by patients best reflects an accurate understanding of the flu virus?
"I could come down with viral or bacterial pneumonia as a result of a bad flu bug."
A male patient of a nurse practitioner has an autosomal dominant disorder. The patient and his partner are considering starting a family. Which of the patient's following statements indicates the patient has an adequate understanding of the genetic basis of this health problem?
"I know that a single mutant allele is to blame for the health problem."
A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease?
"I should have my LDL monitored." ntermittent claudication is the primary symptom of chronic obstructive arterial disease. The two goals of treatment are to decrease their considerable cardiovascular risk and to reduce symptoms. Walking (slowly) to the point of claudication is encouraged because it increases collateral circulation. Addressing blood pressure and high lipid levels are measures to reduce cardiovascular risk. People with diabetes mellitus (DM) develop more extensive and rapidly progressive vascular disease than do people who do not have DM.
The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition?
"I should report episodes of dizziness or fainting."
The nurse is teaching a patient with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which of the following statements by the patient shows that the patient understands this condition?
"I should report episodes of dizziness or fainting."
patient with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis.
"I should report episodes of dizziness or fainting."
A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis?
"I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising."
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."
A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which statement 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."
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." p. 494.
A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?
"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."
A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?
"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation." (p. 416)
A 60-year-old male patient with an acute viral infection is receiving interferon therapy. The nurse practitioner is teaching the family of the patient about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points should the nurse practitioner exclude?
"Interferon can bolster your father's immune system by stimulating natural killer cells that attack viruses."
A nurse practitioner is providing prenatal care and education for a first-time expectant mother, 22 weeks' gestation, who has a diagnosis of a sexually transmitted infection. Which of the following statements by the expectant mother demonstrates an adequate understanding of vertical disease transmission and congenital infections?
"My baby could become infected either across the placenta or during the birth itself."
An elderly patient who was recently diagnosed with emphysema asks the nurse what caused the disease. Which of the following statements is the best response?
"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"
On a routine physical exam visit, the physician mentions that they hear a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds:
"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."
A client who has been diagnosed with mitral valve prolapse asks the nurse if there are any dietary modifications that should be incorporated into her lifestyle. The best response would be:
"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."
A client who has been diagnosed with mitral valve prolapse asks the nurse if there are any dietary modifications that should be incorporated into her lifestyle. The best response would be: a) "Avoid coffee; however, tea is OK." b) "Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms." c) "Energy drinks may help to support metabolism." d) "It is OK to decrease your smoking to one pack per day."
"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms." The treatment of mitral valve prolapse focuses on the relief of symptoms and the prevention of complications. In many cases, the cessation of stimulants such as caffeine, alcohol, and cigarettes may be sufficient to control symptoms. Tea and energy drinks may contain caffeine or stimulants and should be avoided. All nicotine products should be avoided.
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 patient who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The NP providing pretreatment education is explaining some of the potential unwanted effects of the treatment. Which of the following statements by the nurse is most accurate?
"Some patients experience longer-term irritation of skin adjacent to the treatment site."
A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple's inquiry?
"Stem cells can be used as a source of reserve cells for the entire blood production system."
A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner?
"Tension and vessel thickness increase proportionately."
As part of pre-surgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which of the following teaching points best conveys an aspect of the human circulatory system?
"The blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation."
As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function?
"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."
A client in the nursing home wonders why he is having these signs and symptoms of left-sided heart failure. Which explanation will the nurse give the client?
"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."
A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?
"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."
A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?
"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." p. 491.
A nurse is observing a patient's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating which of the following??
"The patient is experiencing premature atrial contractions (PACs)." PACs are contractions that originate in the atrial conduction pathways or atrial muscle cells and occur before the next expected SA node impulse. This impulse to contract usually is transmitted to the ventricle and back to the SA node. The location of the ectopic focus determines the configuration of the P wave. In general, the closer the ectopic focus is to the SA node, the more the ectopic complex resembles a normal sinus complex. Retrograde transmission to the SA node often interrupts the timing of the next sinus beat, such that a pause occurs between the two normally conducted beats.
Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?
"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."
most appropriate for a group of older adults who are concerned about their cardiac health?
"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."
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."
A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her nurse practitioner during an office visit. How can the NP best respond to the woman's query?
"There are many viruses, but only a very few of them have been shown to cause cancer in humans."
The cardiologist just informed a patient that they have a reentry circuit in the electrical conduction system in their heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to them. Which of the following statements most accurately describes what is happening?
"There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast."
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:
"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her nurse practitioner most appropriately respond to her?
"This is very difficult to hear, I'm sure, and we have to observe to see if it spreads because that often happens."
A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client:
"This means your heart is not pumping as much blood out of the heart with each beat." Ejection fraction is the percentage of diastolic volume ejected from the heart [left ventricle] during systole. Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level.
What should the nurse teach the client prior to ergometry?
"This test evaluates cardiac function."
A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate?
"Too much alcohol, too little exercise and too much body fat all contribute to high blood pressure."
A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:
"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked."
A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:
"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. For example, persons with extensive obstruction of a coronary blood vessel may rely on collateral circulation to meet the oxygen needs of the myocardial tissue normally supplied by that vessel. There is no indication that the client is on a blood thinner.
A patient with persistent primary hypertension remains apathetic about his high blood pressure, stating, "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How would the nurse best respond to this patient's statement?
"You may not sense any problems, but it really increases your risk of heart disease and stroke."
A patient with persistent primary hypertension remains apathetic about his high blood pressure, stating, "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How would the nurse best respond to this patient's statement?
"You may not sense any problems, but it really increases your risk of heart disease and stroke." Hypertension is a highly significant risk factor for heart disease and stroke. It would be inappropriate to promote monitoring without promoting lifestyle modifications or other interventions to lower the patient's blood pressure, or teaching the patient about the deleterious effects of hypertension. It is likely unproductive to simply characterize the patient's hypertension as demonstrating that he does not "take care" of himself. Hypertension is not a risk factor for the development of diabetes mellitus.
A client with persistent, primary hypertension remains apathetic about his high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement?
"You may not sense any problems, but it really increases your risk of heart disease and stroke." Hypertension is a highly significant risk factor for heart disease and stroke. It would be inappropriate to promote monitoring without promoting lifestyle modifications or other interventions to lower the client's blood pressure, or teaching the client about the deleterious effects of hypertension. It is likely unproductive to simply characterize the client's hypertension as demonstrating that he does not "take care" of himself. Hypertension is not a risk factor for the development of diabetes mellitus.
wo days post-operative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which of the following teaching points
"You should breath deeply and cough to help your lungs expand as much as possible while you're in bed."
A 51-year-old female patient who is 2 days postoperative on a surgical unit of a hospital is at risk for developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse practitioner is most appropriate? Question options:
"You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed."
The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following teaching points best conveys an aspect of the human circulatory system?
"Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation."
A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session?
"Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk."
A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client?
"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."
****HAVE TO KNOW HEART FAILURE CLASSIFICATION****
*Class 1 - mild* = no limitation of physical activity *Class 2- mild* = slight limitation of physical activity. Comfortable at rest, but ordinary physical activity leads to fatigue, palpitation, dyspnea *Class 3- moderate* = marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity causes fatigue/palpitation/dyspnea *Class 4- severe* = unable to carry out any physical activity without discomfort :( sx's of cardiac insufficiency at rest
*What happens with patients with rheumatic fever in acute stage and chronic stage?*
*acute:* pancarditis = inflammation of myocardium, endocardium, and epicardium *chronic:* valvular fibrosis --> stenosis or insufficiency *can't see them until they get their valves replaced*
****ENDOCARDITIS IS A CONTRA-INDICATION TO PT!!!!****
*endocarditis* = infection/inflammation of the heart's inner lining, usually involving the heart valves. sx's are: fever, chills, sweats, petechiae (leakage of blood)
*What is the difference between hypertrophic and restrictive cardiomyopathies?*
*restrictive* = wall gets stiff, not thickened *hypertrophic* = wall gets stiff AND thick *both lead to impaired filling of ventricles*
*Describe the troponin I (TNI) lab value*
- Quick 1-hour test (*stays high for 10-15 days*) - a little better than CPK
Ways to increase EDV?
-Increase venous return -Increase filling time -Decrease heart rate
*Describe the creatine kinase (CPK), MB band lab value*
-Increases 4-8 hours post MI and stays high for *2-3 days* -Normal CPK = 0-50 with no bands/fractions attached to it
Layers of the heart-from outside to the inside
-Parietal Pericardium -Epicardium -Myocardium -Endocardium
*What are the classic signs and symptoms of acute heart failure (both systolic and diastolic)?*
-Pulmonary edema -Pitting edema -Increased jugular vein distension - Congestion/swollen
Conducting airways include:
nasal cavity ➔ nasopharynx ➔ oropharynx ➔ larynx ➔ trachea ➔ bronchi ➔ bronchioles
Cardiogenic shock
occurs when the heart loses its ability to pump sufficient blood to meet oxygenation needs of body tissues.
Hypovolemic shock
occurs when there has been extensive blood or body fluid loss.
Repolarization of an autorhythmic cell is due to the opening of which channels?
opening of voltage-gated potassium channels causes positive potassium ions to move out of the cell. This efflux of potassium causes the cell to become more negative inside thus, repolarizing the cell.
parasympathetic nervous system
opposes the sympathetic system; calms the body; decreases heart/breathing rate; enhances digestion
At 4 AM the hemodynamic monitoring for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure (MAP) is at the low end of the normal range; at 5 AM the client's MAP has fallen definitively below normal. The nurses should prioritize assessments for:
organ damage and hypovolemic shock. The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. The fact that this client's MAP is falling at a time when it should be at its daily peak is cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk. Low blood pressure does not normally result in aneurysms, edema, or ischemic stroke.
Golgi complex
organelle that modifies, packages, and transports material out of the cell.
The visceral pericardium, or epicardium, covers the
outer surface of the heart
What is a primary cause of cardiomyopathy in patients?
pathological processes in the heart muscle itself, which impairs the heart's ability to contract
sympathetic nervous system
prepares the body for emergencies and stress by increasing the breathing rate, heart rate, and blood flow to muscles
intraplueral pressure
pressure in the pleural cavity
The papillary muscles function to __________.
prevent the AV valves from reversing into the atria
mucous
produced by the epithelial cells in the conducting airways forms a layer that protects the respiratory system by entrapping dust, bacteria, and other foreign particles that enter the airways.
A preventive measure to decrease the risk of developing rheumatic heart disease includes:
prompt diagnosis of streptococcal infections with a throat culture.
The blood vessels in the cardiovascular system are subdivided into the
pulmonary and systemic circuits
The lung capillaries receive deoxygenated blood from the
pulmonary arteries
When deoxygenated blood leaves the right ventricle through a semilunar valve, it is forced into the
pulmonary arteries
The double pump function of the heart includes the right side, which serves as the ________ circuit pump, while the left side serves as the ______ pump
pulmonary; systemic
While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:
recording weight every day at the same time with same type of clothing.
Lympathic vessels
remove particulate matter entering the lungs and plasma proteins that have escaped from the pulmonary capillaries.
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.
What does not control the movement of blood through the heart
size of the atria and ventricles
The primary differences that characterize cardiac muscle cells when comparing them to skeletal muscle fibers are
small size, a single centrally located nucleus, the presence of intercalated discs
Decreased parasympathetic (vagus) stimulation to the heart results in
speeding the heart rate
A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. The nurse knows that the client's blood pressure would be classified as ________ according to American Heart Association guidelines?
stage 1 hypertension
pulmonary lobule
supplied by one terminal bronchiole, an arteriole, the pulmonary capillaries and a venule.
Blood pressure in the large systemic arteries is greatest during
systolic ejection
Which part of the intrinsic conduction system delays the impulse briefly before it moves on to the ventricles?
the AV node slows down the impulse giving the atria time to contract before the ventricles contract.
What does the ECG wave tracing represent?
the ECG waves show the depolarization and repolarization in various areas of the heart.
The major difference between the left and right ventricles relative to their role in heart function is
the LV pumps blood through the high-resistance systemic circulation
Contraction of the atria results from which wave of depolarization on the ECG tracing?
the P wave represents atrial depolarization, which leads to atrial contraction.
What does the QRS complex represent in the ECG wave tracing?
the QRS complex represents depolarization in the ventricles, which have greater mass than the atria.
The "lubb-dubb" sounds of the heart have practical clinical value because they provide information concerning
the action and efficiency of the AV and semilunar valves
lung compliance
the ease with which lungs can be expanded
In order to cause cardiac muscle contraction, the contractile cells must also depolarize. What causes the depolarization of the contractile cells?
the flow of positive ions from the autorhythmic cells (or adjacent cells) brings the membrane to threshold initiating depolarization of the contractile cell.
During ventricular diastole, when the pressure in the left ventricle rises above that in the left atrium
the left AV valve closes
Which heart chamber receives blood from the pulmonary veins?
the left atrium receives oxygenated blood from the pulmonary veins.
Which chamber pumps oxygenated blood out the aorta to the systemic circuit?
the left ventricle pumps oxygenated blood out the aorta to the entire body (systemic circuit).
The sinoatrial node acts as the pacemaker of the heart because these cells are
the ones that depolarize and reach threshold first
mediastinum
the part of the thoracic cavity between the lungs that contains the heart and aorta and esophagus and trachea and thymus
Which heart chamber pumps unoxygenated blood out the pulmonary trunk?
the right ventricle pumps unoxygenated blood out the pulmonary trunk to the lungs.
The diastolic phase of the blood pressure indicates that
the ventricles are "resting"
phases of the cardiac cycle in the correct order, starting after ventricular filling.
the ventricles must contract and eject blood before they relax and fill again.
Valsalva maneuver
used to study the cardiovascular effects of increased intrathoracic pressure on peripheral venous pressures, cardiac filling, and cardiac output, as well as poststrain heart rate and blood pressure receptors.
Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:
ventilation-perfusion mismatch.
glottis
vocal folds and opening between them
Tidal Volume (TV)
volume of air inhaled or exhaled in a normal breath
preload
volume of blood in ventricles at end of diastole
Cardiac Output
volume of blood pumped by one ventricle per minute; stroke volume x heart rate
*What is the complication with restrictive cardiomyopathy?*
walls of the ventricles become stiff, but NOT necessarily thickened *resist normal filling with blood between heartbeats* *heart muscle gradually infiltrated or replaced by scar tissue*
air moves through the conducting airways
warmed, filtered and moistened
DNA
within the nucleus, which serves as the template for making all the RNA
Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?
Β-Adrenergic-blocking drugs
10-year-old male is experiencing an acute exacerbation of his asthma. The most appropriate treatment for this client would be:
β-adrenergic agonist
Which of the following statements regarding alcohol consumption and hypertension are correct? Select all that apply.
• A decrease in heavy alcohol consumption may help to lower blood pressure. • Chronic excessive alcohol consumption can induce hypertension. • Moderate alcohol consumption may decrease risk for cardiovascular disease. Chronic excessive consumption of any alcoholic beverage can induce hypertension. Reducing consumption can help to lower blood pressure. The recommended safe amount of alcohol for women is one drink per day and for men is two drinks per day. While moderate consumption may decrease risk for cardiovascular disease, most authorities do not recommend alcohol consumption
Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply.
• Abdominal • Thoracic
A client comes to the emergency room with complaints of chest pain. When the nurse reads his ECG she sees changes which include T-wave inversion, ST-segment elevation, and an abnormal Q wave. What should she suspect?
• Acute myocardial infarction
When a client suffers from a pericardial effusion which of the following are considered to be factors that will influence what effects it will have on cardiac function? Select all that apply.
• Amount of fluid • Rapidity with which it accumulates • The elasticity of the pericardium
The nurse knows that which of the following drugs can cause secondary hypertension? Select all that apply.
• Amphetamines • Decongestants • Oral contraceptives • Cocaine Amphetamines release norepinephrine from adrenergic nerve terminals and cocaine inhibits its reuptake; both actions cause cardiac stimulation and vasoconstriction that raise blood pressure. Decongestants often are vasoconstricting alpha adrenergic agonists. Oral contraceptives raise blood pressure via a mechanism that is not fully understood. Erythromycin is not associated with hypertension.
What can trigger myocardial ischemia even when there is adequate coronary blood flow? Select all that apply. a) Damaged coronary veins b) Fever c) Carbon monoxide poisoning d) Anemia e) Hypoxia
• Anemia • Carbon monoxide poisoning • Hypoxia Myocardial oxygen supply is determined by the coronary arteries and capillary inflow, and the ability of hemoglobin to transport and deliver oxygen to the heart muscle. Even with adequate coronary blood flow, myocardial ischemia can occur in situations of hypoxia, anemia, or carbon monoxide poisoning. The other options are not relevant to myocardial ischemia
Two months following a myocardial infarction (MI) a client visits the physician because of severe fatigue and shortness of breath. During the evaluation the client reports frequent episodes of palpitations over the past couple of weeks that cause the shortness of breath to increase. A 12-lead ECG reveals that the client has atrial fibrillation with a heart rate of 120. The practitioner should consider which of the following medications? Select all that apply.
• Anticoagulants • Antiarrhythmics Atrial fibrillation (AF) is a rhythm that involves quivering of the atrium rather than contracting rhythmically, causing pooling of blood in the atrium that can lead to the development of thrombi along with a decrease in cardiac output. Anticoagulants are used to decrease the ability of the blood pooling in the atrium to develop clots that could break off and become emboli that lodge in blood vessels elsewhere in the body causing ischemia, often to the brain causing strokes. Antiarrhythmics are used with atrial fibrillation to either convert the rhythm to normal sinus or to control the rate which gives the ventricles more time to fill.
A patient is diagnosed with orthostatic hypotension. The nurse knows that drugs which can predispose a patient to orthostasis include which of the following? Select all that apply.
• Antihypertensives • Psychotropics • Diuretics Antihypertensive and psychotropic drugs and diuretics frequently cause orthostasis. The other options are not generally associated with orthostasis.
The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply.
• Aorta • Capillaries The systemic circulation includes the aorta and capillaries. The pulmonary circulation includes the right heart and pulmonary artery.
The heart consists of four valves. Which are the semilunar values? Select all that apply.
• Aortic • Pulmonary
The client has swelling in his right leg and foot and reports calf pain and tenderness. Pedal pulses are present. Which of the following tests could the practitioner order for this condition? Select all that apply.
• Ascending venography • Duplex ultrasonography • Plasma D-dimer • White blood cell count Several tests are useful for the detection of deep vein thrombosis (DVT). They are ascending venography, ultrasonography, and plasma D-dimer. The most common signs and symptoms of DVT are related to the inflammatory process. An elevated white blood cell count is an accompanying indication of inflammation. An echocardiogram is a test that evaluates heart structure and function.
Autonomic nervous system control of blood pressure is mediated through which of the following? Select all that apply.
• Baroreceptors in blood vessels • Carotid artery chemoreceptors • Pain and strong emotion • Aortic chemoreceptors Baroreceptors in blood vessels and heart sense pressure changes in the circulatory system, and chemoreceptors at the carotid arteries and in the aorta detect blood levels of oxygen, carbon dioxide and hydrogen. When pressure falls or blood gases change, the autonomic nervous system can activate reflex responses to maintain adequate blood flow to vital organs. Pain, emotion and cold also can activate the autonomic nervous system control of blood pressure. Hepatic function does not directly affect autonomic control of blood pressure
Two weeks after receiving a prosthetic mitral valve, a patient presents to the emergency department with fever, anorexia, and splinter hemorrhages of the nails. Which of the following interventions will the nurse implement? Select all that apply.
• Blood cultures • Antibiotics • Monitoring for emboli
The nurse recognizes which of the following as normal age-related blood pressure? Select all that apply.
• Blood pressure at age 10 days is 78 mm Hg systolic. • Blood pressure at age 25 years is ideal at 120 mm Hg systolic. • Blood pressure in newborn infants is approximately 50 mm Hg systolic. Blood pressure of 50 mm Hg in newborn infants rises to approximately 78 mm Hg at 10 days of age. At the end of adolescence, around age 18 years, blood pressure usually has reached adult readings of 120 mm Hg. Beyond age 50 years, systolic pressure usually rises while diastolic pressure falls or remains the same.
The nurse knows that which of the following statements regarding the physiology of blood pressure are correct? Select all that apply.
• Blood pressure is very variable. • Constant elevation of blood pressure can be lethal. • A decrease in blood flow can be an immediate threat to life. Blood pressure is a very variable yet highly regulated function in healthy persons. Blood flow is most vital to heart, brain and kidneys; other tissues can better survive periods of decreased blood flow. Constant elevation of blood pressure (hypertension) can cause severe damage to heart, blood vessels and kidneys, leading to premature disability and death. A sudden decrease in blood flow, especially to the heart and brain, can rapidly be deadly: these organs, vital to survival, require a constant supply of oxygen to function effectively.
The nurse is caring for a young pregnant patient. Which of the following describe cardiovascular changes during a normal pregnancy? Select all that apply.
• Blood pressure rises during the third trimester. • Blood pressure falls during the first trimester. • Levels of angiotensin-II contribute to elevated blood pressure. Blood pressure falls during the first trimester and reaches its lowest level in the second trimester. Pressure gradually rises in the third trimester. Cardiac output is increased throughout pregnancy. Plasma levels of angiotensin-II increase, inducing vasoconstriction that contributes to increased blood pressure.
As the needs of the body change, the heart's ability to increase output needs to change too. This ability in the heart depends on what factors? (Select all that apply.)
• Cardiac contractility • Heart rate • Preload • Afterload
A client with a history of unstable angina is admitted for a knee replacement. He questions the nurse about why continuous ECG monitoring is necessary during this hospital admission. The nurse explains to the patient that with a history of unstable angina it is important to monitor the cardiac rhythms to ensure early detection of which of the following? Select all that apply.
• Cardiac muscle ischemia • Tachyarrhythmias • Bradyarrhythmias • Irregular rhythms For persons with acute coronary syndrome (ACS), which includes conditions that cause cardiac ischemia, ECG monitoring is extremely important in preventing complications that may arise, such as early ischemia and also arrhythmias, including tachyarrhythmias, bradyarrhythmias and irregular rhythms.
A patient brought to the emergency department has preeclampsia. The nurse knows that this disorder can progress to include which of the following complications? Select all that apply.
• Cerebral hemorrhage • Renal failure • Disseminated intravascular coagulation (DIC) • Hepatic failure Severe preeclampsia has risk for cerebral hemorrhage, hepatic and renal failure, and DIC. Platelet counts fall, with less than 100,000/mm2 diagnostic of serious disease.
In caring for clients with acute coronary syndromes (ACS) the nurse knows that without accurate assessments, including ECGs, these clients are at a much higher risk of complications, including which of the following? Select all that apply.
• Continuing myocardial ischemia • Increased area of infarction • Life-threatening arrhythmias 12-lead ECG monitoring is essential to avoid possible complications. Those complications could include; continuing myocardial ischemia, an increase in the size of the infarction along with life-threatening arrhythmias. In the presence of acute coronary syndromes ECG monitoring can detect continuing or new onset cardiac muscle ischemia more quickly and accurately than a client's report of symptoms. Other benefits of ECG monitoring are numerous and the American Heart Association has published practice guidelines to improve patient outcomes in clients with ACS
A patient with persistent primary hypertension is unhappy with the adverse effects of his current antihypertensive regimen. The nurse will tell the patient that there are several types of antihypertensive drugs having different mechanisms of action and different adverse effect profiles. The physician can vary regimens until an acceptable one is found. Which of the following are antihypertensive medications which the physician might select to use? Select all that apply.
• Direct acting vasodilators • Alpha adrenergic blockers • Centrally acting adrenergic agonists There are several groups of antihypertensive medications having different mechanisms of action. Alpha adrenergic blockers inhibit adrenergic stimulation of alpha one receptors that mediates vasoconstriction. Centrally acting adrenergic agonists decrease adrenergic stimulation emanating from the central nervous system. Direct acting vasodilators, as their name implies, mediate vasodilation by direct action on vascular smooth muscle. Combinations of these drugs are used frequently, as giving lower doses of two or three drugs working by different mechanisms will often achieve good blood pressure control with minimal side effects. Angiotensin receptor agonists and beta adrenergic agonists would raise rather than lower blood pressure.
A nurse is evaluating hypertension risk factors with an African American male who works as a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. He paternal grandfather had a stroke. He drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are modifiable risk factors associated with this diagnosis? Select all that apply.
• Excessive alcohol consumption • Obesity Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure and race. Modifiable risk factors are lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.
An elderly client is admitted with the diagnosis of severe aortic regurgitation. Which of the following client reports support this diagnosis? Select all that apply. a) Frequent angina b) Orthopnea c) Exertional dyspnea d) Palpitations e) Paroxysmal nocturnal dyspnea
• Exertional dyspnea • Orthopnea • Paroxysmal nocturnal dyspnea • Palpitations As aortic regurgitation progresses, signs and symptoms of left ventricular failure begin to appear. These include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Angina is a rare symptom. Tachycardia, occurring with emotional stress or exertion, may produce palpitations, head pounding, and premature ventricular contractions.
The nurse is discussing hypertension with a group of patients. The nurse knows that which of the following statements regarding hypertension are true? Select all that apply.
• Family history of hypertension is a risk factor for hypertension. • Diabetes can lead to secondary hypertension. Primary or essential hypertension refers to hypertension with no identifiable cause. Diabetes can result in renal damage and consequent activation of the renin-angiotensin system which can elevate blood pressure. Family history is a nonmodifiable risk for hypertension. Hypertension, because it causes increased workload on the myocardium, can result in left ventricular hypertrophy. Hypertension is most often asymptomatic.
A patient has systolic hypertension. The nurse knows that systolic pressure is influenced by which of the following factors? Select all that apply.
• Heart rate • Compliance of arteries • Stroke volume • Contractile force Systolic pressure is influenced by the volume of blood forced into the systemic circulation with each heart beat (stroke volume). Faster heart rate and greater contractile force will increase systolic pressure. good arterial compliance or flexibility will result in lower systolic pressure. Venous resistance does not influence systolic pressure.
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.
• Inactive lifestyle • High salt consumption • Obesity The prevalence of hypertension in children and adolescents in increasing due to increases in obesity, and lifestyle factors such as lack of exercise and consumption of high-calorie, high-salt foods. Gender is not a factor nor is academic performance.
The nurse recognizes that which of the following is true of the changes in blood flow through the systemic circulation? Select all that apply.
• Intermittent flow from the heart as it contracts and relaxes • Arterial compliance (pulsatile flow) as vessels expand and contract • Arteriolar resistance converts to steady flow Blood ejected with each heartbeat into the aorta and arteries forces these vessels to expand and then relax, with pulsatile flow. Arterioles provide resistance to flow, allowing for steady pressure through the capillaries. Pressure in the venous system is generally low.
A client who has just been diagnosed with mitral valve stenosis tells the nurse that he has heard of the disease but he does not know anything about it. He asks the nurse what it means. What would be the nurse's best response? a) It is a defect of the mitral valve which allows for back flow of blood. b) It is an inflammatory process of the mitral valve. c) It is a disorder of the mitral valve caused by atherosclerosis. d) It is a defect of the mitral valve which causes obstruction of blood flow.
• It is a defect of the mitral valve which causes obstruction of blood flow. Mitral valve stenosis is a defect of the mitral valve which causes obstruction of blood flow, while mitral valve regurgitation is characterized by incomplete closure of the mitral valve and blood moves backward into the left atrium.
Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply.
• Large amount of pink, frothy sputum and new onset of murmur. • Tachypnea with respiratory distress. • Frequent ventricular arrhythmia unrelieved with Amiodarone drip. • Complaints of facial numbness and tingling.
Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply. a) Enhanced renal perfusion as seen as an increase in urine output. b) Frequent ventricular arrhythmia unrelieved with Amiodarone drip. c) Large amount of pink, frothy sputum and new onset of murmur. d) Complaints of facial numbness and tingling. e) Tachypnea with respiratory distress.
• Large amount of pink, frothy sputum and new onset of murmur. • Tachypnea with respiratory distress. • Frequent ventricular arrhythmia unrelieved with Amiodarone drip. • Complaints of facial numbness and tingling. Following MI, many complications can occur. A—pulmonary edema or papillary muscle rupture. B—acute respiratory distress could result from heart failure. C—Life-threatening arrhythmias. D—Acute stroke
A patient is diagnosed with pheochromocytoma. The nurse knows that which of the following procedures help to diagnose and manage this condition? Select all that apply.
• MRI and CT scans • Measurement of urinary catecholamines and metabolites • Radioisotope studies • Drugs to block catecholamine action Pheochromocytoma, a tumor of chromaffin cells, secretes catecholamines such as norepinephrine and epinephrine that produce an elevation in blood pressure. Measurement of urinary catecholamines and metabolites will detect excessive production of catecholamines. MRI and CT scans and radioisotopes that accumulate in chromaffin cells help to locate the aberrant tissue. If the tumor cannot be surgically removed, drugs that inhibit catecholamine secretion or action are administered. Diuretics will not address the root cause of hypertension due to pheochromocytoma
When the electrocardiogram (ECG) of a patient in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta adrenergic blocker. Which of the following factors in the patient's history will cause the nurse to withhold medication? Select all that apply. a) Third-degree heart block b) Hypertension c) Cerebrovascular accident d) Myocardial infarction caused by cocaine use e) Shock
• Myocardial infarction caused by cocaine use • Third-degree heart block • Shock Beta adrenergic blockers are beneficial during acute coronary syndrome because they enhance myocardial perfusion by lengthening diastole. They also reduce sympathetic response, thus decreasing myocardial oxygen demand and systolic blood pressure. However, if a STEMI was caused by cocaine use, beta blockers can intensify the coronary spasm. Additional reasons to avoid beta blockers include left ventricular failure, hypotension, shock, second- or third-degree heart block, and symptomatic bradycardia.
Which of the following factors affect cardiac performance? Select all that apply.
• Preload • Afterload • Myocardial contractility
The heart consists of four valves. Which are the semilunar values? Select all that apply.
• Pulmonary • Aortic
A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are NONmodifiable risk factors associated with this diagnosis? Select all that apply.
• Race • Family history Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure, and race. Modifiable risk factors are lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.
Although the etiology of essential hypertension is mainly unknown, several risk factors have been identified. These risk factors fall under the categories of constitutional risk factors and lifestyle factors. What are the primary risk factors for essential hypertension? (Select all that apply.)
• Race and excessive sodium chloride intake • Type 2 diabetes and obesity • Family history and excessive alcohol consumption The constitutional risk factors include a family history of hypertension, race, and age-related increases in blood pressure. Another factor that is thought to contribute to hypertension is insulin resistance and the resultant hyperinsulinemia that occurs in metabolic abnormalities such as type 2 diabetes. Lifestyle factors can contribute to the development of hypertension by interacting with other risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which of the following topics should be included in the teaching plan? Select all that apply.
• Reduce dietary sodium intake. • Limit alcohol consumption. • Stop smoking. • Consume a diet rich in fruits, vegetables, and low-fat dairy products. Explanation: Hypertension lifestyle modification included the maintenance of normal body weight (BMI, 18.5-24.9 kg/m2) 5-20 mm Hg/10 kg weight loss. Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan including consuming a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat 8-14 mm Hg. Dietary sodium reduction to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride) 2-8 mm Hg. Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day. Moderation of alcohol consumption; limiting consumption to no more than 2 drinks (1 oz or 30 mL ethanol) (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and 1 drink per day in women and lighter-weight persons.
The nurse knows that which of the following statements regarding sodium and hypertension are correct? Select all that apply.
• Reduction in sodium intake often produces a reduction in blood pressure. • Sodium may increase the responsiveness of the cardiovascular system to adrenergic (sympathetic) stimulation. • In the INTERSALT study, urinary sodium excretion and systolic blood pressure are closely correlated. The mechanism by which sodium contributes to hypertension is not clear. It may involve the responsiveness of the cardiovascular system to adrenergic stimulation. Reduction of salt intake will lower blood pressure. Older persons are more sensitive to the effect of salt on blood pressure. Seventy-five percent of sodium intake is from processed foods, 15 percent from cooking and table salt, and 10 percent from natural sodium content of foods
A clinically obese patient diagnosed with stage 2 hypertension is resistant to taking antihypertensive medication because he has no symptoms and "feels fine." The nurse will encourage this patient to attempt lowering his blood pressure in order to decrease the risk of developing which of the following? Select all that apply.
• Renal failure • Coronary artery disease • Dementia • Loss of vision Hypertension has many severe consequences. It fosters atherosclerosis of the coronary arteries and damages retinal blood vessels resulting in loss of vision. Nephrosclerosis and renal failure are frequent sequelae of hypertension. Damage to central nervous system blood vessels can lead to dementia. While hypertension is not a causative factor for diabetes, it frequently occurs together with hypertension and elevated LDL cholesterol. Each of these disorders is a risk factor for heart disease.
A nurse assesses a patient with normal biomarkers who reports angina. Which of the following additional manifestations are late signs of aortic stenosis? Select all that apply. a) Syncope b) Peripheral cyanosis c) Dyspnea d) Hypertension e) Diarrhea
• Syncope • Peripheral cyanosis • Dyspnea The earliest signs of aortic stenosis are a loud systolic ejection murmur or a single or paradoxically split second heart sound. Angina, syncope, and heart failure are later signs of the disorder
The nurse knows that which of the following would put a patient at risk of developing hypertension, if everything else in the body remained unchanged? Select all that apply.
• Systemic vasoconstriction • Intravascular fluid retention • Elevated renin levels Explanation: Increased blood volume and systemic vasoconstriction will increase blood pressure. Elevated renin will increase levels of angiotensin II and aldosterone resulting in vasoconstriction and sodium and water retention. Reduced heart rate will lower blood pressure. Blood viscosity is not a major factor in regulating blood pressure.
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
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
• The arterial system distributes oxygenated blood to the tissues. • The venous system collects deoxygenated blood from the tissues .
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
• The venous system collects deoxygenated blood from the tissues . • The arterial system distributes oxygenated blood to the tissues.
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
• The venous system collects deoxygenated blood from the tissues . • The arterial system distributes oxygenated blood to the tissues. The circulatory system consists of the heart which pumps blood, the arterial system which distributes oxygenated blood to the tissues, the venous system which collects deoxygenated blood from the tissues and returns it to the heart, and the capillaries where exchange of gases, nutrients and waste takes place.
The nurse knows that systolic hypertension carries risk for which of the following cardiovascular events? Select all that apply.
• Thrombosis • Damage to elastic elements of blood vessel walls • Atherosclerosis • Risk for aneurysm With systolic hypertension, increased pulse pressure produces increased stretch of the arteries, resulting in damaged elastic elements and risk for aneurysm. Atherosclerosis and thrombosis as platelets begin to aggregate on rough endothelial surfaces. Systolic hypertension will cause left ventricular hypertrophy rather than right ventricular hypertrophy.
Local control of blood flow is regulated by mechanisms that match blood flow to the metabolic needs of the tissue. Over the short term autoregulation controls flow through the synthesis of vasodilators and vasoconstrictors. Which components of the vascular system are involved in the short term control of blood flow? Select all that apply.
• Tissue • Smooth muscle • Endothelial cells
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.
• Tricuspid • Mitral
Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply.
• Ventricular tachycardia with left bundle branch block pattern. • T-wave inversion in the right precordial leads.
A patient comes to the clinic complaining of anorexia, weight loss, fever, fatigue along with paresthesias, pain, and weakness of the lower extremities. Assessment findings include reddish blue, mottled areas of discoloration to the skin of the lower extremities. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and abnormal liver function tests. A diagnosis of necrotizing vasculitis is confirmed through biopsy. The nurse anticipates treatment with which of the following medications?
High-dose corticosteroid therapy and cytotoxic immunosuppressant agents Clinical signs and symptoms may vary due to the widely varied vascular involvement. It usually begins complaints of anorexia, weight loss, fever, and fatigue often accompanied by signs of organ involvement. Myalgia, arthralgia, and arthritis are common, as are peripheral neuropathies such as paresthesias, pain, and weakness. Skin lesions may also occur and are highly variable. They include reddish blue, mottled areas of discoloration of the skin of the extremities called livedo reticularis, purpura (i.e., black- and-blue discoloration from bleeding into the skin), urticaria (i.e., hives), and ulcers. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and signs of organ involvement such as hematuria and abnormal liver function test results. Diagnosis is confirmed through biopsy specimens demonstrating necrotizing vasculitis of the small and large arteries. Treatment involves use of high-dose corticosteroid therapy and often-cytotoxic immunosuppressant agents (e.g., azathioprine, cyclophosphamide).
A patient comes to the clinic complaining of anorexia, weight loss, fever, fatigue along with paresthesias, pain, and weakness of the lower extremities. Assessment findings include reddish blue, mottled areas of discoloration to the skin of the lower extremities. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and abnormal liver function tests. A diagnosis of necrotizing vasculitis is confirmed through biopsy. The nurse anticipates treatment with which of the following medications?
High-dose corticosteroid therapy and cytotoxic immunosuppressant agents (p. 414)
A 25-year-old Asian American man arrives at the emergency department in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What is the most likely cause of his hematuria and how should it be treated?
His immunoglobulin A (IgA) nephropathy has no known effective treatments.
A 21-year-old male patient has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately capture an aspect of his condition?
His vocal folds have been compromised.
Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability.
Histamine
Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability?
Histamine
Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability?
Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.
Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?
Histamine release causes massive vasodilation.
Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?
Histamine release causes massive vasodilation. p. 506.
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
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: a) Advanced age and low serum total and low-density lipoprotein cholesterol b) High serum high-density lipoprotein and diabetes c) History of cigarette smoking and elevated blood pressure d) Physical inactivity and high serum high-density lipoprotein cholesterol
History of cigarette smoking and elevated blood pressure The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.
major risk factors for coronary artery disease (CAD) with a client
History of cigarette smoking and elevated blood pressure (elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity)
A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia and she is suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion?
Holter monitoring
A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting ECG reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?
Holter monitoring Because sick sinus syndrome frequently involves intermittent or alternating types of arrhythmias, Holter monitoring, which can record changes in rhythm that occur over a period of up to 48 hours, is likely to provide the best picture of the spectrum of cardiac changes in any particular client. Signal-averaged ECG is most useful for identifying specific arrhythmias that may not be clear on a traditional surface ECG. Exercise stress testing measures changes in rhythm specifically in response to exercise. Electrophysiologic studies are used diagnostically to determine a person's potential for arrhythmia formation.
Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?
Hypercholesterolemia(p. 408-409)
The diagnosis is left-sided heart failure. The nurse knows that the most common causes of left-sided failure include which of the following? Select all that apply.
Hypertension Acute myocardial infarction p. 492.
During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides?
Hypertension is a frequent modifiable contributor to aneurysms.
Which of the following statements regarding hypertension are correct? Select all that apply.
Hypertension is more frequent among younger men than in younger women. Hypertension is a major risk factor for cardiovascular disease. Hypertension is one of the most common health problems for adults. (p. 425)
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
Hypertension p. 409
A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure?
Hypertrophic cardiomyopathy
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? a) Heart attack b) Pericarditis c) Dehydration d) Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the interventricular septum, abnormal diastolic filling, cardiac arrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac deat in young athletes.
Cardiomyopathies are classified as either primary or secondary. The primary cardiomyopathies are further classified as genetic, mixed, or acquired. Which of the following are genetically based? (Select all that apply.)
Hypertrophic cardiomyopathy Left ventricular noncompaction
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)
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?
Hypertrophy
A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to be currently occurring as a result of her urinary retention?
Hypertrophy of the bladder muscle and increased bladder wall thickness
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.
Hypertrophy of the myocardium Sympathetic nervous stimulation Increased renin--angiotensin--aldosterone system (RAAS) function Increased preload
A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?
Hypovolemic
A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?
Hypovolemic p. 501.
The nurse is assisting a patient who had a myocardial infarction 2 days ago during a bath. The patient suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the patient was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. Which of the following is a priority intervention at this time?
Immediate defibrillation
A client has suffered damage to his pericardium following a motor vehicle accident. Which consequence could be a possible complication of damaged pericardium that his care providers should assess for?
Impaired regulation of myocardial contraction
A patient has suffered damage to his pericardium following a motor vehicle accident. Which of the following consequences should the nurse practitioner be most likely to rule out?
Impaired regulation of myocardial contraction
A client with a history of heart failure has been assessed and the care team has determined that a reduction in myocardial workload would benefit his prognosis. Which intervention is most likely to meet this client's needs?
Implantation of a ventricular assist device p. 498.
The nurse must achieve which clinical objectives for a client in cardiogenic shock? Select all that apply.
Improve cardiac output Regulate blood volume Increase coronary perfusion Correct pulmonary edema
The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:
Improving quality of life by relieving symptoms
a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:
Improving quality of life by relieving symptoms
The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be
Improving quality of life by relieving symptoms p. 497.
The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:
Improving quality of life by relieving symptoms, p. 497.
Conducting System-Step 4
Impulse travels along the interventricular septum within the AV bundle and the bundle branches to the Purkinje fibers and, via the moderator band, to the papillary muscles of the right ventricle.
The nurse knows that which of the following statements regarding heart failure is correct?
In compensated failure, an increase in preload causes an increase in ventricular contractility. p. 488.
Which of the following statements regarding heart failure is true?
In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.
Which of the following statements regarding heart failure is true?
In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction. p. 489.
Which statement regarding heart failure is true?
In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction.
A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following processes would her care team be most justified in ruling out?
In lung pathology such as emphysema, large amounts of air are trapped at the end of a given breath, a situation that corresponds to increased residual volume and decreased vital capacity. Elastic recoil would tend to suffer, and both alveolar and anatomical dead space consequently increase.
When will the nurse plan to assess a patient's blood pressure to confirm the possible diagnosis of orthostatic hypotension?.
In the morning before arising from bed To confirm orthostatic hypotension, blood pressure should be assessed while the patient is supine and then after standing for one minute and 3 minutes. A fall of 20 mm Hg or more in systolic pressure, or 10 mm Hg or more in diastolic pressure are considered orthostasis.
heart location
In the thoracic cavity-->in the paracardial cavity--> in the paracardium membrane
*If less blood is pumped out, more is left behind and then what happens?*
Increase LVEDP --> Increased L atrial pressure --> Increased pulmonary capillary pressure --> increased pulmonary artery pressure --> Increased R ventricle pressure --> increased R atrial pressure --> HIGH PRESSURE in venous system --> elevated pressure in jugular venous (neck veins)
*What is the primary issue in diastolic heart failure?*
Increase in LVEDP sec. to stiff ventricles *major major issue*
A grandmother, a cook at a nearby school, was recently hospitalized when she lost an extensive amount of blood in a work-related accident. The grandmother tells the nurse that she heard that she would keep feeling faint until the brain made more blood. The nurse knows that when the blood pressure dropped, the pressure in the carotid arteries decreased. This was detected by baroreceptors in the carotid arteries. What did the baroreceptors do?
Increase sympathetic stimulation of the heart and blood vessels
A nurse is caring for a client following surgery. The central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take?
Increase the IV fluid infusion per protocol.
A patient with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would be most likely to confirm this diagnosis?
Increased CO2, increased anion gap, base deficit
As a result of dehydration, a patient's epithelial cells are producing insufficient amounts of mucus. Consequently, the patient's mucociliary blanket is compromised. Which of the following changes would a care provider most reasonably anticipate as a direct result of this change?
Increased amounts of bacteria in the lungs. The primary role of the mucociliary blanket is to trap foreign particles and bacteria and thus prevent their entry into the lungs. The impaired ciliary function may result in an inadequate mucociliary blanket, but the opposite relationship is unlikely. Decreased oxygen and increased carbon dioxide levels may eventually result, but not as a direct or immediate consequence.
Which of the following phenomena would be most likely to be a company increased myocardial oxygen demand (MVO2)?
Increased aortic pressure
Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)? a) Inadequate ventricular end-diastolic pressure b) Use of calcium-channel blocker medications c) Increased aortic pressure d) Ventricular atrophy
Increased aortic pressure An increase in aortic pressure results in a rise in afterload, wall tension, and, ultimately, MVO2. Increased, not inadequate, ventricular end-diastolic pressure would cause an increase in MVO2, and medications such as calcium channel blockers would decrease MVO2. Ventricles would tend to hypertrophy in response to prolonged wall stress and consequent oxygen demand
A nurse is monitoring a client with a resting heart rate of 120 beats/minute. The client has been diagnosed with sinus tachycardia, which is the result of a change in which characteristic of cardiac cells?
Increased automaticity Sinus tachycardia is caused by an increase in the automaticity of the SA node. Changes in excitability, conductivity, and refractoriness do not have effects that would lead to sinus tachycardia.
Natriuretic peptides (NP) are part of the compensatory response to heart failure. Which of the following are actions of NP? Select all that apply.
Increased glomerular filtration Decreased renal reabsorption of sodium and water Inhibition of endothelin action
In a client with hypovolemic shock, which assessment findings alert the nurse that compensatory mechanisms are attempting to support cardiac output. Select all that apply.
Increased heart rate Vasoconstriction Activitation of the renin-angiotensin-aldosterone system (RAAS)
Which of the following data would a clinician consider to be most indicative of acute renal failure?
Increased nitrogenous waste levels, decreased glomerular filtration rate (GFR)
Which of the following clinical findings would be most closely associated with a patient who has interstitial lung disease rather than COPD?
Increased respiratory rate with decreased tidal volume
A nurse on a geriatric medicine unit has noted that a significant majority of the clients on the unit are prescribed antihypertensive medications. Which phenomenon is the nurse most justified in ruling out as a contributing factor?
Increased sensitivity of the renin--angiotensin--aldosterone system Increased sensitivity of the renin--angiotensin--aldosterone system is not a noted phenomenon among older adults. Stiffening of large arteries, increased peripheral vascular resistance, and decreased baroreceptor sensitivity and renal blood flow are all accompaniments of aging.
A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?
Increased sympathetic stimulation of the heart and blood vessels
A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?
Increased sympathetic stimulation of the heart and blood vessels When the baroreceptors in the carotid arteries detected the fall in blood pressure as blood volume was depleted, reflex sympathetic activity increased the rate and force of contraction via beta-1 receptors in the heart, and increased vasoconstriction via alpha-1 receptors in blood vessels. Both of these effects serve to support blood pressure and blood flow to vital organs
A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?
Increased sympathetic stimulation of the heart and blood vessels (p. 420)
hild has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be:
Increased turbulence of air moving through the obstructed airways
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
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?
Increased vascular stiffness
hat 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?
Increased vascular stiffness
Which intervention will the nurse anticipate being prescribed to treat an adult admitted to the ICU with acute respiratory distress syndrome (ARDS)?
Increasing oxygen concentration in the inspired air
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
infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used
Infective endocarditis
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? a) Cardiomyopathy b) Myocardial infarction c) Pericarditis d) Infective endocarditis
Infective endocarditis Infective endocarditis is a serious and potentially life-threatening infection of the inner surface of the heart. Pericarditis involves an inflammatory response of the pericardium. Myocardial infarction is a heart attack while cardiomyopathy is a heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorders.
A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse practitioner providing care for the man is explaining that while it is unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which of the following teaching points should the nurse practitioner eliminate from his teaching for the patient? "
Inflammation helps your body to produce the right antibodies to fight the infection.
client who states he felt fine all day and then within five minutes, began to feel extremely weak and tired and began having a fever.
Influenza
A client asks the nurse if it is possible to contract influenza by being exposed to wound secretions. On what knowledge should the nurse base her response to the client?
Influenza transmission occurs by inhalation of droplet nuclei.
A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What are media treatments are likely to benefit this man
Infusion of normal Saline or ringer lactate to maintain the vascular space (Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock)
A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?
Infusion of normal saline of Ringer lactate to maintain the vascular space
A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?
Infusion of normal saline or Ringer's lactate to maintain the vascular space.
A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man?
Infusion of normal saline or Ringer's lactate to maintain the vascular space.
experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?
Infusion of normal saline or Ringer's lactate to maintain the vascular space.
A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?
Infusion of normal saline or Ringer's lactate to maintain the vascular space. p. 501.
A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man?
Infusion of normal saline or Ringer's lactate to maintain the vascular space. p. 504.
Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?
Inherent spontaneous action-potential
Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?
Inherent spontaneous action-potential The heart has four inherent properties essential in the development and conduction of cardiac rhythms. The property of automaticity is the ability of certain cells in the myocardium to automatically or spontaneously initiate an electrical impulse called an action potential. In a normally functioning heart the rate is controlled by the sinoatrial (SA) node.
A healthy 23-year-old college basketball player is brought to the emergency room following a syncopal episode while playing. On arrival the client was alert and oriented with a heart rate of 50 and regular, blood pressure 100/60, and no complaints. The paramedic giving report to the emergency room nurse describes that on arrival the client was attached to the school's automatic implantable cardioverter defibrillator (AICD) and the initial rhythm demonstrated a heart rate of 250 with differently shaped QRS complexes that also changed size. The rhythm spontaneously converted to normal sinus rhythm before the paramedics arrived. What does the nurse anticipate was the initial rhythm?
Inherited torsade de pointes This client most likely has inherited torsade de points, which is a ventricular arrhythmia that is often caused by a prolonged QT interval. The hallmark of this rhythm is wide QRS complexes that appear to be twisting around a point as it changes negativity. There are two forms; in the genetic form persons with the acquired form involves defects in either the potassium or sodium ion channel defects. The acquired form has a variety of causes, such as electrolyte imbalance, subarachnoid hemorrhage, cocaine use, and many antiarrhythmic medications. There is no information in the question to suggest an acquired form.
A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor?
Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction.
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
A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy?
Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE.
The nurse is reviewing a client's history and recognizes that the client smokes cigarettes. The nurse is concerned because smoking does which of the following?
Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development
A child is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are most accurate? Select all that apply.
Inotropic agents such as digoxin may be used in children. Congenital defects are a risk factor. Symptoms include tachypnea and tachycardia.
A client who has suffered a myocardial infarction is being treated in the emergency room. His pain remains severe even though he was given nitrates and oxygen. The physician now orders morphine for the pain. What method should the nurse to administer the morphine?
Intravenous
The client reports a sudden onset of excruciating pain in the anterior chest and describes it as "tearing or ripping." The physician is unable to palpate a pulse in the client's right arm. Based on the client's history and physical examination, which treatment would be implemented?
Intravenous sodium nitroprusside
A newborn is diagnosed with Tetralogy of Fallot. Prior to surgery, which abnormality should be corrected to prevent a stroke?
Iron deficiency anemia
In which of the following patient situations with a physician be most justified and preliminary ruling out. Carditis as a contributing pathology to the patient's health problems?
Is 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and history of atrial fibrillation.
Heart valves are in what state during isovolumetric contraction?
Isovolumetric contraction is the brief period of time at the beginning of ventricular systole where both the AV valves and semilunar valves are closed. Because these closed valves prevent blood from exiting the ventricles, the volume of the ventricles stays the same despite contraction of the heart muscle. This period of contraction is quite brief - lasting less than 20 msec or about 2 percent of the full cardiac cycle.
A nursing instructor is explaining arterial circulation to a group of nursing students. Which of the following is the most appropriate information for the nurse to provide?
It contains one sixth of the total blood volume.
A client who has just been diagnosed with mitral valve stenosis tells the nurse that he has heard of the disease but he does not know anything about it. He asks the nurse what it means. What would be the nurse's best response?
It is a defect of the mitral valve which causes obstruction of blood flow.
A membranous sac that encloses the heart
It is a low-pressure system that allows for improved gas exchange.
Which of the following is true regarding pulmonary circulation?
It is a low-pressure system that allows for improved gas exchange.
Which of the following is true regarding pulmonary circulation?
It is a low-pressure system that allows for improved gas exchange. The pulmonary circulation consists of the right heart and the pulmonary artery, capillaries, and veins. It is the smaller of the systems and functions at a lower pressure to assist with gas exchange.
The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.
A patient is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which of the following actions is important for the nurse to tell the patient to ensure accuracy in correlating dysrhythmias with symptoms?
It is important to keep a diary of activities and symptoms.
The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state: Select all that apply.
It is the most common cardiovascular disorder. The incidence increases with age. The systolic pressure is greater than or equal to 140 mm Hg. Page 425
A client who was admitted to the cardiac intensive care unit with a diagnosis of myocarditis asks the nurse what caused his disease. What would be the nurse's best response? a) It is usually caused by a viral infection. b) You need to ask your physician. c) It is caused by some type of bacteria. d) There is no research yet on what causes this disease.
It is usually caused by a viral infection. Myocarditis is inflammation of the myocardium. Although there are different causes it is usually caused by a viral infection. Telling the patient there is no research would not be true and telling him to ask the physician would not be therapeutic.
*What is Kawasaki Syndrome?*
It's an early childhood disease involving inflammation of coronary arteries
*What is the pathophysiology behind prinzmetal's angina?*
It's not like stable and unstable angina in that it is NOT caused by atherosclerotic narrowing *INSTEAD*, prinzmetal's angina is caused by arteries *suddenly spasm-ing*, which leads to vasoconstriction of coronary arteries --> ISCHEMIA D: *worst in the AM*
The lymph system correlates with the vascular system without actually being a part of the vascular system. Among other things, the lymph system is the main route for the absorption of fats from the gastrointestinal system. The lymph system empties into the right and left thoracic ducts, which are the points of juncture with the vascular system. What are these points of juncture?
Junctions of the subclavian and internal jugular veins
The pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following?
Kawasaki disease Kawasaki disease involves large, medium-sized and small arteries (frequently the coronaries) and usually occurs in small children. Takayasu arteritis, a large vessel vasculitis, is a granulomatous inflammation of the aorta, usually in people younger than 50 years of age. Microscopic polyangiitis and Wegener's granulomatosis, both small vessel vasculitises, involve the respiratory and renal systems.
The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?
Kussmaul sign
The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis? a) Widening pulse pressure b) Kussmaul sign c) Pulsus paradoxus d) Kussmaul breathing
Kussmaul sign Kussmaul sign is an inspiratory distention of the jugular veins caused by the inability of the right atrium, encased in its rigid pericardium, to accommodate the increase in venous return that occurs with inspiration. None of the other physiologic signs occur in constrictive pericarditis.
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which of the following lipoproteins is the main carrier of cholesterol?
LDL LDL is the main carrier of cholesterol. HDL is 50 percent protein; VLDL carries a large amount of triglycerides. IDLs are fragments of VLDLs after the triglycerides are removed and can be recycled to form VLDLs or converted to LDLs.
Following an ST segment myocardial infarction or STEMI, the nurse should be assessing a patient for which of the following complications? Select all that apply
Large amount of pink, frothy sputum and new onset of murmur, tacky piña with respiratory distress, frequent ventricular arrhythmias unrelieved with Amiodarone drip, complaints of facial numbness and tingling
Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply.
Large amount of pink, frothy sputum and new onset of murmur. Tachypnea with respiratory distress. Frequent ventricular arrhythmia unrelieved with Amiodarone drip. Complaints of facial numbness and tingling.
Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications?
Large amount of pink, frothy sputum and new onset of murmur. Frequent ventricular arrhythmia unrelieved with Amiodarone drip. Complaints of facial numbness and tingling.Tachypnea with respiratory distress
A male lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team have most reasonably expected in the weeks prior to his death?
Large numbers of alveolar macrophages in septal connective tissue
A 28-year-old client is admitted to the hospital for severe dehydration following a marathon, with fatigue the only complaint. Admission vital signs include a heart rate of 38, blood pressure 98/60, RR 16. Cardiac monitor reveals regular QRS complexes preceded by normal P waves. Which of the following does the nurse determine is the most likely cause for the bradycardia?
Large stroke volume This client most likely has a large stroke volume related to the exercise training necessary to participate in a marathon. Trained athletes can potentially develop a normal physiologic cardiomegaly. There are no signs or symptoms to support a reduction in cardiac output.
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 accompanies the vascular response in anaphylaxis?
Laryngeal edema
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
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 accompanies the vascular response in anaphylaxis?
Laryngeal edema p. 506.
most heart attacks (approximately 40 to 50 percent) affect which of the following coronary arteries?
Left anterior descending artery
The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states the blood is shunted to which part of the body?
Left side of the heart to the right side of the heart
When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart?
Left ventricle
*What is the hallmark of L heart failure?*
Left ventricular end-diastolic pressure (LVEDP)
A patient is diagnosed with systolic hypertension. The nurse knows that this patient is at risk for which of the following?
Left ventricular hypertrophy Elevated systolic pressure forces the heart to work harder and can thus provoke left ventricular hypertrophy, increased myocardial oxygen demand, and eventual left-sided failure. Left-sided failure may lead to right-sided failure which can affect the kidneys. Systolic hypertension can exist apart from diastolic hypertension.
A 66-year-old male presents to the emergency department accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F and his blood work indicates his sodium level is 126 mEq/L (normal is 135 to 145 mEq/L). What will be the assessing nurse practitioner's most likely suspicion?
Legionnaire disease Confusion, dry cough, diarrhea, and hyponatremia are associated with Legionnaire disease and less so with bronchopneumonia, Mycoplasma pneumonia, or pneumococcal pneumonia.
A client has arrived in the emergency department in cardiogenic shock. Which assessment findings by the nurse would confirm this diagnosis? Select all that apply.
Less than 5 mL dark, concentrated urine in the past hour BP reading of 80/65 Difficult to arouse with changes in level of consciousness
The nurse administers nitroglycerin to a client with acute coronary syndrome. Which explanation is the best rationale for this intervention?
Limiting the size of the infarction
The nurse administers nitroglycerin to a patient with acute coronary syndrome. Which of the following is the best explanation of the expected outcome?
Limiting the size of the infarction
The physician states that a client has adequate collateral circulation. The nurse interprets this as:
Long-term compensatory regulation of blood flow
A 31-year-old patient with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood gas sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH?
Low albumin and plasma globulin levels
A 30-year-old client arrives with these vital signs: Blood pressure 50/30 mm Hg, pulse 100 beats/min, respiratory rate 12 breaths/min, temperature 101°F (38.3°C). The nurse interprets these results as the client being in shock based on which reading?
Low blood pressure
A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?
Low blood pressure
A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?
Low blood pressure p. 506.
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
A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy one year ago. Which of the following does the nurse suspect is the problem?
Lymphedema
A nurse practitioner is explaining to a 40-year-old male patient the damage that Mycobacterium tuberculosis could do to lung tissue. Which of the following phenomena would underlie the nurse practitioner's explanation?
Macrophages are unable to digest the bacteria, resulting in immune granulomas.
The nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking?
Measure his blood pressure and show him how much higher it is when he is smoking. Although a relationship between smoking and hypertension has not been established, vasoconstriction from nicotine in cigarette smoke will raise blood pressure. Elevated blood pressure and cigarette smoking are independent risk factors for heart disease
A nurse educator on a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice?
Measurement of urine output and mental status assessment
A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which assessment is the nurse most justified in eliminating during a busy morning on the unit?
Measuring the pulse of a client taking an ACE inhibitor. ACE inhibitors act on the renin--angiotensin--aldosterone system and are thus not significant influences on heart rate. They can, however, induce hyperkalemia, and it would be prudent for the nurse to check potassium levels. Beta-adrenergic blockers affect a client's heart rate and diuretics can affect electrolyte levels
813 old boy has had a sore throat for at least a week and has been vomiting for two days. His glands are swollen, and he moves differently because his joints hurt. His parents who believe in natural remedies, I have been treating him with various herbal preparations without success and are now seeking anabiotic treatment. Throat culture show infection with a group a streptococcus. Child is at high-risk for
Mitral valve stenosis
A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have?
Mitral valve stenosis
A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?
Monitor the patient and document the findings. First-degree atrioventricular block is characterized by a prolonged PR interval (>0.20 second). This condition usually produces a regular atrial and ventricular rhythm. Isolated first-degree heart block usually is not symptomatic, and temporary or permanent cardiac pacing is not indicated. The patient should be monitored.
The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain?
Morphine
The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?
Morphine
The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain? a) Demerol b) Morphine c) Codeine d) Fentanyl
Morphine Although a number of analgesic agents have been used to treat pain of myocardial infarction, morphine is the drug of choice and is usually indicated if chest pain is unrelieved with oxygen and nitrates.
ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?
Most ECG-detected ischemic events are clinically silent.
A nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess.
Mucous membranes
A nurse is assessing for cyanosis in a child who has a congenital heart defect. Select the mostimportant area for the nurse to assess.
Mucous membranes
A nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess. a) Mucous membranes b) Tongue c) Sclera of the eyes d) Palms of the hands
Mucous membranes Cyanosis, a bluish color of the skin, most notable in the nail beds and mucous membranes, develops when sufficient deoxygenated blood from the right side of the heart mixes with oxygenated blood in the left side of the heart
Following cardiac surgery, the nurse suspects the client may be developing a cardiac tamponade. Which clinical manifestations would support this diagnosis? Select all that apply
Muffled heart tones Narrowed pulse pressure Low BP—84/60 mm Hg
Following cardiac surgery the nurse suspects the patient may be developing a cardiac Tampa nod. Which of the following clinical manifestations would support this diagnosis? Select all that apply
Muffled heart tones, Nero pulse pressure, low blood pressure of 84/60
Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply.
Muffled heart tones. Narrowed pulse pressure. Low BP—84/60
The nurse is caring for a 75-year-old client with end-stage emphysema who is having severe dyspnea. The nurse is evaluating the client's cardiac rhythms and notes a very irregular rhythm with P waves before most if not all the QRS complexes with a rate of 140. With closer inspection of the cardiac rhythm the nurse notes the P waves all look different. Which of the following most accurately describes this rhythm?
Multifocal atrial tachycardia Multifocal atrial tachycardia (MAT) is the most accurate rhythm choice for the description. The hallmark sign of MAT is at least 3 different P wave morphologies and a rate over 100 beats/minute. Incessant and focal atrial tachycardias have P waves from the same ectopic focus and paroxysmal atrial fibrillation would have fibrillatory (f) waves. MAT is often seen in older adults with chronic obstructive pulmonary disease (COPD).
A pediatric nurse is assessing a newborn diagnosed with persistent patency of the ductus arteriosus. Which of the following findings are associated with this hard affect? Select all that apply
Murmur heard of the second intercostal space, during both Systole and diastole, Blood pressure 84/30 classified as wide pulse pressure
An 81-year-old female has long-standing hypocalcemia secondary to kidney disease and will shortly be moving into an assisted living facility from her own apartment. Which of the following findings should staff at the facility be instructed to observe for?
Muscular spasms and complaints of cramps
What is the most frequent form of tuberculosis that the nurse should focus on?
Mycobacterium tuberculosis
Which of the following health problems can contribute to diastolic dysfunction heart failure?
Myocardial hypertrophy
Which of the following statements regarding causes of systolic and diastolic dysfunction are correct? Select all that apply.
Myocardial hypertrophy causes diastolic dysfunction. Ischemic heart disease causes systolic dysfunction. Valvular insufficiency causes systolic dysfunction. p. 491.
A client has developed left-sided heart failure. Which symptom might have precipitated this condition?
Myocardial infarction
A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?
Myocardial infarction
A client arrives at the doctor's office complaining of severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate which of the following?
Myocardial infarction The ST-segment elevation with myocardial infarction could be caused by a decrease in blood supply to that area of cardiac muscle. However, the mechanism of ST-segment elevation is not clearly understood. The other options with this question are the opposite of other causes of ST-segment elevation
When the electrocardiogram (ECG) of a client in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta-adrenergic blocker. Which factors in the client's history will cause the nurse to withhold medication pending discussion with physician? Select all that apply.
Myocardial infarction caused by cocaine use Third-degree heart block Shock
When the electrocardiogram (ECG) of a patient in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta adrenergic blocker. Which of the following factors in the patient's history will cause the nurse to withhold medication? Select all that apply.
Myocardial infarction caused by cocaine use • Third-degree heart block • Shock
A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?
Myocardial infarction p. 495.
A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?
Myocardial infarction p. 498.
The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.
Myocardial infarction prevention
What is the pathology of dilated cardiomyopathy?
Myocardial mitochondrial dysfunction Leads to less effective heart pump --> increased ventricular EDV and pressure, which dilates the LV (valve stays open) *not pumping blood out from L ventricle, so blood pools there and builds up pressure, which makes the cavity larger*
*In diastolic heart failure, how is ejection fraction?*
NORMAL! (65%)
*Is a zone of infarction likely to recover?*
NOT AT ALL! :(
*Can you see patients with rheumatic fever?*
NOT UNTIL THEY HAVE THEIR VALVES REPLACED
Cause of Rapid Depolarization in Conducting System
Na+ entry K+ loss
Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation? Question options:
Negative intrapleural pressure holds the lungs against the chest wall
A patient's electrocardiogram rhythm shows normal sinus rhythm followed by a complex of six premature ventricular contractions with a return to normal sinus rhythm. Which of the following is the nurse's interpretation of this finding?
Nonsustained ventricular tachycardia Ventricular tachycardia can be sustained, lasting more than 30 seconds and requiring intervention, or it can be nonsustained and stop spontaneously.
A client hospitalized for 72 hours has developed symptoms of a lower respiratory tract infection. Sputum cultures reveal S. aureus as the infectious organism
Nosocomial hospital-acquired infection
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?
Obstructive shock
A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged, resulting in a pulmonary embolism. Which type of shock is this client at risk of experiencing?
Obstructive shock
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?
Obstructive shock p. 505.
On a routine physical exam visit, the physician mentioned that he hears a new murmur. The patient gets worried and ask what does this mean? The physician response,
One of your heart valves is not a opening properly. We need to do an echocardiogram to see which valve is having problems
Which of the following patients with cardiomyopathy does the nurse identify as having the greatest risk for a complication? a) One with peripheral edema and 2-kg weight gain b) One with hepatomegaly and ascites c) One with an ejection fraction of 25% and atrial fibrillation d) One with orthopnea and activity intolerance
One with peripheral edema and 2-kg weight gain One with an ejection fraction of 25% and atrial fibrillation Explanation: Although each set of symptoms is characteristic of cardiomyopathy, the nurse determines the greatest risk occurs with the patient showing evidence of stasis in the heart that can result from a reduced ejection fraction and atrial fibrillation. This patient is most likely to experience an embolus.
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
The pericardium is a tri-layer sac. Which layer prevents acute dilation of the heart chambers and exerts a restraining effect on the left ventricle?
Outer fibrous layer
A 55-year-old man has made an appointment to see his nurse practitioner because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man's most likely diagnosis and possible underlying pathophysiologic problem?
Overactive bladder that may result from both neurogenic and myogenic sources
Considering the PQRST complex of an electrocardiogram (ECG), which of the following letter designations represents atrial depolarization?
P wave
The nurse assesses the electrocardiogram for depolarization of the atria. What does the nurse expect to assess?
P wave above the baseline
*Major problem with hypertrophic cardiomyopathy is what?*
PRESSURE OVERLOAD decreased compliance in ventricles / thicker
A 3-year-old boy has developed croup following a winter cold. His nurse practitioner would recognize that which of the following causative microorganisms and treatments are most likely?
Parainfluenza virus; treatment with a mist tent and oxygen therapy
A monitored hospitalized patient with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which of the following forms of AF is this?
Paroxysmal
The extended, severe exposure of the walls of the blood vessels to the exaggerated pressures that occur in malignant hypertension cause injuries to the walls of the arterioles. Blood vessels in the renal system are particularly vulnerable to this type of damage. Because hypertension is a chronic disease and is associated with autoregulatory changes in the blood flow to major organs, what would be the initial treatment goal for malignant hypertension?
Partial reduction in blood pressure to less critical values Because chronic hypertension is associated with autoregulatory changes in coronary artery, cerebral artery, and kidney blood flow, care should be taken to avoid excessively rapid decreases in blood pressure, which can lead to hypoperfusion and ischemic injury. Therefore, the goal of initial treatment measures should be to obtain a partial reduction in blood pressure to a safer, less critical level, rather than to normotensive levels.
Five hours after presenting to the emergency department with substernal chest pain, a patient's laboratory results demonstrate that troponin I is elevated and the creatine kinase-myoglobin (CK-MB) levels are within normal range. Which of the following is the nurse's interpretation of these results?
Patient is currently experiencing an MI.
Which of the following individuals is at greatest risk for developing a venous thrombosis resulting from venous stasis?
Patient on bed rest Bed rest or immobility causes a pooling of blood in the legs resulting in venous stasis. The other individuals are at risk for hyperreactive blood coagulation that can also result in venous thrombosis.
The nurse is reviewing the lipid results of four clients. Select the client at greatest risk for cardiovascular disease.
Patient with LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL Diagnosis of hyperlipidemia depends on a person's complete lipid profile (total cholesterol, LDL, HDL, and triglyceride levels) after an overnight fast. One person may have a favorable lipid profile with a HDL of 110 mg/dL, a triglyceride level of 175 mg/dL, and an LDL of 130 mg/dL, whereas, another person with a HDL of 40 mg/dL, a triglyceride level of 150 mg/dL, and LDL cholesterol of 205 mg/dL would be at much greater risk for cardiovascular disease.
The nurse is reviewing the lipid results of four clients. Select the client at greatest risk for cardiovascular disease.
Patient with LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL p. 406.
Which patient should be seen first as the nurse starts the shift?
Patient with new onset unstable angina who is scheduled for a cardiac catheterization at 2 pm
An 87-year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority?
Performing a physical examination and history to determine the exact cause and character of the incontinence
A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?
Pericardial effusion
A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing:
Pericardial effusion
exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?
Pericardial effusion
A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering? a) COPD b) Pericardial effusion c) Pericarditis d) Myocardial infarction
Pericardial effusion Pericardial effusion refers to the accumulation of fluid in the pericardial vacuity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200ml of fluid may raise intracardiac pressure to levels that will cause symptoms similar to right-sided heart failure. Pericarditis is inflammation of the pericardium while COPD is a respiratory disease.
*Pericarditis is autoimmune and is inflammation of the pericardium, which causes what?*
Pericardial effusion --> cardiac compression --> cardiac tamponade Sx's: sharp chest pain, worse with deep breath, fever, worst when supine
The nurse working on the cardiac floor identifies which of the following to be the initial treatment of choice for small pericardial effusions and mild cardiac tamponade?
Pericardiocentesis
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 seen in the emergency room with complaints of 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 seen in the emergency room with complaints of 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? a) Myocardial infarction b) Pericarditis c) Pneumonia d) Abdominal aortic aneurysm
Pericarditis This patient is demonstrating signs and symptoms of pericarditis, which includes a triad of chest pain, pericardial friction rub, and EKG changes. Other signs are that the pain is usually abrupt in onset, occurs in the pericardial area, and may radiate to the neck, back, abdomen or side. It is usually worse with deep breathing and swallowing, and the person often finds relief when sitting up and leaning forward.
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 The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.
Following several days in an acidotic state, a hospital patient has returned to the desired pH. Which of the following processes could have contributed to the resolution of the patient's health problem?
Phosphate and ammonia buffer systems in the renal tubules
A client who previously has suffered a myocardial infarction comes to clinic for a routine checkup. He tells the nurse that he has started to experience more episodes of angina pectoris than he had before. The nurse should tell this client that which of the following can precipitate his angina pectoris? Select all that apply.
Physical exertion Exposure to cold Emotional stress
A short, nonsmoking middle-aged man presents to the emergency department with left-sided chest pain and a cough. He says that the pain started abruptly, just after lunch, and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a heart attack. Breath sounds are normal, and he is not cyanotic. Which condition is most likely causing his symptoms?
Pleuritis related to infection
The nurse knows that adequate levels of which of the following electrolytes has been shown to have a beneficial effect on blood pressure?
Potassium Persons with high daily consumption of potassium tend to have lower blood pressure. Sodium intake is correlated with higher blood pressure. The association of chloride and calcium with blood pressure is not established.
A nurse practitioner has ordered the measurement of a cardiac patient's electrolyte levels as part of the patient's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart?
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
Mitochondria
Powerhouse of the cell, organelle that is the site of ATP (energy) production and cellular respiration
A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure?
Prehypertension Normal blood pressure is considered to be systolic below 120 mm Hg or diastolic below 80 mm Hg. Prehypertension is systolic 120-139 mm Hg and diastolic 80-89 mm Hg. This condition should be checked at least once yearly. Stage 1 hypertension is 140-159 mm Hg systolic or 90-99 mm Hg diastolic and should be confirmed within two months. Stage 2 is systolic equal to or greater than 160 mm Hg or diastolic equal to or greater than 100 mm Hg. Antihypertensive medication should be considered for Stage 1 and 2; lifestyle changes should be recommended as appropriate for any blood pressure higher than normal.
Which of the following factors represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?
Preload
The nurse is teaching a client diagnosed with heart failure about preload. Which of the following would be the most appropriate information to provide?
Preload represents the volume work of the heart.
The nurse caring for a patient 12 hours post 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 of the following should the nurse do next?
Prepare for pericardiocentesis
A nurse is caring for a patient with a new diagnosis of rheumatic fever. Which of the following is the highest priority goal of treatment during the acute phase?
Prevent cardiac complications
A nurse is caring for a patient with a new diagnosis of rheumatic fever. Which of the following is the highest priority goal of treatment during the acute phase? a) Prevent cardiac complications b) Reduce inflammation c) Promote nutrition d) Eliminate the infection
Prevent cardiac complications Explanation: Rheumatic fever poses great risk to the patient for long-term heart disease. Interventions to prevent cardiac complications include anti-inflammatories and antibiotics. Adequate nutrition is appropriate for healing but is not the highest priority goal.
Which goal is a priority for a nurse caring for a patient diagnosed with orthostatic hypotension?
Preventing falls p. 433
The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient's anorexia and cachexia?
Products of the tumor itself as well as a hypermetabolic state cause cachexia
A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows which complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply.
Profound dyspnea due to acute respiratory distress syndrome (ARDS) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces Acute renal failure due to decreased/impaired renal perfusion as a result of low BP
A client has many residual health problems related to compromise circulation following a recovery from septic shock. The nurse knows that which of the following complications listed below a result of being diagnosed with septic shock and therefore could be assessed frequently? Select all that apply
Profound dyspnea due to acute respiratory distress syndrome, atelectasis resulting in Injury to endothelial lining a pulmonary vessels, which allow fluid plasma to build up in the alveolar spaces, acute renal failure due to decreased impaired renal perfusion as a result of low blood pressure
A 29-year-old construction worker got a sliver under his fingernail four days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematological processes is most likely occurring in response to the infection?
Proliferation of immature neutrophils
A patient experiencing a sinus arrest would demonstrate which of the following symptoms or findings?
Prolonged periods of asystole demonstrated on an electrocardiogram The patient with sinus arrest refers to failure of the sinoatrial node to discharge and results in an irregular pulse, prolonged periods of asystole, and predisposition to other arrthythmias. The other options do not demonstrate the symptoms demonstrated during a sinus arrest.
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 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 preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following?
Prompt diagnosis of streptococcal infections with a throat culture
A preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following? a) Yearly electrocardiography after the age of 50 b) Blood specimen assessed for rheumatoid factor c) Scheduling regular hearing examinations d) Prompt diagnosis of streptococcal infections with a throat culture
Prompt diagnosis of streptococcal infections with a throat culture Rheumatic heart disease is normally caused by streptococcal infections; therefore early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a patient has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and while the patient may benefit from regular hearing examinations, it is not related to preventing rheumatic heart disease.
The initial medical management for symptomatic patient with obstructive hypertrophic cardio myopathy (HCM)he would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?
Propranolol, a beta adrenergic blocker
The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?
Propranolol, a β-Adrenergic blocker.
ymptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines
Propranolol, a β-Adrenergic blocker.
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:
Pulmonary embolism
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent which of the following?
Pulmonary embolism
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent:
Pulmonary embolism
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent which of the following?
Pulmonary embolism The most common site of a deep vein thrombosis (DVT) is in the venous sinuses in the soleus muscle and posterior tibial and peroneal veins. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT. The other options are caused by occlusions in the arterial system.
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:
Pulmonary embolism : Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli.
Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention?
Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.
Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention?
Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infants first week
assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement techniques
Pulse oximetry
Cardiac tamponade is a serious life-threatening condition that can arise from a number of other conditions. What is a key diagnostic finding in cardiac tamponade?
Pulsus paradoxus
The heart is a four-chambered pump. What is the function of the right ventricle?
Pumps blood to the lungs
Circulatory shock is characterized by an inability of the circulatory system to provide adequate oxygen to body tissues. Which of the following damaging effects at the cellular level can cause hypoxia? Select all that apply.
Pyruvate converted to lactic acid, cellular edema, deranged sodium/potassium balance, impaired cellular production of ATP
The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?
QRS complex
The rapid depolarization phase in the ventricular action potential appears in the electrocardiogram as the __________.
QRS complex
The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?
QRS complex The QRS complex is representative of ventricular depolarization. The P wave is atrial depolarization, the T wave is ventricular repolarization, and the ST segment is the time to ventricular repolarization.
A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are nonmodifiable risk factors associated with this diagnosis? Select all that apply.
Race Family history
A nurse is evaluating hypertension risk factors with a black male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 lb (6.8 kg) in the past year. Which risk factors or hypertension are nonmodifiable? Select all that apply.
Race Family history
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
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 (The person should be placed in a supine position)
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 p. 506.
A female client tells the health care provider that she has recently been experiencing episodes of changes occuring in the color of her fingertips especially when she experiences cold temperatures. She further states that the tips become pale, turn a bluish color, and then become reddened. The client is most likely experiencing:
Raynaud phenomenon (p. 416)
A patient presents to the emergency department with complaints of bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. Which of the following is a potential diagnosis for this patient?
Raynaud's disease
Due to complications, a male postoperative patient has been unable to mobilize for several days following surgery and has developed atelectasis. Which of the following processes would his care team anticipate with relation to his health problem?
Redirection of blood flow away from the lung regions that are hypoxic
*What are the effects of beta blockers*
Reduce myocardial O2 demand (helps with cardiac rhythm) Reduce myocardial damage due to decreased catecholemines Improved diastolic relaxation Inhibition of sympathetically mediated vasoconstriction
The health care provider is preparing to assess a client who has been diagnosed with hypertrophic cardiomyopathy. The provider anticipates the assessment data will include:
Reduced chamber size
The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?
Reduced ventricular efficiency
The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?
Reduced ventricular efficiency p. 486.
Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis?
Release nitric oxide p. 507.
A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?
Renal artery stenosis ACEI are contraindicated in renal artery stenosis, a condition that relies on the renin-angiotensis system to maintain adequate renal perfusion. ACEI are used clinically in the management of heart failure. Coronary artery disease and diabetes do not contraindicate ACEI.
A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?
Renal artery stenosis p. 427.
A pediatric unit will be receiving from a rural medical outpost a patient transfer of an 8-day-old infant with a suspected congenital renal disorder. Which of the following possibilities is the care team most likely to be able to rule out early?
Renal cell carcinoma may be present. May have upper and lower poles of the two kidneys may be fused, kidneys may be misshapen and have cysts, one of the infant's kidneys may have failed to develop to a normal size.
A client has presented to the emergency department in distress and is being rapidly assessed by the care team. Which assessment finding would prompt the team to consider the possibility of acute heart failure?
Respiratory distress with audible crackles p. 496.
A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?
Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.
A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?
Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. Rest and intake of nitroglycerin relieve chest pain with angina but not with an MI. Pain with angina and MI is an subjective symptom for each client. Pain with angina and MI can occur at a variety of times.
A teenager is seen in the emergency room with complaints of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen three weeks before in the clinic and treated with antibiotics for a strep throat. He was better for a few days but now he seems to have gotten worse in the last two days. What should the nurse suspect is wrong with this client?
Rheumatic fever
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
Which of the following is the correct sequence for blood flow through the heart?
Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
Right sided heart failure
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
The conducting system in the heart begins in the __________.
SA Node
Which part of the conduction system initiates the depolarizing impulse, which spreads throughout the heart?
SA node
Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers The atrial conduction begins with the sinoatrial (SA) node, serving as the pacemaker of the heart. Impulses originating in the SA node travel through the atria to the arterioventricular (AV) node. There are three internodal pathways between the SA node and the AV node, including the anterior (Bachmann), middle (Wenckebach), and posterior (Thorel) internodal tracts. These three tracts anastomose with each other proximally to the AV node. The AV junction connects the two conduction systems and provides for one-way conduction between the atria and the ventricles. The impulse travels through the nodal region into the natriuretic hormone region, which connects with the bundle of His (also called the AV bundle). The fibers of the AV node proceed to form the bundle of His, which extends through the fibrous tissue between the valves of the heart and into the ventricular system. The bundle of His penetrates into the ventricles and almost immediately divides into right and left bundle branches that straddle the interventricular septum. The bundle branches move through the subendocardial tissues toward the papillary muscles and then subdivide into the Purkinje fibers, which branch out and supply the outer walls of the ventricles. The Purkinje system, which initiates ventricular conduction, has large fibers that allow for rapid conduction. Once the impulse enters the Purkinje system, it spreads almost immediately to the whole ventricle.
The correct sequential path of a normal action potential in the heart is
SA node -> AV node -> bundle of His -> bundle branches -> Purkinje fibers
Conducting System-Step 1
SA node activity and atrial activation begin
Conducting System
SA node, internodal pathways, AV node, Common bundle of His, bundle branches, Purkinje fibers
A 16 year old adolescent who received a kidney transplant at the age of 10, has recently developed a trend of increasing BP readings. Of the following list of medications, which may be the primary cause for the development of hypertension?
Sandimmune (Cyclosporine).
A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which of the following interventions?
Sclerotherapy or surgery(p. 438)
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?
See the doctor for evaluation immediately.
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following? a) Not worry about it as this is common for someone who has already had a myocardial infarction. b) See the doctor for evaluation immediately. c) Give it 5-10 minutes more to see if there is relief. d) Take a second nitroglycerine.
See the doctor for evaluation immediately. 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).
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
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF 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 patient most likely is experiencing which of the following types of shock?
Septic
A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient's most likely diagnosis?
Septic shock
A patient in the intensive care unit has a blood pressure of 87/39 and his warm flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is the client most likely diagnosis
Septic shock
The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock?
Septic shock
An emergency room nurse is caring for a client with cardiomyopathy who has chest pain and shortness of breath. Vital signs include: heart rate 100, blood pressure 84/62, RR 30 and temp 37.0. Cardiac monitor reveals an irregular rhythm with frequent premature ventricular complexes. The nurse understands that this client is at risk for which of the following?
Serious arrhythmias Cardiomyopathy is disease of the cardiac muscle and premature ventricular contractions increase the risk for more lethal arrhythmias to occur. Heart failure is also a possibility; however, there is not enough information in the question to support heart failure
The diagnosis of chronic stable angina is based on a detailed pain history, the presence of risk factors, invasive and noninvasive studies, and laboratory studies. What test is not used in the diagnosis of angina?
Serum biochemical markers
A nurse witnesses an elderly woman sitting outside who suddenly faints and is helped to the ground by family. She is awake, although confused, heart rate 130, RR 28. The woman states that all of a sudden she felt dizzy, but denies other symptoms. She says that her husband died last week and she has been very upset. The nurse determines that which of the following is the most likely reason for the syncopal episode?
Severe anxiety This person is most likely suffering from severe anxiety following her husband's death, which would be a normal physiologic explanation for the tachyarrhythmia that may have contributed to the syncope. Although the other options are all potential causes of tachyarrhythmias, there is nothing in the question that supports that they would be the cause.
A child is brought to the emergency department struggling to breathe with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following is the most likely diagnosis?
Severe asthma attack
*What are the classic symptoms of myocardiac infarction?*
Severe crushing chest pain *Levine sign* Diaphoresis Dyspnea Nausea Vomiting Lightheadedness Apprehension Severe weakness Denial
An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?
Severity and duration of shock
An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?
Severity and duration of shock p. 508.
Which of the following would be considered a clinical manifestation of acute pericarditis? Select all that apply. a) Pericardial friction rub b) Abnormal ECG results c) Muffled heart sounds d) Narrowed pulse pressure e) Sharp, abrupt onset of chest pain that radiates to the neck
Sharp, abrupt onset of chest pain that radiates to the neck • Pericardial friction rub • Abnormal ECG results Explanation: The manifestations of acute pericarditis include a triad of chest pain, an auscultatory pericardial friction rub, and electrocardiographic (ECG) changes. The pain usually is sharp and abrupt in onset, occurring in the precordial area, and may radiate to the neck, back, abdomen, or side. Pain in the scapular area may result from irritation of the phrenic nerve. The pain typically is pleuritic (aggravated by inspiration and coughing) and positional (decreases with sitting and leaning forward) because of changes in venous return and cardiac filling. A pericardial friction rub results from the rubbing and friction between the inflamed pericardial surfaces. Persons with cardiac tamponade usually have heart sounds that become muffled because of the insulating effects of the pericardial fluid and reduced cardiac function. A key diagnostic finding in cardiac tamponade is pulsus paradoxus or an exaggeration of the normal variation in the systolic blood pressure.
A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of her health problem?
She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately.
A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?
She is susceptible to isotonic fluid volume deficit and hypernatremia as a result of water losses.
A 51-year-old woman diagnosed with multiple sclerosis (MS) five months prior is distressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the facts that would underlie the nurse's response to the patient?
She may be unable to sense her bladder filling as a result of her MS.
A 44-year-old woman developed calf pain during a transatlantic flight followed by acute shortness of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE), which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE?
She was short of breath because ventilation was occurring but perfusion was inadequate.
A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stools that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely?
She will have iron-deficiency anemia due to depletion of iron stores.
A patient who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. What would her care team anticipate when observing her breathing?
Short, shallow breaths
The nurse practitioner is seeing a client who has an acute exacerbation of Crohn's disease. The NP recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the patient's pathology?
Simple columnar epithelium
An 80-year-old client is brought to the emergency room following a syncopal episode at home. The client has a past medical history of atrial fibrillation, type II diabetes, and coronary heart disease. The nurse notes after the cardiac monitor is attached the lack of P waves and the presence of QRS complexes at a rate of 48-54. The nurse determines the presence of which of the following?
Sinus arrest with a junctional escape rhythm Explanation: This client is suffering from sinus arrest with a junctional escape rhythm, demonstrated by the lack of P waves and QRS complexes at a rate of 48-54, which is the escape rhythm. The inherent rate in the junction is 40-60 beats per minute; if the escape rhythm were ventricular the rate would be between 15-40 beats per minute. This client has at least one risk factor for the development of this rhythm and that would be congestive heart failure.
A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which of the following common dysrhythmias is the nurse aware this patient most likely has related to maintaining a large stroke volume?
Sinus bradycardia
A patient is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 sec preceding each QRS complex. Which of the following does the nurse determine the rhythm to be?
Sinus tachycardia Sinus tachycardia is a heart rate >100 bpm that has its origin in the sinoatrial node. A normal P wave and PR interval should precede each QRS complex. The mechanism of sinus tachycardia is enhanced automaticity, related to sympathetic stimulation or withdrawal of vagal tone. Sinus tachycardia is a normal response during any increase in metabolic activity such as fever, stress, anxiety, and the like
Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture? (Select all that apply.)
Size of lipid-rich core Presence of inflammation Thickness of fibrous cap
Which one of the following organs are the two primary sites of lipoprotein synthesis?
Small intestine and liver Page 405
When trying to explain to a new dialysis patient the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:
Small openings that allow large amounts of smaller molecular substances to filter through the gomeruli.
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be: Select all that apply.
Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be: Select all that apply.
Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight (p.408)
A nurse preparing education on managing the risk factors for coronary artery disease (CAD) will stress which information? Select all that apply.
Smoking cessation techniques Identification of high cholesterol foods Importance of exercise on managing hypertension Signs and symptoms of type 2 diabetes mellitus
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 diagnosis?
Stable angina
A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection.
Staphylococcus aureus
nfective endocarditis. Select the most likely cause of infection.
Staphylococcus aureus
*What is "Broken Heart" Syndrome?*
Sudden emotional stress from fear, sorrow, anger, or shock that can cause chest pain and weakening of heart in healthy people Temporary cardiomyopathy sec. to stress/anger (needs quick treatment!....meds) women more affected than men
A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?
Sustained systolic pressure equal to or greater that 160 mm Hg
A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?
Sustained systolic pressure equal to or greater that 160 mm Hg Stage 2 hypertension is systolic pressure greater than 159 mm Hg or diastolic pressure greater than 99 mm Hg. Systolic pressure of 140-159 mm Hg or diastolic pressure of 90-99 mm Hg are characteristic of stage 1 hypertension.
A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?
Sympathetic nervous system premature ventricular complexes can occur in healthy hearts in response to stimulation of the sympathetic nervous system. This client states nighttime studying (possibly with coffee intake) and stress over upcoming exams, both of which can stimulate the sympathetic nervous system.
An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication?
Systemic emboli, especially to brain.
feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve.The nurse assessing possible life-threatening complication?
Systemic emboli, especially to brain.
An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication? a) Petechial hemorrhages under the skin and nail beds. b) Systemic emboli, especially to brain. c) GI upset from the massive amount of antibiotics required to kill the bacteria. d) Pancreas enlargement due to increased need for insulin secretion.
Systemic emboli, especially to brain. Systemic emboli and develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc. B—petechial hemorrhages are s/s of IE. GI upset is common following antibiotic therapy but is not usually life-threatening. Stress can increase insulin needs but not associated with pancreas enlargement.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:
Tearing or ripping-type pain in the chest or back (p. 419)
Which of the following patients is at the greatest risk of developing rheumatic heart disease?
Teenager with untreated strep throat
patients is at the greatest risk of developing rheumatic heart disease?
Teenager with untreated strep throat
Which of the following patients is at the greatest risk of developing rheumatic heart disease? a) Young adult with viral meningitis b) Teenager with untreated strep throat c) Older adult with shingles d) Child with impetigo on the face
Teenager with untreated strep throat Rheumatic fever is caused by group A (beta-hemolytic) streptococcal throat infection. Although the same bacteria cause the skin infection called impetigo, it is not known to cause rheumatic heart disease. Viral infections such as meningitis and shingles (herpes zoster) do not cause rheumatic heart disease.
Which of the following patients is at the greatest risk of developing rheumatic heart disease?
Teenager with untreated strep throat.
A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head?
Temporal
A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional's lowest priority?
Tests of kidney function
A 61-year-old woman who has had an upper respiratory infection for several weeks has presented to her nurse practitioner with complaints of a recent onset of urinary retention. She reveals to her nurse practitioner that she has been taking over-the-counter cold medications at higher than the suggested dose for the past two weeks. Which of the following phenomena will her nurse practitioner most likely suspect is contributing to her urinary retention?
The anticholinergic effects of the medication are impairing normal bladder function.
The nurse knows that which of the following statements regarding the arterial chemoreceptors are correct? Select all that apply.
The chemoreceptors can induce widespread vasodilation. The main function of the chemoreceptors is in regulation of ventilation. The chemoreceptors trigger increased blood pressure in persons with sleep apnea. The chemoreceptors induce systemic hypertension in persons with chronic obstructive pulmonary disease (COPD).
A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was "so fast I couldn't even count it." The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother?
The child is experiencing a reentry rhythm in his right atrium.
The nurse is providing care for a client who has just been diagnosed with long QT syndrome (LQTS). When planning this client's care, the nurse should recognize what implication of the diagnosis?
The client must be closely monitored for ventricular tachycardia The long QT syndrome (LQTS) is characterized by a prolongation of the QT interval that may result in a characteristic type of polymorphic ventricular tachycardia called torsades de pointes and possible sudden cardiac death (SCD). LQTS is not directly related to ACS or cardiomyopathy. Tachycardia is far more likely than bradycardia.
The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?
The client must protect the entire body from cold, not just the extremities.(p. 417)
statements concerning hypoxemia are true?
The condition depends on the body's ability to adapt to lowered oxygen levels. brain is vulnerable to hypoxia.When hypoxemia occurs, metabolic acidosis is a possible outcome. Normally, serum lactate levels are between 1 and 0.5 mmol/L.
The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:
The condition is getting progressively worse.
The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?
The disabling effects that result from involvement of heart valves
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
afterload
The force or resistance against which the heart pumps.
A group of researchers has identified that the prevalence of two particular genetic disorders share a statistical correlation. Which of the following statements best conveys the genetic rationale for this situation?
The genes causing each disorder are likely in the same section of the same chromosome.
The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following?
The kidneys The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water. Neural (autonomic nervous system) and humoral mechanisms (renin-angiotensin-aldosterone system and vasopressin) exert short-term control of blood pressure. Hormonal influence involves release of epinephrine (which works through the sympathetic nervous system) from the adrenal glands.
The majority of ventricular filling occurs while the ventricles and atria are in what state(s)?
The majority of ventricular filling occurs while both the ventricle and atrium are relaxed - while both chambers are in diastole. Ventricular filling also occurs during atrial systole, but this phase only contributes about 30 percent to ventricular filling.
Emergency medical technicians respond to a call to find an 81-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomenon is most likely taking place?
The man's alpha and beta adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate
Which of the following assessment findings of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa?
The man's blood pressure is 178/102 and he has abnormal liver function tests. (p. 751)
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response? a) Let's not worry about the cause as we need to focus on getting him better. b) It can be attributed to drug abuse. c) Sometimes a parasite is involved. d) The most common cause is a staph infection.
The most common cause is a staph infection. Staphylococcal infections have now emerged as the leading cause of infective endocarditis, with streptococci and enterococci as the other two most common causes. Informing the client's wife about the drug abuse connection infers that you think he is a drug addict and is not therapeutic. Parasites are never the cause and telling the patient to focus on her husband also is not appropriate as this is a genuine concern for her.
A 34-year-old male patient has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The patient's family is questioning the care team about why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide to the family?
The normally small transcellular fluid compartment, or third space, is becoming enlarged.
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?
The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following?
The nursing student when studying cardiomyopathies learns that the primary ones are classified into which of the following groups? Select all that apply. a) Mixed b) Acquired c) Primary d) Secondary e) Genetic
The nursing student when studying cardiomyopathies learns that the primary ones are classified into which of the following groups? Select all that apply. a) Mixed b) Acquired e) Genetic The primary cardiomyopathies are classified as genetic, mixed, or acquired, based on their etiology.
A nurse practitioner is doing the admission assessment on a patient who has been transferred to the floor after being diagnosed by the emergency room physician with bilateral pleural effusion. Which of the following findings from the nurse practitioner's initial assessment of the patient is incongruent with the patient's diagnosis, and would require further investigation?
The patient complains of sharp pain exacerbated by deep inspiration.
diagnosed today with pneumococcal pneumonia.
The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.
A 77-year-old male patient with a diagnosis of stomach cancer has been found to have metastases in his liver. The patient and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides?
The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.
Ventricular diastole begins with the closing of the semilunar valves. What phase of the cardiac cycle happens between this event and the later opening of the AV valves?
The prefix iso- means "same" so this is a period of "same volume". While the semilunar valve and AV valve are both closed, blood may not enter nor exit the ventricle. Therefore ventricular volume remains constant during this time. This period of relaxation is quite brief - lasting less than 20 msec or about 2 percent of the full cardiac cycle.
Analysis has shown that a client's right atrial pressure is 30 mmHG. What is the most likely conclusion that the client's care team will draw from this piece of data?
The pressure is excessive given that the right atrium should be at atmospheric pressure.
A teenager comes to the emergency room with a history of strep throat and symptoms that lead the staff to suspect rheumatic fever. Which of the following tests can best establish a diagnosis of rheumatic fever?
There is no definitive test for diagnosing RF.
Hypoxia is said to have a negative inotropic effect on the heart, which means:
There will be interference in the generation of ATP, which is needed for muscle contraction
In infective endocarditis, vegetative lesions grow on the valves of the heart. These vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin strands of clotted blood. What are the possible systemic effects of these vegetative lesions?
They can fragment and cause cerebral emboli.
Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?
They have the same compensatory mechanisms.
Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?
They have the same compensatory mechanisms. p. 488.
Following a winter power outage, a patient who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning?
To increase the amount of oxygen dissolved in plasma
Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?
Transcutaneous The type of pacing described is transcutaneous because it is only form that is accessible externally.
A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?
Troponin assays
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? a) Calcium level b) Complete blood components c) Creatine kinase marker d) Troponin level
Troponin level The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction (MI). The troponin complex, which is part of the actin filament, consists of three subunits (i.e., TnC, TnT, and TnI) that regulate calcium-mediated actin-myosin contractile process in striated muscle (see Chapter 1, Fig. 1-19). TnI and TnT, which are present in cardiac muscle, begin to rise within 3 hours after the onset of MI and may remain elevated for 7 to 10 days after the event. This is especially adventitious in the late diagnosis of MI. The other blood work may be ordered, but not to confirm the diagnosis of MI.
*True/False. Pericarditis is usually benign and can be treated with meds, BUT make sure you discern from CAD!*
True!
A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this client about diagnosing a valvular defect?
Valvular defects usually are detected through cardiac auscultation.
A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this patient about diagnosing a valvular defect?
Valvular defects usually are detected through cardiac auscultation.
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
A patient 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.
Valvular regurgitation
A patient 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 which of the following?
Valvular regurgitation
A patient 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 which of the following?
Valvular regurgitation p. 493.
Which of the following blood vessel cells form the predominant cellular layer in the tunica media and produce vasoconstriction and/or dilation of blood vessels?
Vascular smooth muscle cells (SMCs)
An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:
Vascular stiffness
An older adult client asks the nurse why so many older people develop heart failure. The bestresponse would be increased:
Vascular stiffness
An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:
Vascular stiffness p. 498
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 has progressed to late-stage heart failure is experiencing sympathetic stimulation. The nurse would assess the client for: Select all that apply.
Vasoconstriction Arrhythmias Increased oxygen demand p. 489.
In hypovolemic shock, the main purpose of treatment is correcting or controlling the underlying cause of the hypovolemia and improving the perfusion of the tissues and organs of the body. Which of the following treatments is not a primary form of therapy for hypovolemic shock?
Vasoconstrictive drugs p. 504.
Although Raynaud's phenomenon and thromboangiitis are both characterized by ischemia, Raynaud's phenomenon and thromboangiitis obliterans are caused by which of the following?
Vasospasm; inflammation Raynaud's disease is caused by vasospasms of small distal arteries; thromboangiitis obliterans is caused by an inflammatory process that also affects veins and nerves.
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
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: a) Microemboli being developed in the carotids by Staphylococcus epidermidis b) Vegetative emboli traveling in the blood stream to the lungs c) Blood clots in the left ventricle traveling through the aorta d) Infarction of the tissue surrounding the endocardium of the heart
Vegetative emboli traveling in the blood stream to the lungs The client is exhibiting signs of pulmonary emboli. The infectious loci continuously release bacteria into the bloodstream and are a source of persistent bacteremia, sometimes contributing to pericarditis. As the lesions grow, they cause valve destruction and dysfunction such as regurgitation, ring abscesses with heart block, and perforation. The loose organization of these lesions permits the organisms and fragments of the lesions to form emboli and travel in the bloodstream, causing cerebral, systemic, or pulmonary emboli. If clots are in the left ventricle, they will travel to the brain or kidneys. If emboli are located in the carotids, they will travel to the brain tissue. Infarction of heart tissue will exhibit signs of a myocardial infarction, not pulmonary emboli.
Preload represents the volume work of the heart and is largely determined by:
Venous blood return
A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?
Venous return to the heart
A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?
Venous return to the heart, p. 487.
Which of the following is associated with stasis of blood, increased blood coagulability and vessel wall injury?
Venous thrombosis
The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?
Ventricles contract and blood is ejected from the heart.
A 66-year-old obese man with diagnosis of a Shanna car disease has been diagnosed with heart failure but his care team has characterized as attributed to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis
Ventricular dilation and wall tension are significantly lower than normal
66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?
Ventricular dilation and wall tension are significantly lower than normal.
A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?
Ventricular dilation and wall tension are significantly lower than normal.
A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which assessment finding is inconsistent with his diagnosis?
Ventricular dilation and wall tension are significantly lower than normal.
A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?
Ventricular dilation and wall tension are significantly lower than normal.
diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?
Ventricular dilation and wall tension are significantly lower than normal.
A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?
Ventricular dilation and wall tension are significantly lower than normal. p. 491.
Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?
Ventricular fibrillation Ventricular fibrillation represents severe derangements of cardiac rhythms that terminate fatally within minutes unless corrective measures are taken promptly. All of the other arrhythmias need to have further investigation into etiology, but are not immediately fatal.
A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain. His subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?
Ventricular repolarization
The closing of the left AV valve occurs near the beginning of __________.
Ventricular systole is the contraction of the ventricle. This causes the pressure within the ventricle to quickly rise above that in the atrium, which in turn causes the AV valve to close. The closed AV valve ensures that blood is ejected into the aorta and not back into the atrium.
Which of the following EKG patterns with the nurse observed in a patient admitted for arithmetic right ventricular cardiomyopathy/Dysplasia(ARVC/D)?Select all that apply
Ventricular tachycardia with left bundle branch block pattern, T-wave inversion in the right precordial leads
The nursing student has learned in class that pericarditis is an inflammatory process of the pericardium. Which of the following is known to be the main cause of pericarditis?
Viral infections
The nursing student has learned in class that pericarditis is an inflammatory process of the pericardium. Which of the following is known to be the main cause of pericarditis? a) Viral infections b) Radiation c) Connective tissue disease d) Bacterial infections
Viral infectionsViral infections are the most common cause of pericarditis. The others listed are also causes but not the most frequent.
A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms?
Viruses are killing some of his B cells and becoming incorporated into the genomes of others.
A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient's bleeding?
Vitamin K deficiency
Cardiac output is which of the following per minute? Select all that apply.
Volume of blood pumped Heart rate X stroke volume
The 40-year-old nurse is concerned that her job requires her to stand most of the day. Which of the following therapies could be implemented to prevent tissue injury?
Wearing correctly fitted, elastic support stockings The incidence of varicose veins is more common in females between 30 and 50 years of age and among people who stand for the majority of their day due to an occupation (e.g., nurses). Treatment measures for varicose veins focus on improving venous flow and preventing tissue injury. Support stockings prevent vein distention. Sclerotherapy is used in the treatment of small varicosities. Warfarin therapy and heat application are used to treat deep vein thrombosis
A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following?
Weight gain
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 patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following?
Weight gain p. 492.
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be: Select all that apply.
Weight reduction if overweight • Dietary measures to reduce LDL levels • Smoking cessation The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes; when these are unsuccessful, pharmacologic treatment may be necessary. Therapeutic lifestyle changes include an increased emphasis on physical activity, dietary measures to reduce LDL levels, smoking cessation, and weight reduction for people who are overweight. Increased intake of fats and sodium would cause weight gain and hypertension and result in a negative consequence
A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states, "I don't know how this could happen to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement?
What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved.
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?
Will prevent the conversion of angiotensin I to angiotensin II Among the drugs used in the treatment of hypertension are ACE inhibitors. The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.
A client has been diagnosed with mitral valve stenosis fine his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to this client?
Your mitral valve isn't opening up enough for blood to flow into part of your heart that sends blood into circulation
A nurse in a medical unit has noted that a client's potassium level is elevated at 6.1 mEq/L. The nurse has notified the physician, removed the banana from the client's lunch tray, and is performing a focused assessment. When questioned by the client for the rationale for these actions, which of the following explanations is most appropriate? A. "Your potassium levels in the blood are higher than they should be, which brings a risk of changes in the brain function." B. "I'll need to monitor you today for signs of high potassium; tell me if you feel as if your heart is beating quickly or irregularly." C. "The amount of potassium in your blood is too high, but this can be resolved by changing the intravenous fluid you are receiving." D. "Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness."
Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness." Paresthesia and muscle weakness are manifestations of hyperkalemia. Tachycardia and dysrhythmias are more commonly associated with hypokalemia, and the greatest risks associated with potassium imbalances are cardiac rather than neurological. Hyperkalemia is not normally resolved by correction using IV fluid
*Which zone of MI is when ST segment depresses?* *Which zone is when ST segment depresses then rises?*
Zone of *ischemia* - depresses Zone of *injury* - depresses then rises
*What is the difference between zone of ischemia and zone of injury?*
Zone of ischemia is reversible Zone of injury is ONLY reversible if you do proper exercises with the patient
*Endocarditis is what?*
a bacterial/fungal infection of heart valves
Parasympathetic from the vagus nerve results in
a decrease in heart rate
During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells? a) 20 to 40 minutes b) 10 to 30 minutes c) 10 to 20 minutes d) 30 to 40 minutes
a) 20 to 40 minutes If blood flow can be restored within the 20-to-40-minute time frame, loss of cell viability does not occur or is minimal.
The nursing instructor when teaching about disorders of cardiac function informs the students that all people presenting with ST-segment elevation myocardial infarction (STEMI) should be assessed for reperfusion therapy as quickly as possible. Reperfusion therapy includes which of the following? Select all that apply.
a) Percutaneous coronary intervention (PCI) c) Coronary artery bypass grafting (CABG) d) Fibrinolytic therapy
Tachycardia
abnormally rapid heartbeat (over 100 beats per minute)
Brush cells
act as receptors to monitor air quality
Microfilaments
actin and myosin
Action potentials generated by the autorhythmic cells spread to the contractile cells through what structures in the membrane?
action potentials generated by the autorhythmic cells spread waves of depolarization to contractile cells through gap junctions. If the depolarization causes the contractile cells to reach threshold, they will in turn generate an action potential.
In pulmonary edema
air mixing with red blood cells and albumin, which have leaked into the alveoli, produces frothy blood-tinged sputum. Air moving through the fluid in the lungs causes crackles. The pulse is rapid, as the sympathetic nervous system tries to compensate for poor oxygenation of blood. Confusion arises as the brain receives inadequate oxygenation. The skin is cool, as perfusion of cutaneous capillaries declines.
SV: Stroke Volume
amount of blood ejected out of ventricle with each contraction(stroke)
ESV: End Systolic Volume
amount of blood remaining in each ventricle at the end of ventricular systole
The __________ valve prevents backward flow of blood into the left ventricle.
aortic
Under normal circumstances, the factors responsible for making delicate adjustments to the heart rate as circulatory demands change are
autonomic activity and circulatory hormones
The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)? a) A 78-year-old client admitted with increasing fatigue related to aortic stenosis b) A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation c) A 87-year-old client admitted with uncontrolled dilated cardiomyopathy d) A 24-year-old auto accident client diagnosed with pericardial effusion and cardiac tamponade
b) A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation Explanation: Coronary artery bypass grafting (CABG) may be the treatment of choice for people with significant coronary artery disease (CAD) who do not respond to medical treatment and who are not suitable candidates for percutaneous coronary intervention. CABG does not address valve disorders, pericardial effusion, or cardiomyopathies
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: a) Pneumonia b) Onset of STEMI c) Acute respiratory distress syndrome (ARDS) d) Gastroesophageal reflux disease (GERD)
b) Onset of STEMI The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin
Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?
beta-adrenergic blocking drugs (beta-blockers)
An elderly 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. p. 497.
Mismatching of ventilation and perfusion
both dead air space and shunt produce
On a routine physical exam visit, the physician mentions that they hear a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds: a) "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or lightheaded." b) "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit." c) "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems." d) "This could be caused by an infection. Have you been feeling well the past few weeks?"
c) "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems." Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. Blood flow through a normal valve can increase by 5-7 times the resting volume. Valvular disease is not caused by stress. The murmur can be caused by infection but also stenosis or regurgitation of a valve leaflet. The valve problem is very severe if it is causing signs of decrease cardiac output.
A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics? a) Cardiac catheterization, chest X-ray, electrolyte measurement, and white cell count b) CT of the heart, chest X-ray, ECG c) Echocardiogram, blood cultures, temperature d) ECG, blood pressure, stress test
c) Echocardiogram, blood cultures, temperature An echocardiogram would help visualize the heart, while blood cultures would confirm the presence or absence of microorganisms in circulation and temperature would gauge the presence of infection. A chest X-ray, blood pressure measurement and cardiac catheterization would be less likely to indicate infective endocarditis.
A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: a) Annual blood specimen assessed for rheumatoid factor b) Yearly electrocardiography after the age of 50 c) Prompt diagnosis and treatment of streptococcal infections d) Avoiding frequent dental examinations
c) Prompt diagnosis and treatment of streptococcal infections Rheumatic heart disease is normally caused by streptococcal infections; therefore, early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a client has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and the client should have regular dental examinations.
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be: a) The valve opening is incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium. b) The valve opening permits backward flow to occur when the valve should be closed. c) The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. d) The valve opens backward permitting blood to flow from the right ventricle into the right atrium.
c) The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. This increases the work and volume of the chamber emptying through the narrowed valve—the left atrium in the case of mitral stenosis and the left ventricle in aortic stenosis. An incompetent or regurgitant valve permits backward flow to occur when the valve should be closed—flowing back into the left ventricle during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased.
sympathetic nervous system stimulation
causes airway relaxation, blood vessel constriction, and inhibition of glandular secretions.
*Compared to stable angina, unstable angina is used to denote what?*
changes in anginal pattern OR angina at rest
Distributive or vasodilatory shock
characterized by loss of blood vessel tone, enlargement of the peripheral vascular compartment, and displacement of the vascular volume away from the heart and central circulation.
Reactive Oxygen Species (ROS)
chemically reactive molecules containing oxygen
*What is angina itself?*
chest pain (caused insufficient blood flow to heart sec. to narrowing of coronary artery)
Ventricular systole begins with the __________.
closing of the mitral valve
Rapid Depolarization in Conducting System ends with________.
closure of voltage gated (fast) sodium channels
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.
compensatory mechanisms p. 488.
*What causes rheumatic fever?*
complication of inadequately treated strep throat or scarlet fever
Cytoplasm
composed of water, proteins, neutral fats, and glycogen.
*cardiac tamponade is what?*
compression of the heart from fluid in pericardial sac causing *decreased SV*
Blood from coronary circulation is returned to the right atrium of the heart via
coronary sinus
Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis? a) Have the client swallow slowly and frequently. b) Have the client breathe deeply. c) Have the client change positions to unaffected side. d) Have the client sit up and lean forward.
d) Have the client sit up and lean forward. With acute periocarditis, the pain typically is pleuritic (aggravated by inspiration and swallowing) and positional (decreases with sitting and leaning forward; increases with moving to the side) because of changes in venous return and cardiac filling.
A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection. a) Eikenella corrodens b) Actinobacillus actinomycetemcomitans c) Kingella kingae d) Staphylococcus aureus
d) Staphylococcus aureus While all of these bacteria can cause infective endocarditis, Staphylococcus aureus is the major offender in injection drug abusers, whereas prosthetic heart valve infective endocarditis tends to be caused by coagulase-negative staphylococci (e.g., Staphylococcus epidermidis).
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? a) That there is no definitive test used for diagnoses b) The cost associated with treating the disease c) The fact that it affects young and old d) The disabling effects that result from involvement of heart valves
d) The disabling effects that result from involvement of heart valves Rheumatic fever is a very important cause of heart disease and its most serious and disabling effects result from involvement of the heart valves.
The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is:
decreased afterload.
care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is:
decreased afterload.
The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is
decreased afterload. p. 497.
Neurogenic shock
decreased sympathetic control of blood vessel tone due to a defect in the vasomotor center in the brain stem or the sympathetic outflow to the blood vessels.
diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder
diuretics, dgitalis, beta adrenergic blockers, angiotensin-converting enxyme inhibitors (ACE1)
The volume of blood remaining in the ventricle as diastole begins is called the __________.
end-systolic volume
The three distinct layers of the heart wall include the
epicardium, myocardium, endocardium
epicardium
external layer of the heart and the inner layer of the pericardium; reduces friction
When threshold is reached at the SA node (an autorhythmic cell), what channels open causing further depolarization of the membrane?
fast calcium channels are responsible for the depolarization phase of the autorhythmic cell action potential. When the fast calcium channels open, calcium rushes into the cell making it less negative (or more positive).
Purkinje fibers
fibers from bundle branches that spread throughout ventricles carry electrical impulses, causing them to contract
If each heart muscle cell contracted at its own individual rate, the condition would resemble
fibrilation
Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.
fills rapidly; compresses
urse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided.
has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.
A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client:
has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. p. 499.
The pacemaker potential (unstable resting membrane potential) in the SA node (an autorhythmic cell) is due to a decreased efflux of what ion?
if there is a decreased efflux of potassium while there is a normal influx of sodium, the inside of the cell would become less negative. Thus, threshold would be reached. The ability of these autorhythmic cells to spontaneously depolarize is what results in the pacemaker potential.
The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:
improving quality of life by relieving symptoms.
in heart failure, the increase in renal secretion of renin is caused by?
increased metabolic demand
progressed to late-stage heart failure is experiencing sympathetic stimulation. The nurse would assess the client for:
increased oxgen demand, vasoocontriction, arrthymias
Increased pressure in the ventricles would close what valve(s)?
increased pressure in the ventricles would close the AV valves.
During exercise the most important mechanism to increase cardiac output is
increased sympathetic activity to the ventricles
Cutting the vagus nerve
increases the heart rate
During ventricular systole, the blood volume in the atria is _______, and the volume in the ventricle is _______
increasing; decreasing
Blood returning to the heart from the pulmonary circuit first enters the __________.
left atrium
The left atrium receives blood from the pulmonary circuit and empties it into the
left ventricle
Distributive shock
loss of blood vessel tone, resulting in expansion of the vascular compartment.
Heart failure can have which of the following consequences?
low cardiac out put, pulmonary congestion, systemic congestion,
An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:
many people live with atrial fibrillation without even knowing they have it.
An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:
many people live with atrial fibrillation without even knowing they have it. Many people live with atrial arrhythmias, including atrial fibrillation, without knowing the arrhythmia exists. Atrial arrhythmias are typically less serious because they do not impact the ability of the ventricles to pump. This client is at high risk to develop atrial fibrillation due to his advanced age; the rates of atrial fibrillation begin to increase over the age of 60 and males have a greater prevalence. It is true that atrial fibrillation is a disorganized rhythm; however it is not ventricular. The client may or may not need anticoagulation; there are other considerations to be made before these medications would be considered
symptoms of ACS (acute coronary syndrome). Select the most important interventions that should be implemented.
morphine, ECG monitoring, Oxygen, nitrates, B-adrenergic blockering agents