Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock

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

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

Septic shock

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

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

A client 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 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."

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

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.

A client admitted with septic shock has a blood pressure of 70/46 mm Hg, pulse 125 bpm, respirations 30 breaths/min, temperature 103°F (39.4°C), and blood glucose 266 mg/dL (14.76 mmol/L). Which intervention prescribed by the health care provider should the nurse implement first?

Administer a fluid bolus of normal saline IV at 500 mL/hr.

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).

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

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

Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is:

Atrial fibrillation

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

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

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

Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes?

Cyanosis

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

Decreased cardiac output

A 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 nurse in a nursing home is concerned that a resident may be developing left-sided heart failure. Manifestations of left-sided heart failure would include which symptom?

Dyspnea, cough

Anaphylactic shock causes severe hypoxia very quickly because of which reason?

Histamine release causes massive vasodilation.

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

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

Increased vascular stiffness

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

Infective endocarditis

In distributive shock, there are abnormalities in vascular resistance. Which types of shock display the same distributive pattern? Select all that apply.

Neurogenic Septic Anaphylactic

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

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 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 with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:

Onset of STEMI

A client with heart failure tells the nurse that he is frustrated and is unable to get "a good night's rest." The client relates that he falls asleep and is suddenly awakened and feels as though he is having a hard time breathing and is suffocating. The nurse recognizes this assessment as:

Paroxysmal nocturnal dyspnea

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 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

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 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

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

Structural heart defects

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 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.

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

A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?

Troponin level

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Vasoconstriction

A 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 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

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)

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

fills rapidly; compresses

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

hypovolemic shock due to acute intravascular volume loss.

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.

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

large lipid core.

A preventive measure to decrease the risk of developing rheumatic heart disease includes:

prompt diagnosis of streptococcal infections with a throat culture.

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.

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:

see the doctor for evaluation immediately.

Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:

ventilation-perfusion mismatch.

Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?

Atherosclerosis and unstable angina

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

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

Fixed coronary obstruction

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

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 is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.

Myocardial infarction prevention

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 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is 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

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

Serum biomarkers ECG pattern

A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply.

Severe bronchospasm Wheezing sound on inspiration Hives over entire body Swelling around the lips and eyes

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 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

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

compensatory mechanisms