Pass Point Cardiovascular system

The nurse evaluates the client's understanding of nutritional modifications to manage hypertension. The nurse knows the teaching was successful when the client makes what statement?

"Limiting my salt intake to 2 grams per day will lower my blood pressure." Explanation: To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Chronic, moderate caffeine intake and fat intake do not affect blood pressure.

ventricular tachycardia

This rhythm is ventricular tachycardia, which is characterized by an absent P wave and a heart rate of 140 to 220 bpm. Ventricular tachycardia requires immediate intervention, usually with

What is the expected outcome of thrombolytic drug therapy for stroke?

dissolved emboli Explanation: Thrombolytic enzyme agents are used for clients with a thrombotic stroke to dissolve emboli, thus reestablishing cerebral perfusion. They do not increase vascular permeability, cause vasoconstriction, or prevent further hemorrhage.

The nurse caring for a client on the cardiac unit notices that the client's cardiac monitor shows ventricular fibrillation. What is the priority action by the nurse?

immediate defibrillation Explanation: When ventricular fibrillation is verified, the first intervention is defibrillation. It is the only intervention that will terminate this lethal dysrhythmia. Digoxin will not help in this situation. An I.V. line will need to be established, but it is not the priority. A pacemaker may be needed, but not until the client is stabilized.

The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity?

potassium level of 2.8 mEq/L Explanation: Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.

Which client is at greatest risk for Buerger's disease?

a 29-year-old male with a 14-year history of cigarette smoking. Explanation: Thromboangiitis obliterans (Buerger's disease) is a nonatherosclerotic, inflammatory vasoocclusive disorder. The disorder occurs predominantly in younger men less than 40 years of age, and there is a very strong relationship with tobacco use. Diagnosis is based on age of onset, history of tobacco use, symptoms, and exclusion of diabete

The nurse is teaching a group of women about risk for varicose veins. Which client is at risk for varicose veins?

a client who has had thrombophlebitis Explanation: Secondary varicosities can result from previous thrombophlebitis of the deep femoral veins, with subsequent valvular incompetence. Cerebrovascular accident, anemia, and transient ischemic attacks are not associated with an increased risk of varicose veins.

When assessing a client with left-sided heart failure, the nurse expects to note

air hunger. Explanation: With left-sided heart failure, the client typically has air hunger and other signs of pulmonary congestion. Ascites, jugular vein distention, and pitting edema of the legs are signs of right-sided heart failure.

A client has been diagnosed with atrial fibrillation. The health care provider prescribed warfarin to be taken on a daily basis. The nurse instructs the client to avoid using which over-the-counter medication while taking warfarin?

aspirin Explanation: Aspirin is an antiplatelet medication. The use of aspirin is contraindicated while taking warfarin because it will potentiate the drug's effects. Diphenhydramine and pseudoephedrine do not affect blood coagulation. Digoxin is not an over-the-counter medication; it requires a prescription.

The nurse is assessing a client with chronic bronchitis. For which finding should the nurse suspect that the client is developing right-sided heart failure?

bilateral edema of the feet and ankles A client with chronic bronchitis, a form of chronic obstructive pulmonary disease (COPD), may experience symptoms that are similar to those of left-sided heart failure, such as dyspnea on exertion. However, without other risk factors, the client with COPD is at risk for right-sided, not left-sided, heart failure. Bilateral edema of the feet and ankles would not occur with chronic bronchitis but is evidence of right-sided heart failure due to the resistance to venous return to the right side of the heart. Bilateral crackles that clear with coughing would occur with chronic bronchitis. Note that pulmonary edema is not expected with right-sided heart failure. Nail clubbing develops in chronic bronchitis because of chronic oxygen deprivation and is not evidence of heart failure.

A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the past several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse address?

blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) can decrease the antihypertensive effect of ACE inhibitors and predispose clients to the development of acute renal failure. Common lab tests used to evaluate how well the kidneys are working are BUN, creatinine, and creatinine clearance. Labs such as sodium, potassium, CPK, and WBC levels will not provide information on renal function.

The nurse observes that an older female has small to moderate, distended and tortuous veins running along the inner aspect of her lower legs. The nurse should:

encourage the client to avoid standing in one position for long periods of time. Explanation: The client has varicose veins, which are evident by the tortuous, distended veins where blood has pooled. To prevent pooling of the blood, the client should not stand in one place for long periods of time.It is not necessary to use compression devices, but the client could wear support hose if she stands for long periods of time . he client can consider cosmetic surgery to remove the distended veins, but there is no indication that the client should contact the health care provider at this point in time. The nurse can inspect the client's feet, but the client is not at risk for ulcers at this time.

A physician orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question?

heparin sodium Explanation: Administering heparin, an anticoagulant, could increase the bleeding associated with hemorrhagic stroke. Therefore, the nurse should question this order to prevent additional hemorrhage in the brain. In a client with hemorrhagic stroke, the physician may use dexamethasone to decrease cerebral edema and pressure; methyldopa, to reduce blood pressure; and phenytoin, to prevent seizures

The plan of care for a client with hypertension taking propranolol hydrochloride should include:

instructing the client to notify the health care provider of irregular or slowed pulse rate. Correct response: instructing the client to notify the health care provider of irregular or slowed pulse rate. Explanation: Propranolol hydrochloride is a beta-adrenergic blocking agent used to treat hypertension. In addition to lowering blood pressure by blocking sympathetic nervous system stimulation, the drug lowers the heart rate. Therefore, the client should be assessed for bradycardia and other arrhythmias. The client needs to be instructed not to discontinue medication because sudden withdrawal of propranolol hydrochloride may cause rebound hypertension. Propranolol dosage is not adjusted based on weekly blood pressure readings. Measurement of partial thromboplastin time values is not a factor in treatment of hypertension.

Which position is best for a client with heart failure who has orthopnea?

sitting upright (high Fowler's position) with legs resting on the mattress Explanation: Sitting almost upright in bed with the feet and legs resting on the mattress decreases venous return to the heart, thus reducing myocardial workload. Also, the sitting position allows maximum space for lung expansion. Low Fowler's position would be used if the client could not tolerate high Fowler's position for some reason. Lying on the right side would not be a good position for the client in heart failure. The client in heart failure would not tolerate Trendelenburg position.

The client with heart failure asks the nurse about the reason for taking enalapril maleate. The nurse should tell the client:

"This drug will dilate your blood vessels and lower your blood pressure." Explanation: Enalapril maleate is an angiotensin-converting enzyme inhibitor that prevents conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and also contributes to aldosterone secretion. Thus, enalapril decreases blood pressure through systemic vasodilation. Enalapril does not cause increased vasoconstriction, which would raise blood pressure. The medication has no effect on myocardial contractility or the heart's conduction system.

A client with sepsis begins having labored breathing, confusion, and lethargy. What complication should the nurse assess for in this client?

Acute respiratory distress syndrome (ARDS) Explanation: ARDS is a complication associated with sepsis. ARDS causes respiratory failure and may lead to death, even after the client has recovered from sepsis. Anaphylaxis is a type of distributive or vasogenic shock. COPD is a functional category of pulmonary disease that consists of persistent obstruction of bronchial air flow and involves chronic bronchitis and chronic emphysema. Mitral valve prolapse is a condition in which the mitral valve is pushed back too far during ventricular contraction.

A client with heart failure has assessment findings of jugular vein distension (JVD) when lying flat in bed. What is the best nursing intervention?

Elevate the head of the bed to 30 to 45 degrees and reassess JVD. Explanation: Jugular vein distension should be measured when the head of the client's bed is at 30 to 45 degrees. The healthcare provider may or may not need to be notified, based on the assessment findings with the head of the bed elevated. Further assessment should be performed, but this further assessment does not include obtaining orthostatic blood pressure readings, since these readings do not affect JVD.

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following?

Left ventricular function Explanation: The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The degree of shock is proportional to the extent of left ventricular dysfunction.

A nurse is caring for a client with frequent episodes of ventricular tachycardia. The lab calls with a critically high magnesium level of 11 mg/dL on this client. What is the nurse's priority action?

Obtain an order for calcium gluconate 2 g I.V. push over 2-5 minutes. Explanation: All the actions listed will reduce the serum magnesium concentration. The calcium gluconate will react the quickest to reduce the critical level.

A client is admitted for a revascularization procedure for arteriosclerosis in the left iliac artery. What should the nurse do to promote circulation in the extremities?

Position the left leg at or below the body's horizontal plane. Explanation: Keeping the involved extremity at or below the body's horizontal plane will facilitate tissue perfusion and prevent tissue damage. The nurse should avoid placing the affected extremity on a hard surface, such as a firm mattress, to avoid pressure ulcers. In addition, the involved extremity should be free from heavy overlying bed linens. The nurse should handle the involved extremity in a gentle fashion to prevent friction or pressure. Raising the leg would cause occlusion to the iliac artery, which is contrary to the goal to promote arterial circulation.

The client has had hypertension for 20 years. The nurse should assess the client for?

Renal insufficiency and failure. Explanation: Renal disease, including renal insufficiency and failure, is a complication of hypertension. Effective treatment of hypertension assists in preventing this complication. Valvular heart disease, endocarditis, and peptic ulcer disease are not complications of hypertension.

A client with Raynaud's phenomenon is considering having a sympathectomy. What information should the nurse give the client about this surgery? A sympathectomy is performed:

when other treatment alternatives have not been effective. Explanation: Sympathectomy is scheduled only after other treatment alternatives have been explored and have failed. Medication and stress management are beneficial strategies to prevent advancement of the disease process. If the disease is controlled by medication, there is no reason for surgery.

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?

elevated ST segment Explanation: Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.

What is a priority nursing assessment in the first 24 hours after admission of the client with a thrombotic stroke?

pupil size and pupillary response Explanation: It is crucial to monitor the pupil size and pupillary response to indicate changes around the cranial nerves. The cholesterol level is not a priority assessment, although it may be an assessment to be addressed for long-term healthy lifestyle rehabilitation. Bowel sounds need to be assessed because an ileus or constipation can develop, but this is not a priority in the first 24 hours, when the primary concerns are cerebral hemorrhage and increased intracranial pressure. An echocardiogram is not needed for the client with a thrombotic stroke without heart problems.

A client is scheduled for a treadmill stress test. Prior to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated laboratory value to the health care provider (HCP) prior to the stress test?

troponin level Explanation: The elevated troponin level should be reported to the HCP prior to the stress test as this change indicates myocardial damage. Sending the client to walk on a treadmill for stress testing would be contraindicated with evidence of recent myocardial injury and could further extend the damage. The other blood levels are helpful but not critical to this client's welfare at this point in time.

A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by the nurse best explains the procedure to the client?

"PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter." Explanation: PTCA is best described as insertion of a balloon-tipped catheter into the coronary artery to compress a plaque, thereby opening a stenosed or blocked artery. Cutting away blockages with a special catheter is an atherectomy. Passing a catheter through the coronary arteries to find blocked arteries is a cardiac catheterization. Inserting grafts to divert blood from blocked arteries describes coronary artery bypass graft surgery.

A client is about to undergo cardiac catheterization for which informed consent was obtained. As the nurse enters the room to administer sedation for the procedure, the client states, "I'm really worried about having this open heart surgery." Based on this statement, how should the nurse proceed?

Withhold the medication and notify the physician immediately. Explanation: The nurse should withhold the medication and notify the physician that the client does not understand the procedure. The physician then has the obligation to explain the procedure better to the client and determine whether or not the client understands. If the client does not understand, there cannot be a true informed consent. If the medication is administered before the physician explains the procedure, the sedation may interfere with the client's ability to clearly understand the procedure. The nurse may not just medicate the client and document the finding; the physician must be notified. The procedure does not need to be cancelled, only postponed until the client receives more education and is able to give informed consent.

A child with heart disease starts on oral digoxin. When preparing to administer the medication, what should the nurse do first?

Check the last serum electrolyte results for the child. Explanation: It is most important to know the child's serum potassium level when administering digoxin. Digoxin increases contractility of the heart and increases renal perfusion, resulting in a diuretic effect with increased loss of potassium and sodium. Hypokalemia increases the risk of digoxin toxicity. Verifying the dosage is specified by facility policy and varies among facilities. Although the child may take the medication better from the mother than from the nurse, asking the mother to give the medication is not necessary. In addition, this would be done after the nurse has checked the electrolyte levels. Teaching the parent how to measure the child's heart rate can be done at any time, not necessarily when preparing to give digoxin.

When monitoring a client who is receiving tissue plasminogen activator (t-PA), the nurse should assess the client for which changes?

cardiac arrhythmias Explanation: Cardiac arrhythmias are commonly observed with administration of t-PA. Cardiac arrhythmias are associated with reperfusion of the cardiac tissue. Hypotension is commonly observed with administration of t-PA. Seizures and hypothermia are not generally associated with reperfusion of the cardiac tissue.

The nurse is assessing a client with an atrial septal defect (ASD). Which finding requires immediate nursing intervention?

client having an uneven smile and facial droop Explanation: A fixed S2 split is the hallmark of ASD. The neurologic finding of a facial droop could indicate embolization and stroke; the nurse should notify the healthcare provider immediately. If the client has missed a medication, the nurse should measure the vital signs and administer the medication as soon as possible; however, symptoms of stroke are the priority. The nurse should further assess tachycardia to determine the underlying cause, such as pain or fever, before intervening.

When the nurse is assessing an individual with peripheral artery disease, which clinical manifestation would indicate complete arterial obstruction in the lower left leg?

coldness of the left foot and ankle Explanation: Coldness in the left foot and ankle is consistent with complete arterial obstruction. Other expected findings would include paralysis and pallor. Aching pain, a burning sensation, or numbness and tingling are earlier signs of tissue hypoxia and ischemia and are commonly associated with incomplete obstruction.

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide?

"Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." Explanation: Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 3 to 6 months, not every 9 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina and may repeat the dose every 5 minutes for up to three doses; if this intervention doesn't bring relief, the client should seek immediate medical attention.

During a home visit, the nurse assesses a client who is taking hydrochlorothiazide and lisinopril for the treatment of hypertension. Which finding would indicate the nurse should inform the health care provider of a possible need to change medication therapy?

Client has a persistent cough. Explanation: A persistent cough is a side effect of the ACE inhibitor that may warrant a change to another antihypertensive medication. BP and potassium are within normal limits. The nurse assesses when the drug is taken and changes to an earlier time of administration.

An older adult is admitted to the hospital with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for:

digoxin toxicity. Explanation: Nausea and vomiting, along with hypokalemia, are likely indicators of digoxin toxicity. Hypokalemia is a common cause of digoxin toxicity; therefore, serum potassium levels should be carefully monitored if the client is taking digoxin. The earliest clinical signs of digoxin toxicity are anorexia, nausea, and vomiting. Bradycardia, other dysrhythmias, and visual disturbances are also common signs. Chronic renal failure usually causes hyperkalemia. With persistent vomiting, the client is more likely to develop metabolic alkalosis than metabolic acidosis.

A client is taking spironolactone to control hypertension. The client's serum potassium level is [6 mEq/L (56mmol/L)]. For this client, the nurse's priority should be to assess their

electrocardiogram (ECG) results. Explanation: Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.

A nurse is teaching a client with hypertension about the newly prescribed captopril. Which statements indicate that teaching has been successful? Select all that apply.

"I will contact the doctor if I notice any swelling around my lips." "I will take acetaminophen for headaches." "I will have to have my white blood cells and potassium levels drawn." "This medicine may cause a frequent dry cough; if it occurs, I will call the doctor." Explanation: Captopril requires monitoring the WBC count before therapy and every 2 weeks for first 3 months. The client should notify the healthcare provider if a fever, sore throat, leukopenia, or tachycardia develops. When ACE inhibitors are used with K+ sparing diuretics, K+ supplements, or salt substitutes, hyperkalemia can occur. NSAIDs decrease the effect and may alter renal function. Food decreases absorption. Angioedema is an indication that the ACE inhibitor should be discontinued.

An older client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the health care provider (HCP) has written which prescription for taking the metformin before the procedure?

Withhold the metformin. Explanation: The nurse should verify that the HCP has requested to withhold the metformin prior to any procedure requiring dye such as a cardiac catheterization due to the increased risk of lactic acidosis. Additionally, the drug will usually be withheld for up to 48 hours following a procedure involving dye while it clears the client's system. The HCP may prescribe sliding scale insulin during this time if needed. Regardless of how or when the medication is administered, the medication should be withheld. The amount of protein in the client's diet prior to the cardiac catheterization has no correlation with the medication or the test.

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of

acute pulmonary edema. Explanation: Shortness of breath, agitation, and pink-tinged, foamy sputum signal acute pulmonary edema. This condition results when decreased contractility and increased fluid volume and pressure in clients with heart failure drive fluid from the pulmonary capillary beds into the alveoli. In right-sided heart failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client would have a temperature spike and sputum that varies in color. Cardiogenic shock is indicated by signs of hypotension and tachycardia.

Which cardiac dysrhythmia is Jonathan most likely experiencing?Sinus tachycardia.Sinus tachycardia is distinguished by a heart rate greater than 100 beats per minute, a regular rhythm present, and P waves.Atrial fibrillation.Atrial fibrillation commonly occurs in heart failure. Multiple areas in the atria initiate rapid, irregular electrical stimuli, which results in the inability to see clear P waves on the ECG recording. Some, but not all, of these electrical impulses travel through the AV node, causing an irregular ventricular response. This appears as irregular QRS complexes on the ECG recording and manifests as an irregular pulse rhythm when assessing the client. Ventricular fibrillation.Ventricular fibrillation is distinguished by totally chaotic electrical activity on the ECG recording, with no discernible P waves or QRS complexes (ventricular response). In addition, the client would not be arousable and would lack a pulse. This fatal dysrhythmia requires immediate defibrillation and CPR.Asystole.Asystole is distinguished by a flat line (no electrical activity of any kind) on the ECG recording. In addition, the client would not be arousable and would lack a pulse. This fatal dysrhythmia requires immediate CPR. Previous Section

Which cardiac dysrhythmia is Jonathan most likely experiencing?Sinus tachycardia.Sinus tachycardia is distinguished by a heart rate greater than 100 beats per minute, a regular rhythm present, and P waves.Atrial fibrillation.Atrial fibrillation commonly occurs in heart failure. Multiple areas in the atria initiate rapid, irregular electrical stimuli, which results in the inability to see clear P waves on the ECG recording. Some, but not all, of these electrical impulses travel through the AV node, causing an irregular ventricular response. This appears as irregular QRS complexes on the ECG recording and manifests as an irregular pulse rhythm when assessing the client. Ventricular fibrillation.Ventricular fibrillation is distinguished by totally chaotic electrical activity on the ECG recording, with no discernible P waves or QRS complexes (ventricular response). In addition, the client would not be arousable and would lack a pulse. This fatal dysrhythmia requires immediate defibrillation and CPR.Asystole.Asystole is distinguished by a flat line (no electrical activity of any kind) on the ECG recording. In addition, the client would not be arousable and would lack a pulse. This fatal dysrhythmia requires immediate CPR.

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize?

Lie down or sit in a chair for 5 to 10 minutes after taking the drug. Explanation: Nitrates act primarily to relax coronary smooth muscle and produce vasodilation. They can cause hypotension, which makes the client dizzy and weak. The nurse should instruct the client to lie down or sit in a chair for 5 to 10 minutes after taking the drug. Nitrates are taken at the first sign of chest pain and before activities that might induce chest pain. Sublingual nitroglycerin is taken every 5 minutes for three doses. If the pain persists, the client should seek medical assistance immediately. Nitrates must be stored in a dark place in a closed container because sunlight causes the medication to lose its effectiveness. Alcohol is prohibited because nitrates may enhance the effects of the alcohol.

A client in the intensive care unit (ICU) is on a dobutamine drip. During an assessment the client states, "I was feeling better but now my chest is tight and I feel like my heart is skipping." Physical assessment reveals a heart rate of 110 beats per minute and blood pressure of 160/98 mm Hg. What is the nurse's immediate concern for this client?

The dobutamine may need to be decreased. Explanation: Dobutamine is a vasoactive adrenergic that works by increasing myocardial contractility and stroke volume in order to increase the cardiac output in heart failure clients. A serious side effect of adrenergic drugs is the worsening of a preexisting cardiac disorder. Increasing the dosage of the drug will worsen the problem. The client does not show symptoms of allergic reaction or heart failure.

The nurse is assessing a client with chronic heart failure who is demonstrating neurohormonal compensatory mechanisms. Which are expected findings on assessment? Select all that apply.

decreased cardiac output increased heart rate vasoconstriction in skin, GI tract, and kidneys fluid overload Explanation: Heart failure can be a result of several cardiovascular conditions, which will affect the heart's ability to pump effectively. The body attempts to compensate through several neurohormonal mechanisms. Decreased cardiac output stimulates the aortic and carotid baroreceptors, which activates the sympathetic nervous system to release norepinephrine and epinephrine. This early response increases the heart rate and contractility. It also has some negative effects, including vasoconstriction of the skin, GI tract, and kidneys. Decreased renal perfusion (due to low CO and vasoconstriction) activates the renin-angiotensin-aldosterone process resulting in the release of antidiuretic hormone. This causes fluid retention in an attempt to increase blood pressure, and therefore cardiac output. In the damaged heart, this causes fluid overload. There is no parasympathetic response. Decreased pulmonary perfusion can be a result of fluid overload or concomitant pulmonary disease.