Patho Exam 3
A client from Texas is suspected of being infected with coccidioidomycosis and has been admitted to the hospital with fever, cough, pleuritic chest pain, and skin lesions. When performing a health history, which question would be most valuable to assist with diagnosis?
"Do you work in construction and dig soil?" Explanation: The disease resembles tuberculosis, and its mechanisms of infection are similar to those of histoplasmosis. It is most prevalent in the deserts in southwestern United States, principally in parts of California, Arizona, Nevada, New Mexico, and Texas. The C. immitis and C. posadasii organisms live in soil and can establish new sites in the soil. Events such as dust storms and digging for construction have been associated with increased incidence of the disease.
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."
What should the nurse teach the client prior to ergometry?
"This test evaluates cardiac function."
Cardiogenic shock, septic shock, and hypovolemic shock; what causes each, what are the signs and symptoms of each, and what is the treatment for each?
(See Chart 27.4 in text) Cardiogenic shock - Any condition in which the arterial pressure is reduced to such an extent that if continued, the function of organs is impaired. The heart suddenly can't pump enough blood to meet the body's needs. Results: Hypoperfusion of organs and tissues, an insufficient supply of O2 and nutrients for cellular function. Causes: heart attack, high BP, cardiomyopathy. Some kind of underlying heart problem. Signs & symptoms: Low BP, Cyanosis due to stagnant blood flow and low O2, low urine output, confusion, loss of consciousness. Treatment: Balancing act between improving cardiac output but not too much fluid and strength of stroke volume (Pump) due to fragility of the heart vessels. Vasodilators, nitroglycerin, diuretics, insertion of aortic balloon pump to open up aorta After treatment of first priority (shock), then treatment of underlying problem cause.
*Virchow's triad; know what it is and what the three components are
*Virchow's triad; know what it is and what the three components are = 3 factors that are critically important in the development of venous thrombosis... 1. Stasis of blood 2. Increased blood coagulability 3. Vessel wall injury
STEMI
-ST elevation MI, real-time ongoing death of heart tissue due to ischemia. -MI (STEMI) Normal EKG then, depression to start. Eventually the ST segment goes way up. T wave is inverted (repolarization of ventricles)
The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion?
140 mm Hg or higher
Respiratory assessments including pulse oximetry use
?
The effects of acute head injury on respiratory drive and respirations
?
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.
thoracentesis
A procedure to remove fluid or air from around the lungs. Needle is put through chest wall into pleural space
ventricular tachycardia V-TACH
A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest.
A client recovered from influenza 2 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
Acute lung injury (as can be seen with early COVID), clinical manifestations
Acute lung injury (as can be seen with early COVID), clinical manifestations → Most often called ARDS (Acute Respiratory Distress Syndrome) Life-threatening emergency! Lung injury that allows fluid to leak into the lungs → Leads to ARDS Typically secondary to other severe traumas, big surgeries, in acutely ill and hospitalized patients Manifestations: Rapid onset of profound dyspnea 12-48 hours after the event, lungs fill up with fluid, O2 cannot get to the tissues (impaired gas exchange). Get very sick very fast → high mortality rate. Hard to treat because... how do you get fluid out of alveoli? Put on a ventilator with high pressure to drive out fluid
A client diagnosed with the common cold has been taking an over-the-counter antihistamine for the control of symptoms. What should the client be aware may occur if the drugs are used too frequently over too many days?
Antihistamines are popular OTC drugs because of their action in drying nasal secretions. However, they may dry up bronchial secretions and worsen the cough, and they may cause dizziness, drowsiness, and impaired judgement. If these drugs are used too frequently over too many days, they can cause rebound symptoms
The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be:
Antipyretic medications and rest Explanation: The common cold virus does not respond to antibiotics and should be treated with antipyretic medications and rest. Bed rest is recommended, but complete isolation is not required.
Aortic aneurysm rupture or dissection; signs and symptoms, treatment
Aortic aneurysm rupture or dissection; signs and symptoms, treatment Definition - Acute, life-threatening condition. Hemorrhage into vessel wall with longitudinal tearing (dissection) of vessel wall to form a blood-filled channel. Signs & symptoms - Usually in aorta, **severe back pain, change in mental status, loss of consciousness, weak pulse/decreasing BP Treatment - Surgery (graft/resection, bypass), beta blocker & antihypertensive medications, analgesics, statins, fluids, changes to lifestyle (diet, exercise as tolerated after surgery)
The nurse in the emergency department is assessing a toddler suspected of epiglottitis. Which intervention is considered the priority when working with this client?
Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed.
Atherosclerosis; what causes it; what gender is most susceptible; what role does age play; what role do hypertension and hypercholesterolemia play?
Atherosclerosis; what causes it; what gender is most susceptible; what role does age play; what role do hypertension and hypercholesterolemia play? Definition - Disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls. Can lead to ischemic heart disease, stroke, thrombosis & emboli, aneurysm. Causes - Major risk factors are hypercholesterolemia and inflammation, cigarette smoking, hypertension. Gender most susceptible - More common in men Age - As we age, increased vascular stiffness. Reduced responsiveness to beta-adrenergic stimulation (limits heart's capacity to increase HR), left ventricular hypertrophy, general wearing out of vessel walls + buildup of plaque from years of dietary/lifestyle choices Hypertension/hypercholesterolemia - High blood pressure and cholesterol levels can contribute to heart attack, stroke, other cardiovascular events associated with atherosclerosis. High BP - blood is moving very fast through narrowed arteries (plaque build-up), high risk of embolism High cholesterol - High levels of LDL cholesterol circulating in the blood contribute to the buildup of plaque LDL → bad, HDL → beneficial
Which clients are at greatest risk of developing an occupational lung disease? Select all that apply
Bricklayer Coal miner Slate industry worker Flour miller
C-Reactive Protein (CRP); when is it monitored; what does it mean if it is elevated?
C-Reactive Protein (CRP); when is it monitored; what does it mean if it is elevated? Definition - Made by the liver, released in blood when inflammation is present in the body. Referred to as acute phase reactant because body releases it a few hours after injury, infection, or other inflammation. When is it monitored? After heart attack to monitor status. Also to detect inflammation in the body, confirm other diagnoses. What does it mean if it's elevated? Can mean infection, heart attack, rheumatoid arthritis (autoimmune), pancreatitis, happens with pregnancy or certain contraceptives
Bronchial asthma, pathophysiology
Causes: Genetic, Environmental (viruses, allergens, occupational exposure), Childhood vs Adult (adult usually more severe), Concurrently with a second disease (like COPD) Pathophysiology:
Childhood asthma, causes, signs and symptoms, first line treatments
Childhood asthma, causes, signs and symptoms, first line treatments Causes - Signs & symptoms - First-line treatments -
Chronic bronchitis, cause, clinical manifestations, pathophysiology
Chronic bronchitis, cause, clinical manifestations, pathophysiology Definition: Chronic inflammation of the bronchioles, form of chronic obstructive pulmonary disease (COPD) Cause: Smoking history (primary cause), chronic inhalation of other pollutants, possible genetic predisposition, gastric reflux Manifestations: 'blue bloater' can have syanosis. hypertension and eventually right sided heat failure aka cor pulmonly ...Barrel chest, dyspnea (shortness of breath), tachypnea, rhonchi (wheezing), sputum, hypercapnia (too much CO2), hypoxemia (low O2), polycythemia (thick blood because the body sends message to bone marrow that we need more O2 - makes more RBCs). Cor pulmonale later manifestation. How it works (pathophysiology): Hypertrophy/hyperplasia of bronchioles, ciliary damage, chronic inflammation of walls. Airway narrows & mucus within the airway creates resistance.
A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be:
Constriction of the pulmonary vessels in response to hypoxemia
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic 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.
Cor Pulmonale
Cor Pulmonale Definition: Right-sided heart failure caused by a disorder of the respiratory system Cause: Almost always associated with several different lung diseases (COPD, pulmonary hypertension). If congestion happens in the lung, fluid backs up, R side of heart has to pump harder and harder to get blood through the lungs, heart hypertrophies, doesn't work as well. Fairly unusual.
A nurse is caring for a client with an average heart rate of 56 beats/min. The client has no adverse symptoms associated with this heart rate and is receiving no treatment. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?
Correct response: "Avoid bearing down while having a bowel movement." Explanation: 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.
An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis?
Correct response: "Do you tend to have a cough even when you don't feel sick?" Explanation: A clinical diagnosis of chronic bronchitis requires the history of a chronic productive cough for at least 3 consecutive months over 2 consecutive years. This is not noted to be a strong genetic component of the disease, and childhood RSV is not a risk factor. Immunization status is normally linked to the development of bronchitis.
During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy that she had to be admitted to the hospital. Which statement should the nurse include in the response to this expectant mother?
Correct response: "Essentially, experts don't really know why so many pregnant women develop high blood pressure." Explanation: The root causes of pregnancy-induced hypertension are not known. It is pathological rather than normal, however, and it cannot necessarily be avoided by lifestyle modification. It can be pernicious to both the mother and the fetus.
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?
Correct response: "I'm trying to think of ways that I can cut down the amount of salt that I usually eat." Explanation: Salt and fluid restrictions are indicated for most clients with heart failure (HF). Beta-blockers do not address shortness of breath, and cardiac medications are not normally taken in response to acute symptoms. Clients should be encouraged to maintain—and increase, if possible—physical activity within the limits of their condition.
The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion?
Correct response: 140 mm Hg or higher Explanation: Classification of blood pressure in adults defines a systolic pressure of 140 mm Hg or higher as stage 2 hypertension. Stage 1 hypertension has a systolic pressure between 130 and 139 mm Hg. Systolic blood pressure between 120 and 129 mm Hg is classified as elevated and 119 mm Hg or lower is classified as normal.
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?
Correct response: Activation of the renin-angiotensin-aldosterone mechanism Explanation: 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.
The practitioner's assessment of a client reveals a left leg that has no pedal pulses and is pale from the knee down. The client states that "the pain in my foot started suddenly and is severe." The practitioner suspects which condition?
Correct response: Acute arterial occlusion Explanation: Acute arterial occlusion in an extremity causes sudden onset of acute pain with numbness, tingling, weakness, pallor and coldness. Pulses are absent below the level of the occlusion. Intermittent claudication (or pain with walking) is the primary symptom of chronic obstructive arterial disease (sometimes referred to as arteriosclerosis obliterans). Many people with venous thrombosis are asymptomatic. While they can have pain, they do not lose pulses in the extremity.
A client has been diagnosed with atrial flutter. Which assessment finding correlates with this diagnosis?
Correct response: An atrial heart rate above 240 beats/min Explanation: Atrial flutter is a rapid, atrial, ectopic tachycardia and has an atrial rate from 240 to 450 beats/min. The ventricular rate would not be expected to be as high as 240 beats/min but would be variable, and the blood pressure would not be expected to increase.
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?
Correct response: Anaphylactic Explanation: Signs and symptoms associated with impending anaphylactic shock include abdominal cramps; apprehension; warm or burning sensation of the skin; itching; urticaria (i.e., hives); coughing; choking; wheezing; chest tightness; and difficulty in breathing. The other types of shock do not have these clinical manifestations.
Paroxysmal supraventricular tachycardia arises from which form of reentry?
Correct response: Atrioventricular (AV) nodal Explanation: Paroxysmal supraventricular tachycardia refers to tachydysrhythmias that originate above the bifurcation of the bundle of His and have a sudden onset and termination. It may be the result of AV nodal reentry. The other options are not responsible for paroxysmal supraventricular tachycardia.
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?
Correct response: Backflow from the left ventricle to left atrium Explanation: The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility.
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.
Correct response: Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Explanation: 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.
The nurse is caring for a client who suffered a massive myocardial infarction and is scheduled for an immediate permanent pacemaker insertion due to severe ischemia and damage to both SA and AV nodes. The nurse would expect which of the following?
Correct response: Bradycardia with rate of 20-40 Explanation: Lack of oxygen supply and damage to both the SA and AV nodes will interrupt the ability of either to pace the heart. The basic physiology of the cardiac conduction system is "the cell(s) that paces the fastest will pace the heart" and with dysfunction of both SA and AV nodes, the Purkinje system will take over with a rate between 15 and 40 times per minute.
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?
Correct response: Cardiomyopathy Explanation: Cardiomyopathies result from genetic and/or environmental factors and will result in heart failure. MI and rheumatic diseases may lead to heart failure, but the mechanism is different.
The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?
Correct response: Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation Explanation: Coronary artery bypass grafting (CABG) may be the treatment of choice for people with significant coronary artery disease who do not respond to medical treatment and who are not suitable candidates for percutaneous coronary intervention (PCI). It is also indicated in situations such as failed PCI with persistent pain or hemodynamic instability. CABG does not correct valve disorders, pericardial effusion, or cardiomyopathies.
For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve?
Correct response: Compensatory mechanisms Explanation: The pathophysiology of heart failure involves a decrease in pumping ability of the heart with a consequent decrease in the cardiac output, and activation of compensatory mechanisms that attempt to maintain cardiac output but also contribute to the progression of heart failure. Stimulation of the sympathetic nervous system plays an important role in the compensatory mechanisms and the pathogenesis of heart failure. Heart failure is a muscle contractility problem, unrelated to the electrical conduction that stimulates it.
What should the nurse teach the pregnant woman about congenital heart defects?
Correct response: Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant. Explanation: Congenital heart defects occur during the 3rd week as the heart is the first functional organ system to develop. This may be before a woman realizes she is pregnant. Congenital heart defects can, to some degree, be prevented. They do not occur prior to conception or during conception, but during the growth of the fetus.
The nurse is educating a client diagnosed with pre-hypertension about reducing modifiable risk factors. Which risk factors will the nurse address? Select all that apply.
Correct response: Decreasing salt intake Decreasing alcohol consumption. Increasing dietary potassium Explanation: 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.
A client's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The client is unconscious and without a pulse. Which priority intervention should the nurse take?
Correct response: Defibrillate the client Explanation: Immediate defibrillation using a nonsynchronized, direct-current electrical shock is mandatory for ventricular fibrillation and for ventricular flutter that has caused loss of consciousness.
A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?
Correct response: Echocardiogram Explanation: Most acute arterial occlusions are the result of an embolus or thrombus. Most emboli arise in the heart and are caused by conditions (such as atrial fibrillation) that cause blood clots to develop on the wall of a heart chamber or valve surface. An echocardiogram looks at the structure of the heart. The other tests do not demonstrate blood clots in the heart.
The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?
Correct response: Elevated total cholesterol Explanation: Elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels are associated with dyslipidemia. All the other answers are normal findings.
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?
Correct response: Elevation of triglycerides Explanation: In diabetes mellitus and the metabolic syndrome, typical dyslipidemia is seen with elevation of triglycerides, low HDL, and minimal or modest elevation of LDL. High calorie intake and diabetes mellitus increase the production of VLDL.
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?
Correct response: Have the client sit up and lean forward. Explanation: With acute pericarditis, 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.
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?
Correct response: Hypercholesterolemia Explanation: The cause or causes of atherosclerosis have not been determined with certainty. However, epidemiologic studies have identified predisposing risk factors, which include a major risk factor of hypercholesterolemia. Other risk factors include increasing age, family history of premature coronary heart disease, and male sex.
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?
Correct response: Hypertrophic cardiomyopathy Explanation: HCM is an autosomal dominant heart disease caused by mutations in the genes encoding proteins of the cardiac sarcomere. HCM is the most common cause of sudden cardiac death (SCD) in young athletes. Dilated cardiomyopathy, mitral valve prolapse, and atrial regurgitation all lead to heart failure but much later in life.
The nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. The client suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. What is a priority intervention at this time?
Correct response: Immediate defibrillation Explanation: The classic electrocardiographic pattern of ventricular fibrillation is that of gross distortion without identifiable waveforms or intervals. When the ventricles do not contract, there is no cardiac output, and there are no palpable or audible pulses. Immediate defibrillation using a nonsynchronized, direct-current electrical shock is mandatory for ventricular fibrillation and for ventricular flutter that has caused loss of consciousness.
A nurse is monitoring a client with a resting heart rate of 120 beats/min who has been diagnosed with sinus tachycardia, which can result from a change in which characteristic of cardiac cells?
Correct response: Increased automaticity Explanation: 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.
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?
Correct response: Infective endocarditis Explanation: 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
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?
Correct response: Inherent spontaneous action-potential Explanation: 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 client is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which action is important for the nurse to tell the client to ensure accuracy in correlating dysrhythmias with symptoms?
Correct response: It is important to keep a diary of activities and symptoms. Explanation: Holter monitoring is one form of long-term monitoring during which a person wears a device that digitally records two or three electrocardiographic (ECG) leads for up to 48 hours. During this time, the person keeps a diary of his or her activities or symptoms, which are later correlated with the ECG recording. The client should have no sensation of pins and needles, and although the monitor will detect dysrhythmias, it will not defibrillate the client.
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?
Correct response: Laryngeal edema Explanation: Anaphylaxis is a clinical syndrome that represents the most severe form of systemic allergic reaction. Anaphylactic shock results from an immunologically mediated reaction in which vasodilator substances such as histamine are released into the blood. The vascular response in anaphylaxis is often accompanied by life-threatening laryngeal edema and bronchospasm, circulatory collapse, contraction of gastrointestinal and uterine smooth muscle, and urticaria (hives) or angioedema.
Which diagnostic/assessment findings would be seen in a client with worsening mitral valve stenosis? Select all that apply.
Correct response: Low-pitched diastolic murmur that is increasing in duration Sharp elevation in left atrial pressure Decreased cardiac output Explanation: The increased left atrial pressure eventually is transmitted to the pulmonary venous system, causing pulmonary congestion. A characteristic auscultatory finding in mitral stenosis is an opening snap following the second heart sound, which is caused by the stiff mitral valve. As the stenosis worsens, there is a localized, low-pitched diastolic murmur that increases in duration with the severity of the stenosis. Manifestations are related to the elevation in left atrial pressure and pulmonary congestion such as dyspnea with exertion, decreased cardiac output owing to impaired left ventricular filling, and left atrial enlargement with the development of atrial dysrhythmias and mural thrombi. Severe elevation in left ventricular end-diastolic pressure and left ventricle increases its stroke volume occur with aortic regurgitation.
A motor vehicle accident has resulted in the driver hitting the steering wheel with subsequent fractures of the chest, sternum, and some ribs. Which manifestations would lead the nursing staff to suspect the driver has developed a tension pneumothorax? Select all that apply.
Correct response: Mediastinal shift of the trachea toward one side Subcutaneous emphysema palpated in the upper chest/neck region Explanation: With tension pneumothorax, the structures in the mediastinal space shift toward the opposite side of the chest. There may be distention of the neck veins, subcutaneous emphysema (i.e., presence of air in the subcutaneous tissues of the chest and neck), and clinical signs of shock. Pneumothoraces do not typically cause a friction rub or dysrhythmias. Marked peripheral edema is associated with right-sided heart failure.
Sick sinus syndrome is suspected in the case of a child who is postoperative following cardiac surgery. Which nursing action is most appropriate?
Correct response: Monitor the child's ECG for bradycardia. Explanation: The simple ECG would be enough to give a preliminary diagnosis of sick sinus syndrome, which typically reveals persistent sinus bradycardia. The stress test would be used to determine if the cause was neurologic or muscular in origin. The disease is not self-limiting and would not be revealed by echocardiogram.
In distributive shock, there are abnormalities in vascular resistance. Which types of shock display the same distributive pattern? Select all that apply
Correct response: Neurogenic Septic Anaphylactic Explanation: In distributive shock, the capacity of the vascular compartment is greatly enlarged so that a normal blood volume becomes insufficient. In neurogenic shock, loss of sympathetic (adrenergic) control of blood vessels is lost and extreme vasodilation occurs. In anaphylactic shock, a severe allergic reaction, massive release of histamine induces extreme vasodilation. In septic shock, a response to severe infection, there is vascular dilation. Cardiogenic shock is a loss of ventricular contractility. Hypovolemic shock is a loss of blood volume.
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:
Correct response: Onset of STEMI Explanation: 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.
Considering the PQRST complex of an electrocardiogram (ECG), which letter designation represents atrial depolarization?
Correct response: P wave Explanation: The P wave represents the sinoatrial node and atrial depolarization; the QRS complex depicts ventricular depolarization, and the T wave represents repolarization.
Which of the following are characteristic signs of acute arterial embolism?
Correct response: Pallor, pulselessness, and pain Explanation: The presentation of acute arterial embolism is often described as that of the seven Ps: pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.
A monitored hospitalized client 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 form of AF is this?
Correct response: Paroxysmal Explanation: 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 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 dysrhythmias.
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?
Correct response: Peripheral edema, weight gain Explanation: In right-sided heart failure, blood backs up into the venous side of the circulatory system causing increased hydrostatic pressure in capillaries and leakage of plasma, which forms peripheral edema and becomes apparent as weight gain. The other manifestations listed are not characteristic of right-sided failure.
The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?
Correct response: QRS complex Explanation: 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 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?
Correct response: Raising the head of the bed to a high Fowler's position Explanation: Treatment measures include close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion; and the administration of oxygen, antihistamine drugs, and corticosteroids. The person should be placed in a supine position. This is extremely important because venous return can be severely compromised in the sitting position. This in turn produces a pulseless mechanical contraction of the heart and predisposes to arrhythmias. In several cases, death has occurred immediately after assuming the sitting position.
A client arrives in the ED after an automobile accident. Which clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply.
Correct response: Respiratory rate 34. Asymmetrical chest movements, especially on inspiration Diminished breath sounds over painful chest area Explanation: Manifestations of pneumothorax include increased respiratory rate, dyspnea, asymmetrical movements of chest wall (especially during inspiration), hyperresonant sound on percussion, and decreased or absent breath sounds over area of pneumothorax. The pulse oximetry reading is normal. ABG pH level of 7.38 is a normal finding.
What is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
Correct response: SA node - AV node - bundle of His - bundle branches - Purkinje fibers
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?
Correct response: Septic Explanation: Septic shock can result with the body's response to a severe infection. Neurogenic shock is a loss of sympathetic (adrenergic) control of systemic blood vessel tone. Cardiogenic shock is a loss of cardiac efficiency, and anaphylactic shock is a severe allergic reaction.
Which of the following is called the pacemaker of the heart?
Correct response: Sinoatrial (SA) node Explanation: The specialized excitatory and conduction system of the heart consists of the SA node, in which the normal rhythmic impulse is generated. The heart essentially has two conduction systems: one that controls atrial activity and one that controls ventricular activity. Atrial conduction begins with the SA node, which has the fastest intrinsic rate of firing (60 to 100 beats/minute), normally serving as the pacemaker of the heart. It is a spindle-shaped strip of specialized muscle tissue, about 10 to 20 mm long and 2 to 3 mm wide, located in the posterior wall of the right atrium just below the opening of the superior vena cava and less than 1 mm from the epicardial surface.
A client is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F (38.3°C) 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 second preceding each QRS complex. What does the nurse determine the rhythm to be?
Correct response: Sinus tachycardia Explanation: 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, and anxiety.
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:
Correct response: Sympathetic nervous system Explanation: 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.
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?
Correct response: The client just smoked a cigarette. Explanation: People should be seated when blood pressure is taken, and should not have ingested caffeine or have smoked 30 minutes before the measurement.
The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?
Correct response: The client must protect the entire body from cold, not just the extremities. Explanation: Treatment measures are directed toward eliminating factors that cause vasospasm. Abstinence from smoking and protection from cold are priorities. The entire body must be protected from cold, not just the extremities. Avoidance of stress and anxiety is another important factor, as they may precipitate vascular spasm in predisposed people. Vasoconstrictor medications, such as decongestants, should be avoided. Treatment with vasodilator drugs may be indicated.
Which client will the nurse assess first?
Correct response: The client with premature ventricular contractions Explanation: The nurse should first assess the client with premature ventricular contractions, as ventricular dysrhythmias are most often life-threatening. The other rhythms are not placing the clients in immediate danger.
Which most important complication of atherosclerosis can result in occlusion of small heart vessels?
Correct response: Thrombosis Explanation: Thrombus formations on complicated atherosclerotic lesions are the result of sluggish blood flow and turbulence in the ulcerated plaque region. Fatty streaks are preatherosclerotic plaque changes in vessels. Fibrous plaque is part of the atherosclerosis formation, not a complication of it.
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?
Correct response: Transcutaneous Explanation: The type of pacing described is transcutaneous because it is the only form that is accessible externally.
Which serum biomarker is highly specific for myocardial tissue?
Correct response: Troponin Explanation: 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 myocardial 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?
Correct response: Troponin assays Explanation: The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction. Creatine kinase is an intracellular enzyme found in muscle cells. The troponin level identifies necrosis in cardiac muscles earlier than creatine kinase. The others are not necessarily used when suspecting a myocardial infarction.
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:
Correct response: Unknown Explanation: 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.
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?
Correct response: Valvular defects usually are detected through cardiac auscultation. Explanation: Although valvular heart disease can result from congenital defects, rheumatic heart disease, trauma and other causes, atrial stenosis is usually first diagnosed with auscultation of a loud systolic murmur or a single-split second heart sound. Other tests are not used initially.
Which dysrhythmia is considered to be the most fatal and requires immediate treatment?
Correct response: Ventricular fibrillation Explanation: Ventricular fibrillation represents severe derangements of cardiac rhythms that terminate fatally within minutes unless corrective measures are taken promptly. All of the other dysrhythmias need to have further investigation into etiology, but are not immediately fatal.
A client presents with uncharacteristic chest pain, and his ECG reveals T-wave elevation. This finding suggests an abnormality with which aspect of the cardiac cycle?
Correct response: Ventricular repolarization Explanation: The T wave on an ECG corresponds to ventricular repolarization. Atrial depolarization is represented by the P wave and ventricular depolarization by the QRS complex. The isoelectric or zero line between the P wave and the Q wave represents depolarization of the AV node, bundle branches, and Purkinje system.
A group of nursing students are studying cardiac dysrhythmias and one student states that atrial flutter and atrial fibrillation are not really similar. Which statements are some of the differences between these two dysrhythmias? Select all that apply.
Correct response: Ventricular response to atrial flutter is variable Ventricular response to atrial fibrillation is irregular Atrial fibrillation demonstrates atrial rates between 400-600 In atrial flutter the atrial rate is typically between 200-500 Explanation: Atrial flutter typically has an atrial rate of 240-450 beats per minute; it demonstrates a variable response rate and regularity. At times it can be regular, when the ventricular response rate is defined as a fraction of the atrial rate, like 2:1 conduction. P waves are present before the QRS complexes, although they may be multi-focal. Atrial fibrillation typically has an atrial rate of 400-600, is irregular, and there are fibrillatory (f) waves due to fast multifocal ectopic foci.
A client is pregnant for the first time and is considered to be at high risk for preeclampsia. The care team should prioritize which intervention?
Correct response: Vigilant blood pressure monitoring Explanation: Sodium restriction is not normally recommended during pregnancy. Most medications are contraindicated during pregnancy except in cases where the mother's life is threatened. Close monitoring is the initial focus of care.
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?
Correct response: Weight gain Explanation: In right-sided heart failure, blood backs up into the venous system and increased capillary hydrostatic pressure forces plasma out of the circulatory system, resulting in edema. The accumulation of fluid is evidenced by rapid weight gain. Shortness of breath and decreased renal perfusion and output are characteristic of left-sided failure.
A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?
Correct response: When the client experiences chest pain Explanation: The test of aerobic fitness that is performed on a bicycle or treadmill ergometer starts at a slower pace and builds toward the maximum. It will be stopped when the client experiences abnormal ECG or vital signs, chest pain, severe shortness of breath or a decrease in blood pressure. Maximal heart rate is generally predicted by subtracting age from 220. For the 45-year-old client, a maximal heart rate is 175 beats/min. The test is not stopped unless the client reaches at least 85% of the maximum calculated rate. Because the heart rate of 135 beats/min is only 77% of the maximum, the client would be allowed to continue the test.
Which intervention will the nurse prioritize for the medical management of a client with a dissecting aortic aneurysm?
Correct response: administration of vasodilators and beta-adrenergic blocking medications (beta-blockers) Explanation: Administration of medications to lower blood pressure such as vasodilators and and beta-adrenergic blocking medications which slow heart rate are the expected treatment. Lowering blood pressure will lessen the force of systolic blood ejection from the heart. The client's blood pressure needs to be lowered rather than elevated with epinephrine (adrenergic agonist) and IV fluids. Although the client is likely anxious and in acute pain, pharmacologic treatment of these are not the priority.
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement?
Correct response: apply sequential pneumatic compression devices to lower extremities Explanation: The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction
A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client?
Correct response: beta-adrenergic agonists Explanation: A beta-adrenergic agonist would be the best option to use in an acute exacerbation of asthma. The quick-relief medications include the short-acting beta-adrenergic agonists, anticholinergic agents, and systemic corticosteroids. The short-acting beta-adrenergic agonists relax bronchial smooth muscle and provide prompt relief of symptoms, usually within 30 minutes. All of the other drugs would be used as maintenance treatment.
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?
Correct response: beta-adrenergic blocking drugs (beta-blockers) Explanation: Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with the beta-adrenergic blocking drugs. None of the other types of drugs are used in the treatment of mitral valve prolapse to relieve symptoms or prevent complications.
Which client will the nurse prioritize to assess first?
Correct response: client with sinus arrest Explanation: The client with sinus arrest or "sinus pause" is exhibiting a failure of the sinoatrial node to discharge and this may result in an irregular pulse. Most often, an escape rhythm develops as other pacemakers take over, but sinus arrest may result in prolonged periods of asystole and other abnormal rhythms. The client may need further interventions such as a pacemaker. A respiratory sinus arrhythmia is considered a benign variation seen with respiration in healthy people. Bradycardia and tachycardia can be serious if affecting cardiac output or if tachycardia is resulting in chest pain, but this level of detail was not provided, making the sinus arrest the best choice.
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output
Correct response: compensatory mechanisms Explanation: The pathophysiology of heart failure involves an interaction between two factors: a decrease in pumping ability of the heart with a consequent decrease in the cardiac reserve and the compensatory mechanisms that serve to maintain the cardiac output while also contributing to the progression of heart failure. Myocardial muscle hypertrophy has an important role in long-term adaptation to hemodynamic overload. Stimulation of the sympathetic nervous system plays an important role in the compensatory response to decreased cardiac output and to the pathogenesis of heart failure. Heart failure is a muscle contractility problem, unrelated to the electrical conduction that stimulates it.
An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension?
Correct response: decreased elasticity of the aorta and large arteries Explanation: In aging adults, there is a decrease in the elasticity of the aorta and large arteries making them more rigid, thereby increasing systolic blood pressure. This can lead to increased cardiac afterload and hypertension.
A nurse is teaching a client with newly diagnosed dilated cardiomyopathy (DCM) about associated treatments. The nurse determines that the knowledge is understood when the client correctly matches which drug category to the primary action of decreasing preload by suppressing renal reabsorption of sodium and increasing salt and water excretion?
Correct response: diuretics Explanation: The treatment of DCM is directed toward relieving the symptoms of heart failure and reducing the work of the heart. 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), thereby decreasing preload and cardiac output. Although ACE inhibitors also lower the reabsorption of sodium and water by reducing the amount of circulating levels of aldosterone (through reducing the conversion of angiotensin 1 to angiotension 2), they also prevent vasoconstriction, so the effects on sodium and water retention is not this class of drug's only or primary effect. Calcium channel blockers prevent vasoconstriction as thier primary mechanism of actions, and beta-blockers primarily reduce cardiac output by reducing heart rate and contractility.
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:
Correct response: hypovolemic shock due to acute intravascular volume loss. Explanation: Hypovolemic shock is characterized by diminished blood volume such that there is inadequate filling of the vascular compartment. Hypovolemic shock also can result from an internal hemorrhage or from third-space losses, when extracellular fluid is shifted from the vascular compartment to the interstitial space or compartment, without fluid movement in/out of the cells. Within seconds after the onset of hemorrhage or the loss of blood volume, compensatory manifestations of tachycardia, vasoconstriction, and other signs of sympathetic and adrenal medullary activity appear. There is no indication that this client has developed a pulmonary embolism, is having side effects from versed administration, or is going into renal failure due to an overdose of medication.
The nursing student has learned in his class that coronary artery disease (CAD) is heart disease caused by:
Correct response: impaired coronary blood flow. Explanation: The term coronary artery disease (CAD) describes heart disease caused by impaired coronary blood flow.
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:
Correct response: improving quality of life by relieving symptoms. Explanation: A primary treatment goal for a client with CHF is to improve the quality of life through symptom management. CHF will not be cured, and maintaining a higher oxygen level will assist with dyspnea associated with CHF. A stent is not an option for treatment of CHF.
A health care provider is providing care for a client who developed deep vein thrombosis (DVT) and a pulmonary embolism following a period of bed rest. Which factor will the nurse determine did not contribute to the formation of a DVT?
Correct response: increased heart rate Explanation: Venous stasis, increased blood viscosity both contribute to a hypercoagulable state. Venous injury also increases the risk for thromboembolism formation. Increased heart rate cannot contribute to venous thromboembolism. Tachycardia is a symptom of pulmonary emboli, not a cause.
A client with hypercholesterolemia is being treated with diet and exercise. Which assessment finding is a positive outcome of this treatment regimen?
Correct response: increased high-density lipoproteins Explanation: A goal in prescribing exercise and diet control in clients with hypercholesterolemia is to lower the level of low-density lipoproteins (LDL) and increase the high-density lipoproteins (HDL). Elevated blood glucose is evidence of possible diabetes mellitus.
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:
Correct response: many people live with atrial fibrillation without even knowing they have it. Explanation: Many people live with atrial dysrhythmias, including atrial fibrillation, without knowing the dysrhythmia exists. Atrial dysrhythmias 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.
A preventive measure to decrease the risk of developing rheumatic heart disease includes:
Correct response: prompt diagnosis of streptococcal infections with a throat culture. Explanation: 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 while the client may benefit from regular hearing examinations, it is not related to preventing rheumatic heart disease.
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?
Correct response: right-sided heart failure Explanation: A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and palpitations.
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:
Correct response: see the doctor for evaluation immediately. Explanation: Angina that occurs at rest, is of new onset, or is increasing in intensity or duration denotes an increased risk for myocardial infarction and should be seen immediately using the criteria for acute coronary syndrome (ACS).
A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 beats/min and blood pressure of 86/50 mm Hg. The cardiac monitors show regular rhythm as above. The client states the health care provider has been running blood work to rule out hypothyroidism. Based on the rhythm, what does the nurse report the client has?
Correct response: symptomatic bradyarrhythmia Explanation: This client is suffering from a symptomatic bradyarrhythmia as evidenced by a heart rate of 46 beats/min 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. Wolff-Parkinson-White syndrome is an arrhythmia that arises as a result of anatomic reentry and is a type of paroxysmal supraventricular tachycardia. Third-degree, or complete, AV block occurs when the conduction link between the atria and the ventricles is lost owing to interruption at the AV node and the atria and ventricles develop their own independent rhythm.
Which classification of medications used to self-treat the common cold should be avoided by those with a history of hypertension?
Decongestants
Spontaneous pneumothorax, typical population affected
Definition - Air-filled blister on the lung surface ruptures. Population affected - Occurs in tall, thin, adolescent boys - they grow too tall too fast and pleura
Cushing Syndrome, causes and clinical manifestations
Definition - Excess of cortisol in the body (may also have excess androgen) due to elevated levels of cortisol not being regulated correctly by hypothalamus and pituitary gland Causes - Cortisol-secreting adrenal tumor Corticotropin-producing tumor in another organ. Corticotropin = a major regulator of the hypothalamic-pituitary-adrenal system, involved in stress responses Autoimmune disorders Certain glucocorticoid medications Manifestations - Thin hair, "moon face", hirsutism (excess inappropriate hair growth), buffalo hump, thin extremities, muscle wasting and weakness, petechiae and/or purplish striae, swollen ankles, hypertension, central obesity, acne Slow wound healing/suppressed inflammatory response in autoimmune cases
Infantile bronchiolitis, manifestations and treatment
Definition - Inflammation of the little bronchioles by a virus (antibiotics don't help). Can impair gas exchange. Manifestations - Wheezing, struggling breathing, rapid breathing, exaggerated use of the accessory muscles Retractions - suck in their stomach, can see their ribs Nasal flaring Grunting during expiration Really bad - cyanotic, not getting enough oxygen Treatment - Home/supportive care for most cases. Steroids/bronchodilators are NOT shown to be very effective. Complications can arise secondary to bronchiolitis (pneumonia, ear infection) and those can be treated with antibiotics Dehydration (secondary) can be treated by IV fluids
Pleuritis manifestations, diagnosis and treatment
Definition - Inflammation of the pleura. Can rub against each other, can hear it with a stethoscope, goes with respirations. Tends to be very painful Manifestations/signs & symptoms - Shallow breathing, characteristic late-inspiration/early-expiration pleural friction, coarse vibration on palpation of the affected area, Intercostal tenderness on palpation Diagnosis - Sputum or blood culture for infection, x-rays for pneumonia, ECG to rule out heart disease, possibly biopsy Treatment - treat the underlying cause (cancer, pneumonia, stop certain drugs, chest trauma, kidney disease, infection, etc.) Pain relief, antibiotics, bronchodilators, oxygen therapy as needed If there is fluid accumulation, drainage might be necessary Surgery - if pleural effusion (fluid accumulation) gets too bad
Complications (signs and symptoms) of sustained high left ventricular end diastolic pressure (preload) (blood backs up into the lungs causing crackles and shortness of breath)
Definition - cardiac failure causing pulmonary congestion. This leads to impaired gas exchange and/or pulmonary edema. Signs & symptoms - impaired gas exchange -> cyanosis and signs of hypoxia. Pulmonary edema -> cough with frothy sputum, orthopnea, paroxysmal noctumal dyspnea.
Brain natriuretic peptide (BNP); when is it measured and what do elevated levels indicate?
Definition - hormone secreted by cardiomyocytes in ventricles in response to stretching due to increased ventricular blood volume. When it's measured -if patient displays symptoms of heart failure, used to detect or rule out heart failure. What do elevated levels indicate? The higher the value, more likely heart failure is present and more severe it is.
Tuberculosis Diagnosis and medical treatment
Definition- Mycobacterium M. Tuberculosis, can effect any organ but usually lungs. Macrophages (our own WBC) attack the organ(lungs), resulting in parenchyma destruction of out own lungs. Diagnosis- -Positive tuberculin skin test/ blood test (QuantiFERON gold) -X-RAY showing lesions, hard calcium deposits (Created by macrophages) -Pleural fluid shows bacteria -Urinalysis -Lung biopsy Treatment- - Airborne precautions (private room, negative pressure, N95) -Antitubercular drug therapy for at least 6 months with daily or weekly oral doses. May need second-line oral/injectable, or third-line (for extensively drug-resistant TB). Different regimens if first-line drugs are not tolerated or / contraindicated or drug resistance develops. -Absolutely no smoking -Venous thromboembolism (VTE) prophylaxis (precautions) if the hospitalized - big risk of throwing a clot -If the disease is no longer infectious (in 2-4 weeks) can resume normal activities and continue to take medications -Surgery = Last resort lobectomy or pneumonectomy for patients with multidrug-resistant TB or poor medical treatment prognosis
Pneumonia signs and symptoms
Definition- inflammation of lung structures (can effect entire respiratory tract) caused by bacteria, viruses, gastric secretions aspirated into lungs. Impairs gas exchange! Signs/ symptoms -Tachypnea- fast breathing - Orthopnea- shortness of breath - crackles, wheezing, rhonchi(rattling) - decrease breath sounds - increased Freitas (palpable vibration produced during breathing caused by partial obstruction) -Sputum production -use of accessory muscles - pleural friction rub -bradycardia or tachycardia depending
Pneumothorax, manifestations (clinical assessment), diagnosis and treatment
Definition: Air in pleural space Manifestations: Spontaneous pneumothorax - occurs when an air-filled blister on the lung surface ruptures (occurs in tall, thin, adolescent boys) Traumatic pneumothorax - caused by penetrating or nonpenetrating injuries (someone gets stabbed/ is in an accident and the pleura is damaged) Tension pneumothorax - occurs when the intrapleural pressure exceeds atmospheric pressure (usually problems with mechanical ventilation). Air can get in but can't get out. Breathes in, air goes in. Can't breathe out, air is trapped. Chest cavity keeps getting bigger, eventually compresses the heart and can be deadly very quickly Diagnosis: chest x-ray or ultrasound Treatment:Will put in chest tube to remove air and inflate the lungs (thoracostomy)
Hemothorax, description, causes
Definition: Blood in pleural space Causes: chest trauma, chest/heart surgery Treatment: Will use syringe/tube to remove excess blood (thoracostomy)
Hypoxemia; causes, signs and symptoms, pathophysiology associated with it; body's compensatory mechanisms to it
Definition: Inadequate O2 in the blood Causes: An inadequate O2 in the air (not very common), hypoventilation, disease of the respiratory system, dysfunction of neurological system, problems in circulatory function Signs & symptoms: Mild - metabolic acidosis (not able to get rid of CO2), tachycardia, peripheral vasoconstriction, diaphoresis (sweating), increase in BP, confusion. Patient really feels like they can't breathe. More severe/Chronic hypoxemia - Tachypnea, pulmonary vasoconstriction, increased production of RBCs, cyanosis. Pathophysiology: Impaired diffusion of gases in the alveoli of the lungs (not enough O2 getting through to the blood and to the rest of the body), mismatching of ventilation and perfusion. Body's compensatory mechanisms: Tachycardia and/or tachypnea to try and get more O2 into the body, peripheral vasoconstriction to try and get more O2 to vital organs. Increased production of RBCs to try and get more O2 into circulation. Panic associated with the feeling of not being able to breathe.
Atelectasis, description, causes, signs and symptoms, treatment
Definition: incomplete expansion of a lung or portion of lung Causes: airway obstruction, lung compression, or increased recoil of lung due to loss of pulmonary surfactant. Signs & symptoms: tachypnea, tachycardia, dyspnea, cyanosis, signs of hypoxemia, diminished chest expansion, decreased breath sounds, and intercostal retractions Treatment: reduction obstruction/compression and reinflation of lung. Ambulation, deep breathing, body positions. Oxygen therapy and medications maybe needed.
ventricular fibrillation. V-FIB
Disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest.
When developing the plan of care for a child with respiratory distress, what nursing intervention can the nurse provide that will facilitate respiratory movements and avoid airway compression?
Elevate the head of the bed.
An older adult client's blood pressure (BP) is 120/80 mm Hg when in a lying position. When the nurse retakes the client's BP in a sitting position, the BP is 92/60 mm Hg. Which intervention is appropriate for the nurse to implement?
Encouraging the client to maintain hydration throughout the day
Diagnostic testing has resulted in a diagnosis of small cell lung cancer (SCLC) in an older adult client. When exploring the etiology of the client's disease, what assessment question is most relevant?
Have you ever been a smoker?"
Criteria for community acquired versus hospital acquired pnemonia
How long has the affected person been in the hospital? What are the circumstances? -48 hours or more after hospital admission and not incubated at the admission time According to: - source of infection (where it came from?) - Infectious agent (If cause by COVID then COVID pneumonia) -immune status of the host (immunocompromised)
Hypertension causes and methods to reduce it
Hypertension causes and methods to reduce it Definition: Sustained condition of elevated blood pressure within the arterial circuit. Usually no symptoms! Causes: Age, gender (men more susceptible), race, family history and genetics, diet, tobacco and alcohol consumption, obesity Secondary hypertension → results from some other disorder, such as kidney disease Causes: Primary hyperaldosteronism (Cushing) aldosterone raises BP & retain sodium and water, oral contraceptive drugs, adrenal tumor, many other drugs cause high BP Methods to reduce hypertension: Regular BP monitoring (2 or 3 to confirm the initial diagnosis), - medications - vasodilators, diet & lifestyle changes
Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?
Hypertrophy
An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?
Hypotension
Cardiogenic shock, septic shock, and hypovolemic shock; what causes each, what are the signs and symptoms of each, and what is the treatment for each?
Hypovolemic shock - Life-threatening emergency. Occurs when a person loses more than 20% of their blood - massive hemorrhage. Causes: Not enough blood volume in the body to be pumped, acute loss of 15-20% or more--> loss caused by hemorrhage (whole blood loss), severe burns (plasma loss), or severe dehydration and loss of GI fluids (extracellular fluid loss Signs & symptoms: thirst, increased HR, cool clammy skin, decreased BP, decreased urine output***LATER stages metabolic acidosis, hypothermia, circulatory failure, followed by death***continuous Input and output measurement is essential for assessing status. urine output decreases very quickly in hypovolemic shock--> compensatory mechanism to divert blood flow to important areas (heart, brain) Treatment: restore vascular volume by giving fluids and blood, vasodilators (NOT first priority though, only given when the volume has been corrected but low BP persists)
pleurisy
Inflammation of the visceral and parietal pleura that line the outside of the thoracic cage and envelop the lungs - Often associated with Pleural effusion - Also called Pleuritis
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.
Know normal arterial blood gas (ABG) results
Know normal arterial blood gas (ABG) results An arterial blood gas test measures the amounts of arterial gases, such as oxygen and carbon dioxide. An ABG test requires that a small volume of blood be drawn from the radial artery with a syringe and a thin needle, but sometimes the femoral artery in the groin or another site is used-----> -Partial pressure of oxygen (PaO2): 75 - 100 mmHg -Partial pressure of carbon dioxide (PaCO2): 38 - 42 mmHg -Arterial blood pH: 7.38 - 7.42 -Oxygen saturation (SaO2): 95-100% -Bicarbonate (HCO3): 22 - 28 mEq/L
Signs and symptoms of left-sided heart failure (and where the blood backs up)
Left-sided heart failure = Decreased cardiac output, elevated pulmonary venous pressure Blood backs up in lungs - causes pulmonary congestion Signs & symptoms - shortness of breath, difficulty breathing while lying down, rapid weight gain due to fluid retention, swelling of legs, ankles, feet Pulmonary edema specifically, coughing, constant fatigue/lethargy
When assessing a client for cyanosis, which areas are most appropriate for the nurse to assess? Select all that apply.
Lips Nails Ears Cheeks Explanation: Cyanosis refers to the bluish discoloration of the skin and mucous membranes resulting from an excessive concentration of reduced or deoxygenated hemoglobin in the small blood vessels. It usually is most pronounced in the lips, nail beds, ears, and cheeks. The degree of cyanosis is modified by the amount of cutaneous pigment, skin thickness, and the state of the cutaneous capillaries. Pupils would reflect possible increased intracranial pressure and carbon dioxide levels. Assessing a client's sternum does not reflect oxygen levels.
Which lipoprotein is the main carrier of cholesterol?
Low-density lipoprotein (LDL)
Myocardial infarction; presentation, EKG manifestation
Myocardial infarction; presentation, EKG manifestation Definition - Heart attack/coronary occlusion. Happens when one or more areas of the heart muscle don't get enough oxygen. This happens when blood flow to the heart muscle is blocked Ischemia = inadequate blood flow. Infarction = obstruction of tissue causing local tissue death. Presentation/signs & symptoms - Sudden onset of pain, usually severe and crushing, radiating to the left arm, neck, or jaw Dyspnea, syncope (low BP), tachycardia, nausea/vomiting, extreme weakness, sweating, cold clammy skin Pain not alleviated by rest or medications Sometimes asymptomatic! Pretty unusual but some people don't know they are having/have had one EKG (ECG) manifestation - Changes in pattern or orientation of waveforms
Peripheral arterial occlusion; signs and symptoms, treatment
Peripheral arterial occlusion; signs and symptoms, treatment Definition - Sudden event that interrupts arterial flow to affected tissues (no O2 to tissues) Signs & symptoms - 7 P's : Pistol shot, Pallor, Polar (cold), Pulselessness, Pain, Paraesthesia, Paralysis Treatment - prevention is usually best treatment, antiplatelets, statins to lower cholesterol, walking to increase circulation, sometimes surgical intervention to treat severe occlusions
Peripheral venous stasis; signs and symptoms, complications, treatment
Peripheral venous stasis; signs and symptoms, complications, treatment Definition - Stagnant blood in peripheral (extremities) veins. Can be caused by immobility/bed rest, acute MI, congestive heart failure, shock, venous obstruction. Signs & symptoms - Inflammation in affected area, ulcers, hypercoagulability Complications - Dirty blood pools at extremities, causes ulcers, necrosis Treatment - leg elevation to promote venous return, heat applied to legs to relieve venospasm, TED hose, SCD's, ambulation if tolerated, anticoagulation medications, treatment is aimed at prevention of thrombi
Which factor is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?
Pet dander Explanation: Extrinsic or atopic asthma is typically initiated by a type I hypersensitivity reaction induced by exposure to an extrinsic antigen or allergen such as pet dander. Intrinsic or nonatopic asthma triggers include respiratory tract infections, exercise, hyperventilation, cold air, drugs and chemicals, hormonal changes and emotional upsets, airborne pollutants, and gastroesophageal reflux.
Pleural effusion; pathophysiology, causes, clinical signs and symptoms, treatment
Pleural effusion; pathophysiology, causes, clinical signs and symptoms, treatment Definition - An abnormal collection of fluid in pleural cavity How it works - Causes -The most common causes of pleural effusion are congestive heart failure, cancer, pneumonia, and pulmonary embolism. Signs & symptoms -Symptoms include cough, sharp chest pain, or shortness of breath. Diagnosis - Chest x-rays, ultrasound, CT Treatment - Depends on the cause. Fluid is removed from the pleural cavity with a needle (thoracentesis). Injection of a sclerosing agent into the pleural cavity. Open surgical drainage.
Pain is an expected assessment finding in clients who have which lung disease?
Pleuritis Explanation: The effects of asthma, PAH, and pleural effusion may be profound, but none is typically accompanied by acute pain. Pleuritis, in contrast, is associated with characteristic pleural pain.
Postural hypotension; what is it, why does it occur (in what client population) and what increases it?
Postural hypotension; what is it, why does it occur (in what client population) and what increases it? Definition - Also called orthostatic hypertension. Abnormal drop in BP upon standing Criteria - BP is reduced by at least 20 mmHg or more systolic OR 10 mmHg diastolic within 3 minutes of standing or sitting up at least 60 degrees in bed. Why does it occur? All blood flows to their feet when they stand, BP drops. Dehydration, disruption in blood flow, low BP for one reason or another What population? Elderly, or people on anti-hypertensives, or dehydration, anemia What increases it? Fix underlying problem (many causes)
A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client's respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support?
Prepare for mechanical ventilation.
Influenza presentation, treatment, vaccine (Methods, age limit)
Presentation -Viral infection. Type A most common, causes the most severe disease. Type B less common and less severe (generally think its allergies) Headache, Fever, Myalgia(mustle aches), dry cough, tachycardia, tachypnea, Dyspnea, nasal discharge. With Bacterial Pneumonia- purulent or bloody sputum Treatment - Best is prevent with vaccine Others include home care, fluid/ electrolytes replacement, O2 and assisted ventilation, cool mist humidifier, antipyretic (Tylenol), NSAIDS (Ibuprofen) Treatment for severe - Antiviral drugs. Must be given 24-48 hours from onset of symptoms, otherwise wont work. X-RAY to rule out pneumonia- if there is then use antibiotics for secondary infection Vaccine method - Live attenuated influenza c=vaccine (LAIV) means its damaged (Inactive) virus, cannot give you the flu! Given intranasal or IM injection is killed virus. Age limits- 6 months or older require vaccine annually. Higher dose if older than 65 At-risk are pregnancy, elderly, babies, absence of vaccine by choice or limitation, immunocompromised, chronically ill
A client recently had surgery for a hip fracture. Which nursing intervention would be most effective for preventing pulmonary emboli in this client?
Prevention of the development of a deep vein thrombosis
A client is diagnosed with preeclampsia. The nurse knows that which physiologic factors contribute to preeclampsia development? Select all that apply.
Prostacyclin-thromboxane imbalance Hypersensitivity to the renin-angiotensin-aldosterone system Decreased placental blood flow Insulin resistance
Pulmonary embolism, pathophysiology, causes, clinical signs and symptoms
Pulmonary embolism, pathophysiology, causes, clinical signs and symptoms Definition: Blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow - breaks off from somewhere and lodges itself in the lungs. Remember... a thrombus does not move. An embolus is moving. How it works (pathophysiology): Most often comes from the Right atrium of the heart (bc from there blood moves to the lungs) due to atrial fibrillation - blood clots occur because blood is remaining static in the chamber. Causes: Thrombus - arising from DVT. Fat - mobilized from the bone marrow after a fracture or from a traumatized fat deposit. Amniotic fluid - enters the maternal circulation after rupture of the membranes at the time of delivery. Signs & symptoms: Tend to be very painful. Anything else here? Treatment: Prevent more clots, possible surgical intervention (to remove it if it's too big)
Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?
Pulmonary vessels constrict
Raynaud disease; signs and symptoms, what causes exacerbations, treatment
Raynaud disease; signs and symptoms, what causes exacerbations, treatment Definition - Intense vasospasm of the arteries and arterioles in fingers and (less often) toes when cold Signs & symptoms - lack of color and circulation in tips of fingers, pain/vasospasms Causes of exacerbations - hands getting cold Treatment - Warm up fingers and toes so blood flows back to them
The neonatologist explains to the parents of a neonate born at 35 weeks' gestation that their premature infant will be monitored for complications. Which respiratory complication is the most common?
Respiratory distress syndrome
Rhinosinusitis (Sinusitis) VS common cold
Rhinosinusitis- NOT an infection, sinuses/ allergies Common cold - could be many different viruses *these have similar symptoms of nasal stuffiness /itching and burning of nose etc.
Cardiogenic shock, septic shock, and hypovolemic shock; what causes each, what are the signs and symptoms of each, and what is the treatment for each?
Septic shock - Life-threatening emergency. Occurs when sepsis leads to severely low BP. Sepsis = body's response to severe systemic infection. Causes: A kind of distributive shock. Overwhelmed with microbes, can't regulate vessel size. Massive vasodilation, abnormal distribution of blood to the body. Signs & symptoms: Fever, trouble breathing, poor circulation SOFA - sepsis-related organ failure assessment. low platelets, low glasgow coma scale, high bilirubin, minimal urine Treatment: Treatment of underlying infection & increase blood pressure via vasoconstrictive meds
A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which drug will the nurse anticipate administering first?
Short-acting beta 2-adrenergic agonists such as albuterol (SABA)
Signs of an infant's respiratory distress
Signs of an infant's respiratory distress Upper airway infections (Viral croup, Spasmodic croup, Epiglotitis). Lower airway infections (Acute bronchiolitis) Wheezing, croup (seal noises) Rapid breathing, exaggerated use of the accessory muscles Retractions - suck in their stomach, can see their ribs Nasal flaring Grunting during expiration
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply.
Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight
Cardiac valvular dysfunction (stenosis or regurgitation definition of each) presenting signs and symptoms
Stenosis = Narrowing of heart valve opening so it does not open properly Signs & symptoms - Shortness of breath, dizziness, angina (chest pain/tightness), palpitations, weakness and fatigue, edema in abdomen or feet, increased HR, audible murmur, skin changes - yellowish, bluish tinge, pinkish rash Regurgitation = Also called valvular insufficiency/incompetence. Distortion of valve so it does not close properly, permits backward flow when valve should be closed Mitral valve (L side) regurgitation - fairly common. Blood goes back into the atrium instead of into the aorta & to the body. Signs & symptoms - Abnormal pulse, dysrhythmia, audible murmur, tachycardia, hypotension, diaphoresis, peripheral vasoconstriction, pulmonary edema - blood backs up into lungs, not getting enough out into the body.
A parent of a toddler is concerned about possible side effects of influenza immunizations. What will the nurse teach the parent regarding the influenza vaccine?
The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine.
A client had a tuberculin skin test (TST) performed as part of the immigration process and is surprised that the results are positive. How should the nurse best interpret this result?
The client was exposed to the tubercle bacillus at an indefinite point in the past. A positive reaction to the TST does not mean that a person has active tuberculosis, only that there has been exposure to the bacillus and that cell-mediated immunity to the organism has developed. Tuberculosis has no genetic component to its etiology and a positive TST does not guarantee an active future infection.
When a previously unexposed immunocompetent person is exposed to a person with tuberculosis, the pathogenesis is centered around which physiologic development?
The initiation of a cell-mediated immune response Explanation: The pathogenesis of tuberculosis, in previously unexposed immunocompetent people, is a cell-mediated immune response that confers resistance to the organism and development of hypersensitivity to the tubercular antigens. Pathologic manifestations of tuberculosis, such as caseating granuloma and cavitation, are the result of the hypersensitivity reaction rather than its inherent destructive capabilities. In persons with intact cell-mediated immunity, the cell-mediated immune response results in the development of a granulomatous lesion, called a Ghon focus, that contains the tubercle bacilli, modified macrophages, and other immune cells.
A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse?
The nurse is likely asymptomatic
The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond?
The sweat test measures the concentration of salt in the infant's sweat.
An older adult 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. What is the most likely diagnosis?
Tuberculous empyema due to primary progressive tuberculosis
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?
Vascular smooth muscle cells (SMCs)
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?
Vasoconstriction
Ventricular tachycardia and ventricular fibrillation; what they are and what they look like on a cardiac monitor? (They are both life-threatening)
Ventricular tachycardia (V-tach) - Type of arrhythmia; fast, abnormal HR occurring when the lower chamber of the heart (ventricle) beats too fast to pump well, the body doesn't receive enough oxygenated blood. An electrical signal gets stuck in a ventricle. -Not enough filling time for ventricles = the main problem. Very low BP is one of the first signs (if they have a pulse) -Very short instances (a few seconds long) may not result in problems, but long periods are dangerous. Can lead to cardiac arrest and death! -If there's a pulse with it... usually not lethal. Ventricular fibrillation (V-fib) - Dangerous type of arrhythmia affecting ventricles. Electrical signals cause muscles to quiver (fibrillate) instead of pump normally, blood is not getting out to the body. Still some electrical signal happening but No identifiable electrical complexes (on EKG) -Can lead to cardiac arrest and death! Other kinds of dysrhythmias... Sinus bradycardia (too slow), Sinus tachycardia (too fast), Sinus arrest/asystole (no electrical activity or movement at all, no waves visible. Flatline.)
What disease processes are caused, increased, or aggravated by hypertension?
What disease processes are caused, increased, or aggravated by hypertension? What disease processes? Atherosclerosis vascular disease, vascular rupture, Anything else here? Target organ damage: Heart - hypertrophy bc heart is working harder over long period of time Brain - dementia and cognitive impairment bc blood vessels are being destroyed Peripheral vascular - atherosclerosis Kidney - nephrosclerosis bc tiny vessels can rupture Retinal (eye) complications - high intraocular pressure (tiny vessels) Can lead to hypertensive crisis! Hypertension in pregnancy - Preeclampsia → eclampsia Chronic hypertension, or chronic hypertension with superimposed preeclampsia Gestational hypertension
The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond?
You have a 25% chance that your next child will have CF. Explanation: Cystic fibrosis is autosomal recessive, meaning that two defective genes are needed for a child to be born with the disorder. Both parents must either be carriers (having one defective gene, but no symptoms) or have the disease (two defective genes). If both parents are carriers, each child has 1 in 4 chance of receiving two normal genes, a 50 percent chance of inheriting at least one gene, and a 1 in 4 chance of receiving two abnormal genes and having CF.
plueral effusion
abnormal collection of fluid in the pleural(lung) cavity. Between the 2 pleura- not normal. Can be transient or exudate, purulent(containing pus), chyle, or sanguineous (bloody)
pnemothorax
air in the pleural space
A client is diagnosed with pneumococcal community-acquired pneumonia. Which education does the nurse provide the client?
antibiotics Streptococcus pneumoniae is a bacteria and is the most common cause of pneumonia. This type of pneumonia is referred to as pneumococcal pneumonia. Treatment for bacterial pneumonia involves the use of appropriate antibiotic therapy. Best rest and fluid restriction will reduce the ability to clear respiratory secretions, so is not recommended.
A client with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which term should the nurse use to document this finding?
barrel chest
hemothorax
blood in the pleural cavity
Which client is exhibiting signs of advanced chronic obstructive pulmonary disease (COPD)?
client sitting in bed resting elbows on the overbed table, expiratory wheezes noted
Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
constrictive pericarditis Explanation: In constrictive pericarditis, fibrous, calcified scar tissue develops between the visceral and parietal layers of the serous pericardium. Acute pericarditis is due to inflammation of the pericardium. Pericardial effusion is caused by accumulation of fluid and can lead to cardiac tamponade.
Dyspnea
difficult or labored breathing
Common results of acute respiratory failure are hypoxemia and:
hypercapnia, or excess carbon dioxide in the blood.
A client with asthma comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. What is the most likely cause of the decreased carbon dioxide levels?
hyperventilation
How will the nurse describe unilateral chest pain associated with respiratory movements?
pleuritic Explanation: Pleuritis is usually unilateral and tends to be localized to the lower and lateral part of the chest; pain worsens with chest movements, such as deep breathing and coughing that accentuate pressure changes in the pleural cavity and increase movement of the inflamed or injured pleural surfaces. Musculoskeletal pain usually is bilateral and may occur as the result of frequent, forceful coughing. The pain associated with irritation of the bronchi usually is substernal and dull. Myocardial pain usually is located in the substernal area and is not affected by respiratory movements.
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:
pulmoary embolism
Three days following surgical repair of a hip fracture a client becomes anxious and reports sudden shortness of breath and chest pain that worsens with a deep breath. Which disorder is the client likely experiencing?
pulmonary embolism
A female client tells the health care provider that she has recently been experiencing episodes of changes occurring 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:
raynauds
A child struggling to breathe is brought to the emergency department with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. What is the most likely diagnosis?
severe asthma attack
diaphoresis
sweating, especially to an unusual degree as a symptom of disease or a side effect of a drug.
Sinus Bradycardia/ tachycardia
too slow or too fast
