Patho PrepU Chp 20
Which of the following statements regarding heart failure is true?
In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.
A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?
Venous return to the heart
A patient diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which of the following are often associated with diastolic failure? Select all that apply.
Constrictive pericarditis Myocardial hypertrophy Ischemic heart disease
A nurse is assessing a client in shock for complications of acute renal failure. The most important assessment for the nurse to obtain would be:
Continuous measurement of urine output
A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure?
Diuretic, ACE inhibitor, beta-blocker
A patient is diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder? Select all that apply.
Diuretics Digitalis Beta-adrenergic blockers Angiotensin-converting enzyme inhibitors (ACEI)
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?
Dyspnea and crackles in bilateral lung bases.
A nurse in a nursing home is concerned that a resident may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?
Dyspnea, cough
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:
20 mL/hour
Emergency Medical Technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place?
The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate.
Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?
They have the same compensatory mechanisms.
A patient is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as which of the following?
Valvular regurgitation
A nurse educator is defining heart failure to a group of recent graduates who will begin providing care on a cardiac unit. The educator should describe which phenomenon?
"Heart failure is a complex syndrome resulting from any disorder of the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion."
A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?
"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?
"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."
In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion?
20 mL/hour
A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?
Administer epinephrine (adrenaline).
A client is rushed to the emergency department with symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?
Anaphylactic
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client.
Anaphylatic shock
Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?
Atrial fibrillation
The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock?
Cardiogenic
The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:
Decreased cardiac output
All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?
Epinephrine (Adrenalin).
Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?
Histamine release causes massive vasodilation.
The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:
Improving quality of life by relieving symptoms
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?
Hypertrophy
A 60-year-old woman has just been diagnosed with heart failure and her primary care provider is describing the concept of adaptation. Which compensatory mechanisms may have masked the client's heart failure? Select all that apply.
Hypertrophy of the myocardium Sympathetic nervous stimulation Increased renin--angiotensin--aldosterone system (RAAS) function Increased preload
A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?
Hypovolemic
Natriuretic peptides (NP) are part of the compensatory response to heart failure. Which of the following are actions of NP? Select all that apply.
Increased glomerular filtration Decreased renal reabsorption of sodium and water Inhibition of endothelin action
An 86-year-old male client is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?
Increased vascular stiffness
A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?
Infusion of normal saline or Ringer's lactate to maintain the vascular space.
The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology?
Inhibition of the renin-angiotensin-aldosterone system
Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often accompanies the vascular response in anaphylaxis?
Laryngeal edema
A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?
Low blood pressure
Increased secretion of renin in heart failure is caused by which of the following events?
Low cardiac output
Which of the following health problems can contribute to diastolic dysfunction heart failure?
Myocardial hypertrophy
A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?
Myocardial infarction
A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?
Myocardial infarction
A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing?
Obstructive shock
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema weight gain
A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?
Raising the head of the bed to a high Fowler's position
The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?
Reduced ventricular efficiency
Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis?
Release nitric oxide
Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem?
Right-sided heart failure
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this patient most likely is experiencing which of the following types of shock?
Septic
A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis?
Septic shock
An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?
Severity and duration of shock
After a long bout with vomiting and diarrhea, a patient is suspected to be in hypovolemic shock. Which of the following signs and symptoms will the nurse evaluate to substantiate this diagnosis? Select all that apply.
Tachycardia Acidosis Apprehension
An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:
Vascular stiffness
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?
Vasoconstriction
A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?
Ventricular dilation and wall tension are significantly lower than normal.
Cardiac output is which of the following per minute? Select all that apply.
Volume of blood pumped Heart rate X stroke volume
A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following?
Weight gain
An elderly client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:
blocking the conversion of angiotensin I to angiotensin II.
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.
compensatory mechanisms
The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is:
decreased afterload.
A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client:
has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.
