Prep U Chapter 18,19 & 20
Which intervention is the priority for the medical management of a client with a dissecting aortic aneurysm?
Administration of sodium nitroprusside and β-adrenergic blocking medications
Which intervention would the nurse know is not a primary treatment for the client in hypovolemic shock?
Administration of vasoconstrictive drugs
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 client has a diagnosis of right-sided heart failure. Which body organ should the nurse assess regularly?
liver
Which health condition can contribute to diastolic dysfunction heart failure?
myocardial hypertrophy
A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure?
prehypertension
The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in:
A reading that is too high
The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.
140
Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is
Call for emergency assistance utilizing hospital protocol.
The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
Constrictive pericarditis
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
A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:
"Aspirin will help prevent blood clotting."
A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?
"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation." A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?
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 In hypovolemia, renal vasculature is constricted in a compensatory attempt to circulate blood to more vital organs. Urinary output at 20 mL/hour or below indicates that renal perfusion is too inadequate.
Which client should most benefit from treatment with antithrombin agents?
57-year-old client who has recently been diagnosed with unstable angina
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:
Apply sequential pneumatic compression devices to lower extremities
The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?
Arterioles
The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?
C-reactive protein
A nurse is planning a community education program on hypertension. Which of the following parameters should be included to explain the regulation of arterial blood pressure?
Cardiac output and systemic vascular resistance
When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?
Conversion from aerobic to anaerobic metabolism Explanation: The principal biochemical consequence of MI is the conversion from aerobic to anaerobic metabolism with inadequate production of energy to sustain normal myocardial function. As a result, a striking loss of contractile function occurs within 60 seconds of onset. None of the other answers occur.
When a physician suspects a patient has suffered an acute myocardial infarction, which serum biomarkers should he order? Select all that apply.
Creatine kinase Troponin T Troponin 1
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have to decrease blood pressure?
Decrease vascular volume Diuretics, such as the thiazides, loop diuretics, and the aldosterone antagonist (potassium-sparing) diuretics, lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing salt and water excretion) and cardiac output.
The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:
Decreased cardiac output
A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?
Decreased level of consciousness
A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics?
Echocardiogram, blood cultures, temperature
Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?
Have the client sit up and lean forward.
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 nurse on a geriatric medicine unit has noted that a significant majority of the clients on the unit are prescribed antihypertensive medications. Which phenomenon is the nurse most justified in ruling out as a contributing factor?
Increased sensitivity of the renin--angiotensin--aldosterone system
Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often follows the vascular response in anaphylaxis?
Laryngeal edema
The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states the blood is shunted where to which part of the body?
Left side of the heart to the right side of the heart
The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.
Myocardial infarction prevention
A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?
Raising the head of the bed to a high Fowler's position
A patient presents to the emergency department with complaints of bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. Which of the following is a potential diagnosis for this patient?
Raynaud's disease
The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?
Reduced ventricular efficiency
A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?
Renal artery stenosis p. 427.
An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication?
Systemic emboli, especially to brain. p. 465.
A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which of the following accounts for this lack of change in the diastolic pressure?
Systemic vasoconstriction maintained the diastolic pressure.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:
Tearing or ripping-type pain in the chest or back
Which of the following patients is at the greatest risk of developing rheumatic heart disease?
Teenager with untreated strep throat
What can trigger myocardial ischemia even when there is adequate coronary oxygen supply? Select all that apply.
• Anemia • Carbon monoxide poisoning • Hypoxia -Myocardial oxygen supply is determined by the coronary arteries and capillary inflow, and the ability of hemoglobin to transport and deliver oxygen to the heart muscle. Even with adequate coronary blood flow, myocardial ischemia can occur in situations of hypoxia, anemia, or carbon monoxide poisoning. The other options are not relevant to myocardial ischemia
The nurse will monitor the client for which possible respiratory manifestations of heart failure? Select all that apply.
• Exertional dyspnea • Orthopnea • Cheyne-Stokes respiration • Chronic dry cough Explanation: Exertional dyspnea occurs with increased physical activity. Orthopnea is shortness of breath when lying down, as fluid from the lower body is redistributed to the pulmonary circulation. Cheyne-Stokes breathing is an increase in respiratory depth and rate followed by a decrease and apnea. Congestion of the bronchial mucosa due to poor circulation causes chronic cough. Hyperventilation (which differs from Cheyne-Stokes) is not characteristic of heart failure.
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. Which responses is best for the nurse to educate this client about? Select all that apply.
• Smoking cessation • Dietary measures to reduce LDL levels • Weight reduction if overweight
A nurse assesses a client with normal biomarkers who reports angina. Which additional manifestations are late signs of aortic stenosis? Select all that apply.
• Syncope • Peripheral cyanosis • Dyspnea The earliest signs of aortic stenosis are a loud systolic ejection murmur or a single or paradoxically split second heart sound. Angina, syncope, and heart failure are later signs of the disorder
Which of the following patients is at greatest risk for orthostatic hypotension?
A 66-year-old post-surgery patient on bed rest
The nurse is teaching a patient with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which of the following statements by the patient shows that the patient understands this condition?
"I should report episodes of dizziness or fainting." Explanation: Hypertrophic cardiomyopathy is defined as unexplained thickening of the left ventricle leading to reduced cardiac output and obstructive outflow. It can cause sudden cardiac death in athletes after exertion. Treatment includes beta blockers to reduce outflow obstruction. The calcium channel blocker verapamil may be used but is avoided in patients with severe outflow obstruction. Patients should pace activity and avoid alcohol. Episodes of dizziness or fainting could indicate reduced cardiac output and should be evaluated.
A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis?
"I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising."
A 55-year-old Caucasian man has been diagnosed with atherosclerosis. He understands that his lifestyle includes many of the risk factors for developing the disease, but he asks the nurse, "What actually caused my disease?" Which is the nurse's best scientific answer?
"LDL and VLDLs stimulate endothelial cell dysfunction."
On a routine physical exam visit, the physician mentions that they hear a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds:
"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."
A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?
"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."
A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate?
"Too much alcohol, too little exercise and too much body fat all contribute to high blood pressure."
A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client?
"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."
Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction?
80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose
A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)?
A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest, p. 450.
Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?
A hypercyanotic attack brought on by periods of stress. The degree of obstruction may be dynamic and can increase during periods of stress causing hypercyanotic attacks ("tet spells").
ST-elevated myocardial infarction is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?
Action decreases metabolic demands of the heart.
When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate?
Activated cells that release free radical oxidize LDL which is harmful to the lining of your blood vessels.
27s A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient's increased blood pressure?
Activation of the renin-angiotensin-aldosterone mechanism
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).
The nurse is reviewing a client's medications and lab results. The client has a high LDL level. Which medication can raise this level?
Beta blockers
Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction?
An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose -The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart. The other patients have angina of varying severity.
A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock?
Anaphylactic
A 20-year-old male client is experiencing a severe immunologically mediated reaction, in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client?
Anaphylatic shock
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?
At the apex of the heart
A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plan listed below?
Atherosclerotic occlusive disease necessitating thrombolytic therapy
Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?
Atrial fibrillation
Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?
Beta-adrenergic-blocking drugs. Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with Beta-adrenergic-blocking drugs.
A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?
Black and South Asian people A 2006 Canadian study showed that the ethnic groups consisting of South Asians (30%) and Blacks (31%) in Canada are more likely to have hypertension in comparison to the primarily White population (21%) and East Asians are the least likely to have hypertension (19%).
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Preeclampsia-eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing after 20 weeks of gestation.
The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which of the following blood pressure findings can be characteristic of this condition?
Blood pressure in arms 20 mm Hg higher than in the legs
The nurse knows that which statements regarding the physiology of blood pressure are accurate? Select all that apply.
Blood pressure is very variable. • Constant elevation of blood pressure can be lethal. • A decrease in blood flow can be an immediate threat to life. Blood pressure is a very variable yet highly regulated function in healthy persons. Blood flow is most vital to heart, brain and kidneys; other tissues can better survive periods of decreased blood flow. Constant elevation of blood pressure (hypertension) can cause severe damage to heart, blood vessels and kidneys, leading to premature disability and death. A sudden decrease in blood flow, especially to the heart and brain, can rapidly be deadly: these organs, vital to survival, require a constant supply of oxygen to function effectively.
A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?
Cardiac tamponade
A nurse educator explains a type of cardiac condition as "a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation and often lead to cardiovascular death or progressive heart failure." Which condition fits this definition?
Cardiomyopathy
A 56-year-old male client has been diagnosed with hypercholesterolemia. Which laboratory results that support this diagnosis?
Cholesterol 250 mg/dL and HDL 32 mg/dL
A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect?
Coarctation of the aorta
For clients with heart failure, what pathophysiologic response helps maintain the cardiac reserve?
Compensatory mechanisms
An elderly patient arrives to the healthcare provider's office complaining of a "sore" that won't heal on their lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the patient that the usual treatment is:
Compression therapy to help facilitate blood flow back to the vena cava
A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure?
Diuretic, ACE inhibitor, beta-blocker
A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly matches which of the following drug categories to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion?
Diuretics
The nurse practitioner working in an overnight sleep lab assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?
During apneic periods the patient experiences hypoxemia which stimulates chemoreceptors to induce vasoconstriction.
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
A patient with mitral valve regurgitation and left heart failure reports shortness of breath and fatigue with activities of daily living. Which of the following instructions by the nurse will be ineffective in reducing these symptoms?
Elevating legs for 20 minutes daily
A client has been diagnosed with diabetes mellitus. Which of the following lab results would the practitioner expect?
Elevation of triglycerides
Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?
Emotional stress Angina pectoris usually is precipitated by situations that increase the work demands of the heart, such as physical exertion, exposure to cold, and emotional stress. The pain typically is described as a constricting, squeezing, or suffocating sensation. It usually is steady, increasing in intensity only at the onset and end of the attack. Changing positions abruptly does not cause an attack of angina pectoris.
A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient?
HDL cholesterol is often characterized as being beneficial to health
A 3 year old child with right-sided heart failure has been admitted for worsening of their condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler?
Enlargement of liver.
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).
The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as which of the following?
Fibrous atheromatous plaque
The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?
Genetic
A client who has just been diagnosed with dilated cardiomyopathy asks the nurse what caused the condition. The most appropriate response would be:
Genetic abnormalities
A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring?
HDL
A client who has just recently completed his second series of radiation therapy for lung cancer was admitted yesterday to an acute care facility with ascites. He begins to have jugular vein distention, pedal edema, and dyspnea upon exertion as well as fatigue. What should the nurse suspect?
He has developed constrictive pericarditis.
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
Headache and confusion -Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension
What is the most important factor in myocardial oxygen demand?
Heart rate
Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?
Histamine release causes massive vasodilation.
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:
History of cigarette smoking and elevated blood pressure -The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.
Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?
Hypercholesterolemia
The nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking?
Measure his blood pressure and show him how much higher it is when he is smoking.
A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure?
Hypertrophic cardiomyopathy
A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this?
Hypertrophic cardiomyopathy
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?
Hypertrophy
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
An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related changes predisposes older adults to the development of heart failure?
Increased vascular stiffness
The nurse is assessing the blood pressure of a client who is experiencing cardiogenic shock. Which blood pressure reading is most likely?
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.
A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man?
Infusion of normal saline or Ringer's lactate to maintain the vascular space.
While studying the heart the nursing instructor teaches about pericarditis. Which of the following does she tell the student best defines this disease?
It is an inflammatory process.
The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.
The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state: Select all that apply.
It is the most common cardiovascular disorder. • The incidence increases with age. • The systolic pressure is greater than or equal to 140 mm Hg
A client who was admitted to the cardiac intensive care unit with a diagnosis of myocarditis asks the nurse what caused his disease. What would be the nurse's best response?
It is usually caused by a viral infection.
The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?
Kussmaul sign
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which of the following lipoproteins is the main carrier of cholesterol?
LDL
A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which assessment is the nurse most justified in eliminating during a busy morning on the unit?
Measuring the pulse of a client taking an ACE inhibitor. ACE inhibitors act on the renin--angiotensin--aldosterone system and are thus not significant influences on heart rate. They can, however, induce hyperkalemia, and it would be prudent for the nurse to check potassium levels. Beta-adrenergic blockers affect a client's heart rate and diuretics can affect electrolyte levels
A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have?
Mitral valve stenosis
The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?
Morphine
Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply.
Muffled heart tones. • Narrowed pulse pressure. • Low BP—84/60.
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.
Obesity, high salt consumption, and inactive lifestyle.
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
Which of the following patients with cardiomyopathy does the nurse identify as having the greatest risk for a complication?
One with an ejection fraction of 25% and atrial fibrillation
A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:
Onset of STEMI
A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?
Pericardial effusion
Exudate in the pericardial cavity is a characteristic of which cardiac condition?
Pericardial effusion
A client is seen in the emergency room with complaints of sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?
Pericarditis
A 37-year-old woman is admitted to the unit with a differential diagnosis of rule out pheochromocytoma. What are the most common symptoms the nurse would expect this client to exhibit?
Periodic severe headache and marked variability in blood pressure
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 formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her?
Platelet count; serum creatinine; liver enzymes
A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:
Prompt diagnosis and treatment of streptococcal infections -Rheumatic heart disease is normally caused by streptococcal infections; therefore, early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a client has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and the client should have regular dental examinations.
A preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following?
Prompt diagnosis of streptococcal infections with a throat culture
The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?
Propranolol, a β-Adrenergic blocker.
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent which of the following?
Pulmonary embolism
A teenager is seen in the emergency room with complaints of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen three weeks before in the clinic and treated with antibiotics for a strep throat. He was better for a few days but now he seems to have gotten worse in the last two days. What should the nurse suspect is wrong with this client?
Rheumatic fever
A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which of the following interventions?
Sclerotherapy or surgery
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?
See the doctor for evaluation immediately.
A 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 is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?
Sustained systolic pressure equal to or greater that 160 mm Hg Stage 2 hypertension is systolic pressure greater than 159 mm Hg or diastolic pressure greater than 99 mm Hg. Systolic pressure of 140-159 mm Hg or diastolic pressure of 90-99 mm Hg are characteristic of stage 1 hypertension.
A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relate to these health problems?
The client is 89 years old and takes a diuretic medication for his congestive heart failure.
The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading?
The client just smoked a cigarette.
The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?
The client must protect the entire body from cold, not just the extremities The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?
The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:
The condition is getting progressively worse.
The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?
The disabling effects that result from involvement of heart valves
Which of the following assessment findings of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa?
The man's blood pressure is 178/102 and he has abnormal liver function tests. (p. 751)
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.
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:
The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta -Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. This increases the work and volume of the chamber emptying through the narrowed valve—the left atrium in the case of mitral stenosis and the left ventricle in aortic stenosis. An incompetent or regurgitant valve permits backward flow to occur when the valve should be closed—flowing back into the left ventricle during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased.
Which serum biomarker is highly specific for myocardial tissue?
Troponin
A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?
Troponin assays
A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?
Troponin level
A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this patient about diagnosing a valvular defect?
Valvular defects usually are detected through cardiac auscultation
A 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
An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:
Vascular stiffness
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
Which of the following is associated with stasis of blood, increased blood coagulability and vessel wall injury?
Venous thrombosis
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?
Vigilant blood pressure monitoring
The nursing student has learned in class that pericarditis is an inflammatory process of the pericardium. Which is known to be the main cause of pericarditis?
Viral infections
Which statements regarding systolic and diastolic dysfunction are correct? Select all that apply.
a)In systolic dysfunction, preload increases. b)In systolic dysfunction, the ejection fraction is decreased. d)Separation into systolic or diastolic dysfunction is based on ventricular ejection fraction.
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?
a)Vasoconstriction
A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?
b)Myocardial infarction
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.
A nurse is assessing a client in shock for complications of acute renal failure. Which assessment is priority for the nurse to obtain?
continuously measuring urine output
The nurse is discussing risk factors for hypertension with a client. Which factors are nonmodifiable risk factors for development of hypertension? Select all that apply.
ethnicity advanced age
Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in which of the following?
fingers
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.
A patient has developed atherosclerosis. The nurse knows that a major cause for this disorder is which of the following?
hypertension
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
hypertension
A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. The results suggest that the client's end-diastolic volume is insufficient. Which parameter of cardiac performance will directly decrease as a result of this finding?
preload
Assessment of an older adult client reveals bilateral pitting edema of the client's feet and ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation level of 93% (0.93); and vital signs normal. What is this client's most likely health problem?
right-sided heart failure
The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock?
septic shock
The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following?
the kidneys
The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following?
unknown
A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening?
weight gain
The nursing student, when studying about coronary artery disease, learns that it is commonly divided into different types of disorders which include which of the following? Select all that apply.
• Acute coronary syndrome • Chronic ischemic heart disease Explanation: Coronary heart disease is commonly divided into 2 types of disorders: the acute coronary syndrome and chronic ischemic heart disease.
A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are nonmodifiable risk factors associated with this diagnosis? Select all that apply.
• Race • Family history Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure, and race. Modifiable risk factors are lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which of the following topics should be included in the teaching plan? Select all that apply.
• Reduce dietary sodium intake. • Limit alcohol consumption. • Stop smoking. • Consume a diet rich in fruits, vegetables, and low-fat dairy products. Explanation: Hypertension lifestyle modification included the maintenance of normal body weight (BMI, 18.5-24.9 kg/m2) 5-20 mm Hg/10 kg weight loss. Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan including consuming a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat 8-14 mm Hg. Dietary sodium reduction to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride) 2-8 mm Hg. Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day. Moderation of alcohol consumption; limiting consumption to no more than 2 drinks (1 oz or 30 mL ethanol) (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and 1 drink per day in women and lighter-weight persons.
A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which of the following reasons? Select all that apply.
• To relieve coronary pain • For its vasodilatation effect Explanation: Nitroglycerine is given in the treatment of STEMI because of its vasodilating effect and its ability to relieve coronary pain.
