PrepU Patho Ch. 19 Disorders of Cardiac Function
The nurse, assessing a client with early signs of constrictive pericarditis, should monitor the client for which clinical manifestations? a)Ascites b)Muscle wasting c)Exercise intolerance d)Weight loss
a)Ascites
A client comes to the emergency room with complaints of chest pain. When the nurse reads his ECG she sees changes which include T-wave inversion, ST-segment elevation, and an abnormal Q wave. What should she suspect? a)Coronary artery disease (CAD) b)Acute myocardial infarction c)Pleural effusion d)Pericarditis
b)Acute myocardial infarction
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? a)"I should begin an aerobic exercise program." b)"I should take my verapamil at the same time every day." c)"I should report episodes of dizziness or fainting." d)"I should limit my daily alcohol ingestion to two drinks."
c)"I should report episodes of dizziness or fainting."
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? a)Diarrhea b)Symmetrical joint pain c)Hypoglycemia d)Decreased level of consciousness
d)Decreased level of consciousness
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be: a)The valve opening permits backward flow to occur when the valve should be closed. b)The valve opening is incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium. c)The valve opens backward permitting blood to flow from the right ventricle into the right atrium. d)The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
d)The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
Which serum biomarker is highly specific for myocardial tissue? a)C-reactive protein b)White blood cells c)Creatine kinase d)Troponin
d)Troponin
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? a)Myocardial infarction b)Pericardial effusion c)COPD d)Pericarditis
b)Pericardial effusion
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: a)"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems." b)"It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit." c)"This may make you a little more fatigued than usual. Let me know if you start getting dizzy or lightheaded." d)"This could be caused by an infection. Have you been feeling well the past few weeks?"
a)"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."
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? a)Echocardiogram, blood cultures, temperature b)ECG, blood pressure, stress test c)Cardiac catheterization, chest X-ray, electrolyte measurement, and white cell count d)CT of the heart, chest X-ray, ECG
a)Echocardiogram, blood cultures, temperature
Which of the following patients is at the greatest risk of developing rheumatic heart disease? a)Older adult with shingles b)Teenager with untreated strep throat c)Child with impetigo on the face d)Young adult with viral meningitis
b)Teenager with untreated strep throat
When a physician suspects a patient has suffered an acute myocardial infarction, which serum biomarkers should he order? Select all that apply. a)Magnesium b)Troponin T c)Phosphorous d)Creatine kinase e)Troponin 1
b)Troponin T d)Creatine kinase e)Troponin 1
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? a)Abrupt change in position b)Sedentary lifestyle c)Emotional stress d)Exposure to heat
c)Emotional stress
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following? a)Give it 5-10 minutes more to see if there is relief. b)Not worry about it as this is common for someone who has already had a myocardial infarction. c)Take a second nitroglycerine. d)See the doctor for evaluation immediately.
d)See the doctor for evaluation immediately.
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? a)"With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this." b)"I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising." c)"There are things you can do to reduce the chance that you will need a heart bypass, including limiting physical activity as much as possible." d)"I'll be able to help track the course of your angina through regular blood work that we will schedule at a lab in the community."
b)"I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising."
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? a)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 b)A 67-year-old female whose pain started at 2 a.m. while she was asleep and which responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable c)A 61-year-old man whose pain started at 9 a.m. during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened d)A 33-year-old male whose pain started at 7 a.m. during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable
a)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
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? a)Conversion from aerobic to anaerobic metabolism b)Inadequate production of glycogen with mitochondrial shrinkage c)Conversion from anaerobic to aerobic metabolism d)Overproduction of energy capable of sustaining normal myocardial function
a)Conversion from aerobic to anaerobic metabolism
A client with a history of myocardial infarction tells the healthcare provider they have started to experience more episodes of angina pectoris than before. The provider should tell this client that which activity can precipitate his angina pectoris? Select all that apply. a)Emotional stress b)Reading suspense books c)Physical exertion d)Exposure to cold e)Eating too fast
a)Emotional stress c)Physical exertion d)Exposure to cold
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: a)History of cigarette smoking and elevated blood pressure b)Physical inactivity and high serum high-density lipoprotein cholesterol c)High serum high-density lipoprotein and diabetes d)Advanced age and low serum total and low-density lipoprotein cholesterol
a)History of cigarette smoking and elevated blood pressure
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? a)Hypertrophic cardiomyopathy b)Atrial regurgitation c)Dilated cardiomyopathy d)Mitral valve prolapse
a)Hypertrophic cardiomyopathy
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: a)Onset of STEMI b)Pneumonia c)Acute respiratory distress syndrome (ARDS) d)Gastroesophageal reflux disease (GERD)
a)Onset of STEMI
A nurse preparing education on managing the risk factors for coronary artery disease (CAD) will stress which information? Select all that apply. a)Signs and symptoms of type 2 diabetes mellitus b)Importance of exercise on managing hypertension c)Smoking cessation techniques d)Identification of high cholesterol foods e)Stress management techniques
a)Signs and symptoms of type 2 diabetes mellitus b)Importance of exercise on managing hypertension c)Smoking cessation techniques d)Identification of high cholesterol foods
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? a)Systemic emboli, especially to brain. b)GI upset from the massive amount of antibiotics required to kill the bacteria. c)Petechial hemorrhages under the skin and nail beds. d)Pancreas enlargement due to increased need for insulin secretion.
a)Systemic emboli, especially to brain.
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? a)The disabling effects that result from involvement of heart valves b)The fact that it affects young and old c)That there is no definitive test used for diagnoses d)The cost associated with treating the disease
a)The disabling effects that result from involvement of heart valves
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? a)Troponin assays b)Potassium c)Phosphorous d)Creatine kinase
a)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? a)Troponin level b)Complete blood components c)Calcium level d)Creatine kinase marker
a)Troponin level
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? a)Β-Adrenergic-blocking drugs b)Antianxiety drugs c)Broad-spectrum antibiotic drugs d)Calcium channel blocking drugs
a)Β-Adrenergic-blocking drugs
Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis? a)Have the client change positions to unaffected side. b)Have the client sit up and lean forward. c)Have the client swallow slowly and frequently. d)Have the client breathe deeply.
b)Have the client sit up and lean forward.
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? a)Pericarditis b)Hypertrophic cardiomyopathy c)Heart attack d)Dehydration
b)Hypertrophic cardiomyopathy
The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client. a)Preventing clotting disorders b)Myocardial infarction prevention c)Ensuring adequate oxygenation with continuous oxygen administration d)Assisting the client to return to previous lifestyle
b)Myocardial infarction prevention
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope? a)At the carotid arteries b)Over the aorta c)At the apex of the heart d)Over the sternum
c)At the apex of the heart
The nurse caring for a patient 12 hours post coronary bypass graft notes a sudden decrease in the amount of chest tube drainage, a rapidly narrowing pulse pressure, paradoxical pulse, and shortened amplitude of the QRS complex on the electrocardiogram monitor. Which of the following should the nurse do next? a)Administer IV corticosteroids b)Encourage deep breathing c)Prepare for pericardiocentesis d)Provide pain medications
c)Prepare for pericardiocentesis
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? a)Action increases autonomic nervous system activity. b)Action increases anxiety increasing metabolic demands of the heart. c)Action relieves pain and gives sense of depression. d)Action decreases metabolic demands of the heart.
d)Action decreases metabolic demands of the heart.
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? a)Does not usually occur in young athletes b)Acquired c)Mixed d)Genetic
d)Genetic
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? a)Demerol b)Codeine c)Fentanyl d)Morphine
d)Morphine
A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: a)Avoiding frequent dental examinations b)Annual blood specimen assessed for rheumatoid factor c)Yearly electrocardiography after the age of 50 d)Prompt diagnosis and treatment of streptococcal infections
d)Prompt diagnosis and treatment of streptococcal infections
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? a)Lasix, a diuretic. b)Lanoxin, an inotropic. c)Lisinipril, an ACE-inhibitor. d)Propranolol, a β-Adrenergic blocker.
d)Propranolol, a β-Adrenergic blocker.
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? a)Mononucleosis b)Meningitis c)Flu d)Rheumatic fever
d)Rheumatic fever
Unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) is a clinical syndrome that ranges in severity between stable angina and MI. It is classified according to its risk of causing an acute MI and is diagnosed based on what assessment data? (Select all that apply.) a)Co-existing chronic conditions b)Severity of pain and abruptness of onset c)Blood flow angiography d)Serum biomarkers e)ECG pattern
d)Serum biomarkers e)ECG pattern