CHAPTER 19

Which left atrial pressure readings indicate a risk of increased capillary filtration that results in the clinical manifestations of pulmonary edema? A. 25 mm Hg B. 10 mm Hg C. 6 mm Hg D. 4 mm Hg

A. 25 mm Hg Readings at or above 25 mm Hg are associated with increased capillary filtration and pulmonary edema. The normal left atrial pressure is 4 to 12 mm Hg.

The nurse includes what information when educating a client concerning a first-degree heart block? (Select all that apply.) A. An electrocardiogram is used to identify this conduction disorder. B. Congenital heart defects are often the cause of the disorder. C. The condition is monitored, but not actively managed. D. Bradycardia is a common characteristic. E. First-degree blocks are rare.

A. An electrocardiogram is used to identify this conduction disorder. B. Congenital heart defects are often the cause of the disorder. C. The condition is monitored, but not actively managed. First-degree block is generally identified by a prolonged PR interval (more than 0.20 second) on the ECG. Drugs and organic heart disorders, such as myocardial ischemia and congenital heart defects, may cause first-degree block. First-degree block is generally monitored, but not actively managed except to alleviate the underlying cause, if possible. A second-degree type II block may also result in severe bradycardia due to the number of dropped beats. First-degree block is a common finding and may occur in the absence of organic heart disease.

Which diagnostic analysis is used to identify patients with heart failure? (Select all that apply.) A. BNP (B-type natriuretic peptide) B. ANP (atrial natriuretic peptide) C. Complete blood count (CBC) D. Echocardiogram E. Chest x-ray film

A. BNP (B-type natriuretic peptide) D. Echocardiogram E. Chest x-ray film BNP is a blood test that assists in identifying patients with heart failure. An echocardiogram uses sound waves to create a moving picture of the heart and is used in the diagnosis of heart failure. A chest x-ray is a physical diagnostic test that shows heart structures and is used in the diagnosis of heart failure. Complete blood count (CBC) is a blood analysis used to determine the composition of blood related to amounts of specific cells in a serum sample. The overall effect of ANP on the body is to counter increases in blood pressure and volume caused by the renin-angiotensin system.

A common cause of heart failure is which of the following? (Select all that apply.) A. Coronary artery disease B. Valvular heart disease C. Cardiomyopathy D. Hypertension E. Anemia

A. Coronary artery disease C. Cardiomyopathy D. Hypertension The most common cause of HF is myocardial ischemia from coronary artery disease, followed by hypertension and dilated cardiomyopathy. Valvular heart disease and anemia are not common causes of heart failure.

A patient is admitted to the hospital with left-sided heart failure. Which clinical manifestation would the nurse expect the client to exhibit? (Select all that apply.) A. Cough B. Dyspnea C. Bradypnea D. Crackles in lungs E. Peripheral edema

A. Cough B. Dyspnea D. Crackles in lungs Common clinical manifestations of left-sided heart failure include cough, dyspnea, and crackles in lungs upon auscultation. Bradypnea describes abnormal slowness of breathing not seen in left-sided heart failure. Peripheral edema is associated with right-sided heart failure.

What effect does stimulation of the sympathetic nervous system have on the arterioles and resulting systemic reaction? (Select all that apply.) A. Increased vascular resistance B. Increased blood pressure C. Increased afterload D. Constriction E. Dilation

A. Increased vascular resistance B. Increased blood pressure C. Increased afterload D. Constriction Stimulation of the sympathetic nervous system results in increased vascular resistance, increased blood pressure, increased afterload, and constriction of the arterioles. Stimulation of the sympathetic nervous system results in constriction, not dilation, of the arterioles.

Atrial fibrillation is best described as when A. the P wave precedes, follows, or is buried in the QRS complex. B. disorganized and irregular atrial waves are accompanied by an irregular ventricular rate. C. an atrial rate of 240 to 350 beats/minute in a sawtooth pattern of atrial depolarization is seen. D. P waves occur earlier than normal, preceded by a P wave with a normal QRS configuration.

B. disorganized and irregular atrial waves are accompanied by an irregular ventricular rate. Atrial fibrillation is described as disorganized and irregular atrial waves accompanied by an irregular ventricular rate. Escape rhythms can present with a P wave that precedes, follows, or is buried in the QRS complex. Atrial flutter is typically manifested by a rapid atrial rate of 240 to 350 beats/minute and a characteristic saw-tooth pattern of atrial depolarizations. Premature atrial complexes (PAC) are characterized by P waves that occur earlier than normal, preceded by a P wave with a normal QRS configuration.

A patient has a regular heart rate of 54 beats/minute. The nurse would document this rhythm as A. normal. B. arrhythmia. C. bradycardia. D. tachycardia.

C. bradycardia. Sinus bradycardia is defined as a heart rate of less than 60 beats/minute. Normal sinus rhythm is defined as an impulse rate between 60 and 100 per minute. Sinus arrhythmia is a normal finding associated with fluctuations in autonomic influences and respiratory dynamics. Sinus tachycardia is an abnormally fast heart rate of greater than 100 beats/minute.

. Which medication classification is used to decrease preload in patients with heart failure? A. Calcium channel blockers B. Corticosteroids C. β-Blockers D. Diuretics

D. Diuretics The right ventricle is particularly sensitive to reductions in preload, and care must be taken to avoid a significant drop in right ventricular output when intravascular volume is decreased. Drugs, such as diuretics, may be administered to reduce intravascular volume. Diuretics promote the excretion of fluid by increasing renal blood flow and blocking sodium and chloride reabsorption, or both. Calcium channel blockers are not commonly used to decrease cardiac preload. Corticosteroids are not used for affecting cardiac preload. β-Blockers slow the heart rate and reduce the force with which the heart muscle contracts, thereby lowering blood pressure.

A patient with heart failure reports awakening intermittently with shortness of breath. Which terms appropriately describe this clinical manifestation? A. Dyspnea B. Cyanosis C. Bradypnea D. Paroxysmal nocturnal

D. Paroxysmal nocturnal Paroxysmal nocturnal dyspnea refers to intermittent attacks of severe dyspnea that occur during the night. Dyspnea is a general term referring to difficulty breathing. Cyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. Bradypnea describes abnormal slowness of breathing.