Chapter 20- Heart Failure and circulatory shock

Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:

Ventilation-perfusion mismatch

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:

Weighing every day at the same time with same type of clothing

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 client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which of the following explanations is most appropriate to share?

"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."

client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

A client with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions?

A cardiac glycoside

From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply.

A) A 48-year-old client with uncontrolled hypertension D) A 70-year-old with enlarged left ventricle due to myocardial hypertrophy

The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by: Select all that apply.

A) Accumulation of fluid in the alveoli and airways B) Lung stiffness E) Impaired gas exchange

Electrical burns over a large surface area of a client's body have resulted in hypovolemic shock after the loss of large amounts of blood and plasma. Following physical assessment, which findings lead the nurse to believe the client's body is compensating for this fluid loss? Select all that apply.

A) Increased heart rate D) The client complaining of extreme thirst E) Deep, rapid respirations

At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply.

A)Elongating the cardiac muscle cells D) Decreasing the ventricular wall thickness

The most common causes of left-sided heart failure include:

Acute myocardial infarction

A client has arrived in the emergency department in cardiogenic shock. Which of the following assessment findings confirm this diagnosis? Select all that apply.

B) Less than 5 mL dark, concentrated urine in the past hour C) BP reading of 80/65 D) Difficult to arouse with changes in level of consciousness

A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which of the following clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply.

B) Severe bronchospasm C) Wheezing sound on inspiration D) Hives over entire body E) Swelling around the lips and eyes

For which of the following types of shock might intravenous antibiotic therapy be indicated?

Disruptive shock

In the ICU setting, clients who develop shock need thorough head-to-toe assessments. Which of the following clinical manifestations would alert the health care provider that the client may be developing ischemia associated with gastrointestinal redistribution of blood flow?

Gastric Bleeding

While in the ICU, a client's status changes. The health care providers suspect heart failure. Which of the following diagnostic procedures would give the staff information about pulmonary capillary pressures, which will lead to the most appropriate interventions?

Hemodynamic monitoring

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:

Hypovolemic shock due to acute intravascular volume loss

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

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

One of the principal mechanisms by which the heart compensates for increased workload is:

Myocardial hypertrophy

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

A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the client's end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this?

Preload

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

When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents:

The amount of blood the heart pumps each minute

In an ICU setting, one assessment that would lead the nurse to suspect shock has resulted in decrease blood flow to vital organs is:

Urine output less than 20 mL/hour