Chapter 27 PrepU
A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?
When the client experiences chest pain
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."
The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition?
"I should report episodes of dizziness or fainting."
What should the nurse teach the client prior to ergometry?
"This test evaluates cardiac function."
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
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
A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child?
Antibiotics and anti-inflammatory drugs
Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?
Atherosclerosis and unstable angina
Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is:
Atrial fibrillation
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences?
Backflow from the left ventricle to left atrium
Persistent cyanosis has led an infant's care team to suspect a congenital heart defect. Which assessment findings would suggest coarctation of the infant's aorta?
Blood pressure in the child's legs is lower than in the arms.
What can trigger myocardial ischemia even when there is adequate coronary oxygen supply? Select all that apply. Carbon monoxide poisoning Hypoxia Anemia Damaged coronary veins Fever
Carbon monoxide poisoning Hypoxia Anemia
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
What should the nurse teach the pregnant woman about congenital heart defects?
Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant.
A client diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which conditions are often associated with diastolic failure? Select all that apply. Constrictive pericarditis Valvular stenosis Volume overload Myocardial hypertrophy Ischemic heart disease
Constrictive pericarditis Myocardial hypertrophy Ischemic heart disease
A client who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which manifestation alerts the nurse to a developing complication?
Decreased level of consciousness
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
What is the most important factor in myocardial oxygen demand?
Heart rate
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
Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?
Hypertrophic cardiomyopathy (HCM)
Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?
Hypertrophy
A client with a history of heart failure has been assessed and the care team has determined that a reduction in myocardial workload would benefit his prognosis. Which intervention is most likely to meet this client's needs?
Implantation of a ventricular assist device (VAD)
Which intervention will the nurse anticipate being prescribed to treat an adult admitted to the ICU with acute respiratory distress syndrome (ARDS)?
Increasing oxygen concentration in the inspired air
A newborn is diagnosed with Tetralogy of Fallot. Prior to surgery, which abnormality should be corrected to prevent a stroke?
Iron deficiency anemia
A client who was diagnosed with myocarditis asks the nurse what caused his disease. Which response by the nurse is most accurate?
It is usually caused by a viral infection.
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 to which part of the body?
Left side of the heart to the right side of the heart
Which form of cardiomyopathy would be considered genetically based? Select all that apply. Peripartum cardiomyopathy Left ventricular noncompaction Dilated cardiomyopathy Myocarditis Hypertrophic cardiomyopathy
Left ventricular noncompaction Hypertrophic cardiomyopathy
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
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 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering?
Pericardial effusion
Exudate in the pericardial cavity is a characteristic of which cardiac condition?
Pericardial effusion
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema, weight gain
A client has presented to the emergency department in distress and is being rapidly assessed by the care team. Which assessment finding would prompt the team to consider the possibility of acute heart failure?
Respiratory distress with audible crackles
A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection.
Staphylococcus aureus
A child is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are most accurate? Select all that apply. Symptoms include tachypnea and tachycardia. The etiology of heart failure is similar in children and adults. Congenital defects are a risk factor. Physical activity must be discouraged. Inotropic agents such as digoxin may be used in children.
Symptoms include tachypnea and tachycardia. Congenital defects are a risk factor. Inotropic agents such as digoxin may be used in children.
Which client is at the greatest risk of developing rheumatic heart disease?
Teenager with untreated strep throat
A neonate is born with a congenital heart defect. The nurse realizes this defect most likely originated during which week of development?
The third week of development
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.
Heart failure and circulatory shock are both conditions of circulatory system failure. Which statement regarding these conditions is correct?
They have the same compensatory mechanisms.
Which serum biomarker is highly specific for myocardial tissue?
Troponin
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?
Vasoconstriction
A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?
Vasodilating effects reducing preload and afterload
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 (beta-blockers)
An older adult 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.
Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
constrictive pericarditis
A nurse is teaching a client with newly diagnosed dilated cardiomyopathy (DCM) about associated treatments. The nurse determines that the knowledge is understood when the client correctly matches which drug category to the primary action of decreasing preload by suppressing renal reabsorption of sodium and increasing salt and water excretion?
diuretics
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.
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.
Which health condition can contribute to diastolic dysfunction heart failure?
myocardial hypertrophy
The nurse is assessing a client involved in a motor vehicle collision who has bruising across the sternum from seat belt pressure. The nurse notes muffled heart sounds, and the client's blood pressure is 100/85 mm Hg. The nurse notifies the health care provider to present these findings as evidence of which condition?
pericardial effusion
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:
see the doctor for evaluation immediately.
A client awaiting a heart transplant is experiencing decompensation of the left ventricle that will not respond to medications. The health care provider (HCP) suggests placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. Which response most accurately describes the purpose of a VAD?
"Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?
Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation
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.
A 30-year-old client arrives with these vital signs: Blood pressure 50/30 mm Hg, pulse 100 beats/min, respiratory rate 12 breaths/min, temperature 101°F (38.3°C). The nurse interprets these results as the client being in shock based on which reading?
Low blood pressure
The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myocardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain?
Morphine
A client is seen in the emergency room reporting 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 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 reason? Select all that apply.
To relieve coronary pain For its vasodilation effect
A client comes to the emergency room with all the symptoms of a myocardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order?
Troponin assays
While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:
recording weight every day at the same time with same type of clothing.
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
Which client with cardiomyopathy does the nurse identify as having the greatest risk for a complication?
Client with an ejection fraction of 25% and atrial fibrillation
Which of the following describes surgical correction of tetralogy of Fallot?
Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction
Which statement regarding heart failure is true?
In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction.
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 change predisposes older adults to the development of heart failure?
Increased vascular stiffness
When educating the parents of an infant diagnosed with of Tetralogy of Fallot, the nurse will include which statements related to the physiologic abnormalities of the infant's heart? Select all that apply. The infant has a hole in the ventricular septal. The infant has a small, narrow pulmonary outflow channel. The infant has a large, thick, right ventricular wall. The infant has a very small, narrow aorta. The pulmonary artery arises from the left ventricle.
The infant has a hole in the ventricular septal. The infant has a small, narrow pulmonary outflow channel. The infant has a large, thick, right ventricular wall.
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
A client has developed cardiogenic shock. The most frequent cause of this type of shock is:
Myocardial infarction
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 client 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:
Valvular regurgitation
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
