patho 19
While studying the physiology of the heart, the nursing students have learned that which of the following influence the blood flow in the coronary vessels that supply the myocardium? Select all that apply. Thyroid gland The aortic pressure Hypothalamus Autoregulatory mechanisms Compression of the intramyocardial vessels
The aortic pressure Autoregulatory mechanisms Compression of the intramyocardial vessels
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 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? Blood work can help to diagnose a valvular defect. Valvular defects usually are detected through cardiac auscultation. An ECG can be done to rule out this disease. An MRI, which is more expensive, can be helpful in this diagnosis.
Valvular defects usually are detected through cardiac auscultation.
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." "It will give you a steady relief of your chest pain." "Aspirin prevents blood clotting by halting platelet production." "Aspirin will prevent a heart attack."
"Aspirin will help prevent blood clotting."
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 take my verapamil at the same time every day." "I should report episodes of dizziness or fainting." "I should begin an aerobic exercise program." "I should limit my daily alcohol ingestion to two drinks."
"I should report episodes of dizziness or fainting."
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."
It is known that over 100 distinct myocardial diseases can demonstrate clinical features associated with dilated cardiomyopathy (DCM). What is the most common identifiable cause of DCM in the United States? Cardiotoxic cardiomyopathy Exercise-induced cardiomyopathy Hepatic cardiomyopathy Alcoholic cardiomyopathy
Alcoholic cardiomyopathy
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
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? Rheumatic cardiac disease Myocardial infarction Cardiomyopathy Heart failure
Cardiomyopathy
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? CT of the heart, chest X-ray, ECG ECG, blood pressure, stress test Echocardiogram, blood cultures, temperature Cardiac catheterization, chest X-ray, electrolyte measurement, and white cell count
Echocardiogram, blood cultures, temperature
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? Abrupt change in position Sedentary lifestyle Emotional stress Exposure to heat
Emotional stress
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.
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 is suffering side effects of the radiation. He is having a myocardial infarction. He is showing signs of acute renal failure. He has developed constrictive pericarditis.
He has developed constrictive pericarditis.
What is the most important factor in myocardial oxygen demand? Respiratory rate Heart rate Degree of anxiety Hyperthermia
Heart rate
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? Mitral valve prolapse Dilated cardiomyopathy Atrial regurgitation Hypertrophic cardiomyopathy
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? Heart attack Pericarditis Hypertrophic cardiomyopathy Dehydration
Hypertrophic cardiomyopathy
The nursing student has learned in his class that coronary artery disease (CAD) is heart disease caused by which of the following? Exposure to too much sunlight Impaired coronary blood flow Frequent exercise A congenital defect
Impaired coronary blood flow
A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process? Cardiomyopathy Infective endocarditis Myocardial infarction Pericarditis
Infective endocarditis
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 Mitral valve prolapse Aortic valve prolapse Aortic valve stenosis
Mitral valve stenosis
A 13-year-old boy has had a sore throat for at least a week, vomiting for 2 days, cervical lymph nodes are swollen, and he moves stiffly because his joints hurt. Throat cultures show infection with group A streptococci. This child is at high risk for development of which cardiac abnormality? Mitral valve stenosis. Unstable angina. Vasculitis and aneurysm of the coronary arteries. Myocarditis.
Mitral valve stenosis.
A nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess. Tongue Palms of the hands Sclera of the eyes Mucous membranes
Mucous membranes
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
Which of the following patients with cardiomyopathy does the nurse identify as having the greatest risk for a complication? One with orthopnea and activity intolerance One with an ejection fraction of 25% and atrial fibrillation One with hepatomegaly and ascites One with peripheral edema and 2-kg weight gain
One with an ejection fraction of 25% and atrial fibrillation
Five hours after presenting to the emergency department with substernal chest pain, a patient's laboratory results demonstrate that troponin I is elevated and the creatine kinase-myoglobin (CK-MB) levels are within normal range. Which of the following is the nurse's interpretation of these results?
Patient is currently experiencing an MI.
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? Myocardial infarction Pericarditis Pneumonia Abdominal aortic aneurysm
Pericarditis
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? Encourage deep breathing Provide pain medications Administer IV corticosteroids Prepare for pericardiocentesis
Prepare for pericardiocentesis
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
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 client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following? Give it 5-10 minutes more to see if there is relief. Not worry about it as this is common for someone who has already had a myocardial infarction. Take a second nitroglycerine. See the doctor for evaluation immediately.
See the doctor for evaluation immediately.
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 ordered 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.
Which of the following patients is at the greatest risk of developing rheumatic heart disease? Older adult with shingles Teenager with untreated strep throat Child with impetigo on the face Young adult with viral meningitis
Teenager with untreated strep throat
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
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response? Sometimes a parasite is involved. The most common cause is a staph infection. It can be attributed to drug abuse. Let's not worry about the cause as we need to focus on getting him better.
The most common cause is a staph infection.
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 incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium. The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. The valve opening permits backward flow to occur when the valve should be closed. The valve opens backward permitting blood to flow from the right ventricle into the right atrium.
The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
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 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? Diarrhea Hypoglycemia Decreased level of consciousness Symmetrical joint pain
decreased level of consciousness
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? Broad-spectrum antibiotic drugs Calcium channel blocking drugs β-Adrenergic-blocking drugs Antianxiety drugs
β-Adrenergic-blocking drugs
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. For diuretic purposes To relieve coronary pain For its vasodilatation effect To relieve anxiety
For its vasodilatation effect To relieve coronary pain
The nurse determines that teaching has been effective when a client diagnosed with chronic stable angina states: "Angina may result from exertional activity or emotional stress and be relieved within minutes by rest or by nitroglycerin." "If the angina occurs when I am resting, I do not need to worry." "If it takes longer than 5 to 10 minutes for relief of symptoms after I take my Nitro, I am improving." "Because it is chronic angina, it will not get worse."
"Angina may result from exertional activity or emotional stress and be relieved within minutes by rest or by nitroglycerin."
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'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." "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." "With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this." "I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising."
"I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising."
A client who has been diagnosed with mitral valve prolapse asks the nurse if there are any dietary modifications that should be incorporated into her lifestyle. The best response would be: "It is OK to decrease your smoking to one pack per day." "Energy drinks may help to support metabolism." "Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms." "Avoid coffee; however, tea is OK."
"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."
Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health? "The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel." "The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption." "People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times." "Infections of any sort are often a signal that plaque disruption is in danger of occurring."
"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."
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? "The valve between your left ventricle and left atria is infected and isn't allowing enough blood through." "The normal tissue that makes up the valve between the right sides of your heart has stiffened." "Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation." "Your heart's mitral valve isn't closing properly so blood is flowing backwards in your heart and eventually into your lungs."
"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."
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 A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw
A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest
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 hyperoxygenated period when the infant is at rest A hyperpneic attack in which the infant loses consciousness A hypercyanotic attack brought on by periods of stress A stressful period right after birth that occurs without evidence of cyanosis
A hypercyanotic attack brought on by periods of stress
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 increases anxiety increasing metabolic demands of the heart. Action relieves pain and gives sense of depression. Action decreases metabolic demands of the heart. Action increases autonomic nervous system activity.
Action decreases metabolic demands of the heart.
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? Thrombosis Cardiac tamponade Pericarditis Myocardial infarction
Cardiac tamponade
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? Overproduction of energy capable of sustaining normal myocardial function Conversion from aerobic to anaerobic metabolism Conversion from anaerobic to aerobic metabolism Inadequate production of glycogen with mitochondrial shrinkage
Conversion from aerobic to anaerobic metabolism
Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome? Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium and disruption of the sodium-potassium pump. Increased serum creatinine and troponin I as a result of enzyme release from damaged cells. Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response. Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation.
Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation.
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 a congenital disease. It is an autoimmune response to stress. It is an inflammatory process. It is a result of suffering a myocardial infarction.
It is an inflammatory process.
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. There is no research yet on what causes this disease. It is caused by some type of bacteria. You need to ask your physician.
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 where to which part of the body? Left lung to the right lung Right side of the heart to the left side of the heart Left side of the heart to the right side of the heart Right lung to the left lung
Left side of the heart to the right side of the heart
When the electrocardiogram (ECG) of a client in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta adrenergic blocker. Which factors in the patient's history will cause the nurse to withhold medication pending discussion with physician? Select all that apply. Third-degree heart block Myocardial infarction caused by cocaine use Hypertension Cerebrovascular accident Shock
Myocardial infarction caused by cocaine use Third-degree heart block Shock
A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: Avoiding frequent dental examinations Prompt diagnosis and treatment of streptococcal infections Annual blood specimen assessed for rheumatoid factor Yearly electrocardiography after the age of 50
Prompt diagnosis and treatment of streptococcal infections
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 Yearly electrocardiography after the age of 50 Blood specimen assessed for rheumatoid factor Scheduling regular hearing examinations
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? Lasix, a diuretic. Lisinipril, an ACE-inhibitor. Propranolol, a β-Adrenergic blocker. Lanoxin, an inotropic.
Propranolol, a β-Adrenergic blocker.
A 31-year-old female at 30 weeks' gestation has been diagnosed with peripartum cardiomyopathy. Which statement best captures an aspect of peripartum cardiomyopathy? Treatment is possible in postpartum women but antepartum women are dependent on spontaneous resolution of the problem. The diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes. Symptomology mimics that of stable angina and is diagnosed and treated similarly. Mortality exceeds 50% and very few surviving women regain normal heart function.
The diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.
In infective endocarditis, vegetative lesions grow on the valves of the heart. These vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin strands of clotted blood. What are the possible systemic effects of these vegetative lesions? They can fragment and cause cerebral emboli. They can block the heart valves from closing completely. They can keep the heart valves from opening. They can fragment and make the lesions larger.
They can fragment and cause cerebral emboli.
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 Mixed Does not usually occur in young athletes Acquired
genetic
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 smoking and elevated blood pressure
A client who has suffered a myocardial infarction is being treated in the emergency room. His pain remains severe even though he was given nitrates and oxygen. The physician now orders morphine for the pain. What method should the nurse to administer the morphine? By mouth in a liquid By mouth in pill form Subcutaneous Intravenous
intravenous
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
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? Acute pericarditis Pericardial effusion Constrictive pericarditis Cardiac tamponade
pericardial effusion
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 client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection. Staphylococcus aureus Actinobacillus actinomycetemcomitans Eikenella corrodens Kingella kingae
staphylococcus aureus
Which serum biomarker is highly specific for myocardial tissue?
troponin
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