Patho - Cardio questions for exam 2
The nurse determines that teaching has been effective when a client diagnosed with chronic stable angina (CSA) 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." Explanation: Chronic stable angina (CSA) is provoked by exertional activity or emotional stress and relieved within minutes by rest or by nitroglycerin. A delay of more than 5 to 10 minutes before relief is obtained suggests that the symptoms result from severe ischemia. Angina that occurs at rest, is of new onset, or is increasing in intensity or duration denotes an increased risk for myocardial infarction and should be evaluated using the criteria for CSA.
A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching th client about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium? A membranous sac that encloses the heart The outer muscular layer of the heart The innermost lining of the heart chambers The electrical conduction system of the heart
A membranous sac that encloses the heart Explanation: The pericardium forms a fibrous covering around the heart, holding it in a fixed position in the thorax and providing physical protection and a barrier to infection. The pericardium is a tri-layer sac consisting of a tough, outer fibrous layer and a thin, inner serous layer.
The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by which physiologic response? Select all that apply. Impaired gas exchange Accumulation of fluid in the alveoli and airways Myocardial muscle necrosis Worsening renal failure Lung stiffness
Accumulation of fluid in the alveoli and airways Lung stiffness Impaired gas exchange Explanation: Acute pulmonary edema is the most dramatic symptom of AHFS. It is a life-threatening condition in which capillary fluid moves into the alveoli. The accumulated fluid in the alveoli and airways causes lung stiffness, makes lung expansion more difficult, and impairs the gas exchange function of the lung. With the decreased ability of the lungs to oxygenate the blood, the hemoglobin leaves the pulmonary circulation without being fully oxygenated, resulting in shortness of breath and cyanosis. Worsening renal failure and MI may cause volume overload but are more likely secondary causes of chronic heart failure.
A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is: History of myocardial infarction Heart failure Elevated HDL cholesterol Hypertension
Acute arterial occlusion Explanation: Acute arterial occlusion in an extremity causes sudden onset of acute pain with numbness, tingling, weakness, pallor and coldness. Pulses are absent below the level of the occlusion. Intermittent claudication (or pain with walking) is the primary symptom of chronic obstructive arterial diasease (sometimes referred to as arteriosclerosis obliterans). Many people with venous thrombosis are asymptomatic. While they can have pain, they do not lose pulses in the extremity.
The nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD? Atherosclerosis Excessive exercise Defect in the DNA Excessive use of dairy products
Atherosclerosis Explanation: In most cases, coronary artery disease is caused by atherosclerosis. Exercise is good for people and excessive use of dairy is not related nor is it a defect in DNA. Risk factors can predispose someone to coronary artery disease such as cigarette smoking, high cholesterol, diabetes, advancing age, etc.
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 Thrombosis Myocardial infarction Pericarditis
Cardiac tamponade Explanation: Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart. It can be life-threatening and symptoms include tachycardia, elevated central venous pressure, jugular vein distention, and fall in systolic blood pressure with narrowed pulse pressure. Pericarditis is inflammation of the pericardium. A myocardial infarction does not have these symptoms nor does a thrombus.
Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes? Fibrillation Tamponade Valvular insufficiency Cyanosis
Cyanosis Explanation: Cyanosis develops when impaired pulmonary gas exchange reduces oxygenation of the arterial blood in conditions such as pulmonary edema, left-sided heart failure, or right-to-left cardiac shunting.
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 cigarette smoking and elevated blood pressure Advanced age and low serum total and low-density lipoprotein cholesterol Physical inactivity and high serum high-density lipoprotein cholesterol High serum high-density lipoprotein and diabetes
History of cigarette smoking and elevated blood pressure Explanation: The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.
A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is: History of myocardial infarction Heart failure Elevated HDL cholesterol Hypertension
Hypertension Explanation: Constant high blood pressure damages arterial walls and promotes formation and rupture of plaque, with subsequent stroke and myocardial infarction. Atherosclerosis can also contribute to heart failure. Elevated HDL cholesterol would mitigate the development of atherosclerosis.
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: Hypertension Family history of heart disease Being male 55 years of age
Hypertension Explanation: The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors. The other options are nonmodifiable risk factors for atherosclerosis.
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? Myocardial infarction Cardiomyopathy Infective endocarditis Pericarditis
Infective endocarditis Explanation: Infective endocarditis is a serious and potentially life-threatening infection of the inner surface of the heart. Pericarditis involves an inflammatory response of the pericardium. Myocardial infarction is a heart attack while cardiomyopathy is a heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorders.
Which of the following is true regarding pulmonary circulation? The system functions with an increased arterial pressure to circulate through the distal parts of the body. It is a low-pressure system that allows for improved gas exchange. It is the larger of the two circulatory systems. It consists of the left side of the heart, the aorta, and its branches.
It is a low-pressure system that allows for improved gas exchange. Explanation: The pulmonary circulation consists of the right heart and the pulmonary artery, capillaries, and veins. It is the smaller of the systems and functions at a lower pressure to assist with gas exchange.
While discussing the heart, the nursing instructor teaches about pericarditis. Which statement does the instructor state best defines this disease? It is an inflammatory process. It is an autoimmune response to stress. It is a congenital disease. It is a result of suffering a myocardial infarction.
It is an inflammatory process. Explanation: Pericarditis is an inflammatory process of the pericardium. It may be infectious or occur as the result of systemic disease.
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 Aortic valve stenosis Mitral valve prolapse Aortic valve prolapse
Mitral valve stenosis Explanation: Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole, with left atrial distention and impaired filling of the left ventricle with associated symptoms. Mitral prolapse and aortic valve disorders will lead to the development of cardiomyopathies.
The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client. Assisting the client to return to previous lifestyle Myocardial infarction prevention Ensuring adequate oxygenation with continuous oxygen administration Preventing clotting disorders
Myocardial infarction prevention Explanation: Symptom reduction for quality of life and prevention of MI are treatment goals for stable angina. The other options would not be treatment goals for stable angina.
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: Acute respiratory distress syndrome (ARDS) Pneumonia Gastroesophageal reflux disease (GERD) Onset of STEMI
Onset of STEMI Explanation: The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin.
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process? Release of stress hormones Electrical impulses in the heart Rigidity of the ventricular walls Peripheral vascular resistance
Peripheral vascular resistance Explanation: The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for: Arterial insufficiency Polyarteritis nodosa Vasculitis Pulmonary embolism
Pulmonary embolism Explanation: Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli.
A 45-year-old woman with a diagnosis of multiple sclerosis comes to the clinic complaining of coldness and pain in her fingers. She says that her fingers turn blue, and then her fingers get red, and they throb and tingle. The nurse would expect what diagnosis and treatment for this client? Select all that apply. Arterial thrombosis; streptokinase Raynaud disease; protecting the digits from cold Peripheral artery disease; aspirin Raynaud phenomenon; stop smoking
Raynaud disease; protecting the digits from cold Raynaud phenomenon; stop smoking Explanation: Raynaud disease or phenomenon is a functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes. There are two types of Raynaud disease, primary and secondary. The secondary type, called Raynaud phenomenon, is associated with other disease states or known causes of vasospasm. Raynaud phenomenon is associated with previous vessel injury, such as frostbite; occupational trauma associated with the use of heavy vibrating tools; collagen diseases; neurologic disorders; and chronic arterial occlusive disorders. The initial diagnosis is based on history of vasospastic attacks supported by other evidence of the disorder. Treatment measures are directed toward eliminating factors that cause vasospasm and protecting the digits from trauma during an ischemic episode. Abstinence from smoking and protection from cold are priorities. The presenting symptoms of this client do not support a diagnosis of, or treatment for, arterial thrombosis or peripheral artery disease.
Which adverse effect of direct-acting smooth muscle vasodilators for management of hypertension should the nurse assess for? Hemorrhage Diarrhea Salt and water retention Bradycardia
Salt and water retention Explanation: Direct-acting smooth muscle vasodilators increase the capacity of the vascular compartment, causing reflex retention of salt and water as they attempt to increase blood volume. The initial fall in blood pressure induces reflex tachycardia. Diarrhea and anticoagulant action are not usually effects of the direct acting smooth muscle vasodilators.
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock? Cardiogenic Neurogenic Septic Anaphylactic
Septic Explanation: Septic shock can result with the body's response to a severe infection. Neurogenic shock is a loss of sympathetic (adrenergic) control of systemic blood vessel tone. Cardiogenic shock is a loss of cardiac efficiency, and anaphylactic shock is a severe allergic reaction.
A nurse has worked for 25 years and has recently noticed the development of varicose veins. Which part of the nurse's job is likely most responsible for the development of the varicose veins? Psychosocial and physiologic stress Assisting clients with transfers Irregular sleep and activity schedule Standing upright for long periods
Standing upright for long periods Explanation: Prolonged standing and increased intra-abdominal pressure are important contributing factors in the development of primary varicose veins. Prolonged standing increases venous pressure and causes dilation and stretching of the vessel wall. Stress and sleep patterns have no effect on venous circulation. Lifting can also cause varicose veins, but standing upright is known to be a more significant risk factor.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for: Late hypertensive crisis Tonic-clonic seizures Chest pain radiating to the right arm Tearing or ripping-type pain in the chest or back
Tearing or ripping-type pain in the chest or back Explanation: A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated.
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. The capillaries pump blood. The venous system collects deoxygenated blood from the tissues. The heart exchanges gases, nutrients, and wastes. The arterial system distributes oxygenated blood to the tissues.
The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues. Explanation: The circulatory system consists of the heart, which pumps blood; the arterial system, which distributes oxygenated blood to the tissues; the venous system, which collects deoxygenated blood from the tissues and returns it to the heart; and the capillaries, where exchange of gases, nutrients, and waste takes place.
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply. Pulmonary Aortic Tricuspid Mitral
Tricuspid Mitral Explanation: The heart's atrioventricular valves are the tricupsid and the mitral. The semilunar valves are the pulmonary and aortic.
Assessment of an older adult's lower legs reveals brownish pigmentation on the ankles and shins as well as ankle and foot edema. The nurse recognizes this client is at risk for development of which complication?
Venous ulcers Explanation: The client's presentation is consistent with venous insufficiency and a consequent risk for venous ulcers. Arterial occlusion and insufficiency do not cause pigment changes and edema. Similarly, this presentation is not consistent with atherosclerosis.
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 cor pulmonale pericarditis cardiogenic shock
right-sided heart failure Explanation: A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and palpitations.
A client in the nursing home wonders why he is having these signs and symptoms of left-sided heart failure. Which explanation will the nurse give the client? "The left ventricle is not adequately perfusing your gastrointestinal tract, leading to diarrhea and vomiting." "The left ventricle is pumping excessive amounts of blood through the carotid arteries causing headache." "The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." "The left ventricle is having problems pumping blood forward, so blood is backing up systemically causing edema in your feet."
"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." Explanation: In left-sided failure, the left ventricle pumps inefficiently, blood backs up in the pulmonary circulation, and less, rather than more, blood enters the carotid arteries. Right-sided rather that left-sided heart failure causes blood to back up in the venous circulation, resulting in edema. Congestion of the gastrointestinal tract is usually characteristic of advanced heart failure.
A health care provider was asked by a client, "Why do my hands turn blue when I drive my car in the winter without gloves?" What is the best response? "This sounds like an inflammation in the lining of your veins. You need to take some NSAIDs." "Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen." "Nothing to worry about. We all develop this as we age." "We better order a CT scan. It might be due to a blood clot in your radial artery."
"Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen." Explanation: Raynaud disease is caused by vasospasms of small distal arteries; thromboangiitis obliterans is caused by an inflammatory process that affects veins and nerves.
The nurse knows that which factors will ultimately affect stroke volume? Select all that apply Preload Heart rate Ventricular automaticity Afterload Myocardial contractility
Preload Afterload Myocardial contractility Explanation: Stroke volume (the amount of blood ejected with each ventricular contraction) is determined by preload (volume of blood in the left ventricle just before systole), afterload (peripheral vascular resistance), and the force of myocardial contraction. Heart rate will affect cardiac output. Ventricular automaticity (ability of ventricular cells to spontaneously depolarize) does not affect stroke volume but can affect heart rate if the sinoatrial node loses its ability to control the rate of ventricular contraction.
When an acute event occurs and the circulatory system can no longer provide the body with adequate perfusion of its tissues and organs, cellular hypoxia occurs and the body goes into shock. What are the causes of shock in the human body? Select all that apply. Maldistribution of blood flow Obstruction of blood flow Hypovolemia Excessive vasoconstriction Hypervolemia
Raynaud disease; protecting the digits from cold Raynaud phenomenon; stop smoking Explanation: Raynaud disease or phenomenon is a functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes. There are two types of Raynaud disease, primary and secondary. The secondary type, called Raynaud phenomenon, is associated with other disease states or known causes of vasospasm. Raynaud phenomenon is associated with previous vessel injury, such as frostbite; occupational trauma associated with the use of heavy vibrating tools; collagen diseases; neurologic disorders; and chronic arterial occlusive disorders. The initial diagnosis is based on history of vasospastic attacks supported by other evidence of the disorder. Treatment measures are directed toward eliminating factors that cause vasospasm and protecting the digits from trauma during an ischemic episode. Abstinence from smoking and protection from cold are priorities. The presenting symptoms of this client do not support a diagnosis of, or treatment for, arterial thrombosis or peripheral artery disease.