Patho Exam 3
An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased: a) Cardiac tone and compliance b) Response to Ϝ-adrenergic stimulation c) Myocardial metabolism d) Vascular stiffness
vascular stiffness
A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention? A. A 69-year-old woman who has entered ventricular fibrillation. B. A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia. C. A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation. D. A 60-year-old woman who has just been diagnosed with a first-degree AV block.
A. A 69-year-old woman who has entered ventricular fibrillation
Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply. A. Abdominal B. Carotid C. Thoracic D. Femoral
A. Abdominal C. Thoracic
When explaining to a patient why they only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to: A. Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually. B. The possibility that the person has elevated INR levels that prevents blood from backlogging in the vessel. C. The release of substances formed by special glands that transport the blood cell-by-cell through smaller spaces. D. Good genetic makeup that allows occluded arteries to keep vasodilating to meet metabolic needs.
A.Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually.
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: a) "Avoid coffee; however, tea is OK." b) "Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms." c) "Energy drinks may help to support metabolism." d) "It is OK to decrease your smoking to one pack per day."
B. "Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."
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? a) COPD b) Pericardial effusion c) Pericarditis d) Myocardial infarction
B. pericardial effusion
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? a) Myocardial infarction b) Pericarditis c) Pneumonia d) Abdominal aortic aneurysm
B. pericarditis
A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:
Bicuspid valve
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? a) A 33-year-old male whose pain started at 7 a.m. during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable b) A 61-year-old man whose pain started at 9 a.m. during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened c) 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 d) A 67-year-old female whose pain started at 2 a.m. while she was asleep and which responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable
C )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
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: a) "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or lightheaded." b) "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit." c) "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems." d) "This could be caused by an infection. Have you been feeling well the past few weeks?"
C. "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."
A client is admitted to the hospital with severe bradycardia, heart rate in low to upper 40s, after contracting Lyme disease. She asks the nurse why the heart rate is so slow. The most accurate response would be a possible disassociation between the atria and ventricles due which of the following? A. Purkinje system block B. Inflammation of the SA node C. AV nodal block D. SA node excitation
C. AV nodal block
he 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 myocardial 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? A. Codeine B. Fentanyl C. Morphine D. Demerol
C. Morphine
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: A. Physical inactivity and high serum high-density lipoprotein cholesterol B. Advanced age and low serum total and low-density lipoprotein cholesterol C. High serum high-density lipoprotein and diabetes D. History of cigarette smoking and elevated blood pressure
D. History of cigarette smoking and elevated blood pressure
A client who has just been diagnosed with mitral valve stenosis tells the nurse that he has heard of the disease but he does not know anything about it. He asks the nurse what it means. What would be the nurse's best response? a) It is a defect of the mitral valve which allows for back flow of blood. b) It is an inflammatory process of the mitral valve. c) It is a disorder of the mitral valve caused by atherosclerosis. d) It is a defect of the mitral valve which causes obstruction of blood flow.
D. It is a defect of the mitral valve which causes obstruction of blood flow.
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? a) Let's not worry about the cause as we need to focus on getting him better. b) It can be attributed to drug abuse. c) Sometimes a parasite is involved. d) The most common cause is a staph infection.
D. The most common cause is a staph infection.
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? a) Cardiomyopathy b) Myocardial infarction c) Pericarditis d) Infective endocarditis
D. infective endocarditis
A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection. a) Eikenella corrodens b) Actinobacillus actinomycetemcomitans c) Kingella kingae d) Staphylococcus aureus
D. staphylococcus aureus
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? a) Calcium level b) Complete blood components c) Creatine kinase marker d) Troponin level
D. troponin
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: a) Decreased retention of sodium b) Increased ejection fraction c) Decreased cardiac output d) Increased renal blood flow
Decreased cardiac output
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? a) Chest pain and intermittent ventricular tachycardia. b) Muscle cramping and cyanosis in the feet. c) Petechia and spontaneous bleeding d) Dyspnea and crackles in bilateral lung bases.
Dyspnea and crackles in bilateral lung bases
A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?
Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.
Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
A client is visiting the primary physician and appears extremely nervous. The intake nurse does his vital signs and notes an increase in both his heart rate and blood pressure. In an effort to better understand the client's presenting signs and symptoms the nurse asks the client about his concerns and the client states that the person who performed his pre-visit told him that he had an arrhythmia. Which is the most therapeutic response about cardiac arrhythmias that the nurse can make?
They can occur in diseased or healthy hearts.
Which serum biomarker is highly specific for myocardial tissue?
Troponin
The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is: a) decreased afterload. b) increased preload. c) increased afterload. d) decreased cardiac output.
a. decreased after load **decreased after load, increases the stroke volume **
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? a) "I'm trying to think of ways that I can cut down the amount of salt that I usually eat." b) "I'm going to avoid as much physical activity as I can so that I preserve my strength." c) "I'll be sure to take my beta blocker whenever I feel short of breath." d) "I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on."
a. "I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
A client who was admitted to the cardiac intensive care unit with a diagnosis of myocarditis asks the nurse what caused his disease. What would be the nurse's best response? a) It is usually caused by a viral infection. b) You need to ask your physician. c) It is caused by some type of bacteria. d) There is no research yet on what causes this disease.
a. It is usually caused by a viral infection.
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: a) Hypovolemic shock due to acute intravascular volume loss b) Side effects from versed administration causing excessive vasoconstriction c) Pulmonary embolism due to development of deep vein thrombosis d) Renal failure due to an overdose of medication
a. hypovolemic shock due to acute intravascular volume loss.
A nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess. a) Mucous membranes b) Tongue c) Sclera of the eyes d) Palms of the hands
a. mucous membranes
A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client: a) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. b) complains of dyspnea and has adventitious breath sounds on auscultation (listening) .c) has cyanotic lips and extremities, low urine output, and low blood pressure. d) has a distended bladder, facial edema, and nighttime difficulty breathing.
a. pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occassional upper right quadrant pain
The nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD? a) Excessive use of dairy products b) Atherosclerosis c) Defect in the DNA d) Excessive exercise
b. atherosclerosis
A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following? a) Shortness of breath b) Weight gain c) Decreased blood pressure d) Copious urination
b. weight gain
The nurse knows that factors that affect stroke volume include which of the following? Select all that apply a) Myocardial contractility b) Heart rate c) Preload d) Ventricular automaticity e) Afterload
c, e, a
A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? a) Beta-blocker, potassium supplement, anticoagulant b) Anticoagulant, antihypertensive, calcium supplement c) Diuretic, ACE inhibitor, beta-blocker d) Antihypertensive, diuretic, antiplatelet aggregator
c. diuretic, ACE inhibitor, beta-blocker
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? a) Cardiac catheterization, chest X-ray, electrolyte measurement, and white cell count b) CT of the heart, chest X-ray, ECG c) Echocardiogram, blood cultures, temperature d) ECG, blood pressure, stress test
c. echocardiogram, blood cultures, temperature
A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock? a) Distributive b) Cardiogenic c) Hypovolemic d) Obstructive
c. hypovolemic
Which of the following conditions reflect failure of the circulatory system? Select all that apply. a) Renal dysfunction b) Orthostasis c) Circulatory shock d) Heart failure e) Suppression of the renin-agiotensin-aldosterone system (RAAS)
circulatory shock, heart failure
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output. a) parasympathetic system b) electrical conductivity c) aortic hypertrophy d) compensatory mechanisms
compensatory mechanisms
In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion? a) 40—20 mL/hour b) 60—40 mL/hour c) 80—60 mL/hour d) 20 mL/hour
d. 20 mL/hr
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? a) Myocardial infarction b) Pericarditis c) Thrombosis d) Cardiac tamponade
d. cardiac tamponade rapid accumulation of exudate compresses of the heart
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? a) Exposure to heat b) Abrupt change in position c) Sedentary lifestyle d) Emotional stress
d. 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? a) Have the client swallow slowly and frequently. b) Have the client breathe deeply. c) Have the client change positions to unaffected side. d) Have the client sit up and lean forward.
d. have the client sit up and lean forward
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? a) Heart attack b) Pericarditis c) Dehydration d) Hypertrophic cardiomyopathy
d. hypertrophic cardiomyopathy
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells? a) Hyperplasia b) Dysplasia c) Atrophy d) Hypertrophy
d. hypertrophy
A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings? a) Elevated temperature b) Slow respiratory rate c) Elevated pulse rate d) Low blood pressure
d. low blood pressure
Which serum biomarker is highly specific for myocardial tissue? a) C-reactive protein b) White blood cells c) Creatine kinase d) Troponin
d. troponin
A patient 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 which of the following? a) Infective endocarditis b) Pericardial effusion c) Valvular stenosis d) Valvular regurgitation
d. valvular regurgitation
A patient has developed pericarditis. The nurse knows that this condition will increase the risk for development of which condition?a) Distributive shock b) Systolic dysfunction c) Diastolic dysfunction d) Obstructive shock
diastolic dysfunction
The diagnosis is hypovolemic shock. The nurse knows that causes of hypovolemic shock include which of the following? Select all that apply. a) Severe dehydration b) Fifteen percent blood volume loss c) Myocardial infarction d) Excessive vasoconstriction e) Severe burns
e, b, a
Increased secretion of renin in heart failure is caused by which of the following events? a) Increased renal blood flow b) Arrhythmias c) Hypertension d) Low cardiac output
low cardiac output
A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition? a) Pulmonary edema b) Stroke c) Hypotension d) Myocardial infarction
myocardial infarction
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? a) Obstructive shock b) Cardiogenic shock c) Distributive shock d) Hypovolemic shock
obstructive shock
A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis? a) Hypovolemic shock b) Obstructive shock c) Septic shock d) Neurogenic shock
septic shock
What are the physiologic signs and symptoms of cardiogenic shock? (Select all that apply.) a) Increased urine output related to increased renal perfusion b) Rise in central venous pressure (CVP) c) Increased extraction of O2 from hemoglobin d) Decrease in mean arterial blood pressures e) Hypercapnic lips and nail beds
• Decrease in mean arterial blood pressures Rise in central venous pressure (CVP) Increased extraction of O2 from hemoglobin