Pathophysiology Chapter 19

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." p. 455.

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?

Alcoholic cardiomyopathy

When a physician suspects a patient has suffered an acute myocardial infarction, which serum biomarkers should he order? Select all that apply.

Creatine kinase Troponin T Troponin 1

Cardiac tamponade is a serious life-threatening condition that can arise from a number of other conditions. What is a key diagnostic finding in cardiac tamponade?

Pulsus paradoxus (466-467)

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.

The aortic pressure Autoregulatory mechanisms Compression of the intramyocardial vessels p. 448.

Which serum biomarker is highly specific for myocardial tissue?

Troponin

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 p. 449.

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 p. 449.

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." p. 463.

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 report episodes of dizziness or fainting."p. 468.

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'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising." p. 456.

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:

"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms." p. 462

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." p. 446.

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." p. 446.

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?

"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."

During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?

20 to 40 minutes p. 453-454.

Which client should most benefit from treatment with antithrombin agents?

57-year-old client who has recently been diagnosed with unstable angina

Four clients 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 client most likely experienced myocardial infarction?

80-year-old woman whose pain 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(p. 452)

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, p. 450.

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 decreases metabolic demands of the heart. p. 452.

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 p. 450.

A client is admitted to the intensive care unit suspected of having infective endocarditis. Which of the following tests is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client?

Blood culture

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 p. 462.

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 p. 446.

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 p. 466.

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?

Cardiomyopathy p. 468.

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

Constrictive pericarditis p. 467

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?

Decreased level of consciousness p. 450.

Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant?

During feeding

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?

Echocardiogram, blood cultures, temperature p. 458.

Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome?

Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation.p. 449

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?

Emotional stress

A client with heart failure has just had an automatic defibrillator installed in her chest wall. When the nurse is performing follow-up assessments in the coming months, which finding is most likely the result of a complication?

Fever and diaphoresis p. 457.

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 its vasodilatation effect To relieve coronary pain (p. 450)

A client who has just been diagnosed with dilated cardiomyopathy asks the nurse what caused the condition. The most appropriate response would be:

Genetic abnormalities p. 469.

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 p. 468.

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. p. 466.

What is the most important factor in myocardial oxygen demand?

Heart rate p. 446.

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 p. 456.

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

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?

Hypertrophic cardiomyopathy p. 468.

The nursing student has learned in his class that coronary arterydisease (CAD) is heart disease caused by which of the following?

Impaired coronary blood flow p. 444.

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?

Infective endocarditis p. 457.

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?

Intravenous p. 451.

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 an inflammatory process. p. 465

The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states that blood is shunted from the:

Left side of the heart to the right side of the heart p. 474.

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

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 nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess.

Mucous membrane (p. 474)

When the electrocardiogram (ECG) of a patient in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta adrenergic blocker. Which of the following factors in the patient's history will cause the nurse to withhold medication? Select all that apply.

Myocardial infarction caused by cocaine use Third-degree heart block Shock p. 452

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 p. 455.

Which of the following patients with cardiomyopathy does the nurse identify as having the greatest risk for a complication?

One with an ejection fraction of 25% and atrial fibrillation p.469

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 p. 450

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?

Pericardial effusion, p. 466.

The nurse working on the cardiac floor identifies which of the following to be the initial treatment of choice for small pericardial effusions and mild cardiac tamponade?

Pericardiocentesis p. 466.

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?

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?

Prepare for pericardiocentesis p. 466.

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 infection p. 458.

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?

Propranolol, a β-Adrenergic blocker. p. 469.

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 p. 458.

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. p. 447.

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

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 order 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. p. 465.

Which of the following patients is at the greatest risk of developing rheumatic heart disease?

Teenager with untreated strep throat p. 458.

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 p. 458.

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?

The most common cause is a staph infection. p. 457.

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 respond "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems." p. 475.

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.p. 463.

A teenager comes to the emergency room with a history of strep throat and symptoms that lead the staff to suspect rheumatic fever. Which of the following tests can best establish a diagnosis of rheumatic fever?

There is no definitive test for diagnosing RF. p. 458.

Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply.

Ventricular tachycardia with left bundle branch block pattern. T-wave inversion in the right precordial leads. p. 469.

A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His 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:

mitral valve stenosis. p. 461.

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?

Β-Adrenergic-blocking drugs p. 463.