PREP U CH. 27 DISORDERS OF CARDIAC FUNCTION AND HEART FAILURE

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

A client asks the purpose of an exercise stress test. What is the nurse's best response?

"The test is used to measure functional status during stress."

A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which explanation is most appropriate to share?

"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."

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 having problems pumping blood forward, and this is causing blood to back up into your lungs."

ST-elevated myocardial infarction (STEMI) 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.

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?

Administer epinephrine (adrenaline).

What is the most common identifiable cause of secondary cardiomyopathy?

Alcohol abuse

Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?

Atherosclerosis and unstable angina

Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is:

Atrial fibrillation

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

Which client with cardiomyopathy does the nurse identify as having the greatest risk for a complication?

Client with an ejection fraction of 25% and atrial fibrillation

The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:

Decreased cardiac output

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

Fixed coronary obstruction

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.

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?

Hypertrophy

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

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often follows the vascular response in anaphylaxis?

Laryngeal edema

Increased secretion of renin in heart failure is caused by which event?

Low cardiac output

Which description sums up the basic pathophysiology of heart failure that the nurse would include when educating a client?

Low cardiac output due to reduced pumping ability

The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain?

Morphine

Exudate in the pericardial cavity is a characteristic of which cardiac condition?

Pericardial effusion

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?

Peripheral edema, weight gain

The nurse caring for a client 12 hours after a 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 action should the nurse take next?

Prepare for pericardiocentesis

How can the health care provider determine if the client has "aerobic fitness"?

Tests help to determine aerobic fitness by measuring heart rate while under the stress of exercise.

When lecturing to a group of students about the pathophysiologic principles behind heart failure, the instructor defines cardiac output as which example?

The amount of blood the heart pumps each minute

The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:

The condition is getting progressively worse.

A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as:

Valvular regurgitation

A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?

Venous return to the heart

A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client?

anaphylatic shock

An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:

blocking the conversion of angiotensin I to angiotensin II.

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

hypovolemic shock due to acute intravascular volume loss.

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:

see the doctor for evaluation immediately.

For which consequences of cardiogenic shock will the nurse monitor a trauma client? Select all that apply.

-Decreased stroke volume -Decreased cardiac output -Increased afterloading

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 client's history will cause the nurse to withhold medication pending discussion with physician? Select all that apply.

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

The sympathetic (adrenergic) nervous system is an important compensatory mechanism in heart failure. Which statements regarding the sympathetic nervous system response to heart failure are correct? Select all that apply.

-The sympathetic nervous system responds rapidly to a fall in cardiac output. -The sympathetic nervous system increase in heart rate and force of contraction support cardiac output. -The sympathetic nervous system increase in cardiac workload and oxygen use can cause ischemia and worsening of heart failure.

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

The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:

20 mL/hour

A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock?

Anaphylactic

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

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?

Hypertrophic cardiomyopathy (HCM)

An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure?

Increased vascular stiffness

The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.

Myocardial infarction prevention

A client 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 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering?

Pericardial effusion

A teenager is seen in the emergency room with reports of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen 3 weeks before in the clinic and treated with antibiotics for strep throat. He was better for a few days but now he seems to have gotten worse in the last 2 days. What should the nurse suspect is wrong with this client?

Rheumatic fever

Heart failure and circulatory shock are both conditions of circulatory system failure. Which statement regarding these conditions is correct?

They have the same compensatory mechanisms.

Which serum biomarker is highly specific for myocardial tissue?

Troponin

A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?

When the client experiences chest pain

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?

beta-adrenergic blocking drugs (beta-blockers)

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:

improving quality of life by relieving symptoms.

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

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:

recording weight every day at the same time with same type of clothing.

A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order?

Troponin assays

Following cardiac surgery, the nurse suspects the client may be developing a cardiac tamponade. Which clinical manifestations would support this diagnosis? Select all that apply

Low BP—84/60 mm Hg Muffled heart tones Narrowed pulse pressure

The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition?

"I should report episodes of dizziness or fainting."

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?

Conversion from aerobic to anaerobic metabolism

A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?

Pericarditis

A client 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