ch 19

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? a.During feeding b.During sleep c.During burping d. During bathing

a Heart failure manifests itself as tachypnea or dyspnea at rest or on exertion. For the infant, this most commonly occurs during feeding.

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. What would be the nurse's best response? a. It is a defect of the mitral valve which causes obstruction of blood flow. b. It is an inflammatory process of the mitral valve. c. It is a defect of the mitral valve which allows for back flow of blood. d.It is a disorder of the mitral valve caused by atherosclerosis.

a Mitral valve stenosis is a defect of the mitral valve which causes obstruction of blood flow mitral valve regurgitation is characterized by incomplete closure of the mitral valve and blood moves backward into the left atrium.

Which statement provides blood work results and rationale that would be most closely associated with acute coronary syndrome? a. Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation b. 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 c. Increased serum creatinine and troponin I as a result of enzyme release from damaged cells d. Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response

a Myocardial necrosis releases creatine kinase and troponins that normally exist intracellularly. Serum creatinine and potassium are not core markers of heart damage and myoglobin creatine kinase levels rise, not fall, with cardiac events.

Exudate in the pericardial cavity is a characteristic of which cardiac condition? a. Pericardial effusion b. Constrictive pericarditis c. Cardiac tamponade d. Acute pericarditis

a Pericardial effusion, either acute or chronic, refers to the presence of an exudate in the pericardial cavity. Acute pericarditis is characterized by chest pain, ECG changes, and pericardial friction rub. Cardiac tamponade represents a life-threatening compression of the heart resulting from excess fluid in the pericardial sac. In constrictive pericarditis, scar tissue develops between the visceral and parietal layers of the serous pericardium. In time, the scar tissue contracts and interferes with cardiac filling.

The nursing instructor teaches the students that when a client is suffering from pericarditis he/she will have a friction rub. Which description best describes a friction rub? a. An audible medical sign that is high-pitched and results from the rubbing and friction between the inflamed pericardial surfaces. b. An audible medical sign that is difficult to distinguish from wheezes. c. An audible medical sign that is low-pitched and results from the rubbing and friction between the inflamed pericardial surfaces. d. An audible medical sign that is low-pitched and results from the infection.

a Pericardial friction rub is described as an audible medical sign that is high-pitched or scratchy, and results from the rubbing and friction between the inflamed pericardial surfaces.

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: a. Prompt diagnosis and treatment of streptococcal infections b. Avoiding frequent dental examinations c. Yearly electrocardiography after the age of 50 d. Annual blood specimen assessed for rheumatoid factor

a Rheumatic heart disease is normally caused by streptococcal infections; therefore, early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a client has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease. The client should have regular dental examinations.

A client is admitted to the intensive care unit suspected of having infective endocarditis. Which test is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client? a. Blood culture b. CBC c. ECG d. Echocardiogram

a The blood culture remains the most definitive diagnostic procedure and is essential to guide treatment. An echo, ECG, clinical findings, and lab information are also used to help in the diagnosis.

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? a. They can fragment and cause cerebral emboli. b. They can keep the heart valves from opening. c. They can block the heart valves from closing completely. d. They can fragment and make the lesions larger.

a The intracardiac vegetative lesions also have local and distant systemic effects. The loose organization of these lesions permits the organisms and fragments of the lesions to form emboli and travel in the bloodstream, causing cerebral, systemic, or pulmonary emboli. Preventing the valves of the heart from either opening or closing completely is not a systemic effect of the lesions. Fragmentation of the lesions does not make them larger.

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. Troponin level b. Complete blood components c. Calcium level d. Creatine kinase marker

a The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction (MI). The troponin complex, which is part of the actin filament, consists of three subunits (i.e., TnC, TnT, and TnI) that regulate calcium-mediated actin-myosin contractile process in striated muscle (see Chapter 1, Fig. 1-19). TnI and TnT, which are present in cardiac muscle, begin to rise within 3 hours after the onset of MI and may remain elevated for 7 to 10 days after the event. This is especially adventitious in the late diagnosis of MI. The other blood work may be ordered, but not to confirm the diagnosis of MI.

A nurse is assessing a client diagnosed with severe mitral valve stenosis. The nurse anticipates which classic assessment finding? a. Transient ischemic attacks b. Orthopnea c. Ventricular arrhythmias d. Hypertension

b The symptoms of mitral valve stenosis are those of pulmonary congestion, including nocturnal paroxysmal dyspnea and orthopnea. Atrial tachycardia and atrial fibrillation develop in 30% to 40% of clients with mitral valve stenosis. Transient ischemic attacks occur more frequently in persons with mitral valve prolapse.

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 reason? Select all that apply. a. To relieve anxiety b. For its vasodilation effect c. To relieve coronary pain d. For diuretic purposes

b, c Nitroglycerine is given in the treatment of STEMI because of its vasodilating effect and its ability to relieve coronary pain.

When a physician suspects a client has suffered an acute myocardial infarction, which serum biomarkers should he order? Select all that apply. a. Phosphorous b. Creatine kinase c. Troponin T d. Troponin 1 e. Magnesium

b,c,d Serum biomarkers for acute coronary syndrome (ACS) include troponin 1 and troponin T as well as creatine kinase. The others may be drawn but they are not used for diagnosing and treating an acute myocardial infarction.

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. a. Thyroid gland b. The aortic pressure c. Hypothalamus d. Compression of the intramyocardial vessels e. auto regularity mechanism

b,d,e Blood flow in the coronary vessels that supply the myocardium is influenced by the aortic pressure, the autoregulatory mechanisms, and compression of the intramyocardial vessels by the contracting heart muscle.

Which form of cardiomyopathy would be considered genetically based? Select all that apply. a. Myocarditis b. Left ventricular noncompaction c. Peripartum cardiomyopathy d. Dilated cardiomyopathy e. hypertrophic cardiomyopathy

b,e Hypertrophic cardiomyopathy and left ventricular noncompaction are genetic in origin. Myocarditis and peripartum cardiomyopathies are acquired syndromes. Dilated cardiomyopathies are genetic and acquired.

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 client about diagnosing a valvular defect? a. Blood work can help to diagnose a valvular defect. b. An MRI, which is more expensive, can be helpful in this diagnosis. c. Valvular defects usually are detected through cardiac auscultation. d. An ECG can be done to rule out this disease.

c Although valvular heart disease can result from congenital defects, rheumatic heart disease, trauma and other causes, atrial stenosis is usually first diagnosed with auscultation of a loud systolic murmur or a single-split second heart sound. Other tests are not used initially.

A nurse is assessing for cyanosis in a child who has a congenital heart defect. Select the most important area for the nurse to assess. a. Tongue b. Sclera of the eyes c. Mucous membranes d. Palms of the hands

c Cyanosis, a bluish color of the skin that is most notable in the nail beds and mucous membranes, develops when sufficient deoxygenated blood from the right side of the heart mixes with oxygenated blood in the left side of the heart.

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 to which part of the body? a. Right lung to the left lung b. Right side of the heart to the left side of the heart c. Left side of the heart to the right side of the heart d. Left lung to the right lung

c Defects that result in a left-to-right shunt are categorized as acyanotic disorders since they do not compromise oxygenation of blood in the pulmonary circulation.

A community health nurse is conducting a seminar at a local church group on health and wellness. Which of the following does she tell the group is the leading cause of death in the United States? a. Automobile accidents b. Infectious diseases c. Heart disease d. Cancer

c Heart disease affects persons of all ages and all walks of life. It is the leading cause of death in the United States as well as other developed nations of the world.

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? a. Mixed b. Acquired c. Genetic d. Does not usually occur in young athletes

c Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young athletes. It actually occurs in 1 person out of every 500.

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? a. Pericarditis b. Myocardial infarction c. Pericardial effusion d. COPD

c Pericardial effusion refers to the accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200 mL of fluid may raise intracardiac pressure to levels that will cause symptoms similar to right-sided heart failure. Pericarditis is inflammation of the pericardium COPD is a respiratory disease.

A client who came to the emergency room and was diagnosed with ST-segment elevation myocardial infarction (STEMI) experienced "sudden death." The emergency room nurse explains sudden death from a STEMI as death that occurs within what time frame of symptom onset? a. 30 minutes b. 2 hours c. 1 hour d. 15 minutes

c Sudden death from STEMI is death that occurs within one hour of symptom onset.

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. A stressful period right after birth that occurs without evidence of cyanosis b. A hyperoxygenated period when the infant is at rest c. A hypercyanotic attack brought on by periods of stress d. A hyperpneic attack in which the infant loses consciousness

c The degree of obstruction may be dynamic and can increase during periods of stress causing hypercyanotic attacks ("tet spells"). None of the other answers occur in association with tetralogy of Fallot or tet spells.

A client comes to the emergency room with reports of chest pain. When the nurse reads his ECG she sees changes which include T-wave inversion, ST-segment elevation, and an abnormal Q wave. What should she suspect? a. Pleural effusion b. Coronary artery disease (CAD) c. Pericarditis d. Acute myocardial infarction

d An acute myocardial infarction diagnosis includes unstable angina, T-wave inversion, ST-segment elevation, and abnormal Q wave on the ECG. The other diagnoses do not normally exhibit these findings on the ECG.

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 set of diagnostics? a. CT of the heart, chest X-ray, ECG b. ECG, blood pressure, stress test c. Cardiac catheterization, chest X-ray, electrolyte measurement, and white cell count d. Echocardiogram, blood cultures, temperature

d An echocardiogram would help visualize the heart, while blood cultures would confirm the presence or absence of microorganisms in circulation and temperature would gauge the presence of infection. A chest X-ray, blood pressure measurement, and cardiac catheterization would be less likely to indicate infective endocarditis.

A client who was diagnosed with myocarditis asks the nurse what caused his disease. Which response by the nurse is most accurate? a. You need to ask your physician. b. There is no research yet on what causes this disease. c. It is caused by some type of bacteria. d. It is usually caused by a viral infection.

d Myocarditis is inflammation of the myocardium. Although there are different causes, it is usually caused by a viral infection. Telling the client there is no research would not be true and telling him to ask the physician would not be therapeutic.

Which client is at the greatest risk of developing rheumatic heart disease? a. Young adult with viral meningitis b. Older adult with shingles c. Child with impetigo on the face d. Teenager with untreated strep throat

d Rheumatic fever is caused by group A (beta-hemolytic) streptococcal throat infection. Although the same bacteria causes the skin infection called impetigo, it is not known to cause rheumatic heart disease. Viral infections such as meningitis and shingles (herpes zoster) do not cause rheumatic heart disease.

An IV drug abuser walks into the ED telling the nurse, "I am sick." The client looks 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 the client's mitral valve. The client is admitted to ICU. The nurse will be assessing this client for which possible life-threatening complication? a. Pancreas enlargement due to increased need for insulin secretion. b.Petechial hemorrhages under the skin and nail beds. c. GI upset from the massive amount of antibiotics required to kill the bacteria. d. Systemic emboli, especially to brain.

d Systemic emboli develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc. Petechial hemorrhages are signs/symptoms of infective endocarditis (IE). GI upset is common following antibiotic therapy but is not usually life-threatening. Stress can increase insulin needs but is not associated with pancreas enlargement.

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? a. Overproduction of energy capable of sustaining normal myocardial function b. Inadequate production of glycogen with mitochondrial shrinkage c. Conversion from anaerobic to aerobic metabolism d. Conversion from aerobic to anaerobic metabolism

d The principal biochemical consequence of MI is the conversion from aerobic to anaerobic metabolism with inadequate production of energy to sustain normal myocardial function. As a result, a striking loss of contractile function occurs within 60 seconds of onset.

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? a. Pneumonia b. Myocardial infarction c. Abdominal aortic aneurysm d. Pericarditis

d This client is demonstrating signs and symptoms of pericarditis, which includes a triad of chest pain, pericardial friction rub, and EKG changes. Other signs are that the pain is usually abrupt in onset, occurs in the pericardial area, and may radiate to the neck, back, abdomen or side. It is usually worse with deep breathing and swallowing, and the person often finds relief when sitting up and leaning forward.

The nursing student has learned in class that pericarditis is an inflammatory process of the pericardium. What is known to be the main cause of pericarditis? a. Connective tissue disease b. Radiation c. Bacterial infections d. Viral infections

d Viral infections are the most common cause of pericarditis. The others listed are also causes but not the most frequent.

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? a. He is having a myocardial infarction. b. He is suffering side effects of the radiation. c. He is showing signs of acute renal failure. d. He has developed constrictive pericarditis.

d Longstanding inflammation from mediastinal radiation, cardiac surgery and infection is usually the cause of constrictive pericarditis. Ascites is the early finding and can be followed by pedal edema, dyspnea upon exertion, fatigue and jugular vein distention.

A nurse is caring for a client with a new diagnosis of rheumatic fever. What is the highestpriority goal of treatment during the acute phase? a. Prevent cardiac complications b. Reduce inflammation c. Eliminate the infection d. Promote nutrition

a

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. a. Narrowed pulse pressure b. Bounding femoral pulse c. Heart rate 78 d. Muffled heart tones e. Low BP—84/60 mm Hg

a,d,e Cardiac tamponade results in increased intracardiac pressure, progressive limitation of ventricular diastolic filling, and decreased stroke volume, and cardiac output. This accumulation of fluid results in tachycardia, elevated CVP, jugular vein distention, fall in systolic BP, narrowed pulse pressure and signs of shock. Heart sounds may be muffled. A pulse rate of 78 is normal (not tachycardic). With pulsus paradoxus, the arterial pulse as palpated at the carotid or femoral artery becomes weakened (not bulging) or absent with inspiration.

What is the most common identifiable cause of secondary cardiomyopathy? a. Heart transplant b.Alcohol abuse c.Heart failure d. Genetic abnormalities

b Alcohol abuse is a cause of secondary cardiomyopathy the other options result in primary cardiomyopathy.

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? a. Cardiotoxic cardiomyopathy b. Alcoholic cardiomyopathy c. Exercise-induced cardiomyopathy d. Hepatic cardiomyopathy

b Alcoholic cardiomyopathy is the single most common identifiable cause of DCM in the United States and Europe.

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? a. Aortic valve prolapse b. Mitral valve prolapse c. Mitral valve stenosis d. Aortic valve stenosis

b 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 nursing student, when studying about coronary artery disease, learns that it is commonly divided into different types of disorders. Which disorders would be included? Select all that apply. a. Tertiary heart disease b. Secondary heart disease c. Chronic ischemic heart disease d. Acute coronary syndrome e. Primary heart disease

c,d Coronary heart disease is commonly divided into 2 types of disorders: the acute coronary syndrome and chronic ischemic heart disease.

The nursing instructor when teaching about disorders of cardiac function informs the students that all people presenting with ST-segment elevation myocardial infarction (STEMI) should be assessed for reperfusion therapy as quickly as possible. Reperfusion therapy includes which of the following? Select all that apply. a. Mechanical ventilation b. Dialysis c. Fibrinolytic therapy d. Coronary artery bypass grafting (CABG) e. Percutaneous coronary intervention (PCI)

c.d.e all people presenting with a STEMI should be assessed for reperfusion therapy as soon as possible. Reperfusion therapy includes ... fibrinolytic therapy percutaneous coronary intervention coronary artery bypass grafting.

Which client should most benefit from treatment with anti-thrombin agents? a. Young client diagnosed with hypertrophic cardiomyopathy (HCM) b. Client who was thought to have had an MI but who was later diagnosed with pericarditis c. 29-year-old client who developed endocarditis by injecting with a dirty needle d. 57-year-old client who has recently been diagnosed with unstable angina

d Anticoagulation therapy prevents myocardial infarction in clients with acute coronary syndrome. Pericarditis, HCM, and endocarditis do not normally warrant anticoagulation.

Which phenomenon would be most likely to accompany increased myocardial oxygen demand (MVO2)? a. Ventricular atrophy b. Use of calcium-channel blocker medications c. Inadequate ventricular end-diastolic pressure d. Increased aortic pressure

d An increase in aortic pressure results in a rise in afterload, wall tension, and, ultimately, MVO2. Increased, not inadequate, ventricular end-diastolic pressure would cause an increase in MVO2, and medications such as calcium-channel blockers would decrease MVO2. Ventricles would tend to hypertrophy in response to prolonged wall stress and consequent oxygen demand.