Chapter 20: Heart Failure and Circulatory Shock

Which health problem is associated with heart failure as a result of diastolic dysfunction? -Uncontrolled hypertension -Chronic bradycardia -Ischemic heart disease -Myocardial hypertrophy

Myocardial hypertrophy

A client has developed cardiogenic shock. The most frequent cause of this type of shock is: -Hypertension -Heart failure -Myocardial infarction -Allergic reaction

Myocardial infarction

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged, resulting in a pulmonary embolism. Which type of shock is this client at risk of experiencing? -Cardiogenic shock -Hypovolemic shock -Obstructive shock -Distributive shock

Obstructive shock

Knowing the high incidence and prevalence of heart failure among older adults, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which teaching point is most accurate? -"Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure." -"Heart failure will often first show up with persistent coughing and lung crackles." -"Residents in early heart failure will often be flushed and have warm skin and a fever." -"Complaints of chest pain are actually more often related to heart failure than to myocardial infarction."

"Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure."

A 75-year-old client is being evaluated for heart failure. Which questions will the nurse ask to confirm common signs and symptoms observed in older adults experiencing heart failure? Select all that apply. -"Do you easily get tired?" -"Do you have swelling in your ankles?" -"Are you eating more than usual?" -"Are you feeling depressed?" -"Do you get up often during the night to urinate?"

-"Do you easily get tired?" -"Do you have swelling in your ankles?" -"Are you feeling depressed?" -"Do you get up often during the night to urinate?"

Which conditions reflect failure of the circulatory system? Select all that apply. -Orthostasis -Circulatory shock -Renal dysfunction -Suppression of the renin-angiotensin-aldosterone system (RAAS) -Heart failure

-Circulatory shock -Heart failure

Manifestations of heart failure are due to the decreased pumping ability of the heart. The nurse should monitor for which signs and symptoms of heart failure? Select all that apply. -Fatigue -Exercise intolerance -Cyanosis -Malnutrition -Hyperglycemia

-Fatigue -Exercise intolerance -Cyanosis -Malnutrition

In distributive shock, there are abnormalities in vascular resistance. Which types of shock display the same distributive pattern? Select all that apply. -Neurogenic -Cardiogenic -Septic -Hypovolemic -Anaphylactic

-Neurogenic -Septic -Anaphylactic

The ICU nurse should anticipate which medications being prescribed for a client in cardiogenic shock? Select all that apply. -Nitroprusside -Nitroglycerin -Ibuprofen -Dobutamine -Milrinone

-Nitroprusside -Nitroglycerin -Dobutamine -Milrinone

Cardiac output is defined as which physiologic function per minute? Select all that apply. -Ventricular volume load -Volume of blood pumped -Arterial afterload -Contractility force generated -Heart rate x stroke volume

-Volume of blood pumped -Heart rate x stroke volume

A client with a new diagnosis of heart failure has received a new prescription. Which medication category is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions? -A beta-adrenergic blocker (beta-blocker) -A diuretic -A cardiac glycoside -An ACE inhibitor

A cardiac glycoside

Cardiac reserve refers to which of the following events? -Volume of blood ejected with each ventricular contraction -Ability to increase cardiac output during physical exercise -Volume of blood in left ventricle just before systole -Venous return to the heart

Ability to increase cardiac output during physical exercise

Which intervention would the nurse know is not a primary treatment for the client in hypovolemic shock? -Surgery to repair the site of bleeding -Administration of intravenous fluids -Administration of vasoconstrictive drugs -Infusion of blood and blood products

Administration of vasoconstrictive drugs

Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is: -Atrial fibrillation -Ventricular fibrillation -Atrioventicular heart block -Nodal tachycardia

Atrial fibrillation

A female older adult client has presented with a new onset of shortness of breath, and the client's physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of bloodwork? -BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the client's dyspnea from a respiratory pathology. -BNP is an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure. -BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. -BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the client's dyspnea from a respiratory pathology.

A client has been diagnosed with heart failure. The client's cardiac contractility will be primarily affected by which factor? Intracellular K+ levels Ca2+ levels in the myocardium The gradient between intracellular and extracellular H+ levels Serum Na+ levels

Ca2+ levels in the myocardium

A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause. -Diastolic dysfunction -Frontward failure -Backward failure -Systolic dysfunction

Diastolic dysfunction

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy, pink sputum. The priority intervention is: -Have medical supply department bring up suction equipment. -Apply oxygen via nasal cannula at 3 pm. -Page respiratory therapy to come give him a breathing treatment. -Call for emergency assistance utilizing hospital protocol.

Call for emergency assistance utilizing hospital protocol.

Which statement regarding heart failure is true? -Aortic stenosis is a major cause of congestive heart failure. -A frequent symptom of right-sided heart failure is dyspnea. -The average client with congestive heart failure has a normal lifespan. -Compensated congestive heart failure may be clinically asymptomatic.

Compensated congestive heart failure may be clinically asymptomatic.

Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes? -Valvular insufficiency -Tamponade -Fibrillation -Cyanosis

Cyanosis

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 -Increased ejection fraction -Increased renal blood flow -Decreased retention of sodium

Decreased cardiac output

In the ICU setting, clients who develop shock need thorough head-to-toe assessments. Which clinical manifestation would alert the health care provider that the client may be developing ischemia associated with gastrointestinal redistribution of blood flow? -Gastric bleeding -Nausea and vomiting -Irritable bowel syndrome -Copious, high-volume diarrhea

Gastric bleeding

Neurogenic shock, or spinal shock, is a phenomenon caused by the inability of the vasomotor center in the brain stem to control blood vessel tone through the sympathetic outflow to the blood vessels. In neurogenic shock, what happens to the heart rate and the skin? -Heart rate slower than normal; skin warm and dry -Heart rate faster than normal; skin cool and moist -Heart rate slower than normal; skin cool and moist -Heart rate slower than normal; skin warm and dry

Heart rate slower than normal; skin warm and dry

A health care provider suspects a client has heart failure. Which diagnostic procedure would give the staff information about pulmonary capillary pressures, which will lead to the most appropriate interventions? -Echocardiography -Radionuclide ventriculography -Cardiac magnetic resonance imaging -Hemodynamic monitoring

Hemodynamic monitoring

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 client has developed which type of shock? -Cardiogenic -Hypovolemic -Distributive -Obstructive

Hypovolemic

A client with a history of heart failure has been assessed and the care team has determined that a reduction in myocardial workload would benefit his prognosis. Which intervention is most likely to meet this client's needs? -Cardioversion -Regular administration of inotropic drugs -An implantable defibrillator -Implantation of a ventricular assist device (VAD)

Implantation of a ventricular assist device (VAD)

A client diagnosed with septic shock who is experiencing tissue hypoxia likely will activate which pathophysiologic process? -Inflammatory mediators -Anaphylactic response -Preexisting coagulation disorder -Aerobic metabolism

Inflammatory mediators

The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology? -Water retention -Increased tubular sodium reabsorption -Inhibition of the renin-angiotensin-aldosterone system -Sympathetic nervous stimulation

Inhibition of the renin-angiotensin-aldosterone system

Increased secretion of renin in heart failure is caused by which event? -Hypertension -Increased renal blood flow -Low cardiac output -Dysrhythmias

Low cardiac output

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? -Vertigo, headache -Weakness, palpitations -Dyspnea, cough -Peripheral edema, weight gain

Peripheral edema, weight gain

A 62-year-old female client presents to the emergency department and is diagnosed with acute heart failure syndrome. Which assessment finding would the nurse expect? -Productive cough with frothy sputum. -Increased urination and dry skin. -Shortness of breath and bradycardia. -Slowed breathing and dehydration.

Productive cough with frothy sputum.

A client in the intensive care unit died shortly after developing multiple organ dysfunction syndrome (MODS). Which health problem most likely preceded the client's MODS? -Heart failure -Disseminated intravascular coagulation -Acute renal failure -Sepsis

Sepsis

An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock? -Loss of perfusion and duration of shock -Loss of perfusion and degree of immune-mediated response -Severity and duration of shock -Severity of shock and degree of immune-mediated response

Severity and duration of shock

When lecturing to a group of students about the pathophysiologic principles behind heart failure, the instructor defines cardiac output as which example? -Strength of the right ventricular pump to move blood -The amount of blood the heart pumps each minute -The amount of blood pumped out of the heart with each beat -The volume of blood stretching the heart muscle at the end of diastole

The amount of blood the heart pumps each minute

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which phenomenon is most likely taking place? -The man's alpha- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate. -Hemolysis and blood pooling are taking place in the man's peripheral circulation. -Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism. -Intracellular potassium and extracellular sodium levels are rising as a result of sodium-potassium pump failure.

The man's alpha- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate.

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? -Blood ejected from each ventricle with each contraction -Venous return to the heart -Blood pumped by each ventricle in 1 minute -Resistance to ventricular emptying

Venous return to the heart

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output. -aortic hypertrophy -compensatory mechanisms -electrical conductivity -parasympathetic system

compensatory mechanisms

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: -decreased afterload. -increased afterload. -increased preload. -decreased cardiac output.

decreased afterload.

A nurse will be providing care for a female client who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which statement best describes the presentation that the nurse should anticipate? The client: -has a distended bladder, facial edema, and difficulty breathing during nighttime hours. -complains of dyspnea and has adventitious breath sounds on auscultation (listening). -has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. -has cyanotic lips and extremities, low urine output, and low blood pressure.

has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

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: -pulmonary embolism due to development of deep vein thrombosis. -side effects from the administration of midazolam, causing excessive vasoconstriction. -renal failure due to an overdose of medication. -hypovolemic shock due to acute intravascular volume loss.

hypovolemic shock due to acute intravascular volume loss.

A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. The results suggest that the client's end-diastolic volume is insufficient. Which parameter of cardiac performance will directly decrease as a result of this finding? -inotropy -cardiac contractility -preload -afterload

preload

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 -pericarditis -cardiogenic shock -cor pulmonale

right-sided heart failure

The nurse knows that which factors will ultimately affect stroke volume? Select all that apply -Preload -Afterload -Myocardial contractility -Heart rate -Ventricular automaticity

-Preload -Afterload -Myocardial contractility

In circulatory shock, the adrenergic (or sympathetic) nervous system is activated. The nurse knows that stimulation of beta-2 adrenergic receptors will result in which responses? Select all that apply. -Increased force of myocardial contraction -Increase in heart rate -Vasoconstriction in many vascular beds -Vasodilation of the skeletal muscle vascular bed -Dilation of the bronchioles

-Vasodilation of the skeletal muscle vascular bed -Dilation of the bronchioles

Anaphylactic shock is directly associated with: -loss of blood volume. -bacterial blood infection. -failure of the heart as a pump. -type I hypersensitivity response.

-type I hypersensitivity response.

A client has developed pericarditis. The nurse knows this condition will increase the risk for developing which condition? -Obstructive shock -Distributive shock -Diastolic dysfunction -Systolic dysfunction

Diastolic dysfunction

The nurse knows that persons with atrial fibrillation are at risk of developing which cardiac complication? -Cardiogenic shock -Hypovolemic shock -Systolic dysfunction -Diastolic dysfunction

Diastolic dysfunction

A nurse is administering morning medications to a number of clients on a medical unit. Which medication regimen is most suggestive that the client has a diagnosis of heart failure? -Antihypertensive, diuretic, antiplatelet aggregator -Diuretic, ACE inhibitor, beta-blocker -Anticoagulant, antihypertensive, calcium supplement -Beta-blocker, potassium supplement, anticoagulant

Diuretic, ACE inhibitor, beta-blocker

A 30-year-old woman presents at a hospital after fainting at a memorial service and she is diagnosed as being in neurogenic shock. Which signs/symptoms is she most likely to display? -Faster than normal heart rate -Pain -Dry and warm skin -Increased thirst

Dry and warm skin

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the client displaying which clinical manifestation? -Chest pain and intermittent ventricular tachycardia. -Dyspnea and crackles in bilateral lung bases. -Petechia and spontaneous bleeding. -Muscle cramping and cyanosis in the feet.

Dyspnea and crackles in bilateral lung bases.

A nurse in a nursing home is concerned that a resident may be developing left-sided heart failure. Manifestations of left-sided heart failure would include which symptom? -Diarrhea, nausea, vomiting -Dyspnea, cough -Fatigue, headache -Weakness, peripheral edema

Dyspnea, cough

What is the primary physiologic result of obstructive shock? -Left ventricular hypertrophy -Elevated right heart pressure -Right atrial hypertrophy -Decreased right heart pressure

Elevated right heart pressure

A client is experiencing circulatory shock. The nurse is aware that compensation will occur with stimulation of the beta-2 (β2) receptors. The nurse anticipates the client will experience which physiologic response? -Relaxation of the bronchioles -Increasingly stronger myocardial contraction -Increase in heart rate -Vasoconstriction of skeletal muscle

Relaxation of the bronchioles

Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis? -Release nitric oxide -Vasoconstrict the capillary bed -Cause bradycardia -Activate erythropoiesis

Release nitric oxide

Heart failure and circulatory shock are both conditions of circulatory system failure. Which statement regarding these conditions is correct? -They have the same remediation. -They have the same compensatory mechanisms. -They have the same pathogenesis. -They have the same etiology.

They have the same compensatory mechanisms.

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 -neurogenic shock -septic shock -cardiogenic shock

anaphylatic shock

A 77-year-old client with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could: -decrease renal perfusion and result in development of ascites. -be a result of catecholamines released from SNS, which could increase the myocardial oxygen demand. -Desensitize the alpha-adrenergic receptors leading to increase in norepinephrine levels. -prolong the electrical firing from the SA node resulting in development of a heart block.

be a result of catecholamines released from SNS, which could increase the myocardial oxygen demand.

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: -selectively blocking the synthesis of renin in the kidneys. -blocking the conversion of angiotensin I to angiotensin II. -enhancing inotropy by maximizing calcium channel function. -promoting cardiac output through a reduction in afterload.

blocking the conversion of angiotensin I to angiotensin II.

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. -eliminating CHF through curing the disease. -maintaining higher oxygen levels to decrease the work of breathing. -placing a stent for fluid drainage from the heart.

improving quality of life by relieving symptoms.

Which health condition can contribute to diastolic dysfunction heart failure? -uncontrolled hypertension -chronic bradycardia -anemia -myocardial hypertrophy

myocardial hypertrophy

Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by: -hyperventilation. -excessive surfactant. -hyperinflated alveolar sacs. -ventilation-perfusion mismatch.

ventilation-perfusion mismatch.

Which statement regarding heart failure is true? -The most common cause of left-sided heart failure is right-sided heart failure. -The most common cause of congestive heart failure is angina pectoris. -In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction. -The edema of right-sided heart failure is associated with low plasma osmotic pressure.

In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction.

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. -The client is improving. -Results are not significant assessment data. -The more the results continue to increase, the better outcome for the client.

The condition is getting progressively worse.

Heart failure can increase one's risk for developing manifestions related to which complications? Select all that apply. -Atherosclerosis -Pulmonary congestion -Hypertension -Systemic congestion -Low cardiac output

-Pulmonary congestion -Systemic congestion -Low cardiac output

The nurse is assessing the blood pressure of a client who is experiencing cardiogenic shock. Which blood pressure reading is most likely? 210/100 180/90 90/75 96/40

90/75

in heart failure, what causes the increase in renal secretion of renin? -Increased metabolic demand -Decreased cardiac output -Increased renal perfusion -Hypertension

Decreased cardiac output

A 3-year-old child with right-sided heart failure has been admitted for worsening of their condition. Which assessment would be considered one of the earliest signs of systemic venous congestion in this toddler? -Breathlessness with activity -Excessive crying -Enlargement of liver -Increased urine output

Enlargement of liver

The most common causes of left-sided heart failure include: - acute myocardial infarction. - chronic pulmonary disease. - impaired renal blood flow. - tricuspid valve regurgitation.

acute myocardial infarction.

In an ICU setting, one assessment that would lead the nurse to suspect that shock has led to decreased blood flow to vital organs is: -warm legs with peripheral vasodilation. -urine output less than 20 mL/hour. -blood pressure staying in the 98/72 range for the past hour. -sleepiness and difficulty to arouse without using painful stimuli.

urine output less than 20 mL/hour.

A nurse educator is defining heart failure to a group of recent graduates who will begin providing care on a cardiac unit. The educator should describe which phenomenon? -"Heart failure is a complex syndrome resulting from a lack of oxygen to the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion." -"Heart failure is a complex syndrome resulting from any disorder of the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion." -"Heart failure is a complex syndrome resulting in a structural disorder of the heart that ultimately results in pulmonary or systemic congestion." -"Heart failure is a complex syndrome resulting from any functional or structural disorder of the heart that results in or increases the risk of infarction."

"Heart failure is a complex syndrome resulting from any disorder of the heart that results in or increases the risk of developing manifestations of low cardiac output and/or pulmonary or systemic congestion."

All of the following interventions are ordered STAT for a client stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first? -Epinephrine -Normal saline infusion -Dexamethasone -Diphenhydramine

Epinephrine

Anaphylactic shock causes severe hypoxia very quickly because of which reason? -Generalized vasoconstriction reduces venous return. -Metabolic rate is greatly increased. -Histamine release causes massive vasodilation. -Heart rate and contractility are reduced.

Histamine release causes massive vasodilation.

The nurse knows that which statement regarding heart failure is most accurate? -Right-sided failure is often the result of increased afterload due to hypertension. -Low-output failure is caused by excessive metabolic demands. -In compensated failure, an increase in preload causes an increase in ventricular contractility. -The most common cause of left-sided failure is right-sided failure.

In compensated failure, an increase in preload causes an increase in ventricular contractility.

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are most likely to benefit the man? -Resolution of compensatory pulmonary edema and heart dysrhythmias. -Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility. -Infusion of normal saline or Ringer's lactate to maintain the vascular space. -Administration of oxygen and epinephrine to promote perfusion.

Infusion of normal saline or Ringer's lactate to maintain the vascular space.

A client has a diagnosis of right-sided heart failure. Which body organ should the nurse assess regularly? -Liver -Stomach -Brain -Kidneys

Liver

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education? -Placing a pulse oximeter on the client to monitor oxygenation status -Raising the head of the bed to a high Fowler's position -Administration of 2L of oxygen by nasal cannula -Inserting an IV to begin a normal saline infusion

Raising the head of the bed to a high Fowler's position

A client has presented to the emergency department in distress and is being rapidly assessed by the care team. Which assessment finding would prompt the team to consider the possibility of acute heart failure? -Respiratory distress with audible crackles -Chest pain that is not relieved with nitrates -Chest pain that is not relieved by morphine -Uncharacteristic cognitive changes

Respiratory distress with audible crackles

A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which assessment finding is inconsistent with his diagnosis? -His resting blood pressure is normally in the range of 150/90 and an echocardiogram indicates his ejection fraction is 30%. -His end-diastolic volume is higher than normal and his resting heart rate is regular and 82 beats/minute. -He is currently volume overloaded following several days of intravenous fluid replacement. -Ventricular dilation and wall tension are significantly lower than normal.

Ventricular dilation and wall tension are significantly lower than normal.

After a long bout with vomiting and diarrhea, a client is suspected to be in hypovolemic shock. Which clinical manifestations will the nurse assess that substantiates this diagnosis? Select all that apply. -Tachycardia -Acidosis -Slow, shallow respiration -Warm, dry skin -Apprehension

-Tachycardia -Acidosis -Apprehension

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which statement demonstrates an accurate understanding of his new diagnosis? -"I'll be sure to take my beta-blocker whenever I feel short of breath." -"I'm going to avoid as much physical activity as I can so that I preserve my strength." -"I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on." -"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

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? -"You must be drinking way too many liquids. Your kidneys cannot filter all that you are drinking during the day." -"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water." -"Your heart muscle is overstretched, so it's not able to pump all the blood out. The prescribed 'water pills' help by decreasing your weight." -"Since your heart function is impaired, the lungs are not able to oxygenate the blood and your kidneys are wearing out."

"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 pumping excessive amounts of blood through the carotid arteries causing headache." -"The left ventricle is having problems pumping blood forward, so blood is backing up systemically causing edema in your feet." -"The left ventricle is not adequately perfusing your gastrointestinal tract, leading to diarrhea and vomiting." -"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, and this is causing blood to back up into your lungs."

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: -"Pull your blood from the right side of the heart and run it through a machine to oxygenate it better, and then return it to your body." -"Measure the pressures inside your heart continuously to asses pumping ability of your left ventricle." -"Have a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." -"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

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

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which statement by the physician best captures an aspect of these differences? -"You'll find that, in pediatric clients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." -"Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young clients." -"Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate." -"Fever is a sign of heart failure in children that you are unlikely to see in older adults."

"You'll find that, in pediatric clients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."

Which clients are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply. -A 48-year-old client with uncontrolled hypertension -A marathon runner with history of chronic bradycardia whose pulse rate is 46 -A 57-year-old client with history of ischemic heart disease -A 70-year-old with enlarged left ventricle due to myocardial hypertrophy

-A 48-year-old client with uncontrolled hypertension -A 70-year-old with enlarged left ventricle due to myocardial hypertrophy

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. -Accumulation of fluid in the alveoli and airways -Lung stiffness -Worsening renal failure -Myocardial muscle necrosis -Impaired gas exchange

-Accumulation of fluid in the alveoli and airways -Lung stiffness -Impaired gas exchange

Regarding the various forms of heart failure, the nurse knows that which statements are correct? Select all that apply. -Aortic stenosis can cause left-sided failure. -Cardiomyopathy is a common cause of heart failure. -Compensated heart failure may be clinically asymptomatic. -The most common cause of left-sided failure is blood volume loss. -Right-sided heart failure produces pulmonary congestion and edema.

-Aortic stenosis can cause left-sided failure. -Cardiomyopathy is a common cause of heart failure. -Compensated heart failure may be clinically asymptomatic.

Which statements regarding heart failure in older adults are true? Select all that apply. -Causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction. -Mechanisms of heart failure in older adults as compared to children are dissimilar. -Sensitivity of beta-adrenergic receptors decreases, resulting in decreased ventricular contractility. -Exertional dyspnea is more prominent than in younger adults. -It is more difficult to diagnose because of underlying chronic diseases.

-Causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction. -Sensitivity of beta-adrenergic receptors decreases, resulting in decreased ventricular contractility. -It is more difficult to diagnose because of underlying chronic diseases.

A client diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which conditions are often associated with diastolic failure? Select all that apply. -Constrictive pericarditis -Myocardial hypertrophy -Ischemic heart disease -Volume overload -Valvular stenosis

-Constrictive pericarditis -Myocardial hypertrophy -Ischemic heart disease

The Frank-Starling mechanism is a compensatory response to heart failure that can support cardiac output but also worsen heart failure. Which statements regarding this mechanism are correct? Select all that apply. -Decrease in cardiac output causes an increase in preload. -Increase in preload will increase ventricular wall tension and myocardial oxygen demand. -Increased oxygen demand produces ischemia. -Excessive stretch on the ventricular wall will decrease preload. -Diuretics reduce blood volume and myocardial oxygen demand.

-Decrease in cardiac output causes an increase in preload. -Increase in preload will increase ventricular wall tension and myocardial oxygen demand. -Increased oxygen demand produces ischemia. -Diuretics reduce blood volume and myocardial oxygen demand.

What are the physiologic clinical manifestations of cardiogenic shock? Select all that apply. -Decrease in mean arterial blood pressures -Increased urine output related to increased renal perfusion -Rise in central venous pressure (CVP) -Hypercapnic lips and nail beds -Increased extraction of O2 from hemoglobin

-Decrease in mean arterial blood pressures -Rise in central venous pressure (CVP) -Increased extraction of O2 from hemoglobin

The nurse knows that administration of insulin to a client in septic shock will provide which beneficial effects? Select all that apply. -Decreased risk of infection -Suppression of inflammation -Better wound healing -Inactivation of coagulation factors -Decreased production of cytokines by monocytes

-Decreased risk of infection -Better wound healing

For which consequences of cardiogenic shock will the nurse monitor a trauma client? Select all that apply. -Decreased stroke volume -Decreased blood volume -Decreased cardiac output -Decreased preloading -Increased afterloading

-Decreased stroke volume -Decreased cardiac output -Increased afterloading

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on their left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which assessment findings would confirm the client may be in the early stages of cardiogenic shock? Select all that apply. -Decreasing mean arterial pressure (MAP) -Low BP reading of 86/60 -Urine output 15 mL last hour -Low pulmonary capillary wedge pressure (PCWP) -Periods of confusion

-Decreasing mean arterial pressure (MAP) -Low BP reading of 86/60 -Urine output 15 mL last hour -Periods of confusion

A client is diagnosed with heart failure. Which types of medications are usually prescribed to manage this disorder? Select all that apply. -Diuretics -Digitalis -Nonsteroidal anti-inflammatory drugs (NSAIDs) -Beta-adrenergic blockers (beta-blockers) -Angiotensin-converting enzyme (ACE) inhibitors

-Diuretics -Digitalis -Beta-adrenergic blockers (beta-blockers) -Angiotensin-converting enzyme (ACE) inhibitors

An older adult woman presents arrives in the emergency department after fainting at the funeral of a loved one. She is diagnosed with shock as a result of impaired sympathetic outflow based on which clinical manifestations? Select all that apply. -Faster than normal heart rate -Acute chest pain -Dry, warm skin -Increased thirst -Bradycardia

-Dry, warm skin -Bradycardia

A client exhibits signs and symptoms of heart failure, including fatigue and shortness of breath. Which diagnostic procedure is usually prescribed to support a diagnosis of heart failure? Select all that apply. -Electrocardiogram (EKG) -Cardiac computed tomography (CCT) -Blood urea nitrogen (BUN) -Echocardiography -Chest x-ray

-Electrocardiogram (EKG) -Cardiac computed tomography (CCT) -Echocardiography -Chest x-ray

Which changes associated with aging contribute to heart failure development in older adults? Select all that apply -Increased incidence of mitral stenosis -Sludge buildup in the kidneys -Elevated diastolic BP -Increased vascular stiffness -Inflammation in the joints due to arthritis

-Elevated diastolic BP -Increased vascular stiffness

At the cellular level, how do cardiac muscle cells respond to an increase in ventricular volume to the point of overload? Select all that apply. -Elongating the cardiac muscle cells -Thickening of the individual myocytes -Replicating the myofibrils -Decreasing the ventricular wall thickness -Symmetrically widening and lengthening the hypertrophy

-Elongating the cardiac muscle cells -Decreasing the ventricular wall thickness

The nurse will monitor the client for which possible respiratory manifestations of heart failure? Select all that apply. -Exertional dyspnea -Orthopnea -Cheyne-Stokes respiration -Chronic, dry cough -Hyperventilation

-Exertional dyspnea -Orthopnea -Cheyne-Stokes respiration -Chronic, dry cough

What are the signs and symptoms of heart failure? Select all that apply. -Fluid retention -Ruddy complexion -Fatigue -Bradycardia -Chronic productive cough

-Fluid retention -Fatigue

Acute pulmonary edema often occurs with heart failure. Which signs of acute pulmonary edema should the nurse monitor their clients for? Select all that apply. -Frothy, blood-tinged sputum -Respiratory crackles -Hot, dry skin -Confusion -Rapid pulse

-Frothy, blood-tinged sputum -Respiratory crackles -Confusion -Rapid pulse

A client has a new diagnosis of left-sided heart failure. The nurse knows the most common causes of left-sided failure include which physiologic responses? Select all that apply. -Tricuspid valve dysfunction -Impaired renal blood flow -Chronic pulmonary disease -Hypertension -Acute myocardial infarction

-Hypertension -Acute myocardial infarction

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

-Hypertrophy

A 60-year-old woman has just been diagnosed with heart failure and her primary care provider is describing the concept of adaptation. Which compensatory mechanisms may have masked the client's heart failure? Select all that apply. -Hypertrophy of the myocardium -Sympathetic nervous stimulation -Increased renin-angiotensin-aldosterone system (RAAS) function -Increased renal excretion of potassium -Increased preload

-Hypertrophy of the myocardium -Sympathetic nervous stimulation -Increased renin-angiotensin-aldosterone system (RAAS) function -Increased preload

The nurse must achieve which clinical objectives for a client in cardiogenic shock? Select all that apply. -Improve cardiac output -Increase cardiac workload and oxygen use -Regulate blood volume -Increase coronary perfusion -Correct pulmonary edema

-Improve cardiac output -Regulate blood volume -Increase coronary perfusion -Correct pulmonary edema

Which statements regarding systolic and diastolic dysfunction are correct? Select all that apply. -Separation into systolic or diastolic dysfunction is based on ventricular ejection fraction. -In systolic dysfunction, the ejection fraction is decreased. -In systolic dysfunction, preload increases. -In diastolic dysfunction, the ejection fraction decreases. -In diastolic dysfunction, preload increases.

-In systolic dysfunction, the ejection fraction is decreased. -In systolic dysfunction, preload increases. -In diastolic dysfunction, the ejection fraction decreases.

Which statements regarding heart failure are true? Select all that apply -Myocardial infarction is a frequent cause of right-sided failure. -In uncompensated left-sided heart failure, there is pulmonary congestion and edema. -In compensated heart failure, cardiac output is normal. -In uncompensated right-sided heart failure, there is peripheral venous congestion and edema. -Pulmonary hypertension is a frequent cause of left-sided failure.

-In uncompensated left-sided heart failure, there is pulmonary congestion and edema. -In compensated heart failure, cardiac output is normal. -In uncompensated right-sided heart failure, there is peripheral venous congestion and edema.

Natriuretic peptides (NP) are part of the compensatory response to heart failure. Which are actions of NP? Select all that apply. -Increased glomerular filtration -Decreased renal reabsorption of sodium and water -Venous and arterial vasoconstriction -Activation of the renin-angiotensin-aldosterone system (RAAS) -Inhibition of endothelin action

-Increased glomerular filtration -Decreased renal reabsorption of sodium and water -Inhibition of endothelin action

Electrical burns over a large surface area of a client's body have resulted in hypovolemic shock. Following physical assessment, which findings lead the nurse to believe the client's body is compensating for this fluid loss? Select all that apply. -Increased heart rate -Vasodilation with warm extremities -Diuresis with output of 100 mL/hour -The client complaining of extreme thirst -Deep, rapid respirations

-Increased heart rate -The client complaining of extreme thirst -Deep, rapid respirations

A client has arrived in the emergency department in cardiogenic shock. Which assessment findings by the nurse would confirm this diagnosis? Select all that apply. -Bright red color noted in the nail beds and lips -Less than 5 mL dark, concentrated urine in the past hour -BP reading of 80/65 -Difficult to arouse with changes in level of consciousness -Diminished breath sounds in the bases, bilaterally

-Less than 5 mL dark, concentrated urine in the past hour -BP reading of 80/65 -Difficult to arouse with changes in level of consciousness

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 -Reduced tissue perfusion especially to the kidney -Activated sympathetic (adrenergic) reflexes -Myocardial remodeling of scar tissue

-Low cardiac output due to reduced pumping ability

Which statements regarding causes of systolic and diastolic dysfunction are most accurate? Select all that apply. -Pericardial effusion causes systolic dysfunction. -Myocardial hypertrophy causes diastolic dysfunction. -Hypertension causes diastolic dysfunction. -Ischemic heart disease causes systolic dysfunction. -Valvular insufficiency causes systolic dysfunction.

-Myocardial hypertrophy causes diastolic dysfunction. -Ischemic heart disease causes systolic dysfunction. -Valvular insufficiency causes systolic dysfunction.

An acutely ill client is developing multiple organ dysfunction syndrome (MODS). The nurse knows that which statements regarding multiple organ dysfunction syndrome are accurate? Select all that apply. -Organs affected include kidneys, lungs, liver, brain, and heart. -MODS rarely occurs with septic shock. -Homeostasis is disrupted. -Risk factors for development of MODS include severe trauma, hepatic dysfunction, and prolonged hypotension. -Treatment is primarily supportive of the affected organs.

-Organs affected include kidneys, lungs, liver, brain, and heart. -Homeostasis is disrupted. -Risk factors for development of MODS include severe trauma, hepatic dysfunction, and prolonged hypotension. -Treatment is primarily supportive of the affected organs.

A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows which complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply. -Profound dyspnea due to acute respiratory distress syndrome (ARDS) -Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces -Formation of plaque within vessels supplying blood to the heart, causing muscle damage and chest pain -Acute renal failure due to decreased/impaired renal perfusion as a result of low BP -Flushed skin and pounding headache that coincides with each heartbeat

-Profound dyspnea due to acute respiratory distress syndrome (ARDS) -Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces -Acute renal failure due to decreased/impaired renal perfusion as a result of low BP

A person in circulatory shock may experience which damaging effects at the cellular level caused by lack of oxygen supply? Select all that apply. -Pyruvate converted to lactic acid -Cellular edema -Deranged sodium/potassium balance -Decreased lysosomal enzyme release -Impaired cellular production of adenosine triphosphate (ATP)

-Pyruvate converted to lactic acid -Cellular edema -Deranged sodium/potassium balance -Impaired cellular production of adenosine triphosphate (ATP)

A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply. -Incontinent of urine -Severe bronchospasm -Wheezing sound on inspiration -Hives over entire body -Swelling around the lips and eyes

-Severe bronchospasm -Wheezing sound on inspiration -Hives over entire body -Swelling around the lips and eyes

Proper perfusion of vital organs requires which physiologic conditions to be present? Select all that apply. -Sufficient blood volume to fill the vascular compartment -Efficient cardiac pumping ability -Intact vascular system -Ability of organs to extract oxygen and nutrients from blood -Efficient renal function

-Sufficient blood volume to fill the vascular compartment -Efficient cardiac pumping ability -Intact vascular system -Ability of organs to extract oxygen and nutrients from blood

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 inhibits the renin-angiotensin-aldosterone system (RAAS) to decrease blood volume. -The sympathetic nervous system vasoconstriction preserves blood flow to all body organs. -The sympathetic nervous system increase in cardiac workload and oxygen use can cause ischemia and worsening of heart failure.

-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 client has developed disseminated intravascular coagulation (DIC). The nurse knows that which statements regarding DIC are true? Select all that apply. -Thrombotic occlusion occurs in small and midsized blood vessels. -Bleeding may accompany coagulation. -Generation of thrombin increases. -Endogenous anticoagulation mechanisms are suppressed. -Fibrin removal increases.

-Thrombotic occlusion occurs in small and midsized blood vessels. -Bleeding may accompany coagulation. -Generation of thrombin increases. -Endogenous anticoagulation mechanisms are suppressed.

A client who has progressed to late-stage heart failure is experiencing sympathetic stimulation. The nurse would correlate which manifestations with sympathetic response? Select all that apply. -Vasoconstriction -Dysrhythmias -Increased oxygen demand -Bradycardia -Increased cardiac contractility

-Vasoconstriction -Dysrhythmias -Increased oxygen demand

Hypovolemic shock is characterized by a loss of blood volume or extracellular fluid. Administering which of the following would manage a client with hypovolemic shock? Select all that apply. -Whole blood -Vasoconstrictor drugs -Packed red blood cells -Plasma volume expanders -Crystalloids

-Whole blood -Packed red blood cells -Plasma volume expanders -Crystalloids

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which level indicates inadequate renal perfusion? 80—60 mL/hour 60—40 mL/hour 40—20 mL/hour 20 mL/hour

20 mL/hour

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 40 mL/hour 60 mL/hour 80 mL/hour

20 mL/hour

A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man? -Resolution of compensatory pulmonary edema and heart dysrhythmias. -Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility. -Infusion of normal saline or Ringer's lactate to maintain the vascular space. -Administration of oxygen and epinephrine to promote perfusion.

Infusion of normal saline or Ringer's lactate to maintain the vascular space.

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? -Uterine smooth muscle relaxation -Laryngeal edema -Bronchodilation -Gastrointestinal relaxation

Laryngeal edema

A 30-year-old client arrives with these vital signs: Blood pressure 50/30 mm Hg, pulse 100 beats/min, respiratory rate 12 breaths/min, temperature 101°F (38.3°C). The nurse interprets these results as the client is in shock based on which reading? -Elevated temperature -Elevated pulse rate -Low blood pressure -Slow respiratory rate

Low blood pressure

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 Hypovolemia Excessive vasoconstriction Obstruction of blood flow Hypervolemia

Maldistribution of blood flow Hypovolemia Obstruction of blood flow

A nurse educator on a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? -Measurement of urine output and mental status assessment -Pupil response and counting the patient's apical heart rate -Palpation of pedal (foot) pulses and pain assessment -Activity tolerance and integumentary inspection

Measurement of urine output and mental status assessment

A client has developed left-sided heart failure. Which symptom might have precipitated this condition? -Pulmonary edema -Hypotension -Stroke -Myocardial infarction

Myocardial infarction

A client with heart failure tells the nurse that he is frustrated and is unable to get "a good night's rest." The client relates that he falls asleep and is suddenly awakened and feels as though he is having a hard time breathing and is suffocating. The nurse recognizes this assessment as: -Paroxysmal nocturnal dyspnea -Orthopnea -Cardiac asthma -Sleep apnea

Paroxysmal nocturnal dyspnea

The pathogenesis of multi-organ dysfunction syndrome (MODS) is not clearly understood at this time. Supportive management is currently the focus of treatment in this disorder. What is not a major risk factor in MODS? -Advanced age -Alcohol abuse -Respiratory dysfunction -Infarcted bowel

Respiratory dysfunction

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? -Septic -Neurogenic -Cardiogenic -Anaphylactic

Septic

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: -Pericardial effusion -Infective endocarditis -Valvular regurgitation -Valvular stenosis

Valvular regurgitation

An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased: -Vascular stiffness -Response to beta-adrenergic stimulation -Cardiac tone and compliance -Myocardial metabolism

Vascular stiffness

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins? -Vasoconstriction -Vasodilation -Diuretic -Natriuretic

Vasoconstriction