Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock
A client asks the purpose of an exercise stress test. What is the nurse's best response? "This is to assess your tolerance of isometric exercise." "This test is necessary prior to starting medication therapy for obesity." "This will help you endure exercise." "The test is used to measure functional status during stress."
"The test is used to measure functional status during stress."
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. "Are you feeling depressed?" "Do you get up often during the night to urinate?" "Do you have swelling in your ankles?" "Are you eating more than usual?" "Do you easily get tired?"
"Are you feeling depressed?" "Do you get up often during the night to urinate?" "Do you have swelling in your ankles?" "Do you easily get tired?"
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 trying to think of ways that I can cut down the amount of salt that I usually eat." "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."
What should the nurse teach the client prior to ergometry? "This test evaluates cardiac function." "You must be able to jog to do this test." "This is an invasive test." "Do not eat prior to having this test."
"This test evaluates cardiac function."
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: 40 mL/hour 60 mL/hour 80 mL/hour 20 mL/hour
20 mL/hour Urine output decreases very quickly in hypovolemic shock. Compensatory mechanisms decrease renal blood flow as a means of diverting blood flow to the heart and brain. Oliguria of 20 mL/hour or less indicates inadequate renal perfusion.
Which client should most benefit from treatment with anti-thrombin agents? Client who was thought to have had an MI but who was later diagnosed with pericarditis 57-year-old client who has recently been diagnosed with unstable angina Young client diagnosed with hypertrophic cardiomyopathy (HCM) 29-year-old client who developed endocarditis by injecting with a dirty needle
57-year-old client who has recently been diagnosed with unstable angina
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? Antianxiety drugs Broad-spectrum antibiotic drugs Calcium-channel blocking drugs beta-adrenergic blocking drugs (beta-blockers)
Beta-adrenergic-blocking drugs. Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with Beta-adrenergic-blocking drugs.
The nurse is caring for a client who has just experienced an acute myocardial infarction. Which type of shock is this client likely to experience? Septic Cardiogenic Neurogenic Hypovolemic
Cardiogenic
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? Rheumatic cardiac disease Myocardial infarction Heart failure Cardiomyopathy
Cardiomyopathy
For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve? Compensatory mechanisms Aortic hypertrophy Electrical conductivity Parasympathetic system
Compensatory mechanisms
The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium? Pleural effusion Acute pericarditis Constrictive pericarditis Mediastinal radiation
Constrictive pericarditis
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. Cyanosis Hyperglycemia Exercise intolerance Fatigue Malnutrition
Fatigue Exercise intolerance Cyanosis Malnutrition
Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: Increased collateral circulation Excessive endothelial relaxing factors Intermittent vessel vasospasms Fixed coronary obstruction
Fixed coronary obstruction
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? Takotsubo cardiomyopathy Hypertrophic cardiomyopathy (HCM) Dilated cardiomyopathy (DCM) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)
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 cardiac contractility Increased vascular stiffness Loss of action potential Orthostatic hypotension
Increased vascular stiffness Increased vascular stiffness in older adults causes a progressive increase in systolic blood pressure with advancing age, which in turn contributes to the development of left ventricular hypertrophy and altered diastolic filling.
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: Gastroesophageal reflux disease (GERD) Acute respiratory distress syndrome (ARDS) Onset of STEMI Pneumonia
Onset of STEMI The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin.
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? COPD Myocardial infarction Pericarditis Pericardial effusion
Pericardial effusion Explanation:Pericardial effusion refers to the accumulation of fluid in the pericardial vacuity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200ml of fluid may raise intracardiac pressure to levels that will cause symptoms similar to right-sided heart failure. Pericarditis is inflammation of the pericardium while COPD is a respiratory disease.
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? Inserting an IV to begin a normal saline infusion Administration of 2L of oxygen by nasal cannula Placing a pulse oximeter on the client to monitor oxygenation status Raising the head of the bed to a high Fowler's position
Raising the head of the bed to a high Fowler's position
The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock? Cardiogenic shock Hypovolemic shock Anaphylactic shock Septic shock
Septic shock
A nurse preparing education on managing the risk factors for coronary artery disease (CAD) will stress which information? Select all that apply. Stress management techniques Signs and symptoms of type 2 diabetes mellitus Smoking cessation techniques Identification of high cholesterol foods Importance of exercise on managing hypertension
Signs and symptoms of type 2 diabetes mellitus Importance of exercise on managing hypertension Smoking cessation techniques Identification of high cholesterol foods
Which client is at the greatest risk of developing rheumatic heart disease? Child with impetigo on the face Teenager with untreated strep throat Older adult with shingles Young adult with viral meningitis
Teenager with untreated strep throat 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.
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. To relieve anxiety For diuretic purposes To relieve coronary pain For its vasodilation effect
To relieve coronary pain For its vasodilatation effect Explanation:Nitroglycerine is given in the treatment of STEMI because of its vasodilating effect and its ability to relieve coronary pain.
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? 40—20 mL/hour 60—40 mL/hour 80—60 mL/hour 20 mL/hour
Urinary output at 20 mL/hour or below indicates that renal perfusion is too inadequate.
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 Pericardial effusion Infective endocarditis Valvular stenosis
Valvular regurgitation
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins? Vasodilation Diuretic Natriuretic Vasoconstriction
Vasoconstriction
A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect? Increased preload Reduction of cardiac refractory periods Vasodilating effects reducing preload and afterload Decreased heart rate and increased stroke volume
Vasodilating effects reducing preload and afterload Nitroglycerin produces its effects by releasing nitric oxide in vascular smooth muscle of the target tissues, resulting in relaxation of this muscle and increased blood flow. This drug does not decrease heart rate. Because it vasodilates, it decreases preload. Nitroglycerine does not affect cardiac refractory periods.
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: 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. eliminating CHF through curing the disease.
improving quality of life by relieving symptoms.
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to: take a second nitroglycerine. not worry about it as this is common for someone who has already had a myocardial infarction. see the doctor for evaluation immediately. give it 5-10 minutes more to see if there is relief.
see the doctor for evaluation immediately.
