Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock

Five hours after presenting to the emergency department with substernal chest pain, a client's laboratory results demonstrate that troponin I is elevated and the creatine kinase-myoglobin (CK-MB) levels are within normal range. What is the nurse's interpretation of these results? Client has not experienced a myocardial infarction (MI). Client is currently experiencing an MI. Client most likely had an MI 2 days ago. Client experienced an MI 24 hours ago.

Client is currently experiencing an MI.

When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI? Conversion from aerobic to anaerobic metabolism Overproduction of energy capable of sustaining normal myocardial function Conversion from anaerobic to aerobic metabolism Inadequate production of glycogen with mitochondrial shrinkage

Conversion from aerobic to anaerobic metabolism

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

On a routine physical exam visit, the physician mentions that he hears a new murmur. The client gets worried and asks, "What does this mean?" The physician responds: "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit." "This could be caused by an infection. Have you been feeling well the past few weeks?" "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems." "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or lightheaded."

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

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.

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

An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure? Increased vascular stiffness Orthostatic hypotension Increased cardiac contractility Loss of action potential

Increased vascular stiffness

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

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

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

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

Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture? Select all that apply. Size of lipid-rich core Preponderance of smooth muscle cells Presence of inflammation Decrease in blood pressure and coronary blood flow Thickness of fibrous cap

Size of lipid-rich core Presence of inflammation Thickness of fibrous cap

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

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.

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

Which individual is likely experiencing the manifestation of acute coronary syndrome (ACS)? A client whose most recent ECG indicates that silent myocardial ischemia has occurred A client who occasionally experiences persistent and severe chest pain when at rest A client who sometimes experiences chest pain when climbing stairs A client who has recently been diagnosed with variant (vasospastic) angina

A client who occasionally experiences persistent and severe chest pain when at rest

ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI? Action increases autonomic nervous system activity. Action decreases metabolic demands of the heart. Action increases anxiety, in turn increasing metabolic demands of the heart. Action relieves pain and gives sense of depression.

Action decreases metabolic demands of the heart.

Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function? Atherosclerosis and unstable angina Pericardial effusion and cardiac tamponade Dilated cardiomyopathies Aortic valve regurgitation and aortic stenosis Atherosclerosis and unstable angina

Atherosclerosis and unstable angina

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. For its vasodilation effect For diuretic purposes To relieve coronary pain To relieve anxiety

For its vasodilation effect To relieve coronary pain

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be: History of cigarette smoking and elevated blood pressure High serum high-density lipoprotein and diabetes Advanced age and low serum total and low-density lipoprotein cholesterol Physical inactivity and high serum high-density lipoprotein cholesterol

History of cigarette smoking and elevated blood pressure

A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this? Heart attack Dehydration Pericarditis Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy

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

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 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.

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

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

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? Pericarditis Myocardial infarction Pericardial effusion COPD

Pericardial effusion

The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock? Anaphylactic shock Septic shock Cardiogenic shock Hypovolemic shock

Septic shock

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? Systemic emboli, especially to brain. Petechial hemorrhages under the skin and nail beds. GI upset from the massive amount of antibiotics required to kill the bacteria. Pancreas enlargement due to increased need for insulin secretion.

Systemic emboli, especially to brain.

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.

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 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

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