NUR 4135 PrepU Chapter 27
A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process? Cardiomyopathy Pericarditis Myocardial infarction Infective endocarditis
Infective endocarditis Explanation: Infective endocarditis is a serious and potentially life-threatening infection of the inner surface of the heart. Pericarditis involves an inflammatory response of the pericardium. Myocardial infarction is a heart attack while cardiomyopathy is a heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorders.
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." Explanation: Salt and fluid restrictions are indicated for most clients with heart failure (HF). Beta-blockers do not address shortness of breath, and cardiac medications are not normally taken in response to acute symptoms. Clients should be encouraged to maintain—and increase, if possible—physical activity within the limits of their condition.
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? 60—40 mL/hour 20 mL/hour 80—60 mL/hour 40—20 mL/hour
20 mL/hour Explanation: In hypovolemia, renal vasculature is constricted in a compensatory attempt to circulate blood to more vital organs. Urinary output at 20 mL/hour or below indicates that renal perfusion is too inadequate.
A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first? Administer epinephrine (adrenaline). Start a normal saline infusion. Complete a 12-lead ECG. Administer diphenhydramine.
Administer epinephrine (adrenaline). Explanation: Treatment includes immediate discontinuation of the inciting agent or institution of measures to decrease its absorption; close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion. Epinephrine is given in an anaphylactic reaction because it constricts blood vessels and relaxes the smooth muscle in the bronchioles, thus restoring cardiac and respiratory function.
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences? Backup of blood from the right atrium into the superior vena cava Backflow from the left ventricle to left atrium Backflow from the right ventricle to the right atrium during systole Inhibition of the SA node's normal action potential
Backflow from the left ventricle to left atrium Explanation: The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility.
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? Heart failure Myocardial infarction Rheumatic cardiac disease Cardiomyopathy
Cardiomyopathy Explanation: Cardiomyopathies result from genetic and/or environmental factors and will result in heart failure. MI and rheumatic diseases may lead to heart failure, but the mechanism is different.
A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which clinical manifestations would be observed if this client has aortic stenosis? Select all that apply. Syncope Heartburn Palpitations Decrease in exercise tolerance Exertional dyspnea
Decrease in exercise tolerance Exertional dyspnea Syncope Explanation: Because of the slow onset of aortic valve stenosis, the heart is able to compensate by hypertrophying and may still maintain a normal chamber volume and ejection fraction. As the stenosis progresses, the client will experience classic symptoms of angina, syncope, heart failure, decrease in exercise tolerance, or exertional dyspnea. Palpitations are not usually noted with aortic stenosis.
In teaching a pregnant client, the nurse informs the client that fetal heart development begins during which week after conception? Fetal heart development occurs between the third and eighth week. Fetal cardiac development begins in the fifth week. Fetal development begins immediately after conception. Fetal cardiac development begins in the second week.
Fetal heart development occurs between the third and eighth week. Explanation: Fetal heart development occurs between the third and eighth week.
A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure? Atrial regurgitation Mitral valve prolapse Dilated cardiomyopathy Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy Explanation: HCM is an autosomal dominant heart disease caused by mutations in the genes encoding proteins of the cardiac sarcomere. HCM is the most common cause of sudden cardiac death (SCD) in young athletes. Dilated cardiomyopathy, mitral valve prolapse, and atrial regurgitation all lead to heart failure but much later in life.
Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?
Hypertrophic cardiomyopathy (HCM) Explanation: The most frequent symptoms of HCM are dyspnea and chest pain in the absence of coronary artery disease. Syncope (fainting) is also common and is typically postexertional, when diastolic filling diminishes and outflow obstruction increases. Ventricular dysrhythmias are also common, and sudden death may occur, often in athletes after extensive exertion. Risk factors for sudden cardiac death among clients with HCM include a family history of syncope or sudden cardiac death, certain mutations, and extreme hypertrophy of the left ventricle. HCM is characterized by a massively hypertrophied left ventricle with a reduced chamber size.
Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells? Atrophy Hyperplasia Dysplasia Hypertrophy
Hypertrophy Explanation: Myocardial hypertrophy is a compensatory mechanism in heart failure as the heart attempts to maintain adequate pumping ability. Paradoxically, hypertrophy can gradually decrease cardiac efficiency.
Which phenomenon would be most likely to accompany increased myocardial oxygen demand (MVO2)? Use of calcium-channel blocker medications Ventricular atrophy Increased aortic pressure Inadequate ventricular end-diastolic pressure
Increased aortic pressure Explanation: 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.
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 Orthostatic hypotension Increased vascular stiffness Loss of action potential
Increased vascular stiffness Explanation: 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 loss of action potential does not typically accompany aging, and contractility tends to decrease as a result of cardiac stiffness. Orthostatic hypotension is neither a normal age-related change nor a cause of heart failure.
When teaching about heart attacks, the nursing instructor tells the students that most heart attacks (approximately 40 to 50 percent) affect which coronary artery? Pulmonary artery Left circumflex artery Right coronary artery Left anterior descending artery
Left anterior descending artery Explanation: Approximately 30 to 40 percent of infarcts affect the right coronary artery, 40 to 50 percent affect the left anterior descending artery, and the remaining 15 to 20 percent affect the left circumflex artery. The pulmonary artery does not come into play with an infarct.
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 being in shock based on which reading? Elevated pulse rate Elevated temperature Slow respiratory rate Low blood pressure
Low blood pressure Explanation: Low blood pressure is characteristic of most occurrences of shock. Hypoperfusion of the systemic tissue results from deficient cardiac output. Most often, hypotension and hypoperfusion are present. Elevated pulse rate may be a compensatory effort to support blood pressure. Elevated temperature can occur with septic shock. Decreased respiratory rate is not characteristic of shock
The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myocardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain? Morphine Codeine Fentanyl Demerol
Morphine Explanation: Although a number of analgesic agents have been used to treat pain of myocardial infarction, morphine is the drug of choice and is usually indicated if chest pain is unrelieved with oxygen and nitrates.
A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have? Pericarditis Pneumonia Abdominal aortic aneurysm Myocardial infarction
Pericarditis Explanation: 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.
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? Weakness, palpitations Vertigo, headache Peripheral edema, weight gain Dyspnea, cough
Peripheral edema, weight gain Explanation: In right-sided heart failure, blood backs up into the venous side of the circulatory system causing increased hydrostatic pressure in capillaries and leakage of plasma, which forms peripheral edema and becomes apparent as weight gain. The other manifestations listed are not characteristic of right-sided failure.
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 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
Raising the head of the bed to a high Fowler's position Explanation: Treatment measures include close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion; and the administration of oxygen, antihistamine drugs, and corticosteroids. The person should be placed in a supine position. This is extremely important because venous return can be severely compromised in the sitting position. This in turn produces a pulseless mechanical contraction of the heart and predisposes to arrhythmias. In several cases, death has occurred immediately after assuming the sitting position.
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? Anaphylactic Neurogenic Septic Cardiogenic
Septic Explanation: Septic shock can result with the body's response to a severe infection. Neurogenic shock is a loss of sympathetic (adrenergic) control of systemic blood vessel tone. Cardiogenic shock is a loss of cardiac efficiency, and anaphylactic shock is a severe allergic reaction.
What is the primary cause of heart failure in infants and children? Reactions to medications Hyperkalemia Idiopathic heart disease Structural heart defects
Structural heart defects Explanation: Structural (congenital) heart defects are the most common cause of heart failure in children.
Which client is at the greatest risk of developing rheumatic heart disease? Teenager with untreated strep throat Older adult with shingles Young adult with viral meningitis Child with impetigo on the face
Teenager with untreated strep throat Explanation: 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 has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response? The most common cause is a staph infection. It can be attributed to drug abuse. Let's not worry about the cause as we need to focus on getting him better. Sometimes a parasite is involved.
The most common cause is a staph infection. Explanation: Staphylococcal infections have now emerged as the leading cause of infective endocarditis, with streptococci and enterococci as the other two most common causes. Informing the client's wife about the drug abuse connection infers that you think he is a drug addict and is not therapeutic. Parasites are never the cause. Telling the client to focus on her husband also is not appropriate, as this is a genuine concern for her.
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be: The valve opens backward, permitting blood to flow from the right ventricle into the right atrium. The valve opening is incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium. The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. The valve opening permits backward flow to occur when the valve should be closed.
The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. Explanation: Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. This increases the work and volume of the chamber emptying through the narrowed valve—the left atrium in the case of mitral stenosis and the left ventricle in aortic stenosis. An incompetent or regurgitant valve permits backward flow to occur when the valve should be closed—flowing back into the left ventricle during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased.
Heart failure and circulatory shock are both conditions of circulatory system failure. Which statement regarding these conditions is correct? They have the same etiology. They have the same remediation. They have the same pathogenesis. They have the same compensatory mechanisms.
They have the same compensatory mechanisms. Explanation: Heart failure and circulatory shock have common compensatory mechanisms that attempt to support cardiac output and tissue perfusion. They do not share common pathogenesis, causes, or remediation.
A client comes to the emergency room with all the symptoms of a myocardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order? Troponin assays Creatine kinase Phosphorous Potassium
Troponin assays Explanation: The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction. Creatine kinase is an intracellular enzyme found in muscle cells. The troponin level identifies necrosis in cardiac muscles earlier than creatine kinase. The others are not necessarily used when suspecting a myocardial infarction.
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? Calcium-channel blocking drugs Antianxiety drugs beta-adrenergic blocking drugs (beta-blockers) Broad-spectrum antibiotic drugs
beta-adrenergic blocking drugs (beta-blockers) Explanation: Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with the beta-adrenergic blocking drugs. None of the other types of drugs are used in the treatment of mitral valve prolapse to relieve symptoms or prevent complications.
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. renal failure due to an overdose of medication. side effects from the administration of midazolam, causing excessive vasoconstriction. hypovolemic shock due to acute intravascular volume loss.
hypovolemic shock due to acute intravascular volume loss. Explanation: Hypovolemic shock is characterized by diminished blood volume such that there is inadequate filling of the vascular compartment. Hypovolemic shock also can result from an internal hemorrhage or from third-space losses, when extracellular fluid is shifted from the vascular compartment to the interstitial space or compartment, without fluid movement in/out of the cells. Within seconds after the onset of hemorrhage or the loss of blood volume, compensatory manifestations of tachycardia, vasoconstriction, and other signs of sympathetic and adrenal medullary activity appear. There is no indication that this client has developed a pulmonary embolism, is having side effects from versed administration, or is going into renal failure due to an overdose of medication.
Which situation related to transition from fetal-to-perinatal circulation would be most likely to necessitate medical intervention? Pressure in pulmonary circulation and the right side of the infant's heart fall markedly. Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries. Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week. Systemic vascular resistance and left ventricular pressure are both increasing.
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