Patho Ch.19
The health care provider is preparing to assess a client who has been diagnosed with hypertrophic cardiomyopathy. The provider anticipates the assessment data will include which finding?
Reduced chamber size Explanation: Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the ventricular septum, abnormal diastolic filling, cardiac arrhythmias and, in some cases, intermittent left ventricular outflow obstruction. The other choices are findings in dilated cardiomyopathy.
A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis?
"I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising." Explanation: Aspirin, exercise, and weight loss are all identified treatments for angina. Angina does not normally necessitate blood work, heparin administration, or avoidance of activity.
A client who has been diagnosed with mitral valve prolapse asks the nurse if there are any dietary modifications that should be incorporated into her lifestyle. The best response would be:
"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."
Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction?
80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose
Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome?
Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation.
Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction?
An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart. The other patients have angina of varying severity.
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?
At the apex of the heart The murmur of mitral valve stenosis is heard during diastole when blood is flowing through the constricted valve; it is characteristically a low-pitched, rumbling murmur best heard at the apex of the heart.
The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
Constrictive pericarditis Explanation: In constrictive pericarditis, fibrous, calcified scar tissue develops between the visceral and parietal layers of the serous pericardium. Acute pericarditis is due to inflammation of the pericardium. Pleural effusion is caused by accumulation of fluid and can lead to cardiac tamponade.
Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?
Have the client sit up and lean forward. Explanation: With acute periocarditis, the pain typically is pleuritic (aggravated by inspiration and swallowing) and positional (decreases with sitting and leaning forward; increases with moving to the side) because of changes in venous return and cardiac filling.
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 Explanation: The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.
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 of the following disorders was the player's most likely cause of death?
Hypertrophic cardiomyopathy (HCM)
A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have?
Mitral valve stenosis Explanation: Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole, with left atrial distention and impaired filling of the left ventricle with associated symptoms. Mitral prolapse and aortic valve disorders will lead to the development of cardiomyopathies.
The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?
Morphine 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 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:
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 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?
Pericardial effusion
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 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?
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 client is seen in the emergency room with complaints of 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 Explanation: This patient 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.
A client with a history of myocardial infarction tells the healthcare provider they have started to experience more episodes of angina pectoris than before. The provider should tell this client that which activity can precipitate his angina pectoris? Select all that apply.
Physical exertion Exposure to cold Emotional stress
A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:
Prompt diagnosis and treatment of streptococcal infections
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.
A teenager is seen in the emergency room with complaints of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen three weeks before in the clinic and treated with antibiotics for a strep throat. He was better for a few days but now he seems to have gotten worse in the last two days. What should the nurse suspect is wrong with this client?
Rheumatic fever Explanation: Rheumatic fever is an immune-mediated inflammatory disease that occurs a few weeks after a group A strep (sore throat). It can manifest as an acute, recurrent or chronic disorder.
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?
See the doctor for evaluation immediately.
An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication?
Systemic emboli, especially to brain.
The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes:
T-wave changes Explanation: Unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) is a clinical syndrome of myocardial ischemia ranging from angina to myocardial infarction. The ECG pattern associated with in NSTEMI may display normal or ST-segment depression (or transient ST-segment elevation) and T-wave changes. The degree of ST-segment deviation from baseline is an important measure of ischemia and indicator of prognosis. Abnormal Q waves occur with ACS.
Which of the following patients is at the greatest risk of developing rheumatic heart disease?
Teenager with untreated strep throat Explanation: Rheumatic fever is caused by group A (beta-hemolytic) streptococcal throat infection. Although the same bacteria cause 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.
The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?
The disabling effects that result from involvement of heart valves Rheumatic fever is a very important cause of heart disease and its most serious and disabling effects result from involvement of the heart valves.
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:
The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
Which serum biomarker is highly specific for myocardial tissue?
Troponin
A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?
Troponin assays
A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?
Troponin level
Which of the following ECG patterns would the nurse observe in a client admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply.
Ventricular tachycardia with left bundle branch block pattern. T-wave inversion in the right precordial leads. The electrical (ECG) changes associated with ARVC/D include ventricular tachycardia with LBBB, T-wave inversion in the right precordial leads, and epsilon waves. Right ventricular BBB may also be present. Atrial flutter and sinus arrhythmia with 10 AV block is not characteristic of this form of cardiomyopathy.
