Patho Chapter 20

A client who has progressed to late-stage heart failure is experiencing sympathetic stimulation. The nurse would assess the client for: Select all that apply.

Vasoconstriction Arrhythmias Increased oxygen demand p. 489.

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Vasoconstriction p. 490.

In hypovolemic shock, the main purpose of treatment is correcting or controlling the underlying cause of the hypovolemia and improving the perfusion of the tissues and organs of the body. Which of the following treatments is not a primary form of therapy for hypovolemic shock?

Vasoconstrictive drugs p. 504.

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 p. 497.

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, p. 497.

The nurse knows that which of the following statements regarding heart failure is correct?

In compensated failure, an increase in preload causes an increase in ventricular contractility. p. 488.

Which of the following statements regarding heart failure is true?

In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction. p. 489.

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?

Venous return to the heart, p. 487.

Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes?

Cyanosis p. 492.

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure?

Diuretic, ACE inhibitor, beta-blocker p. 489.

A patient is diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder? Select all that apply.

Diuretics Digitalis Beta-adrenergic blockers Angiotensin-converting enzyme inhibitors (ACEI) p. 497.

A nurse in a nursing home is concerned that a resident may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?

Dyspnea, cough

A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause.

Diastolic dysfunction p. 492.

A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?

Myocardial infarction p. 495.

A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?

Myocardial infarction p. 498.

Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points 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." p. 495.

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat." p. 494.

A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?

"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." p. 491.

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 p. 504

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion?

20 mL/hour p. 504.

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 p. 504.

Cardiac reserve refers to which of the following events?

Ability to increase cardiac output during physical exercise p. 487.

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). p. 506.

A client is rushed to the emergency department with symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?

Anaphylactic p. 506.

A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client.

Anaphylatic shock p. 506.

Regarding heart failure, the nurse knows that which of the following 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. p. 486.

Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?

Atrial fibrillation p. 495

A 77 year old patient 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:

Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand. p. 490.

A client has been diagnosed with heart failure. The client's cardiac contractility will be primarily affected by which factor?

Ca2+ levels in the myocardium p. 487.

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:

Call for emergency assistance utilizing hospital protocol.(p. 497)

The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock?

Cardiogenic p. 504.

Which of the following conditions reflect failure of the circulatory system? Select all that apply.

Circulatory shock Heart failure p. 486.

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 p. 488.

The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following?

Decreased cardiac outputp. 490.

Which of the following consequences of cardiogenic shock will the nurse monitor? Select all that apply.

Decreased stroke volume Decreased cardiac output Increased afterloading p. 504.

A patient exhibits signs and symptoms of heart failure, including fatigue and shortness of breath. Which of the following tests are suggested to support a diagnosis of heart failure? Select all that apply.

Electrocardiogram (EKG) Cardiac computed tomography (CCT) Echocardiography Chest x-ray p. 496.

All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?

Epinephrine (Adrenalin). p. 506.

Manifestations of heart failure are due to the decreased pumping ability of the heart. The nurse will monitor for which of the following signs and symptoms of heart failure? Select all that apply.

Fatigue Exercise intolerance Cyanosis Malnutrition p. 492.

What are the signs and symptoms of heart failure? (Select all that apply.)

Fluid retention Fatigue p. 494.

Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?

Histamine release causes massive vasodilation. p. 506.

The diagnosis is left-sided heart failure. The nurse knows that the most common causes of left-sided failure include which of the following? Select all that apply.

Hypertension Acute myocardial infarction p. 492.

Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?

Hypertrophy p. 488.

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 patient has developed which of the following types of shock?

Hypovolemic p. 501.

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?

Implantation of a ventricular assist device p. 498.

An 86-year-old male client is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?

Increased vascular stiffness, p. 499.

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 likely to most benefit the man?

Infusion of normal saline or Ringer's lactate to maintain the vascular space. p. 501.

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?

Infusion of normal saline or Ringer's lactate to maintain the vascular space. p. 504.

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 accompanies the vascular response in anaphylaxis?

Laryngeal edema p. 506.

A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?

Low blood pressure p. 506.

Increased secretion of renin in heart failure is caused by which of the following events?

Low cardiac output p. 490.

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 p. 494.

Which of the following statements regarding causes of systolic and diastolic dysfunction are correct? Select all that apply.

Myocardial hypertrophy causes diastolic dysfunction. Ischemic heart disease causes systolic dysfunction. Valvular insufficiency causes systolic dysfunction. p. 491.

The nurse should suggest which of the following medications for a patient in cardiogenic shock? Select all that apply.

Nitroprusside (Nitropress) Nitroglycerin Dobutamine (Dobutrex) Milrinone (Primacor) p. 498.

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing?

Obstructive shock p. 505.

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?

Peripheral edema weight gain p. 492.

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?

Raising the head of the bed to a high Fowler's position p. 506.

The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?

Reduced ventricular efficiency p. 486.

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:

Relaxation of the bronchioles p. 501

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 p. 507.

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 p. 496.

Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem?

Right-sided heart failure

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF 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 patient most likely is experiencing which of the following types of shock?

Septic p. 506.

An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?

Severity and duration of shock p. 508.

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. p. 490.

Emergency Medical Technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place?

The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate. p. 487.

A client with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions?

The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following?

The sympathetic (adrenergic) nervous system is an important compensatory mechanism in heart failure. Which of the following 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 increase in cardiac workload and oxygen use can cause ischemia and worsening of heart failure. p. 489

Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?

They have the same compensatory mechanisms. p. 488.

A patient 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 which of the following?

Valvular regurgitation p. 493.

An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:

Vascular stiffness p. 498

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 of the following assessment findings is inconsistent with his diagnosis?

Ventricular dilation and wall tension are significantly lower than normal. p. 491.

A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following?

Weight gain p. 492.

An elderly 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:

blocking the conversion of angiotensin I to angiotensin II. p. 497.

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.

compensatory mechanisms p. 488.

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. p. 497.

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client:

has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. p. 499.