Pathophys chapter 27

The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?

Genetic

The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.

Myocardial infarction prevention

In an ICU setting, one assessment that would lead the nurse to suspect that shock has led to decreased blood flow to vital organs is:

urine output less than 20 mL/hour.

A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:

"Aspirin will help prevent blood clotting."

A client asks the purpose of an exercise stress test. What is the nurse's best response?

"The test is used to measure functional status during stress."

A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

What should the nurse teach the client prior to ergometry?

"This test evaluates cardiac function."

A client is diagnosed with heart failure. Which types of medications are usually prescribed to manage this disorder? Select all that apply.

- Diuretics - Digitalis - Beta-adrenergic blockers(beta-blockers) - Angiotensin-converting enzyme (ACE) inhibitors

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.

- Fatigue - Exercise intolerance - Cyanosis - Malnutrition

Which form of cardiomyopathy would be considered genetically based? Select all that apply.

- Hypertrophic cardiomyopathy - Left ventricular noncompaction

A client is brought to the emergency department with symptoms of acute coronary syndrome (ACS). Select the most important interventions that should be implemented. Select all that apply.

- Oxygen - Morphine - Nitrates - ECG monitoring - β-adrenergic blocking agents

Proper perfusion of vital organs requires which physiologic conditions to be present? Select all that apply.

-Sufficient blood volume to fill the vascular compartment -Efficient cardiac pumping ability -Intact vascular system -Ability of organs to extract oxygen and nutrients from blood

The sympathetic (adrenergic) nervous system is an important compensatory mechanism in heart failure. Which 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.

A client has developed disseminated intravascular coagulation (DIC). The nurse knows that which statements regarding DIC are true? Select all that apply.

-Thrombotic occlusion occurs in small and midsized blood vessels. -Bleeding may accompany coagulation. -Generation of thrombin increases. -Endogenous anticoagulation mechanisms are suppressed.

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

Which client should most benefit from treatment with anti-thrombin agents?

57-year-old client who has recently been diagnosed with unstable angina

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hypercyanotic attack brought on by periods of stress

What should the nurse teach the pregnant woman about congenital heart defects?

Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant.

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).

It is known that over 100 distinct myocardial diseases can demonstrate clinical features associated with dilated cardiomyopathy (DCM). What is the most common identifiable cause of DCM in the United States?

Alcoholic cardiomyopathy

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

Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?

Atherosclerosis and unstable angina

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?

Backflow from the left ventricle to left atrium

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

A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment, the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?

Cardiac tamponade

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?

Cardiomyopathy

The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?

Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation

For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve?

Compensatory mechanisms

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

Cyanosis

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

Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant?

During feeding

What is the most important factor in myocardial oxygen demand?

Heart rate

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

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?

Hypertrophic cardiomyopathy

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)

Which statement regarding heart failure is true?

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

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

Which intervention will the nurse anticipate being prescribed to treat an adult admitted to the ICU with acute respiratory distress syndrome (ARDS)?

Increasing oxygen concentration in the inspired air

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.

A newborn is diagnosed with Tetralogy of Fallot. Prior to surgery, which abnormality should be corrected to prevent a stroke?

Iron deficiency anemia

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?

Laryngeal edema

Which description sums up the basic pathophysiology of heart failure that the nurse would include when educating a client?

Low cardiac output due to reduced pumping ability

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

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?

Obstructive shock

A nurse is assessing a client diagnosed with severe mitral valve stenosis. The nurse anticipates which classic assessment finding?

Orthopnea

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?

Pericardial effusion

Exudate in the pericardial cavity is a characteristic of which cardiac condition?

Pericardial effusion

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

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?

Peripheral edema, weight gain

The pathogenesis of multi-organ dysfunction syndrome (MODS) is not clearly understood at this time. Supportive management is currently the focus of treatment in this disorder. What is not a major risk factor in MODS?

Respiratory dysfunction

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

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

Septic shock

What is the primary cause of heart failure in infants and children?

Structural heart defects

Select the client who may be at risk for developing an increased resistance to blood flow.

The client in hypovolemic shock experiencing extreme dehydration

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.

A neonate is born with a congenital heart defect. The nurse realizes this defect most likely originated during which week of development?

The third week of development

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

They have the same compensatory mechanisms.

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

A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this client about diagnosing a valvular defect?

Valvular defects usually are detected through cardiac auscultation.

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

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

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?

Vasodilating effects reducing preload and afterload

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

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?

beta-adrenergic blocking drugs (beta-blockers)

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

compensatory mechanisms

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

fills rapidly; compresses

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:

hypovolemic shock due to acute intravascular volume loss.

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.

A preventive measure to decrease the risk of developing rheumatic heart disease includes:

prompt diagnosis of streptococcal infections with a throat culture.

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:

recording weight every day at the same time with same type of clothing.

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

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:

see the doctor for evaluation immediately.