porth patho chapt 19
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."
On a routine physical exam visit, the physician mentions that they hear a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds:
"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."
Which of the following patients is at the greatest risk of developing rheumatic heart disease?
Teenager with untreated strep throat.
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?
Β-Adrenergic-blocking drugs
A client comes to the emergency room with complaints of chest pain. When the nurse reads his ECG she sees changes which include T-wave inversion, ST-segment elevation, and an abnormal Q wave. What should she suspect?
• Acute myocardial infarction
Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?
"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."
A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client?
"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."
The nurse is teaching a patient with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which of the following statements by the patient shows that the patient understands this condition?
"I should report episodes of dizziness or fainting."
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."
A client who came to the emergency room and was diagnosed with ST-segment elevation myocardial infarction (STEMI) experienced "sudden death." The emergency room nurse explains sudden death from a STEMI as death that occurs within what time frame of symptom onset?
1 hour
ST-elevated myocardial infarction 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 decreases metabolic demands of the heart.
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
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 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 nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD?
Atherosclerosis
Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?
Emotional stress
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
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
A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics?
Echocardiogram, blood cultures, temperature
A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?
Decreased level of consciousness
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.
A client who has just recently completed his second series of radiation therapy for lung cancer was admitted yesterday to an acute care facility with ascites. He begins to have jugular vein distention, pedal edema, and dyspnea upon exertion as well as fatigue. What should the nurse suspect?
He has developed constrictive pericarditis.
A community health nurse is conducting a seminar at a local church group on health and wellness. Which of the following does she tell the group is the leading cause of death in the United States?
Heart disease
The nursing instructor, while teaching the physiology of the heart, informs the students that there are 3 major determinants of myocardial oxygen demand, which include the heart rate, left ventricular contractility, and systolic pressure. Which does she tell them 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 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?
Hypertrophic cardiomyopathy
Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)?
Increased aortic pressure
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?
Infective endocarditis
A client who has suffered a myocardial infarction is being treated in the emergency room. His pain remains severe even though he was given nitrates and oxygen. The physician now orders morphine for the pain. What method should the nurse to administer the morphine?
Intravenous
While studying the heart the nursing instructor teaches about pericarditis. Which of the following does she tell the student best defines this disease?
It is an inflammatory process.
The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states that blood is shunted from the:
Left side of the heart to the right side of the heart
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
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
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 was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing:
Pericardial effusion
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
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 preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following?
Prompt diagnosis of streptococcal infections with a throat culture
The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?
Propranolol, a β-Adrenergic blocker.
Cardiac tamponade is a serious life-threatening condition that can arise from a number of other conditions. What is a key diagnostic finding in cardiac tamponade?
Pulsus paradoxus
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
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.
The diagnosis of chronic stable angina is based on a detailed pain history, the presence of risk factors, invasive and noninvasive studies, and laboratory studies. What test is not used in the diagnosis of angina?
Serum biochemical markers
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.
A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection.
Staphylococcus aureus
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
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
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.
In infective endocarditis, vegetative lesions grow on the valves of the heart. These vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin strands of clotted blood. What are the possible systemic effects of these vegetative lesions?
They can fragment and cause cerebral emboli.
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
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 patient about diagnosing a valvular defect?
Valvular defects usually are detected through cardiac auscultation.
An IV drug abuser has been diagnosed with infective endocarditis. He is in the emergency department reporting increasing shortness of breath, rapid breathing, chest pain that worsens with breathing, and coughing up blood. The health care provider recognizes this may be caused by:
Vegetative emboli traveling in the blood stream to the lungs
The nursing student has learned in class that pericarditis is an inflammatory process of the pericardium. Which of the following is known to be the main cause of pericarditis?
Viral infections
Two weeks after receiving a prosthetic mitral valve, a patient presents to the emergency department with fever, anorexia, and splinter hemorrhages of the nails. Which of the following interventions will the nurse implement? Select all that apply.
• Blood cultures • Antibiotics • Monitoring for emboli
An elderly client is admitted with the diagnosis of severe aortic regurgitation. Which of the following client reports support this diagnosis? Select all that apply.
• Exertional dyspnea • Orthopnea • Paroxysmal nocturnal dyspnea • Palpitations
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 of the following reasons? Select all that apply.
• For its vasodilatation effect • To relieve coronary pain
Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply.
• Large amount of pink, frothy sputum and new onset of murmur. • Tachypnea with respiratory distress. • Frequent ventricular arrhythmia unrelieved with Amiodarone drip. • Complaints of facial numbness and tingling.
While studying the physiology of the heart, the nursing students have learned that which of the following influence the blood flow in the coronary vessels that supply the myocardium? Select all that apply.
• The aortic pressure • Autoregulatory mechanisms • Compression of the intramyocardial vessels
Which of the following ECG patterns would the nurse observe in a patient 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.
