PrepU Patho Ch. 20 Heart Failure and Circulatory Shock
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? a)"I'm trying to think of ways that I can cut down the amount of salt that I usually eat." b)"I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on." c)"I'm going to avoid as much physical activity as I can so that I preserve my strength." d)"I'll be sure to take my beta blocker whenever I feel short of breath."
a)"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
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? a)Anaphylactic b)Septic c)Neurogenic d)Cardiogenic
a)Anaphylactic
Regarding the various forms of heart failure, the nurse knows that which statements are correct? Select all that apply. a)Aortic stenosis can cause left-sided failure. b)The most common cause of left-sided failure is blood volume loss. c)Compensated heart failure may be clinically asymptomatic. d)Right-sided heart failure produces pulmonary congestion and edema. e)Cardiomyopathy is a common cause of heart failure.
a)Aortic stenosis can cause left-sided failure. c)Compensated heart failure may be clinically asymptomatic. e)Cardiomyopathy is a common cause of heart failure.
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: a)Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand. b)Decrease renal perfusion and result in development of ascites. c)Prolong the electrical firing from the SA node resulting in development of a heart block. d)Desensitize the α-adrenergic receptors leading to increase in norepinephrine levels.
a)Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand.
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: a)Call for emergency assistance utilizing hospital protocol. b)Have medical supply department bring up suction equipment. c)Page respiratory therapy to come give him a breathing treatment. d)Apply oxygen via nasal cannula at 3 lpm.
a)Call for emergency assistance utilizing hospital protocol.
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? a)Dyspnea, cough b)Diarrhea, nausea, vomiting c)Fatigue, headache d)Weakness, peripheral edema
a)Dyspnea, cough
Which statements regarding systolic and diastolic dysfunction are correct? Select all that apply. a)In systolic dysfunction, preload increases. b)In systolic dysfunction, the ejection fraction is decreased. c)In diastolic dysfunction, preload increases. d)Separation into systolic or diastolic dysfunction is based on ventricular ejection fraction. e)In diastolic dysfunction, the ejection fraction decreases.
a)In systolic dysfunction, preload increases. b)In systolic dysfunction, the ejection fraction is decreased. d)Separation into systolic or diastolic dysfunction is based on ventricular ejection fraction.
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? a)Increased vascular stiffness b)Orthostatic hypotension c)Increased cardiac contractility d)Loss of action potential
a)Increased vascular stiffness
Hypovolemic shock is characterized by a loss of blood volume or extracellular fluid. Administering which of the following would manage a patient with hypovolemic shock? Select all that apply. a)Packed red cells b)Vasoconstrictor drugs c)Whole blood d)Crystalloids e)Plasma volume expanders
a)Packed red cells c)Whole blood d)Crystalloids e)Plasma volume expanders
An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock? a)Severity and duration of shock b)Severity of shock and degree of immune-mediated response c)Loss of perfusion and duration of shock d)Loss of perfusion and degree of immune-mediated response
a)Severity and duration of shock
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? a)Valvular regurgitation b)Infective endocarditis c)Pericardial effusion d)Valvular stenosis
a)Valvular regurgitation
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins? a)Vasoconstriction b)Vasodilation c)Diuretic d)Natriuretic
a)Vasoconstriction
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output. a)compensatory mechanisms b)electrical conductivity c)aortic hypertrophy d)parasympathetic system
a)compensatory mechanisms
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? a)Neurogenic b)Cardiogenic c)Hypovolemic d)Septic
b)Cardiogenic
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? a)Dexamethasone (Decadron). b)Epinephrine (Adrenalin). c)Diphenhydramine (Benadryl). d)Normal saline infusion.
b)Epinephrine (Adrenalin).
Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons? a)Generalized vasoconstriction reduces venous return. b)Histamine release causes massive vasodilation. c)Metabolic rate is greatly increased. d)Heart rate and contractility are reduced.
b)Histamine release causes massive vasodilation.
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells? a)Dysplasia b)Hypertrophy c)Hyperplasia d)Atrophy
b)Hypertrophy
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? a)Gastrointestinal relaxation b)Laryngeal edema c)Bronchodilation d)Uterine smooth muscle relaxation
b)Laryngeal edema
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? a)Pupil response and counting the patient's apical heart rate b)Measurement of urine output and mental status assessment c)Activity tolerance and integumentary inspection d)Palpation of pedal (foot) pulses and pain assessment
b)Measurement of urine output and mental status assessment
A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following? a)Allergic reaction b)Myocardial infarction c)Heart failure d)Hypertension
b)Myocardial infarction
The nurse knows that the basic pathophysiology of heart failure is best described as which of the following? a)Reduced tissue perfusion b)Reduced ventricular efficiency c)Activated sympathetic (adrenergic) reflexes d)Myocardial remodeling
b)Reduced ventricular efficiency
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: a)has a distended bladder, facial edema, and nighttime difficulty breathing. b)has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. c)has cyanotic lips and extremities, low urine output, and low blood pressure. d)complains of dyspnea and has adventitious breath sounds on auscultation (listening).
b)has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.
A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause. a)Backward failure b)Frontward failure c)Systolic dysfunction d)Diastolic dysfunction
d)Diastolic dysfunction
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? a)"The left ventricle is not adequately perfusing your gastrointestinal tract, leading to diarrhea and vomiting." b)"The left ventricle is pumping excessive amounts of blood through the carotid arteries causing headache." c)"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." d)"The left ventricle is having problems pumping blood forward so blood is backing up systemically causing edema in your feet."
c)"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."
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: a)80 mL/hour b)60 mL/hour c)20 mL/hour d)40 mL/hour
c)20 mL/hour
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? a)Administer diphenhydramine (Benadryl). b)Start a normal saline infusion. c)Administer epinephrine (adrenaline). d)Complete a 12 lead ECG.
c)Administer epinephrine (adrenaline).
Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes? a)Tamponade b)Valvular insufficiency c)Cyanosis d)Fibrillation
c)Cyanosis
The nurse knows that persons with atrial fibrillation are at risk of developing which cardiac complication? a)Cardiogenic shock b)Hypovolemic shock c)Diastolic dysfunction d)Systolic dysfunction
c)Diastolic dysfunction
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? a)Resolution of compensatory pulmonary edema and heart arrhythmias. b)Administration of oxygen and epinephrine to promote perfusion. c)Infusion of normal saline or Ringer's lactate to maintain the vascular space. d)Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility.
c)Infusion of normal saline or Ringer's lactate to maintain the vascular space.
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? a)Dyspnea, cough b)Vertigo, headache c)Peripheral edema weight gain d)Weakness, palpitations
c)Peripheral edema weight gain
The nurse knows that the basic pathophysiology of heart failure is best described as which of the following? a)Reduced tissue perfusion b)Activated sympathetic (adrenergic) reflexes c)Reduced ventricular efficiency d)Myocardial remodeling
c)Reduced ventricular efficiency
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? a)Intracellular potassium and extracellular sodium levels are rising as a result of sodium-potassium pump failure. b)Hemolysis and blood pooling are taking place in the man's peripheral circulation. c)The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate. d)Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism.
c)The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate.
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? a)Decreased blood pressure b)Shortness of breath c)Weight gain d)Copious urination
c)Weight gain
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: a)promoting cardiac output through a reduction in afterload. b)selectively blocking the synthesis of renin in the kidneys. c)blocking the conversion of angiotensin I to angiotensin II. d)enhancing inotropy by maximizing calcium channel function.
c)blocking the conversion of angiotensin I to angiotensin II.
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? a)40—20 mL/hour b)80—60 mL/hour c)60—40 mL/hour d)20 mL/hour
d)20 mL/hour
The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following? a)Increased renal perfusion b)Hypertension c)Increased metabolic demand d)Decreased cardiac output
d)Decreased cardiac output
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? a)Anticoagulant, antihypertensive, calcium supplement b)Antihypertensive, diuretic, antiplatelet aggregator c)Beta-blocker, potassium supplement, anticoagulant d)Diuretic, ACE inhibitor, beta-blocker
d)Diuretic, ACE inhibitor, beta-blocker
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: a)Maintaining higher oxygen levels to decrease the work of breathing b)Placing a stent for fluid drainage from the heart c)Eliminating CHF through curing the disease d)Improving quality of life by relieving symptoms
d)Improving quality of life by relieving symptoms
Which of the following statements regarding heart failure is true? a)The most common cause of congestive heart failure is angina pectoris. b)The most common cause of left heart failure is right heart failure. c)The edema of right heart failure is associated with low plasma osmotic pressure. d)In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.
d)In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.
Increased secretion of renin in heart failure is caused by which of the following events? a)Arrhythmias b)Increased renal blood flow c)Hypertension d)Low cardiac output
d)Low cardiac output
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? a)Hypovolemic shock b)Distributive shock c)Cardiogenic shock d)Obstructive shock
d)Obstructive shock
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? a)Administration of 2L of oxygen by nasal cannula b)Inserting an IV to begin a normal saline infusion c)Placing a pulse oximeter on the client to monitor oxygenation status d)Raising the head of the bed to a high Fowler's position
d)Raising the head of the bed to a high Fowler's position
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 which physiologic response? a)Vasoconstriction of skeletal muscle b)Increasingly stronger myocardial contraction c)Increase in the heart rate of the client d)Relaxation of the bronchioles
d)Relaxation of the bronchioles
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? a)Cor pulmonale b)Cardiogenic shock c)Pericarditis d)Right-sided heart failure
d)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? a)Neurogenic b)Anaphylactic c)Cardiogenic d)Septic
d)Septic
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: a)Results are not significant assessment data. b)The client is improving. c)The more the results continue to increase, the better outcome for the client. d)The condition is getting progressively worse.
d)The condition is getting progressively worse.
Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct? a)They have the same etiology. b)They have the same remediation. c)They have the same pathogenesis. d)They have the same compensatory mechanisms.
d)They have the same compensatory mechanisms.
