CHAPTER 27 MASTER

In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the client's health problems?

A. A 61-year-old man whose ECG was characterized by widespread T-wave inversions on admission but whose T waves have recently normalized.

B. A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation.

C. A 56-year-old obese man who is reporting chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge.

D. A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels.

Ans: B

S3 and S4 irregularities and irregular heart rate are not noted symptoms of pericarditis. Widespread T-wave inversions that later normalize; chest pain radiating to the neck and scapula that is worse on inspiration; and high white cells, erythrocyte sedimentation rate, and C-reactive protein levels are all indicators of pericarditis.

Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply

1. Muffled heart tones

2. Narrowed pulse pressure

3. Low BP—84/60

4. Heart rate 78

5. Bounding femoral pulse

1,2,3

Feedback: Cardiac tamponade results in increased intracardiac pressure, progressive limitation of ventricular diastolic filling, and decreased stroke volume and cardiac output. This accumulation of fluid results in tachycardia, elevated CVP, jugular vein distention, fall in systolic BP, narrowed pulse pressure, and signs of shock. Heart sounds may be muffled. A pulse rate of 78 is normal (not tachycardic). With pulsus paradoxus, the arterial pulse as palpated at the carotid or femoral artery becomes weakened (not bulging) or absent with inspiration.

Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)?

1. Inadequate ventricular end-diastolic pressure

2. Use of calcium channel blocker medications

3. Increased aortic pressure

4. Ventricular atrophy

3

Feedback: An increase in aortic pressure results in a rise in afterload, wall tension, and, ultimately, MVO2. Increased, not inadequate, ventricular end-diastolic pressure would cause an increase in MVO2, and medications such as calcium channel blockers would decrease MVO2. Hypertrophy of ventricles would occur in response to prolonged wall stress and consequent oxygen demand.

As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?

1. Echocardiogram, PET scan, ECG

2. Ambulatory ECG, cardiac MRI, echocardiogram

3. Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy

4. Cardiac catheterization, cardiac CT, exercise stress testing

1

Feedback: An echocardiogram would provide an image of the client's heart, while a PET scan reveals metabolic activity and an ECG the electrical activity. Answer B would lack data on the client's myocardial metabolism; answer C would lack electrical and physical measurement information; answer D would lack electrical measurement of his heart.

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?

1. “People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times.”

2. “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.”

3. “Infections of any sort are often a signal that plaque disruption is in danger of occurring.”

4. “The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption.”

2

Feedback: Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge and result in thrombus formation. Plaque disruption is noted to correlate with sympathetic events and is not seemingly random; infections and respiratory problems are not noted to be associated with obstruction of blood flow, however.

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 client MOST likely experienced myocardial infarction?

A. A 33-year-old man whose pain started at 7 am during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable.

B. A 67-year-old female whose pain started at 2am while she was asleep and which responded to nitrates; the ECG showed dysrhythmias and ST-segment elevation; cardiac markers remained stable.

C. An 80-year-old woman whose pain started at 6am shortly after awakening and was not relieved by nitrated or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose.

D. A 61-year-old man whose pain started at 9am during a short walk and responded to nitrated, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened.

Ans: C

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 clients have angina of varying severity.

Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome?

1. Increased serum creatinine and troponin I as a result of enzyme release from damaged cells

2. Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium, and disruption of the sodium–potassium pump

3. Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation

4. Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response

3

Feedback: Myocardial necrosis releases creatine kinase and troponins that normally exist intracellularly. Serum creatinine and potassium are not core markers of heart damage, and myoglobin and creatine kinase levels rise, not fall, with cardiac events.

A number of clients have presented to the emergency department in the last 32 hours with reports that are preliminarily indicative of myocardial infarction. Which client is LEAST likely to have an ST-segment myocardial infarction (STEMI)?

A. A 70-year-old woman who is reporting shortness of breath and vague chest discomfort.

B. A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin.

C. A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw.

D. A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest.

Ans: D

STEMI pain is not normally relieved by rest, nor would fever be a common symptom. Shortness of breath, vague chest discomfort, fatigue, GI symptoms and radiating substernal pain are all associated with STEMI.

Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply.

1. Large amount of pink, frothy sputum and new onset of murmur

2. Tachypnea with respiratory distress

3. Frequent ventricular arrhythmia unrelieved with amiodarone drip

4. Complaints of facial numbness and tingling

5. Enhanced renal perfusion as seen as an increase in urine output

1,2,3,4

Feedback: Following MI, many complications can occur: Answer choice A relates to pulmonary edema or papillary muscle rupture; answer choice B refers that acute respiratory distress could result from heart failure; answer choice C relates to life-threatening arrhythmias; answer choice D relates to acute stroke.

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?

1. “I'll be able to help track the course of your angina through regular blood work that we will schedule at a lab in the community.”

2. “With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this.”

3. “I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising.”

4. “There are things you can do to reduce the chance that you will need a heart bypass, including limiting physical activity as much as possible.”

3

Feedback: Aspirin, exercise, and weight loss are all identified treatments for angina. Angina does not normally necessitate blood work, heparin administration, or avoidance of activity

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?

1. Lisinopril, an ACE inhibitor

2. Lasix, a diuretic

3. Propranolol, a B-adrenergic blocker

4. Lanoxin, an inotropic

3

Feedback: B-Adrenergic blockers are generally the initial choice for persons with symptomatic HCM. Calcium channel blockers can also be used. ACE inhibitors, diuretics, or positive inotropics are not the first-line medications.

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.

1. Atrial flutter

2. Ventricular tachycardia with left bundle branch block pattern

3. T-wave inversion in the right precordial leads

4. Sinus arrhythmia with a first-degree AV block

5. Development of a “U” wave following a normal T wave

2,3

Feedback: 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 a first-degree AV block are not characteristic of this form of cardiomyopathy.

A 31-year-old African American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy?

1. Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.

2. Treatment is possible in postpartum women, but antepartum women are dependent on spontaneous resolution of the problem.

3. Mortality exceeds 50%, and very few surviving women regain normal heart function.

4. Symptomatology mimics that of stable angina and is diagnosed and treated similarly.

1

Feedback: Immune responses, diet, and infections are all potential etiologies of peripartum cardiomyopathy. Treatment is complicated, but not impossible, in antepartum women due to possible teratogenic drug effects. About half of women suffer long-term effects on cardiac function, while signs and symptoms are similar to those of early heart failure.

An IV drug abuser walks into the ED telling the nurse, "I am sick." The client looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on the client's mitral valve. The client is admitted to the ICU. The nurse will be assessing this client for which possible life-threatening complication?

A. Systemic emboli, especially to brain.

B. Petechial hemorrhages under the skin and nail beds.

C. GI upset from the massive amount of antibiotics required to kill the bacteria.

D. Pancreas enlargement due to increased need for insulin secretion.

Ans: A

Systemic emboli develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc. Petechial hemorrhages are signs/symptoms of infective endocarditis (IE). GI upset is common following antibiotic therapy but is not usually life-threatening. Stress can increase insulin needs but is not associated with pancreas enlargement.

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?

1. CT of the heart, chest x-ray, and ECG

2. Echocardiogram, blood cultures, and temperature

3. ECG, blood pressure, and stress test

4. Cardiac catheterization, chest x-ray, electrolyte measurement, and white cell count

2

Feedback: An echocardiogram would help visualize the heart, while blood cultures would confirm the presence or absence of microorganisms in circulation, and temperature would gauge the presence of infection. A chest x-ray, blood pressure measurement, and cardiac catheterization would be less likely to indicate infective endocarditis.

A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His glands are swollen, and he moves stiffly because his joints hurt. His parents, who believe in “natural remedies,” have been treating him with various herbal preparations without success and are now seeking antibiotic treatment. Throat cultures show infection with group A streptococci. This child is at high risk for

1. myocarditis.

2. mitral valve stenosis.

3. infective endocarditis.

4. vasculitis

2

Feedback: Group A streptococcal infection can be adequately treated with antibiotics, but this infection may have been present long enough to trigger an immune response—rheumatic fever—that will damage his heart valves, ultimately causing mitral valve stenosis. Group A streptococcal infection is not known to predispose to myocarditis, endocarditis, or vasculitis and aneurysm of coronary arteries.

On a routine physical exam visit, the physician mentions that he hears a new murmur. The client gets worried and asks, "What does this mean?" The physician responds:

A. "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit."

B. "This could be caused by an infection. Have you been feeling well the past few weeks?"

C. "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."

D. "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or lightheaded."

Ans: C

Stenosis refers to a narrowing of the of the valve orifice and failure of the valve leaflets to open normally. Blood flow through a normal valve can increase by 5-7 times the resting volume. Valvular disease is not caused by stress. The murmur can be caused by infection but also stenosis or regurgitation of a valve leaflet. The valve problem is very severe if it is causing signs of decrease cardiac output.

A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which teaching point would be MOST accurate to convey to the client?

A. "The normal tissue that makes up the valve between the right sides of your heart has stiffened."

B. "Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."

C. "Your heart's mitral valve isn't closing properly so blood is flowing backwards in your heart and eventually into your lungs."

D. "The valve between your left ventricle and left atria is infected and isn't allowing enough blood through."

Ans: B

Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole with left atrial distention and impaired filling of the left ventricle. It does not exist in the right side of the heart and the problem is associated primarily with improper ventricular filling and with pulmonary backflow only secondarily. Though it is often caused by infection, it is not an infectious process of the valve per se.

A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client has aortic stenosis? Select all that apply.

1. Decrease in exercise tolerance

2. Exertional dyspnea

3. Palpitations

4. Syncope

5. Heartburn

1,2,4

Feedback: Because of the slow onset of aortic valve stenosis, the heart is able to compensate by hypertrophying and may still maintain a normal chamber volume and ejection fraction. As the stenosis progresses, the patient will experience classic symptoms of angina, syncope, heart failure, and decrease in exercise tolerance or exertional dyspnea. Palpitations and heartburn are not usually noted with aortic stenosis.

Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention?

1. Pressure in pulmonary circulation and the right side of the infant's heart fall markedly.

2. Alveolar oxygen tension increases causing reversal of pulmonary vasoconstriction of the fetal arteries.

3. Systemic vascular resistance and left ventricular pressure are both increasing.

4. Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.

4

Feedback: One of the hallmarks of the transition from placental circulation is a rapid and then steady decrease in pulmonary vascular resistance. Answers A, B, and C relate normal physiological processes.

A pediatric nurse is assessing a newborn diagnosed with persistent patency of the ductus arteriosus. Which of the following findings are associated with this heart defect? Select all that apply.

1. Murmur heard at the second intercostal space, during both systole and diastole

2. BP 84/30 classified as a wide pulse pressure

3. Shortness of breath with activity such as kicking

4. Stridor with inspiratory wheezes

5. Bulging jugular neck veins

1,2

Feedback: Persistent patency of the ductus arteriosus is defined as a duct that remains open for greater than 3 months. A murmur is detected within days of birth. It is loudest at the second left intercostal space and is continuous through systole and diastole. A wide pulse pressure is common (BP 84/30). Most newborns have an elevated respiratory rate with exertional activity. Stridor is usually associated with bronchial infections or narrowing of the airways. Bulging jugular neck veins are associated with right-sided heart failure.

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which pathophysiologic result should the nurse anticipate?

A. There is a break in the normal wall between the right and left atria that results in compromised oxygenation.

B. The aortic valve is stenotic, resulting in increased afterload.

C. Blood outfflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

D. The right ventricle is atrophic as a consequence of impaired myocardial blood supply.

Ans: C

Tetralogy of Fallot is marked by obstruction or narrowing of the pulmonary outflow channel, including pulmonic valve stenosis, a decrease in the size of the pulmonary trunk, or both. The characteristic septal defect is ventricular not atrial. Aortic valve stenosis and right ventricular atrophy are not associated with the diagnosis.

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?

1. His resting blood pressure is normally in the range of 150/90, and an echocardiogram indicates his ejection fraction is 30%.

2. His end-diastolic volume is higher than normal, and his resting heart rate is regular and 82 beats/minute.

3. He is presently volume overloaded following several days of intravenous fluid replacement.

4. Ventricular dilation and wall tension are significantly lower than normal.

4

Feedback: Systolic dysfunction is associated with increased ventricular dilation and wall tension. Hypertension, low ejection fraction, high preload, and volume overload are all commonly associated with systolic dysfunction.

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

A. has a distended bladder, facial edema, and difficulty breathing during nighttime hours.

B. complains of dyspnea and has adventitious breath sounds on auscultation.

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

D. has cyanotic lips and extremities, low urine output, and low blood pressure.

Ans: C

Right-sided failure is associated with peripheral edema, fatigues, and, on occasion, upper right quadrant pain. Abdominal distention can occur with right-side failure when the liver becomes engorged. Facial edema, pulmonary edema, peripheral cyanosis, low urine output and low blood pressure are less associated with right-sided failure. Left-sided failure is primarily associated with pulmonary signs/symptoms like dyspnea, pulmonary edema, frothy pink sputum, and respiratory congestion.

An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure?

1. An increase in preload via the Frank-Starling mechanism

2. Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

3. Activation of the renin–angiotensin–aldosterone system and secretion of brain natriuretic peptide (BNP)

4. AV node pacemaking activity and vagal nerve suppression

4

Feedback: Reassignment of cardiac pacemaking activities and suppression of the vagal nerve are not noted compensatory actions related to heart failure. Increased preload and sympathetic stimulation, increased levels of epinephrine and norepinephrine, and activation of the renin–angiotensin–aldosterone system and secretion of brain natriuretic peptide (BNP) are all noted compensatory mechanisms.

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?

1. Chest pain and intermittent ventricular tachycardia

2. Dyspnea and crackles in bilateral lung bases

3. Petechia and spontaneous bleeding

4. Muscle cramping and cyanosis in the feet

2

Feedback: Although it may preserve the resting cardiac output, the resulting chronic elevation of left ventricular end-diastolic pressure is transmitted to the atria and the pulmonary circulation, causing pulmonary congestion.

A 77-year-old client with a history of coronary artery disease and heart failure has arrived in the emergency room with rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:

A. Decrease renal perfusion and result in development of ascites.

B. be a result of catecholamines released from SNS, which could increased the myocardial oxygen demand.

C. desensitize the alpha-adrenergic receptors leading to increase in norepinephrine levels.

D. prolong the electrical firing from the SA node resulting in development of a heart block.

Ans: B

An increase in sympathetic activity by stimulation of the beta-adrenergic receptors of the heart leads to tachycardia, vasoconstriction, and dysrhythmias. Acutely, tachycardia significantly increased the workload of the heart, this increasing myocardial O2 demand and leading to cardiac ischemia, myocyte damage, and decreased contractility. Decrease renal perfusion would activate the RAAS system, increasing heart rate and BP further. Ventricular dysrhythmias are primarily seen at this stage of HF.

A nurse educator in 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?

1. Measurement of urine output and mental status assessment

2. Pupil response and counting the patient's apical heart rate

3. Palpation of pedal (foot) pulses and pain assessment

4. Activity tolerance and integumentary inspection

1

Feedback: Both increased and decreased urine output can be markers of heart failure, as can changes in mental status not attributable to other factors. While heart auscultation, pedal pulses, and activity tolerance are relevant parameters, integumentary inspection, pupil response, and pain assessment are less likely to be relevant assessment components.

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 of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to

1. have medical supply department bring up suction equipment.

2. apply oxygen via nasal cannula at 3 lpm.

3. page the respiratory therapist to come give him a breathing treatment.

4. call for emergency assistance utilizing hospital protocol.

4

Feedback: Mr. V. is experiencing acute pulmonary edema. This is a life-threatening condition. The person is seen sitting and gasping for air. The pulse is rapid, the skin is moist, and the lips/nail beds are cyanotic. Dyspnea and air hunger are accompanied by productive cough with frothy and often blood-tinged sputum (pink). The patient needs the emergency responder team (including ICU nurses, physicians, respiratory therapist, etc.) to intervene. Applying O2 by mask will not increase his oxygen level fast enough, and he is probably mouth breathing (gasping for air). Suction equipment may be needed, but getting a physician to give orders for diuretics and inotropic medications is the priority. Of course respiratory therapist will arrive with the emergency assistance team.

A female older adult client has presented with a new onset of shortness of breath, and the client's physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the MOST accurate rationale for the physician's choice of bloodwork?

A. BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the client's dyspnea from a respiratory pathology.

B. BNP is an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure.

C. BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

D. BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Ans: A

BNP is released to compensate for heart failure and elevated levels help confirm the diagnosis of heart failure as opposed to respiratory etiologies. It does not measure the effectiveness of the RAA system, the risk of cognitive deficits, or the specific severity of pulmonary symptoms of heart failure.

A nurse is administering morning mediations to a number of clients on a medical unit. Which medication regimen is MOST suggestive that the client has a diagnosis of heart failure?

A. Antihypertensive, diuretic, anti-platelet aggregator.

B. Diuretic, ACE inhibitor, beta-blocker.

C. Anticoagulant, antihypertensive, calcium supplement.

D. Beta-blocker, potassium supplement, anticoagulant.

Ans: B

Diuretics, ACE inhibitors, and beta-blockers are all commonly used in the treatment of heart failure. Anti-platelet aggregator, calcium and potassium supplements, and anticoagulants are less likely to relate directly to a diagnosis of heart failure.

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which phenomenon is MOST likely taking place?

A. The man's alpha- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate.

B. Hemolysis and blood pooling are taking place in the man's peripheral circulation.

C. Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism.

D. Intracellular potassium and extracellular sodium levels are rising as a result of sodium-potassium pump failure.

Ans: A

Alpha- and beta-adrenergic receptor activation is a central response to all types of show. Hemolysis is not a noted accompaniment to shock. Bronchodilation, not bronchoconstriciton, often results from adrenergic stimulation. Sodium-potassium pump failure results in increased extracellular potassium and intracellular sodium.

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be in the early stages of cardiogenic shock? Select all that apply.

1. Decreasing mean arterial pressure (MAP)

2. Low BP reading of 86/60

3. Urine output of 15 mL last hour

4. Low pulmonary capillary wedge pressure (PCWP)

5. Periods of confusion

1,2,3,5

Feedback: Signs and symptoms of cardiogenic shock include indications of hypoperfusion with hypotension (BP 96/60), decrease in mean arterial pressure (MAP) due to poor stroke volume, and a narrow pulse pressure. Urine output decreases because of lower renal perfusion pressures. PCWP is usually elevated due to increased preload. Periods of confusion or altered cognition/consciousness may occur because of low cardiac output.

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 MOST likely to benefit the man?

A. Resolution of compensatory pulmonary edema and heart dysrhythmias.

B. Infusion of vasodilators of foster perfusion and inotropes to improve heart contractility.

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

D. Administration of oxygen and epinephrine to promote perfusion.

Ans: C

Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock, and be achieved in the short term through intravenous administration of saline solution of Ringer's lactate. Resolution of pulmonary edema and heart dysrhythmias and infusion of vasodilators are associated with treatment of cardiogenic shock, while oxygen and epinephrine would address anaphylactic shock.

A 30-year-old woman presents at a hospital after fainting at a memorial service and she is diagnosed as being in neurogenic shock. Which signs/symptoms is she MOST likely to display?

A. Faster than normal heart rate

B. Pain

C. Dry and warm skin

D. Increased thirst

Ans: C

In contrast to hypovolemic shock, in which the heart rate is faster than normal and the skin is cold and clammy, a person in neurogenic shock is likely to have a slower than normal heart rate and dry, warm skin. Fainting due to emotional causes is a transient form of neurogenic shock, while increased thirst is an early sign of hypovolemic shock.

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?

1. Epinephrine (Adrenalin)

2. Normal saline infusion

3. Dexamethasone (Decadron)

4. Diphenhydramine (Benadryl)

1

Feedback: Treatment includes immediate discontinuation of the inciting agent; close monitoring of CV and respiratory function; and maintenance of respiratory gas exchange, cardiac output, and tissue perfusion. Epinephrine is given in an anaphylactic reaction because it constricts blood vessels and relaxes the smooth muscle in the bronchioles.

A patient in the intensive care unit has a blood pressure of 87/39 mmHg and has warm, flushed skin accompanying his sudden decline in level of consciousness. The client also has arterial and venous dilation and a decrease in systemic vascular resistance. What is the client's MOST likely diagnosis?

A. hypovolemic shock

B. septic shock

C. neurogenic shock

D. obstructive shock

Ans: B

Low blood pressure accompanied by warm, flushed skin and cognitive changes is indicative of septic shock, as is vessel dilation and decreased vascular resistance.

A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows that which of the following complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply.

1. Profound dyspnea due to acute respiratory distress syndrome

2. Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces

3. Formation of plaque within vessels supplying blood to the heart causing muscle damage and chest pain

4. Acute renal failure due to decreased/impaired renal perfusion as a result of low BP

5. Flushed skin and pounding headache that coincides with each heart beat

1,2,4

Feedback: ARDS, atelectasis, and acute renal failure are all noted consequences of shock that might be, respectively, treated by dialysis, an ostomy, or platelet transfusion. Plaque formation to heart vessels is not directly related to any of the identified consequences of shock. Pounding headache that coincides with each heart beat may occur with migraine headaches.

A 3-year-old child with right-sided heart failure has been admitted for worsening of the condition. Which assessment would be considered one of the earliest signs of systemic venous congestion in this toddler?

A. breathlessness with activity

B. excessive crying

C. enlargement of liver

D. increased urine output

Ans: C

With RV function impaired, systemic venous congestion develops. Hepatomegaly due to liver congestion often is one of the first signs of systemic venous congestion in infants and children.

A pediatrician is teaching a group of medical student about some of the particularities of heart failure in children as compared with older adults. Which statement by the physician BEST captures an aspect of these difference?

A. "You'll find that, in pediatric clients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."

B. "Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young clients."

C. "Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate."

D. "Fever is a sign of heart failure in children that you are unlikely to see in older adults."

Ans: A

The pulmonary edema that accompanies heart failure is more often interstitial rather than alveolar in children. Jugular venous distention is difficult to gauge in children. Low blood pressure and fever are not noted signs of heart failure in children.

Which of the following changes associated with aging contributes to heart failure development in older adults? Select all that apply

1. Increased incidence of mitral stenosis

2. Sludge buildup in the kidneys

3. Elevated diastolic BP

4. Increased vascular stiffness

5. Inflammation in the joints due to arthritis

3,4

Feedback: Changes with aging contribute to the development of HF in older adults. First is reduced responsiveness to -adrenergic stimulation. Second is increased vascular stiffness that contributes to ventricular hypertrophy. Third, the heart itself becomes less compliant with age. Fourth relates to altered myocardial metabolism at the level of the mitochondria. Older adults usually develop aortic stenosis and mitral regurgitation. Kidney stones do not contribute to HF. Increase in diastolic pressure compromises LV filling leading to increases in pressures predisposing to HF. Arthritis is not associated with heart failure.

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?

1. “Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure.”

2. “Heart failure will often first show up with persistent coughing and lung crackles.”

3. “Residents in early heart failure will often be flushed and have warm skin and a fever.”

4. “Complaints of chest pain are actually more often related to heart failure than to myocardial infarction.”

1

Feedback: Cognitive changes can often accompany heart failure in the elderly. Pulmonary edema is a later sign, and they are less likely to display coughing, chest pain of flushed skin, and fever

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?

1. pericarditis

2. cor pulmonale

3. cardiogenic shock

4. right-sided heart failure

4

What are the physiologic clinical manifestations of cardiogenic shock? Select all that apply.

1. Rise in central venous pressure (CVP)

2. Increased extraction of O₂ from hemoglobin

3. Decrease in mean arterial blood pressures

4. Hypercapnic lips and nail beds

5. Increased urine output related to increased renal perfusion

1,2,3

A family member comes rushing out of a client’s room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply.

1. Hives over entire body

2. Wheezing sound on inspiration

3. Severe bronchospasm

4. Incontinent of urine

5. Swelling around the lips and eyes

1,2,3,5

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

1. not worry about it as this is common for someone who has already had a myocardial infarction.

2. take a second nitroglycerine.

3. see the health care provider for evaluation immediately.

4. give it 5-10 minutes more to see if there is relief.

3

A client has just been told that they have an infection of the inner surface of the heart. They are also told that the bacteria has invaded their heart valves. What term is used for this disease process?

1. Myocardial infarction

2. Pericarditis

3. Infective endocarditis

4. Cardiomyopathy

3

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on their left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which assessment findings would confirm the client may be in the early stages of cardiogenic shock? Select all that apply.

1. Decreasing mean arterial pressure (MAP)

2. Urine output 15 mL last hour

3. Low pulmonary capillary wedge pressure (PCWP)

4. Low BP reading of 86/60

5. Periods of confusion

1,2,4,5

Electrical burns over a large surface area of a client's body have resulted in hypovolemic shock. Following physical assessment, which findings lead the nurse to believe the client's body is compensating for this fluid loss? Select all that apply.

1. Vasodilation with warm extremities

2. Deep, rapid respirations

3. Increased heart rate

4. Diuresis with output of 100 mL/hour

5. The client reporting extreme thirst

2,3,5

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

1. They have the same etiology.

2. They have the same compensatory mechanisms.

3. They have the same remediation.

4. They have the same pathogenesis.

2

Neurogenic shock, or spinal shock, is a phenomenon caused by the inability of the vasomotor center in the brain stem to control blood vessel tone through the sympathetic outflow to the blood vessels. In neurogenic shock, what happens to the heart rate and the skin?

1. Heart rate slower than normal; skin cool and moist

2. Heart rate faster than normal; skin warm and dry

3. Heart rate faster than normal; skin cool and moist

4. Heart rate slower than normal; skin warm and dry

4

Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

1. pleural effusion

2. mediastinal radiation

3. acute pericarditis

4. constrictive pericarditis

4

A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. The client describes the pain as severe and feels as if they are suffocating. They have taken nitroglycerin and not experienced any relief. The client is most likely experiencing:

1. Acute respiratory distress syndrome (ARDS)

2. Gastroesophageal reflux disease (GERD)

3. Onset of STEMI

4. Pneumonia

3

The nurse working in cardiac rehab stresses the importance of which interventions to their clients who have suffered a myocardial infarction to improve their overall health? Select all that apply.

1. Psychosocial management

2. Education related to medications

3. Proper nutrition

4. Smoking cessation

5. Adequate exercise

6. Religious preferences

1,2,3,4,5

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.

1. Fatigue

2. Hyperglycemia

3. Malnutrition

4. Cyanosis

5. Exercise intolerance

1,3,4,5

An older adult client has been diagnosed with chronic heart failure. They are prescribed an ACE inhibitor to treat the symptoms and improve their quality of life. This drug will alleviate the client's symptoms of heart failure by:

1. promoting cardiac output through a reduction in afterload.

2. selectively blocking the synthesis of renin in the kidneys.

3. blocking the conversion of angiotensin I to angiotensin II.

4. enhancing inotropy by maximizing calcium channel function.

3

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:

1. Results are not significant assessment data.

2. The more the results continue to increase, the better outcome for the client.

3. The condition is getting progressively worse.

4. The client is improving.

3

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

1. Intact vascular system

2. Efficient renal function

3. Efficient cardiac pumping ability

4. Sufficient blood volume to fill the vascular compartment

5. Ability of organs to extract oxygen and nutrients from blood

1,3,4,5

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

1. measuring their urine output daily to check for a decrease in output.

2. taking blood pressure daily and calling the health care provider if it is decreased.

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

4. listening to the breath sound with a stethoscope every morning.

3

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

1. 60—40 mL/hour

2. 80—60 mL/hour

3. 40—20 mL/hour

4. 20 mL/hour

4

Which assessment finding would be considered a clinical manifestation of acute pericarditis? Select all that apply.

1. Muffled heart sounds

2. Pericardial friction rub

3. Abnormal ECG results

4. Sharp, abrupt onset of chest pain that radiates to the neck

5. Narrowed pulse pressure

2,3,4

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?

1. placing a pulse oximeter on the client to monitor oxygenation status

2. inserting an IV to begin a normal saline infusion

3. administering 2 liters of oxygen by nasal cannula

4. raising the head of the bed to a high Fowler position

4

A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that they have 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering?

1. Pericarditis

2. Myocardial infarction

3. Pericardial effusion

4. COPD

3

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

1. Natriuretic

2. Vasodilation

3. Diuretic

4. Vasoconstriction

4

Which intervention would the nurse know is not a primary treatment for the client in hypovolemic shock?

1. Administration of intravenous fluids

2. Infusion of blood and blood products

3. Surgery to repair the site of bleeding

4. Administration of vasoconstrictive drugs

4

A client is told that they have 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:

1. Valvular stenosis

2. Pericardial effusion

3. Valvular regurgitation

4. Infective endocarditis

3

The nurse is preparing to auscultate for a mitral valve stenosis murmur. Where is the best location to place the stethoscope?

1. Over the sternum

2. Over the aorta

3. At the apex of the heart

4. At the carotid arteries

3

Which factor(s) will ultimately affect stroke volume? Select all that apply.

1. myocardial contractility

2. ventricular automaticity

3. preload

4. heart rate

5. afterload

1,3,5

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 spouse that this medication is given for which reason? Select all that apply.

1. To relieve anxiety

2. To relieve coronary pain

3. For diuretic purposes

4. For its vasodilation effect

2,4

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?

1. Backflow from the left ventricle to left atrium

2. Backup of blood from the right atrium into the superior vena cava

3. Backflow from the right ventricle to the right atrium during systole

4. Inhibition of the SA node's normal action potential

1

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 health care provider will order?

1. Potassium

2. Phosphorous

3. Creatine kinase

4. Troponin assays

4

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?

1. Have the client breathe deeply.

2. Have the client change positions to unaffected side.

3. Have the client swallow slowly and frequently.

4. Have the client sit up and lean forward.

4

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. The client's pulse was high, their blood pressure was low, and their skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock?

1. Cardiogenic

2. Septic

3. Neurogenic

4. Anaphylactic

2

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

1. Septic

2. Cardiogenic

3. Anaphylactic

4. Neurogenic

3

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

1. Congenital heart defects occur during conception.

2. Congenital heart defects cannot be prevented.

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

4. Congenial heart defects occur prior to conception as a result of exposure to toxins.

3

A client has just returned from their surgical procedure. During initial vital sign measurements, the nurse notes that the client’s heart rate is 111 beats/minute and the blood pressure is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

1. kidney injury due to an overdose of medication.

2. side effects from the administration of midazolam, causing excessive vasoconstriction.

3. pulmonary embolism due to development of deep vein thrombosis.

4. hypovolemic shock due to acute intravascular volume loss.

4

A client who has just been diagnosed with atrial stenosis asks their nurse what can cause a problem with heart valves. Which causes of dysfunction of the heart valves should the nurse relay to this client? Select all that apply.

1. Inflammation

2. Degenerative changes

3. Rheumatic heart disease

4. Trauma

5. Ischemic heart disease

6. Congenital defects

1,2,3,4,5,6

What is the most important factor in myocardial oxygen demand?

1. Hyperthermia

2. Respiratory rate

3. Degree of anxiety

4. Heart rate

4

A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?

1. When the electrocardiogram (ECG) shows sinus tachycardia

2. When the client states feeling soreness in the muscles

3. When the heart rate reaches 135 beats/min

4. When the client experiences chest pain

4

A client is seen in the emergency room reporting sharp chest pain that started abruptly. The client says it has radiated to their neck and abdomen. They also state that it is worse when they take a deep breath or swallows. They tell the nurse that when they sit up and lean 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?

1. Pericarditis

2. Abdominal aortic aneurysm

3. Pneumonia

4. Myocardial infarction

1

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

1. Client who was thought to have had an MI but who was later diagnosed with pericarditis

2. 29-year-old client who developed endocarditis by injecting with a dirty needle

3. Young client diagnosed with hypertrophic cardiomyopathy (HCM)

4. 57-year-old client who has recently been diagnosed with unstable angina

4

Hypovolemic shock is characterized by a loss of blood volume or extracellular fluid. Administering which of the following would manage a client with hypovolemic shock? Select all that apply.

1. Whole blood

2. Crystalloids

3. Plasma volume expanders

4. Vasoconstrictor drugs

5. Packed red blood cells

1,2,3,5

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

1. Mixed

2. Acquired

3. Genetic

4. Does not usually occur in young athletes

3

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?

1. A stressful period right after birth that occurs without evidence of cyanosis

2. A hypercyanotic attack brought on by periods of stress

3. A hyperpneic attack in which the infant loses consciousness

4. A hyperoxygenated period when the infant is at rest

2

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 their prognosis. Which intervention is most likely to meet this client's needs?

1. Regular administration of inotropic drugs

2. Implantation of a ventricular assist device (VAD)

3. An implantable defibrillator

4. Cardioversion

2

A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain they experience while mowing their lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?

1. Increased preload

2. Vasodilating effects reducing preload and afterload

3. Decreased heart rate and increased stroke volume

4. Reduction of cardiac refractory periods

2

A child is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are most accurate? Select all that apply.

1. Inotropic agents such as digoxin may be used in children.

2. Physical activity must be discouraged.

3. Congenital defects are a risk factor.

4. The etiology of heart failure is similar in children and adults.

5. Symptoms include tachypnea and tachycardia.

1,3,5

Following an ST-segment myocardial infarction (STEMI), the nurse should be assessing the client for which possible complication(s)? Select all that apply.

1. large amount of pink, frothy sputum and new onset of murmur

2. tachypnea with respiratory distress

3. frequent ventricular arrhythmia unrelieved with amiodarone drip

4. reports of facial numbness and tingling

5. enhanced renal perfusion as seen as an increase in urine output

1,2,3,4

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?

1. Cardiomyopathy

2. Myocardial infarction

3. Heart failure

4. Rheumatic cardiac disease

1

A client has undergone insertion of a drug-eluting stent. Based on clinical trials, which medications, when taken in combination, have been found effective to prevent restenosis if taken for up to 1 year after the procedure? Select all that apply.

1. nitroglycerin

2. clopidogrel

3. aspirin

4. ibuprofen

5. vitamin C

2,3

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?

1. Inadequate production of glycogen with mitochondrial shrinkage

2. Conversion from anaerobic to aerobic metabolism

3. Overproduction of energy capable of sustaining normal myocardial function

4. Conversion from aerobic to anaerobic metabolism

4

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.

1. Exertional dyspnea

2. Paroxysmal nocturnal dyspnea

3. Frequent angina

4. Orthopnea

5. Palpitations

1,2,4,5

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?

1. Obstructive shock

2. Cardiogenic shock

3. Distributive shock

4. Hypovolemic shock

1

The nurse is assessing a client involved in a motor vehicle collision who has bruising across the sternum from seat belt pressure. The nurse notes muffled heart sounds, and the client's blood pressure is 100/85 mm Hg. The nurse notifies the health care provider to present these findings as evidence of which condition

1. pericardial effusion

2. pericarditis

3. cardiomyopathy

4. pulmonary hypertension

1

The nurse teaches a client with heart failure how to prevent acute exacerbations. Which actions does the nurse stress as the most effective for preventing acute, overt heart failure?

Select three (3).

1. implementing infection control measures

2. maintaining a low-sodium diet

3. elevating lower legs during the day

4. performing deep breathing and coughing exercises

5. engaging in a regular exercise program

6. adhering to antihypertensive medications

1,2,6

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:

1. Decreased cardiac output

2. Increased ejection fraction

3. Increased renal blood flow

4. Decreased retention of sodium

1

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?

1. Mitral valve prolapse

2. Mitral valve stenosis

3. Aortic valve prolapse

4. Aortic valve stenosis

2

A nurse is teaching a client with newly diagnosed dilated cardiomyopathy (DCM) about associated treatments. The nurse determines that the knowledge is understood when the client correctly matches which drug category to the primary action of decreasing preload by suppressing renal reabsorption of sodium and increasing salt and water excretion?

1. calcium channel blockers

2. angiotensin-converting enzyme (ACE) inhibitors

3. diuretics

4. beta-blockers

3

A client diagnosed with septic shock who is experiencing tissue hypoxia likely will activate which pathophysiologic process?

1. Aerobic metabolism

2. Preexisting coagulation disorder

3. Anaphylactic response

4. Inflammatory mediators

4

A client comes to the emergency room with reports of chest pain, and the nurse notes ST-segment elevation on the electrocardiogram (ECG). For which conditions will the nurse prioritize assessing?

Select two (2).

1. stable angina

2. pericarditis

3. endocarditis

4. pleural effusion

5. acute myocardial infarction

2,5