porth patho chapt 20 – Flashcards
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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?
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Raising the head of the bed to a high Fowler's position
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Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?
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Hypertrophy
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While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:
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Weighing every day at the same time with same type of clothing
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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:
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Improving quality of life by relieving symptoms
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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?
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"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
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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?
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20 mL/hour
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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?
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Cardiogenic
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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:
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20 mL/hour
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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?
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Right-sided heart failure
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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?
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Septic
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A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client.
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Anaphylatic shock
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For which of the following types of shock might intravenous antibiotic therapy be indicated?
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Distributive shock
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A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?
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Hypovolemic
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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?
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"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."
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The nurse knows that advanced age is a risk factor for heart failure. Which statements regarding heart failure in older adults are true? Select all that apply.
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• Causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction. • Sensitivity of beta adrenergic receptors decreases resulting in decreased ventricular contractility. • It is more difficult to diagnose because of underlying chronic diseases.
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Which of the following statements regarding heart failure is true?
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In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.
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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:
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has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.
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A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?
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Low blood pressure
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A patient is diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder? Select all that apply.
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• Beta-adrenergic blockers • Angiotensin-converting enzyme inhibitors (ACEI) • Digitalis • Diuretics
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Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?
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Histamine release causes massive vasodilation.
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Cardiac output is which of the following per minute? Select all that apply.
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• Volume of blood pumped • Heart rate X stroke volume
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Increased secretion of renin in heart failure is caused by which of the following events?
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Low cardiac output
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A patient has developed disseminated intravascular coagulation (DIC). The nurse knows that which statements regarding DIC are true? Select all that apply.
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• Thrombotic occlusion occurs in small and midsized blood vessels. • Bleeding may accompany coagulation. • Generation of thrombin increases. • Endogenous anticoagulation mechanisms are suppressed.
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The nurse should suggest which of the following medications for a patient in cardiogenic shock? Select all that apply.
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• Nitroprusside (Nitropress) • Nitroglycerin • Dobutamine (Dobutrex) • Milrinone (Primacor)
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The nurse knows that which of the following statements regarding heart failure is correct?
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In compensated failure, an increase in preload causes an increase in ventricular contractility.
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In heart failure patients, the nurse knows that many compensatory mechanisms attempt to support cardiac output. Included among these mechanisms are which of the following? Select all that apply.
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• Vasoconstriction • Increased heart rate • Activitation of the renin angiotensin system (RAAS)
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A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis?
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Septic shock
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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?
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Laryngeal edema
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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?
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Peripheral edema weight gain
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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?
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Obstructive shock
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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?
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Anaphylactic
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A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:
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Hypovolemic shock due to acute intravascular volume loss
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Which of the following health problems can contribute to diastolic dysfunction heart failure?
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Myocardial hypertrophy
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When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents:
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The amount of blood the heart pumps each minute
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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?
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Weight gain
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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?
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Valvular regurgitation
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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?
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Diuretic, ACE inhibitor, beta-blocker
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A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:
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"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
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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:
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The condition is getting progressively worse.
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A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences?
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"You'll find that in pediatric patients pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."
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Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?
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They have the same compensatory mechanisms.
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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?
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Administer epinephrine (adrenaline).
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Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?
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Atrial fibrillation
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A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?
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Myocardial infarction
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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?
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Infusion of normal saline or Ringer's lactate to maintain the vascular space.
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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?
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Dyspnea, cough
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Cardiac output is which of the following per minute? Select all that apply.
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• Volume of blood pumped • Heart rate X stroke volume
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A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?
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Myocardial infarction
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The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.
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compensatory mechanisms
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Regarding heart failure, the nurse knows that which of the following statements are correct? Select all that apply.
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• Aortic stenosis can cause left-sided failure. • Cardiomyopathy is a common cause of heart failure. • Compensated heart failure may be clinically asymptomatic.
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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:
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Decreased cardiac output
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Circulatory shock is characterized by an inability of the circulatory system to provide adequate oxygen to body tissues. Which of the following damaging effects at the cellular level can cause hypoxia? Select all that apply.
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• Pyruvate converted to lactic acid • Cellular edema • Deranged sodium/potassium balance • Impaired cellular production of adenosine triphosphate (ATP)
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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?
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The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate.
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Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis?
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Release nitric oxide
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Cardiac reserve refers to which of the following events?
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Ability to increase cardiac output during physical exercise
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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?
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Measurement of urine output and mental status assessment
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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?
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Increased vascular stiffness
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What is the primary physiologic result of obstructive shock?
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Elevated right heart pressure
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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:
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Call for emergency assistance utilizing hospital protocol.
