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Ch 19 Course Point-Patho taken from http://thepoint.lww.com/book/show

Terms in this set (53)

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:

a) The valve opening is incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium.
b) The valve opening permits backward flow to occur when the valve should be closed.
c) The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
d) The valve opens backward permitting blood to flow from the right ventricle into the right atrium.
c) The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.

Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. This increases the work and volume of the chamber emptying through the narrowed valve—the left atrium in the case of mitral stenosis and the left ventricle in aortic stenosis. An incompetent or regurgitant valve permits backward flow to occur when the valve should be closed—flowing back into the left ventricle during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased.
Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction?

a) A 33-year-old male whose pain started at 7 a.m. during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable
b) A 61-year-old man whose pain started at 9 a.m. during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened
c) An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose
d) A 67-year-old female whose pain started at 2 a.m. while she was asleep and which responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable
An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose


The 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 patients have angina of varying severity.
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response?

a) Let's not worry about the cause as we need to focus on getting him better.
b) It can be attributed to drug abuse.
c) Sometimes a parasite is involved.
d) The most common cause is a staph infection.
The most common cause is a staph infection.

Staphylococcal infections have now emerged as the leading cause of infective endocarditis, with streptococci and enterococci as the other two most common causes. Informing the client's wife about the drug abuse connection infers that you think he is a drug addict and is not therapeutic. Parasites are never the cause and telling the patient to focus on her husband also is not appropriate as this is a genuine concern for her.
A nurse is caring for a patient with a new diagnosis of rheumatic fever. Which of the following is the highest priority goal of treatment during the acute phase?




a) Prevent cardiac complications
b) Reduce inflammation
c) Promote nutrition
d) Eliminate the infection
Prevent cardiac complications
Explanation:

Rheumatic fever poses great risk to the patient for long-term heart disease. Interventions to prevent cardiac complications include anti-inflammatories and antibiotics. Adequate nutrition is appropriate for healing but is not the highest priority goal.
On a routine physical exam visit, the physician mentions that they hear a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds:

a) "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or lightheaded."
b) "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit."
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 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."


Stenosis refers to a narrowing 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 with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?


a) Calcium level
b) Complete blood components
c) Creatine kinase marker
d) Troponin level
Troponin level

The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction (MI). The troponin complex, which is part of the actin filament, consists of three subunits (i.e., TnC, TnT, and TnI) that regulate calcium-mediated actin-myosin contractile process in striated muscle (see Chapter 1, Fig. 1-19). TnI and TnT, which are present in cardiac muscle, begin to rise within 3 hours after the onset of MI and may remain elevated for 7 to 10 days after the event. This is especially adventitious in the late diagnosis of MI. The other blood work may be ordered, but not to confirm the diagnosis of MI.
A client who has suffered a myocardial infarction is being treated in the emergency room. His pain remains severe even though he was given nitrates and oxygen. The physician now orders morphine for the pain. What method should the nurse to administer the morphine?

a) By mouth in a liquid
b) Subcutaneous
c) Intravenous
d) By mouth in pill form
c) Intravenous

Morphine is given intravenously when a patient is in the emergency room suffering a myocardial infarction. It is given intravenously because of the rapid onset of action, and it does not elevate enzyme levels
Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant?


a) During feeding
b) During sleep
c) During bathing
d) During burping
During feeding

Heart failure manifests itself as tachypnea or dyspnea at rest or on exertion. For the infant, this most commonly occurs during feeding. The other answers are incorrect.
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?

a) At the carotid arteries
b) Over the aorta
c) At the apex of the heart
d) Over the sternum
At the apex of the heart

The murmur of mitral valve stenosis is heard during diastole when blood is flowing through the constricted valve; it is characteristically a low-pitched, rumbling murmur best heard at the apex of the heart. The other locations would not be effective.
A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process?

a) Cardiomyopathy
b) Myocardial infarction
c) Pericarditis
d) Infective endocarditis
Infective endocarditis

Infective endocarditis is a serious and potentially life-threatening infection of the inner surface of the heart. Pericarditis involves an inflammatory response of the pericardium. Myocardial infarction is a heart attack while cardiomyopathy is a heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorders.
A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?



a) Hypoglycemia
b) Diarrhea
c) Symmetrical joint pain
d) Decreased level of consciousness
Decreased level of consciousness

Fibrinolytic therapy is most effective in treating STEMI when administered within 30 minutes after the onset of symptoms. It can still be beneficial up to 12 hours after the onset of ischemic pain. Patients who should not receive fibrinolytic therapy are those with a history of intracranial hemorrhage or significant trauma within the preceding 3 months. The primary complication of fibrinolytic treatment is intracranial bleeding that usually occurs within the first 24 hours following treatment. This would be evident with a change in mental status.
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

a) Advanced age and low serum total and low-density lipoprotein cholesterol
b) High serum high-density lipoprotein and diabetes
c) History of cigarette smoking and elevated blood pressure
d) Physical inactivity and high serum high-density lipoprotein cholesterol
History of cigarette smoking and elevated blood pressure
The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.
A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection.

a) Eikenella corrodens
b) Actinobacillus actinomycetemcomitans
c) Kingella kingae
d) Staphylococcus aureus
d) Staphylococcus aureus

While all of these bacteria can cause infective endocarditis, Staphylococcus aureus is the major offender in injection drug abusers, whereas prosthetic heart valve infective endocarditis tends to be caused by coagulase-negative staphylococci (e.g., Staphylococcus epidermidis).
The nursing student when studying cardiomyopathies learns that the primary ones are classified into which of the following groups? Select all that apply.

a) Mixed
b) Acquired
c) Primary
d) Secondary
e) Genetic
The nursing student when studying cardiomyopathies learns that the primary ones are classified into which of the following groups? Select all that apply.

a) Mixed
b) Acquired
e) Genetic

The primary cardiomyopathies are classified as genetic, mixed, or acquired, based on their etiology.
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?


a) Have the client swallow slowly and frequently.
b) Have the client breathe deeply.
c) Have the client change positions to unaffected side.
d) Have the client sit up and lean forward.
d) Have the client sit up and lean forward.

With acute periocarditis, the pain typically is pleuritic (aggravated by inspiration and swallowing) and positional (decreases with sitting and leaning forward; increases with moving to the side) because of changes in venous return and cardiac filling.
The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?

a) Demerol
b) Morphine
c) Codeine
d) Fentanyl
Morphine

Although a number of analgesic agents have been used to treat pain of myocardial infarction, morphine is the drug of choice and is usually indicated if chest pain is unrelieved with oxygen and nitrates.
An IV drug abuser has been diagnosed with infective endocarditis. He is in the emergency department reporting increasing shortness of breath, rapid breathing, chest pain that worsens with breathing, and coughing up blood. The health care provider recognizes this may be caused by:

a) Microemboli being developed in the carotids by Staphylococcus epidermidis
b) Vegetative emboli traveling in the blood stream to the lungs
c) Blood clots in the left ventricle traveling through the aorta
d) Infarction of the tissue surrounding the endocardium of the heart
Vegetative emboli traveling in the blood stream to the lungs

The client is exhibiting signs of pulmonary emboli. The infectious loci continuously release bacteria into the bloodstream and are a source of persistent bacteremia, sometimes contributing to pericarditis. As the lesions grow, they cause valve destruction and dysfunction such as regurgitation, ring abscesses with heart block, and perforation. The loose organization of these lesions permits the organisms and fragments of the lesions to form emboli and travel in the bloodstream, causing cerebral, systemic, or pulmonary emboli. If clots are in the left ventricle, they will travel to the brain or kidneys. If emboli are located in the carotids, they will travel to the brain tissue. Infarction of heart tissue will exhibit signs of a myocardial infarction, not pulmonary emboli.
When the electrocardiogram (ECG) of a patient in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta adrenergic blocker. Which of the following factors in the patient's history will cause the nurse to withhold medication? Select all that apply.




a) Third-degree heart block
b) Hypertension
c) Cerebrovascular accident
d) Myocardial infarction caused by cocaine use
e) Shock
• Myocardial infarction caused by cocaine use
• Third-degree heart block
• Shock

Beta adrenergic blockers are beneficial during acute coronary syndrome because they enhance myocardial perfusion by lengthening diastole. They also reduce sympathetic response, thus decreasing myocardial oxygen demand and systolic blood pressure. However, if a STEMI was caused by cocaine use, beta blockers can intensify the coronary spasm. Additional reasons to avoid beta blockers include left ventricular failure, hypotension, shock, second- or third-degree heart block, and symptomatic bradycardia.
A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:

a) Pneumonia
b) Onset of STEMI
c) Acute respiratory distress syndrome (ARDS)
d) Gastroesophageal reflux disease (GERD)
b) Onset of STEMI

The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin
The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?

a) That there is no definitive test used for diagnoses
b) The cost associated with treating the disease
c) The fact that it affects young and old
d) The disabling effects that result from involvement of heart valves
d) The disabling effects that result from involvement of heart valves

Rheumatic fever is a very important cause of heart disease and its most serious and disabling effects result from involvement of the heart valves.
The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)?

a) A 78-year-old client admitted with increasing fatigue related to aortic stenosis
b) A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation
c) A 87-year-old client admitted with uncontrolled dilated cardiomyopathy
d) A 24-year-old auto accident client diagnosed with pericardial effusion and cardiac tamponade
b) A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation

Explanation:
Coronary artery bypass grafting (CABG) may be the treatment of choice for people with significant coronary artery disease (CAD) who do not respond to medical treatment and who are not suitable candidates for percutaneous coronary intervention. CABG does not address valve disorders, pericardial effusion, or cardiomyopathies
A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?

a) Myocardial infarction
b) Pericarditis
c) Thrombosis
d) Cardiac tamponade
Cardiac tamponade

Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart. It can be life-threatening and symptoms include tachycardia, elevated central venous pressure, jugular vein distention, fall in systolic blood pressure with narrowed pulse pressure. Pericarditis is inflammation of the pericardium. A myocardial infarction does not have these symptoms nor does a thrombus
A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this?

a) Heart attack
b) Pericarditis
c) Dehydration
d) Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the interventricular septum, abnormal diastolic filling, cardiac arrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac deat in young athletes.
A nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess.

a) Mucous membranes
b) Tongue
c) Sclera of the eyes
d) Palms of the hands
Mucous membranes

Cyanosis, a bluish color of the skin, most notable in the nail beds and mucous membranes, develops when sufficient deoxygenated blood from the right side of the heart mixes with oxygenated blood in the left side of the heart
A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

a) Annual blood specimen assessed for rheumatoid factor
b) Yearly electrocardiography after the age of 50
c) Prompt diagnosis and treatment of streptococcal infections
d) Avoiding frequent dental examinations
c) Prompt diagnosis and treatment of streptococcal infections

Rheumatic heart disease is normally caused by streptococcal infections; therefore, early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a client has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and the client should have regular dental examinations.
Which of the following patients is at the greatest risk of developing rheumatic heart disease?


a) Young adult with viral meningitis
b) Teenager with untreated strep throat
c) Older adult with shingles
d) Child with impetigo on the face
Teenager with untreated strep throat

Rheumatic fever is caused by group A (beta-hemolytic) streptococcal throat infection. Although the same bacteria cause the skin infection called impetigo, it is not known to cause rheumatic heart disease. Viral infections such as meningitis and shingles (herpes zoster) do not cause rheumatic heart disease.
A client who was admitted to the cardiac intensive care unit with a diagnosis of myocarditis asks the nurse what caused his disease. What would be the nurse's best response?

a) It is usually caused by a viral infection.
b) You need to ask your physician.
c) It is caused by some type of bacteria.
d) There is no research yet on what causes this disease.
It is usually caused by a viral infection.

Myocarditis is inflammation of the myocardium. Although there are different causes it is usually caused by a viral infection. Telling the patient there is no research would not be true and telling him to ask the physician would not be therapeutic.
A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:



a) "Aspirin will help prevent blood clotting."
b) "Aspirin prevents blood clotting by halting platelet production."
c) "It will give you a steady relief of your chest pain."
d) "Aspirin will prevent a heart attack."
"Aspirin will help prevent blood clotting."
Explanation:
Aspirin (i.e., acetylsalicylic acid) is the preferred antiplatelet agent for preventing platelet aggregation in persons with ACS. Aspirin, which acts by inhibiting synthesis of the prostaglandin thromboxane A2, is thought to promote reperfusion and reduce the likelihood of rethrombosis. This dose of aspirin is not appropriate for pain relief, and the final option does not demonstrate therapeutic communication.
Which of the following patients with cardiomyopathy does the nurse identify as having the greatest risk for a complication?

a) One with peripheral edema and 2-kg weight gain
b) One with hepatomegaly and ascites
c) One with an ejection fraction of 25% and atrial fibrillation
d) One with orthopnea and activity intolerance
One with peripheral edema and 2-kg weight gain
One with an ejection fraction of 25% and atrial fibrillation
Explanation:
Although each set of symptoms is characteristic of cardiomyopathy, the nurse determines the greatest risk occurs with the patient showing evidence of stasis in the heart that can result from a reduced ejection fraction and atrial fibrillation. This patient is most likely to experience an embolus.
During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?


a) 20 to 40 minutes
b) 10 to 30 minutes
c) 10 to 20 minutes
d) 30 to 40 minutes
a) 20 to 40 minutes

If blood flow can be restored within the 20-to-40-minute time frame, loss of cell viability does not occur or is minimal.
A client is seen in the emergency room with complaints of sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?

a) Myocardial infarction
b) Pericarditis
c) Pneumonia
d) Abdominal aortic aneurysm
Pericarditis

This patient is demonstrating signs and symptoms of pericarditis, which includes a triad of chest pain, pericardial friction rub, and EKG changes. Other signs are that the pain is usually abrupt in onset, occurs in the pericardial area, and may radiate to the neck, back, abdomen or side. It is usually worse with deep breathing and swallowing, and the person often finds relief when sitting up and leaning forward.
The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes:

a) T-wave changes
b) Significant ST-segment elevation
c) Peaked T waves
d) Deep Q waves
T-wave changes

Unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) is a clinical syndrome of myocardial ischemia ranging from angina to myocardial infarction. The ECG pattern associated with in NSTEMI may display normal or ST-segment depression (or transient ST-segment elevation) and T-wave changes. The degree of ST-segment deviation from baseline is an important measure of ischemia and indicator of prognosis. Abnormal Q waves occur with ACS.
A nurse assesses a patient with normal biomarkers who reports angina. Which of the following additional manifestations are late signs of aortic stenosis? Select all that apply.

a) Syncope
b) Peripheral cyanosis
c) Dyspnea
d) Hypertension
e) Diarrhea
• Syncope
• Peripheral cyanosis
• Dyspnea

The earliest signs of aortic stenosis are a loud systolic ejection murmur or a single or paradoxically split second heart sound. Angina, syncope, and heart failure are later signs of the disorder
Which of the following would be considered a clinical manifestation of acute pericarditis? Select all that apply.

a) Pericardial friction rub
b) Abnormal ECG results
c) Muffled heart sounds
d) Narrowed pulse pressure
e) Sharp, abrupt onset of chest pain that radiates to the neck
Sharp, abrupt onset of chest pain that radiates to the neck
• Pericardial friction rub
• Abnormal ECG results
Explanation:
The manifestations of acute pericarditis include a triad of chest pain, an auscultatory pericardial friction rub, and electrocardiographic (ECG) changes. The pain usually is sharp and abrupt in onset, occurring in the precordial area, and may radiate to the neck, back, abdomen, or side. Pain in the scapular area may result from irritation of the phrenic nerve. The pain typically is pleuritic (aggravated by inspiration and coughing) and positional (decreases with sitting and leaning forward) because of changes in venous return and cardiac filling. A pericardial friction rub results from the rubbing and friction between the inflamed pericardial surfaces. Persons with cardiac tamponade usually have heart sounds that become muffled because of the insulating effects of the pericardial fluid and reduced cardiac function. A key diagnostic finding in cardiac tamponade is pulsus paradoxus or an exaggeration of the normal variation in the systolic blood pressure.
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?

a) Cardiac catheterization, chest X-ray, electrolyte measurement, and white cell count
b) CT of the heart, chest X-ray, ECG
c) Echocardiogram, blood cultures, temperature
d) ECG, blood pressure, stress test
c) Echocardiogram, blood cultures, temperature

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 client who has just been diagnosed with mitral valve stenosis tells the nurse that he has heard of the disease but he does not know anything about it. He asks the nurse what it means. What would be the nurse's best response?

a) It is a defect of the mitral valve which allows for back flow of blood.
b) It is an inflammatory process of the mitral valve.
c) It is a disorder of the mitral valve caused by atherosclerosis.
d) It is a defect of the mitral valve which causes obstruction of blood flow.
• It is a defect of the mitral valve which causes obstruction of blood flow.

Mitral valve stenosis is a defect of the mitral valve which causes obstruction of blood flow, while mitral valve regurgitation is characterized by incomplete closure of the mitral valve and blood moves backward into the left atrium.
What can trigger myocardial ischemia even when there is adequate coronary blood flow? Select all that apply.

a) Damaged coronary veins
b) Fever
c) Carbon monoxide poisoning
d) Anemia
e) Hypoxia
• Anemia
• Carbon monoxide poisoning
• Hypoxia

Myocardial oxygen supply is determined by the coronary arteries and capillary inflow, and the ability of hemoglobin to transport and deliver oxygen to the heart muscle. Even with adequate coronary blood flow, myocardial ischemia can occur in situations of hypoxia, anemia, or carbon monoxide poisoning. The other options are not relevant to myocardial ischemia
The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?


a) Widening pulse pressure
b) Kussmaul sign
c) Pulsus paradoxus
d) Kussmaul breathing
Kussmaul sign

Kussmaul sign is an inspiratory distention of the jugular veins caused by the inability of the right atrium, encased in its rigid pericardium, to accommodate the increase in venous return that occurs with inspiration. None of the other physiologic signs occur in constrictive pericarditis.
A client who has been diagnosed with mitral valve prolapse asks the nurse if there are any dietary modifications that should be incorporated into her lifestyle. The best response would be:

a) "Avoid coffee; however, tea is OK."
b) "Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."
c) "Energy drinks may help to support metabolism."
d) "It is OK to decrease your smoking to one pack per day."
"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."

The treatment of mitral valve prolapse focuses on the relief of symptoms and the prevention of complications. In many cases, the cessation of stimulants such as caffeine, alcohol, and cigarettes may be sufficient to control symptoms. Tea and energy drinks may contain caffeine or stimulants and should be avoided. All nicotine products should be avoided.
The nursing student has learned in class that pericarditis is an inflammatory process of the pericardium. Which of the following is known to be the main cause of pericarditis?

a) Viral infections
b) Radiation
c) Connective tissue disease
d) Bacterial infections
Viral infectionsViral infections are the most common cause of pericarditis. The others listed are also causes but not the most frequent.
A nurse who works on a pediatric cardiology unit of a hospital is providing for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results 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 right ventricle is atrophic as a consequence of impaired myocardial blood supply.
c) Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.
d) The aortic valve is stenotic, resulting in increased afterload.
Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

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

a) Enhanced renal perfusion as seen as an increase in urine output.
b) Frequent ventricular arrhythmia unrelieved with Amiodarone drip.
c) Large amount of pink, frothy sputum and new onset of murmur.
d) Complaints of facial numbness and tingling.
e) Tachypnea with respiratory distress.
• Large amount of pink, frothy sputum and new onset of murmur.
• Tachypnea with respiratory distress.
• Frequent ventricular arrhythmia unrelieved with Amiodarone drip.
• Complaints of facial numbness and tingling.

Following MI, many complications can occur. A—pulmonary edema or papillary muscle rupture. B—acute respiratory distress could result from heart failure. C—Life-threatening arrhythmias. D—Acute stroke
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.

a) Frequent angina
b) Orthopnea
c) Exertional dyspnea
d) Palpitations
e) Paroxysmal nocturnal dyspnea
• Exertional dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Palpitations

As aortic regurgitation progresses, signs and symptoms of left ventricular failure begin to appear. These include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Angina is a rare symptom. Tachycardia, occurring with emotional stress or exertion, may produce palpitations, head pounding, and premature ventricular contractions.
Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)?

a) Inadequate ventricular end-diastolic pressure
b) Use of calcium-channel blocker medications
c) Increased aortic pressure
d) Ventricular atrophy
Increased aortic pressure

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. Ventricles would tend to hypertrophy in response to prolonged wall stress and consequent oxygen demand
A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?

a) COPD
b) Pericardial effusion
c) Pericarditis
d) Myocardial infarction
Pericardial effusion
Pericardial effusion refers to the accumulation of fluid in the pericardial vacuity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200ml of fluid may raise intracardiac pressure to levels that will cause symptoms similar to right-sided heart failure. Pericarditis is inflammation of the pericardium while COPD is a respiratory disease.
Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?


a) Exposure to heat
b) Abrupt change in position
c) Sedentary lifestyle
d) Emotional stress
Emotional stress

Angina pectoris usually is precipitated by situations that increase the work demands of the heart, such as physical exertion, exposure to cold, and emotional stress. The pain typically is described as a constricting, squeezing, or suffocating sensation. It usually is steady, increasing in intensity only at the onset and end of the attack. Changing positions abruptly does not cause an attack of angina pectoris.
A preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following?

a) Yearly electrocardiography after the age of 50
b) Blood specimen assessed for rheumatoid factor
c) Scheduling regular hearing examinations
d) Prompt diagnosis of streptococcal infections with a throat culture
Prompt diagnosis of streptococcal infections with a throat culture

Rheumatic heart disease is normally caused by streptococcal infections; therefore early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a patient has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and while the patient may benefit from regular hearing examinations, it is not related to preventing rheumatic heart disease.
Which serum biomarker is highly specific for myocardial tissue?

a) C-reactive protein
b) White blood cells
c) Creatine kinase
d) Troponin
Troponin

The troponin assays have high specificity for myocardial tissue and have become the primary biomarker tests for the diagnosis of myocardial infarction. Creatine kinase is specific for muscle injury but is not as focused as is troponin. White blood cells and C-reactive protein are associated with inflammation.
The nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD?

a) Excessive use of dairy products
b) Atherosclerosis
c) Defect in the DNA
d) Excessive exercise
Atherosclerosis

In most cases, coronary artery disease is caused by atherosclerosis. Exercise is good for people and excessive use of dairy is not related nor is it a defect in DNA. Risk factors can predispose someone to coronary artery disease such as cigarette smoking, high cholesterol, diabetes, advancing age, etc
An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication?

a) Petechial hemorrhages under the skin and nail beds.
b) Systemic emboli, especially to brain.
c) GI upset from the massive amount of antibiotics required to kill the bacteria.
d) Pancreas enlargement due to increased need for insulin secretion.
Systemic emboli, especially to brain.

Systemic emboli and 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. B—petechial hemorrhages are s/s of IE. GI upset is common following antibiotic therapy but is not usually life-threatening. Stress can increase insulin needs but not associated with pancreas enlargement.
The nurse is assessing a client for early signs of constrictive pericarditis. The most likely manifestation would be:

a) Weight loss
b) Muscle wasting
c) Exercise intolerance
d) Ascites
Ascites

Ascites is an early finding in constrictive pericarditis, along with pedal edema, dyspnea on exertion, and fatigue. The other options are late signs of constrictive pericarditis.
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?

a) Not worry about it as this is common for someone who has already had a myocardial infarction.
b) See the doctor for evaluation immediately.
c) Give it 5-10 minutes more to see if there is relief.
d) Take a second nitroglycerine.
See the doctor for evaluation immediately.

Angina that occurs at rest, is of new onset, or is increasing in intensity or duration denotes an increased risk for myocardial infarction and should be seen immediately using the criteria for acute coronary syndrome (ACS).
ST-elevated myocardial infarction is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?


a) Action decreases metabolic demands of the heart.
b) Action increases anxiety increasing metabolic demands of the heart.
c) Action relieves pain and gives sense of depression.
d) Action increases autonomic nervous system activity.
Action decreases metabolic demands of the heart.

Although a number of analgesic agents have been used to treat the pain of STEMI, morphine is usually the drug of choice. It usually is indicated if chest pain is unrelieved with oxygen and nitrates. The reduction in anxiety that accompanies the administration of morphine contributes to a decrease in restlessness and autonomic nervous system activity, with a subsequent decrease in the metabolic demands of the heart. Morphine does not cause a feeling of depression to the client.
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