Cardiovascular 2 Quiz Flashcards
Alternate in strength
Pulsus alternans
Decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels
Left sided heart (ventricular) failure
Can occur when cardiac output remains normal or above normal
High output failure
Percentage of blood ejected from the heart during systole
Ejection fraction
Activated by reduced blood flow to the kidney
Renin angiotensin system
Increased volume and pressure develop and result in peripheral edema
Right sided heart failure
True or false
Most heart failure begins with failure of the left ventricle and progresses to failure of both ventricles
True
True or false
As the ejection fraction decreases, tissue perfusion diminshes and blood accumulates in the pulmonary vessels
True
True or false
B type natriuretic peptide is produced and released by the ventricles when the patient has fluid overload as a result of heart failure
True
Cardiac output is the product of heart rate and stroke volume and an increase in hr results in an immediate increase in cardiac output
True
True or false
The intial compensatory mechanism of the heart that maintains cardiac output is increased sympathetic stimulation
True
The nurses taking in history on a patient recently diagnosed with heart failure patients to sometimes having trouble catching my breath but is unable to provide one. What questions the nurse asked to gather more data about the patient’s symptoms?
What was your most strenuous activity in the past week?
The night shift nurse is listening to report hears that a patient has paroxysmal nocturnal dyspnea. What does the nurse plan to do next?
Check on the patient several hours after bedtime and assist the patient to sit upright and dangle the feet when dyspnea
The nursing assessing a patient with right-sided heart failure. Which assessment findings with the nurse expect to see in this patient?
- Dependent edema
- Polyuria at night
- Hepatomegaly
The nurses assessing the patient with left sided heart failure. Which assessment findings of expect to see in this patient?
- Displacement of the apical impulse to the left
- S3 heart sound
- Paroxysmal nocturnal dyspnea
- Oliguria during the day
- Wheezes or crackles
Based on the etiology and the main cause of heart failure, which patient has the greatest need for health promotion measures to prevent heart failure
Patient with hypertension
What is an early sign of left ventricular failure that a patient is most likely to report?
Nocturnal coughing
The nurse is reviewing diagnostic test result for a patient is hypertensive. Which lab result is an early warning sign of decreased her compliance, and prompts the nurse immediately notify the healthcare provider?
Presence of microalbumineria
The nurses interviewing a patient with a history of high blood pressure and heart problems. Which statement by the patient causes the nurse to suspect the patient may have heart failure?
I had to take of my wedding ring last week
A patients bilateral radial pulse are occasionally weak and irregular. Which assessment technique does the nurse use first to investigate this finding?
Take the apical pulse for one minute noting any irregularity in heart rhythm
A patient is at risk for heart failure, but currently has no official medical diagnosis. While assessing the patients lungs, the nurse hears profuse crackles. What does the nurse do next?
Ask the patient to cough and reascultate the lungs
A patient is admitted for heart failure and has edema, neck vein distention and ascites. What is the most reliable way to monitor fluid gain or loss in this patient?
Weight the patient daily at the same time with the same scale
The home health nurse is evaluating a patient for being treated for heart failure. Which statement by the patient is the best indicator of hope and well-being of the desired psychological outcome?
I’m looking forward to dancing with my wife on our wedding anniversary
The nurse is reviewing the lab results for a patient whose chief complaint is dyspnea. Which diagnostic test best differentness between heart failure and lung dysfunction?
B type natruitetic peptide
The nursing student is assisting in the care of a patient with advanced right sided heart failure. In addition to bringing a stethoscope, what additional piece of equipment does the student bring in order to assess the patient?
Tape measure
Which test is the best tool for diagnosing heart failure?
Echocardiography
A patient with heart failures inadequate tissue perfusion. Which nursing interventions are included in the plan of care for this patient?
- Monitor respiratory rate, rhythm and quality every 1-4 hours
- Auscultate breath sounds every 4-8 hours
- Provide supplemental o2 to maintain o2 sats above 90%
- Assist eh patient in performing coughing and deep breathing exercises every 2 hours
Which interventions are effective for a patient with a potential for pulmonary edema caused by heart failure?
- Sodium and fluid restriction
- Admin of loop diuretics
- Position in semi fowlers to high fowlers
AN older patient with heart failure is volume depleted and has a low sodium level. The health care provider has ordered valsartan an angiotensin receptor blocker (ARB). After the initial dose, what does the nurse carefully monitor this patient for?
Hypotension
The health care provider has ordered an ARB for a patient with heart failure. The parameters are to maintain a systolic blood pressure range from 90-110 mmhm. Today the patient has a blood pressure of 110/80 mmhm but shows acute confusion. What is the nurses priority action?
Assess the patient for other symptoms of decreased tissue perfusion
A patient with heart failure has excessive aldosterone secretion and is therefore experiencing thirst and continuously asking for water. What does the nurse instruct the UAP to do?
Restrict fluid to a normal 2 liter a day and chart accurate I&O
A patient is prescribed diuretics for treatment of heart failure. Because of this therapy, the nurse pay particular attention to which lab test result.
Serum potassium
An older adult patient is taking digoxin for treatment of heart failure. What is the priority nursing action for this patient related to the medication therapy?
Check that the dose sin the lowest possible range for therapeutic effect
A patient is receiving digoxin therapy for heart failure. What assessment does the nurse perform before administering the medication?
Auscultate the apical pulse rate and heart rhythm
The nurse is reviewing the ECG of a patient on digoxin therapy. What early sign of digitalis toxicity does the nurse look for?
Loss of P wave
Which lab test monitors for potential cardiac problems and digoxin toxicity?
Serum potassium level
A patient is receiving an infusion of nesiritide (Ngtrecor) for treatment of heart failure. What is the priority nursing assessment who administering this medication?
Monitor for hypotension
A patient has recently been diagnosed with acute heart failure. Which medication order does the nurse question?
Cardvedilol, (COREG), a beta blocker
Patient has an ejection fraction of less than 30%. The nurse repairs to provide patient education about which potential treatment?
Automatic implantable cardio defibrillator
The nurse identifies a priority problem with the TV and weakness for the patient with heart failure. After ambulating 200 feet down the hall the patient’s blood pressure change is more than 20 MMH G. How does the nurse interpret this data?
The activity is too stressful
A patient with heart failure is anxious to recover quickly. After ambulating with the UAP, the nurse observe the patient has dyspnea. The nurse asked the patient to read her exertion on a scale of 1 to 20 and the patient says I can keep going it’s only about a 15. What is the nurses best response?
Slow down a bit, ideally you should be less than the 12
Why does the nurse document the precise location of crackles auscultated in the lungs of a patient with heart failure?
The level of fluid of ascends as the pulmonary edema worsens
Patient comes to the emergency department extremely anxious, tachycardic, and struggling for air with a moist cough productive of frothy, blood tinged sputum. What is the priority nursing intervention?
Administer high flow oxygen therapy via face mask
A patient is treated for acute pulmonary edema. Which medications is the nearest prepared to administer to this patient?
- Sublingual nitroglycerin
- IV Lasix
- IV morphine sulfate
- IV nitroglycerin
What is expected outcome for the collaborative problem potential for pulmonary Adema?
Clear lung sounds
The nurses teaching a patient with heart failure about sign and symptoms that suggest a return at worsening of heart failure. What does the nurse include in the teaching?
- Cold symptoms lasting more than 3 to 5 days
- Excessive awakening at night to urinate
- Development of dyspnea or angina at rest or worsening angina
- Increased swelling in the feet, ankles, or hands
A patient is prescribed bumetanide. What is an important teaching point for the nurse include about this medication?
Information about potassium rich foods to include in the diet
The nurses teaching a patient about treatment regimen for heart failure. Which statement by the patient indicates a need for further instruction?
I must weigh myself once a month and watch for fluid retention
Mitral valve stenosis
- Hepatoma gaily is a late sign
- Irregular rhythm and atrial fib can cause emboli
- Right-sided heart failure, later cardiac output fails
- Rumbling apical diastolic murmur
- Right-sided heart failure or results and neck mean distention
Mitral valve insufficiency
- Usually coexist with some degree of mitral stenosis
- Irregular rhythm, atrial fib can cause emboli
- Symptom-free for decades, later related to left ventricular failure
- Right-sided heart failure or results and neck vein distention
- S3 often present due to severe regurgitation
Mitral valve prolapse
- Most patients are asymptomatic
- Leaflets enlarge and fall back into the left atrium during systole
- Normal heart rate and blood pressure
Aortic stenosis
- Classic signs of dyspnea angina and syncope
- Becoming a disorder of aging populations
- Murmur, systolic Cresendo to dec
Aortic insufficiency
- A high pitch, blowing deCresendo diastolic murmur
2. The patient may experience palpations while lying on left side
The patient is diagnosed with moderate mitral valve stenosis. Which findings is the nurse most likely to encounter during the physical assessment of this patient?
- Dyspnea on exertion
- Orthopnea
- Palpitations
4, neck vein distention
The nurse hears in report that the patient has been diagnosed with mitral insufficiency. Which early symptom is most likely to be first reported by the patient?
Chronic weakness
A patient is diagnosed with mitral valve stenosis. Which finding warrants immediate notification of the healthcare provider because of potential for decompensation?
Irregularity irregular heart rhythm signifying atrial fib
The nurse is assessing the pulses of a patient with valvular disease and find founding a trip arterial pulses. What is finding is characteristic of?
Aortic regurgitation
Patient with a history of valvular heart disease requires a routine colonoscopy. The nurse notify the healthcare provider to obtain a patient prescription for which type of medication?
Antibiotics
What is the most common preventable cause of valvular heart disease?
Beta hemolytic streptococcus infection
Assessing a patient at risk for valvular disease and find pitting edema. The signing is a sign for which type of valvular disease?
Mitral valve stenosis and insufficiency
The HCP recommend so patient the diagnostic testing performed to assess for valvular heart disease. The nurse teaches the patient about which test is commonly used for this purpose?
Echocardiography
Long term anticoagulation therapy for valvular heart disease and chronic atrial fib includes which drug?
Warfarin sodium ( Coumadin)
The surgical noninvasive intervention of a balloon valvuloplasty is often used for which type of patient?
Older adults who are non-surgical candidate
The nurses caring for a patient who had a valvuloplasty. The nurse matters for which common complication in the post procedural.?
Bleeding and emboli
A patient with a prosthetic valve replacement must understand that pop postoperative care will include lifelong therapy with which type of medication
Anticoagulants
Patient is a candidate for a xenograft valve. The nurse emphasizes that this have a valve does not require anticoagulant therapy, but which will require which intervention?
Replacement in about 7 to 10 years
Patient is scheduled for valve surgery. Which medication is the nurse advise the patient to discontinue for several days before the procedure?
Anticoagulants
Where is the most common problem for the patient with valvular heart disease?
Reduced cardiac output
The nurses giving discharge instructions to the patient who had valve surgery. Which homecare instructions of the nurse include in the teaching plan?
- Using an electric razor to avoid skin cuts
- Report any bleeding or excessive bruising
- Watch for or report any fever, drainage, redness at the site
- AVoid heavy lifting for 3 to 6 months
- Report dyspnea, syncope, dizziness, Adema, and palpation
- Avoid any procedure using magnetic resonance if a prostatic valve with used
Vegetation fragments in circulation resulting in a cerebrovascular accident or transient ischemic attack
Systemic emboli
Read flat pinpoint spots or legions and mucous membranes and conjunctivae
Petechiae
Small red streaks or black longitudinal lines of nail bad
Splinter hemorrhages
Having a systolic blood pressure higher an expiration on inspiration
Pulsus paradoxes
Scratch a high-pitched sound heard I left lower sternal border
Pericardial friction rub
Small nodules on myocardium replaced by scar tissue
Aschoff bodies
Excess fluid in the pericardial cavity
Cardiac tamponade
Grating pain is aggravated by breathing
Pericarditis
Scratchy high-pitched sound heard on auscultation of her left lower sternal border
Pericarditis
A new regurgitant murmur
Endocarditis
Janeways lesions
Endocarditis
Olser nodes
Endocarditis
Petechiae
Endocarditis
Rheumatic carditis
Streptococcal infection
Aschoffs bodies
Which patients are at greatest risk of developing infective endocarditis?
IV drug user,
patient with a prosthetic mitral valve replacement, postoperative,
patient with mitral stenosis who recently had an abscessed tooth removed,
older adult patient with urinary tract infection and valve damage
A patient with aortic valve endocarditis reports fatigue and shortness of breath. Crackles or heard on long auscultation. What do these assessment findings likely indicate?
Valve incompetence resulting in heart failure
The patient is admitted for possible infective endocarditis. Which test of the nurse anticipate will be performed to confirm a positive diagnosis?
Blood cultures
Patient is diagnosed with new onset infective endocarditis. Which recent procedure is the patient most likely to report?
Teeth cleaning
In what way does arterial embolization to the brain manifests itself in a patient with infective endocarditis
Dysphagia
Which treatment intervention applies to a patient with infective endocarditis question
Hospitalization for initial IV anabiotic’s, possibly with a central line
What is the definitive treatment for a patient with chronic constructive pericarditis?
Surgical excision of the pericardium
Dressler syndrome can occur after myocardial infarction. The syndrome is characterized by which symptoms?
Fever, pericarditis, pleural effusion
A patient is admitted to the unit with assessment findings that include substernal pain that radiates to the left shoulder. The pain is described by the patient to be grading in his words with inspiration and coughing. What is the cause of this patient’s symptoms?
Acute pericarditis
Which signs or symptoms occur with chronic constrictive pericarditis?
Pericardium becomes Rigid
Ventricles inadequately fill
Heart failure eventually occur
True or false
A patient with pericarditis develops a pericardial effusion. This can result in another complication called cardiac tamponade
True
The nurse is assessing a patient with pericarditis. In order to hear pericardial friction rub, which technique does the nurse use?
Place the diaphragm of the left lower sternal border
A patient is admitted for pericarditis. In order to assist the patient to feel more comfortable, what does the nurse instruct the patient to do?
Sit up and lean forward
The nurse is reviewing the ECG have a patient admitted for acute pericarditis. Which ECG changes the nurse anticipate?
St-T spiking
A patient is admitted for pericarditis. However the patient likely describes pain?
Grating, substernal pain is aggravated by inspiration
Which patient is our greatest risk for developing viral pericarditis?
30-year-old man with a respiratory infection
What is the common treatment for rheumatic carditis?
Antibiotics for 10 days
Which medication is used to treat rheumatic carditis?
Antibiotic (penicillin )
Assessment findings for a patient with acute pericarditis indicate neck vein distention, clear lungs, muffled heart sounds, tachycardia, tachypnea and a greater than 10 MM HG difference in systolic pressure on inspiration then on expiration. What is the nurses first response to these assessment findings?
Administer oxygen and immediately report the findings to the healthcare provider
Patient had an emergency pericardiocentesis for cardiac tamponade. Which nursing intervention’s are included in the post procedural care for this patient?
- Closely monitor for the recurrence of tamponade,
- be prepared to provide adequate fluid volumes to increase cardiac output,
- be prepared to assist in emergency sternotomy if tamponade recurs,
- send the pericardial effusion specimen to the lab for culture
Which is a characteristic of dilated cardiomyopathy?
Causes symptoms of left ventricular failure
Which type of cardiomyopathy results from replacement of myocardial tissue with fibrous and fatty tissue?
Arrhythmogenic right ventricular cardiomyopathy
A patient may die without any symptoms of which type of cardio myopathy?
Hypertrophic cardiomyopathy
Cause of dilated cardiomyopathy may include which factors?
- Alcohol abuse,
- infection,
- chemotherapy,
- Poor nutrition
Which descriptions accurately characterized restrictive cardiomyopathy?
- Prognosis is poor
2. symptoms are similar to left or right heart failure 3. is the rarest of cardiomyopathy
The patient reports having a sore throat two weeks ago now reports chest pain. On physical assessment, the nurse here’s a new murmur, pericardial friction rub, and tachycardia. ECG shows a prolonged PR interval of what condition is the nurse expect in this patient?
Rheumatic carditis
Patient has received a heart transplant for dilated cardiomyopathy. Because the patient is at high risk for cardiac tamponade, of which signs or symptoms does the nurse immediately notify the provider?
Pulses paradoxus and muffled heart sounds
The nurses assessing a patient who has received a heart transplant. Which clinical manifestation suggest transplant rejection?
Shortness of breath,
new bradycardia,
hypotension,
decreased ejection fraction
A client with left ventricular heart failure is taking digoxin 0.25 mg daily. What changes does the nurse expect to find at this medication is therapeutically effective?
- Diuresis
- Decreased edema
- Decreased pulse rate
A nurse identify signs of electoral like to present in a client with heart failure who is receiving bumetanide and D I GO XIN. What does the nurse determines the cause of the depletion?
Diuretic therapy
A client has edema in the lower extremities during the day, which disappears at night. But which medical problem does the nurse conclude this clinical findings consistent?
Ventricular heart failure
Client admitted to the hospital has edematous ankles. What you going to do to best reduce edema of the lower extremities?
Elevate the legs
What clinical indicators is the nurse most likely to identify when taking the admission history of a client with right ventricular failure?
Edema and dyspnea
What change in pressure does the nurse conclude is responsible for the lower extremity pitting Adema have a client with right ventricular heart failure?
Increase in plasma hydrostatic pressure
The family of a client with right ventricular heart failure expresses concern about the clients increasing abdominal girth. What physiologic changes should the nurse consider when explaining the clients condition?
Increased pressure within the circulatory system
What dietary choices the nurse instruct the client taking spironolCtone to avoid?
Potatoes and Cantaloupe
A nurse is advising a client about the risks associated with failing to seek treatment for acute pharyngitis caused by Beta hemolytic streptococcus. For what health problem with the client at risk?
Endocarditis
What effect of anxiety makes it important for the nurse to allay the anxiety of a patient with heart failure?
Increased cardiac workload
What should the nurse do to help alleviate the distress of a client with heart failure and pulmonary edema?
Place the client in the orthopenic position
When an older client with heart failure is transferred from the emergency department to the medical service, what should the nurse on the unit do first?
Assess the clients heart and lung sounds
A nurses caring for a client with an infection caused by group a beta hemolytic streptococci. The nurses should assess the client for responses associated with which illness?
Rheumatic fever
A client with heart failure is on a drug regimen of did Jackson and for roast of mine. The client dislikes oranges and bananas. Which fruit should the nurse encourage the client to eat?
Apricots because they are high in potassium and Lasix is potassium depleting
A nurses caring for a client with heart failure. Healthcare provider alert order the 2 g sodium diet. What should the nurse include when explaining how low salt diet helps achieve a therapeutic outcome?
Allows excess tissue fluid to be excreted
