Heart Failure Flashcards
Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply. 1 Hypertension 2 Hyperthyroidism 3 Cardiomyopathy 4 Rheumatic heart disease 5 Coronary artery disease (CAD)
1 Hypertension 3 Cardiomyopathy 5 Coronary artery disease (CAD)
Primary causes of heart failure linked to specific genes and gene mutations include hypertension, cardiomyopathy, and CAD. Hyperthyroidism and rheumatic heart disease are primary causes of heart failure that are not linked to specific genes and gene mutations.
A patient is prescribed an angiotensin-converting enzyme (ACE) inhibitor for the treatment of heart failure (HF). Which mechanism will this medication block?
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Secretion of aldosterone
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Conversion of pro-renin to renin
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Conversion of angiotensin I to angiotensin II
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Conversion of angiotensinogen to angiotensin I
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Conversion of angiotensin I to angiotensin II
Angiotensin I is subsequently converted to angiotensin II by the ACE found in the lungs. When renal blood flow is reduced, the juxtaglomerular cells secrete renin into the circulation. Renin carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin II also stimulates the secretion of the hormone aldosterone; it causes the reabsorption of sodium and water into the blood, which increases the BP.
Which condition causes cor pulmonale? 1 Liver disease 2 Renal disease 3 Pulmonary disease 4 Preexisting heart disease
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Pulmonary disease
Cor pulmonale is a cardiac condition in which a disease of the pulmonary system causes an increase in right ventricular pressure. This increased right ventricular pressure causes right ventricular failure, which may eventually lead to heart failure. This term is not used for heart disease caused by liver, kidney, or preexisting heart disease.
Which respiratory rate would the nurse anticipate when assessing a patient who is developing pulmonary edema? 1 10 to 14 breaths/min 2 16 to 20 breaths/min 3 22 to 24 breaths/min 4 32 to 36 breaths/min
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32 to 36 breaths/min
A respiratory rate higher than 30 breaths/min is often found in patients with pulmonary edema. A patient experiences dyspnea and orthopnea as a result of the accumulation of edematous fluid in the lung tissues, which affects the patient’s respiratory rate. Respiratory rates in the ranges of 10 to 24 breaths/min indicate normal respiration.
Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO) in heart failure? Select all that apply. 1 Ventricular dilation 2 Ventricular hypertrophy 3 Production of endothelin 4 Release of renin by the kidneys 5 Activation of the sympathetic nervous system (SNS)
1 Ventricular dilation 2 Ventricular hypertrophy 5 Activation of the sympathetic nervous system (SNS)
Increased contraction as a result of dilation initially leads to increased CO and maintenance of BP and perfusion. The increased contractile power of the heart’s muscle fibers as a result of hypertrophy initially leads to an increase in CO and maintenance of tissue perfusion. The SNS responds by releasing catecholamines (epinephrine and norepinephrine), which enhance peripheral vasoconstriction and cause an increase in the heart rate and myocardial contractility. Initially, this compensatory mechanism is beneficial, with a result of increased CO. Endothelin is a potent vasoconstrictor; it contributes to the development of heart failure. The release of renin by the kidneys starts a cascade of events, which results in further water and sodium retention in an already-overloaded state.
A patient is diagnosed with heart failure. Which factors may influence the patient's cardiac output (CO)? Select all that apply. 1 Stroke volume 2 Portal pressure 3 Respiratory rate 4 Ventricular filling 5 Myocardial contractility
1 Stroke volume 4 Ventricular filling 5 Myocardial contractility
CO depends on various factors, such as stroke volume, filling of the ventricles, and myocardial contractility. Stroke volume × heart rate = CO. Decreased filling of the ventricles decreases CO. Impaired myocardial contractility decreases CO. Respiratory rate and portal pressure do not alter CO.
Which items in a patient’s medical history are risk factors for heart failure (HF)? Select all that apply. 1 Cirrhosis 2 Hypertension 3 Multiple sclerosis 4 Marfan's syndrome 5 Metabolic syndrome
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Hypertension
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Metabolic syndrome
Hypertension and coronary artery disease (CAD) are the primary risk factors for HF. Other co-morbidities, such as diabetes, metabolic syndrome, advanced age, tobacco use, and vascular disease, contribute to the risk of the development of HF. Cirrhosis, multiple sclerosis, and Marfan’s syndrome are not precipitating causes of HF.
Which area of the body would best show accumulation of edema in a patient with heart failure (HF) who spends most of the time in bed? 1 Feet 2 Lungs 3 Sacrum 4 Abdomen
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Sacrum
In patients with HF who spend a great deal of time in bed, it would be important to assess the sacral area for edema. Edema related to HF may also be found in the feet, lungs, and abdomen. But in this patient, given the history of bed rest, the sacrum will be the most accurate area to assess.
A patient is diagnosed with left-sided heart failure. Which assessment finding would the nurse expect? 1 Orthopnea 2 Low BP 3 Pulsating neck veins 4 Edema in the lower extremities
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Orthopnea
Orthopnea, difficulty breathing except when sitting or standing, is a symptom of advanced heart failure, especially left-sided failure. When the heart fails as a pump, blood backs up into the lungs, causing fluid to leak from the alveolar membrane. As this process continues, pulmonary edema may develop. Patients may experience hypotension or hypertension, depending on the severity of the disease. Pulsating neck veins and edema in the lower extremities are characteristics of right-sided heart failure.
Which assessment finding is consistent with right-sided heart failure (HF)? 1 Jugular venous distention (JVD) 2 Presence of S3 and S4 heart sounds 3 Paroxysmal nocturnal dyspnea (PND) 4 Displacement of the point of maximal impulse (PMI)
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Jugular venous distention (JVD)
JVD is a sign of right-sided HF. Presence of S3 and S4 heart sounds, PND, and displacement of the PMI are all signs/symptoms of left-sided HF.
Paroxysmal nocturnal dyspnea is indicative of which more serious problem? 1 Chronic obstructive pulmonary disease (COPD) 2 Asthma 3 Bronchitis 4 Heart failure
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Heart failure
A classic symptom of left-sided heart failure is paroxysmal nocturnal dyspnea, which awakens the patient after several hours of sleep. Although a patient with COPD, asthma, or bronchitis may experience shortness of breath, these symptoms do not usually manifest while the patient is sleeping.
Which condition causes the symptoms of right-sided heart failure? 1 Decreased preload 2 Increased cardiac output 3 Fluid congestion in the lungs 4 Systemic venous congestion
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Systemic venous congestion
The symptoms of right-sided heart failure are caused by the backup of blood into the venous system. Preload in right-sided heart failure is increased. Cardiac output is decreased in right-sided heart failure. Fluid congestion in the lungs is a symptom of left-sided heart failure
