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Questions and Answers

A patient with heart failure is prescribed an ACE inhibitor. What is the primary mechanism by which this medication benefits the patient?

  • Blocking the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion. (correct)
  • Increasing the heart rate to compensate for reduced stroke volume.
  • Promoting sodium and water retention to increase preload.
  • Enhancing myocardial contractility to increase cardiac output directly.

A patient diagnosed with heart failure exhibits Cheyne-Stokes respirations. Which underlying compensatory mechanism is most likely contributing to this breathing pattern?

  • Impaired gas exchange due to pulmonary edema and reduced lung compliance. (correct)
  • Increased sympathetic nervous system activity leading to pulmonary vasoconstriction.
  • Activation of the renin-angiotensin-aldosterone system causing fluid overload.
  • Myocardial hypertrophy resulting in diastolic dysfunction and reduced cardiac output.

In a patient with acute decompensated heart failure who is volume overloaded, which of the following hemodynamic changes would warrant cautious administration of a loop diuretic?

  • Elevated pulmonary capillary wedge pressure (PCWP) and decreased cardiac output.
  • Elevated PCWP and decreased SVR.
  • Normal PCWP and increased systemic vascular resistance (SVR).
  • Low PCWP and elevated SVR. (correct)

A patient with heart failure has developed atrial fibrillation with rapid ventricular response. Which combination of medications is most appropriate to control both the rate and rhythm, considering the patient's underlying condition?

<p>Metoprolol and amiodarone. (B)</p> Signup and view all the answers

A patient with chronic heart failure is being transitioned from intravenous diuretics to oral medication before discharge. What key teaching point should the nurse emphasize regarding self-monitoring to detect early signs of worsening heart failure?

<p>Weigh yourself daily and report any weight gain of 3 pounds or more in 2 days. (C)</p> Signup and view all the answers

What is the underlying mechanism by which the Frank-Starling law of the heart contributes to compensatory mechanisms in heart failure?

<p>Increased preload enhances the force of ventricular contraction to a point, improving cardiac output. (B)</p> Signup and view all the answers

A patient with a history of hypertension and left ventricular hypertrophy is diagnosed with heart failure with preserved ejection fraction (HFpEF). What pathophysiological characteristic is primarily responsible for this condition?

<p>Impaired ventricular relaxation and increased stiffness leading to diastolic dysfunction. (C)</p> Signup and view all the answers

Which compensatory mechanism in heart failure is most directly associated with increased myocardial oxygen demand and potential for ischemia?

<p>Sympathetic nervous system stimulation. (C)</p> Signup and view all the answers

A patient with heart failure is prescribed spironolactone. What is the most critical electrolyte imbalance the nurse should monitor for, and what signs and symptoms might indicate its presence?

<p>Hyperkalemia; muscle cramps, peaked T waves, and cardiac arrest. (C)</p> Signup and view all the answers

What is the primary rationale for restricting sodium intake in patients with heart failure?

<p>To minimize fluid retention and reduce preload. (C)</p> Signup and view all the answers

During an assessment, a nurse auscultates an S3 heart sound in a patient with dilated cardiomyopathy. What is the most likely mechanism producing this sound?

<p>Sudden deceleration of blood entering a noncompliant ventricle during early diastole. (B)</p> Signup and view all the answers

A patient with worsening dyspnea is suspected of having acute pulmonary edema. Which diagnostic finding would most strongly support this diagnosis?

<p>Increased B-type natriuretic peptide (BNP). (B)</p> Signup and view all the answers

A patient with severe heart failure is being considered for cardiac resynchronization therapy (CRT). What are the key criteria for determining the appropriateness of this intervention?

<p>LVEF less than 35%, NYHA class II or III symptoms, and QRS duration of 120 ms or greater. (B)</p> Signup and view all the answers

In managing a patient with acute decompensated heart failure, when is the use of a vasodilator such as nitroglycerin contraindicated or require extreme caution?

<p>When the patient has symptomatic hypotension or severe aortic stenosis. (B)</p> Signup and view all the answers

What long-term adverse effect is most concerning with chronic use of high-dose loop diuretics in patients with heart failure?

<p>Ototoxicity. (A)</p> Signup and view all the answers

Which beneficial counterregulatory mechanism offsets the effects of the Renin-Angiotensin-Aldosterone System in heart failure?

<p>Release of natriuretic peptides promoting vasodilation and diuresis. (D)</p> Signup and view all the answers

What is the primary goal of using an intra-aortic balloon pump (IABP) in a patient with acute decompensated heart failure?

<p>To decrease afterload and improve coronary artery perfusion. (D)</p> Signup and view all the answers

What is the underlying pathophysiology of pulsus paradoxus in cardiac tamponade, a complication of pericardial effusion?

<p>Decreased systolic blood pressure during inspiration due to impaired ventricular filling. (B)</p> Signup and view all the answers

What is the most life-threatening potential complication of performing a pericardiocentesis to treat cardiac tamponade?

<p>Myocardial or coronary artery laceration. (B)</p> Signup and view all the answers

A patient diagnosed with constrictive pericarditis is likely to exhibit which of the following cardiovascular findings?

<p>Kussmaul’s sign (increase in jugular venous pressure with inspiration). (A)</p> Signup and view all the answers

Following a viral infection, a patient develops acute myocarditis leading to dilated cardiomyopathy. What cellular mechanism is most likely contributing to the myocardial damage?

<p>Autoimmune response causing activation of cytotoxic $\text{T}$ cells and destruction of myocytes. (A)</p> Signup and view all the answers

A patient with confirmed acute myocarditis suddenly develops signs of heart failure. Which intervention is most crucial to prevent further cardiovascular decompensation?

<p>Enforcing strict bed rest to reduce myocardial workload. (A)</p> Signup and view all the answers

A patient with infective endocarditis develops splinter hemorrhages and Osler's nodes. What pathophysiological event is most directly responsible for these clinical manifestations?

<p>Immune complex deposition causing vasculitis and microemboli. (D)</p> Signup and view all the answers

A patient with a prosthetic heart valve is undergoing a dental procedure. Which guideline should the nurse follow regarding antibiotic prophylaxis to prevent infective endocarditis?

<p>Administer antibiotics only if the dental procedure involves manipulation of gingival tissue or perforation of the oral mucosa. (A)</p> Signup and view all the answers

A patient is diagnosed with infective endocarditis involving the mitral valve. For which potential embolic event should the nurse monitor most closely?

<p>Stroke. (B)</p> Signup and view all the answers

What is the primary rationale for obtaining multiple blood cultures over a short period when diagnosing infective endocarditis?

<p>To increase the likelihood of identifying intermittent bacteremia. (D)</p> Signup and view all the answers

Which of the following assessment findings would be most concerning in a patient with infective endocarditis?

<p>New onset of a loud heart murmur. (D)</p> Signup and view all the answers

A patient with a history of rheumatic fever presents with shortness of breath and fatigue. An echocardiogram reveals mitral stenosis. What is the pathophysiological mechanism related to murmur development?

<p>Impaired left ventricular filling due to narrowing of the mitral valve orifice. (B)</p> Signup and view all the answers

A patient has had rheumatic fever. Which of the following long-term prophylactic measures is most important for a patient with a history of rheumatic fever?

<p>Prophylactic antibiotic administration to prevent recurrent streptococcal infections. (B)</p> Signup and view all the answers

A patient with a history of rheumatic heart disease develops atrial fibrillation. What is the priority nursing intervention related to this new dysrhythmia?

<p>Initiating anticoagulation therapy to prevent thromboembolic complications. (B)</p> Signup and view all the answers

A patient with acute rheumatic fever exhibits Sydenham's chorea. What is the most important nursing consideration?

<p>Providing a quiet environment and protecting the patient from injury. (A)</p> Signup and view all the answers

A patient with acute pericarditis develops muffled heart sounds, jugular venous distension, and hypotension. What potentially life-threatening complication should the nurse suspect?

<p>Cardiac tamponade. (C)</p> Signup and view all the answers

What is the underlying mechanism explaining the relief of chest pain associated with pericarditis when a patient sits up and leans forward?

<p>Reduced friction between the inflamed pericardial layers. (C)</p> Signup and view all the answers

A patient is diagnosed with acute pericarditis secondary to a viral infection. What is the primary goal of nursing care related to pain management?

<p>Administering NSAIDs and positioning the patient for comfort. (C)</p> Signup and view all the answers

A patient with heart failure is being evaluated using echocardiography. Which finding would be most indicative of systolic heart failure (HFrEF)?

<p>Left ventricular ejection fraction (LVEF) less than 40% (D)</p> Signup and view all the answers

A patient with a history of hypertension is diagnosed with heart failure with preserved ejection fraction (HFpEF). Which pathophysiological mechanism is the primary contributor to the development of HFpEF in this patient?

<p>Impaired ventricular relaxation and increased stiffness of the left ventricle (C)</p> Signup and view all the answers

A patient with heart failure demonstrates Cheyne-Stokes respirations. Which underlying compensatory mechanism is most likely contributing to this breathing pattern?

<p>Prolonged circulation time between the lungs and the brainstem (B)</p> Signup and view all the answers

A patient with a history of heart failure is prescribed spironolactone. What is the most critical electrolyte imbalance the nurse should monitor for, and what signs and symptoms might indicate its presence?

<p>Hyperkalemia; muscle weakness, paresthesias, and peaked T waves on ECG (B)</p> Signup and view all the answers

A patient with acute pericarditis is being treated with NSAIDs and colchicine. Which statement best explains the rationale for using colchicine in addition to NSAIDs in this patient?

<p>To inhibit neutrophil migration and reduce recurrent pericarditis (D)</p> Signup and view all the answers

Flashcards

Heart Failure

A complex clinical syndrome where the heart cannot provide enough blood to meet the body's needs.

Heart Failure Prevalence

Impacts 6.2 million Americans and that number is expected to rise to 8.5 million by 2030.

Hypertension can cause HF.

Long term aggressive treatment can reduce HF by 50%.

Starling's Law of the Heart

Strength of ventricular contraction increases when the ventricle is stretched before contraction.

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Systole

Ventricular contraction; myocardial fibers are tightening and shortening.

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Diastole

Muscle fibers lengthen, the heart dilates, and cavities fill with blood.

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Stroke Volume

Amount of blood ejected from the ventricle with each contraction.

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Cardiac Output

Amount of blood pumped by the ventricle in one minute.

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Preload

Venous blood return to atria and filling pressure of right and left side of heart.

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Afterload

The resistance that the ventricle must generate to open the pulmonary or aortic valves.

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Contractility (Inotropy)

The force of ventricular ejection.

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Ejection Fraction

Amount of blood pumped out of the ventricle with each heartbeat divided by the amount of blood present in the ventricle just prior to systole.

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Systolic Heart Failure

Systolic heart failure has a reduced ejection fraction (EF).

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Diastolic Heart Failure

Diastolic heart failure has a preserved ejection fraction (EF).

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Left Ventricular Failure

Either systolic, diastolic, or both (combined).

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Acute Decompensated Heart Failure

Volume overload becomes life-threatening, severe pulmonary edema develops.

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Renin-Angiotensin-Aldosterone System

Renin, angiotensin, and aldosterone release which increase Na+ and water retention.

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Sympathetic Nervous System (SNS)

Catecholamines increase HR, contractility, and peripheral vasoconstriction.

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Hypertrophy

Muscle mass and cardiac wall thickness increase. Concentric Hypertrophy.

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Dilation

Attempt to adapt to increase in circulating volume. Eccentric Hypertrophy.

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Ventricular Remodeling

Change in the structure of the heart over time (dimensions/mass/shape).

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Natriuretic Peptides

These hormones counteract the SNS and RAAS effects.

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Nitric Oxide & Prostaglandins

These molecules lead to vasodilation and decrease afterload.

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Inotropes

modify the force of contraction either + or –.

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Beta Blockers

Blocks SNS.

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Vasodilators

Act on smooth muscle wall to open capillary beds.

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Diuretics

Decreases circulating volume.

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SGLT-2 Inhibitors

Drugs that cause osmotic diuresis by increasing urine glucose concentrations.

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ACE Inhibitors

These drugs stop the conversion of angiotensin I to II.

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ARB's

Block angiotensin II at the receptor site.

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Neprilysin-angiotensin inhibitors

These drugs block degradation of natriuretic peptides and blocks RASS.

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ACCF/AHA Stage A

At high risk for HF, but no heart disease or symptoms.

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ACCF/AHA Stage B

Heart disease is present but there are no signs or symptoms.

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ACCF/AHA Stage C

Heart disease is present with prior or current symptoms.

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ACCF/AHA Stage D

Advanced heart disease with continued HF requiring specialized therapy.

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NYHA Class I

No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF.

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NYHA Class II

Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF.

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NYHA Class III

Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of HF.

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NYHA Class IV

Inability to carry out any physical activity without discomfort. Symptoms may be present at rest.

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Interprofessional Care

O2 therapy, Bedrest, diet restrictions, daily weights.

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Worsening S/S of Heart Failure

HF leads to persistent productive cough.

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Infective Endocarditis.

Infection of the endocardium & therefore of the cardiac valves

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Layers of the heart

The layers of the heart form outter to inner.

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Rheumatic Fever: Criteria

Joints, erythema marginatum, subcutaneous nodules.

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