Chapter 34- Heart Failure and Circulatory Shock
Chapter 34- Heart Failure and Circulatory Shock
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Chapter 34- Heart Failure and Circulatory Shock
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? | |
| A) | His resting blood pressure is normally in the range of 150/90, and an echocardiogram indicates his ejection fraction is 30%. | |
| B) | His end-diastolic volume is higher than normal, and his resting heart rate is regular and 82 beats/minute. | |
| C) | He is presently volume overloaded following several days of intravenous fluid replacement. | |
| D) | Ventricular dilation and wall tension are significantly lower than normal. | |
| Ans: | D | |
| Feedback: | ||
| Systolic dysfunction is associated with increased ventricular dilation and wall tension. Hypertension, low ejection fraction, high preload, and volume overload are all commonly associated with systolic dysfunction. | ||
| 2. | 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 | |
| A) | has a distended bladder, facial edema, and nighttime difficulty breathing. | |
| B) | complains of dyspnea and has adventitious breath sounds on auscultation (listening). | |
| C) | has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. | |
| D) | has cyanotic lips and extremities, low urine output, and low blood pressure. | |
| Ans: | C | |
| Feedback: | ||
| Right-sided failure is associated with peripheral edema, fatigue, and, on occasion, upper right quadrant pain. Abdominal distention can occur with right-sided failure when the liver becomes engorge. Facial edema, pulmonary edema, peripheral cyanosis, low urine output, and low blood pressure are less associated with right-sided failure. Left-sided failure is primarily associated with pulmonary signs and symptoms like dyspnea, pulmonary edema, frothy pink sputum, and respiratory congestion. | ||
| 3. | An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure? | |
| A) | An increase in preload via the Frank-Starling mechanism | |
| B) | Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine | |
| C) | Activation of the renin–angiotensin–aldosterone system and secretion of brain natriuretic peptide (BNP) | |
| D) | AV node pacemaking activity and vagal nerve suppression | |
| Ans: | D | |
| Feedback: | ||
| Reassignment of cardiac pacemaking activities and suppression of the vagal nerve are not noted compensatory actions related to heart failure. Increased preload and sympathetic stimulation, increased levels of epinephrine and norepinephrine, and activation of the renin–angiotensin–aldosterone system and secretion of brain natriuretic peptide (BNP) are all noted compensatory mechanisms. | ||
| 4. | The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? | |
| A) | Chest pain and intermittent ventricular tachycardia | |
| B) | Dyspnea and crackles in bilateral lung bases | |
| C) | Petechia and spontaneous bleeding | |
| D) | Muscle cramping and cyanosis in the feet | |
| Ans: | B | |
| Feedback: | ||
| Although it may preserve the resting cardiac output, the resulting chronic elevation of left ventricular end-diastolic pressure is transmitted to the atria and the pulmonary circulation, causing pulmonary congestion. | ||
| 5. | A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of “impending doom.” Based on pathophysiologic principles, the nurse knows the rapid heart rate could | |
| A) | decrease renal perfusion and result in the development of ascites. | |
| B) | be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. | |
| C) | desensitize the a-adrenergic receptors leading to increase in norepinephrine levels. | |
| D) | prolong the electrical firing from the SA node resulting in the development of a heart block. | |
| Ans: | B | |
| Feedback: | ||
| An increase in sympathetic activity by stimulation of the b-adrenergic receptors of the heart leads to tachycardia, vasoconstriction, and arrhythmias. Acutely, tachycardia significantly increases the workload of the heart, thus increasing myocardial O2 demand and leading to cardiac ischemia, myocyte damage, and decreased contractility. Decreased renal perfusion would activate the RAA system, increasing heart rate and BP further. Ventricular arrhythmias are primarily seen at this stage of HF. | ||
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