NRSG 502 – Pathophysiology Exam 3 (Ch. 27, 22, 23, 24, 40, 41), Graduate Nursing Course,
Comprehensive Study Guide and System-Based Review
Assessment of an older adult client reveals bilateral pitting edema of the client's feet and
ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation
level of 93% (0.93); and vital signs normal. What is this client's most likely health problem?
right-sided heart failure
pericarditis
cardiogenic shock
cor pulmonale - correct answer ✔✔right-sided heart failure
A major effect of right-sided heart failure is the development of peripheral edema. A client who
is in shock would not have stable vital signs. Cor pulmonale would be accompanied by
manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by
fever, precordial pain, dyspnea, and palpitations.
A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted
in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for
this child?
Cardiac catheterization and corticosteroid therapy
Implanted pacemaker and beta-adrenergic blockers (beta-blockers)
Antibiotics and anti-inflammatory drugs
Pain control and oxygen therapy - correct answer ✔✔Antibiotics and anti-inflammatory drugs
A diagnosis of rheumatic fever (RF) necessitates the use of antibiotics (usually penicillin) and
anti-inflammatory drugs. These measures supersede the importance of pain control and oxygen
therapy. Cardiac catheterization, corticosteroid therapy, pacemakers, and beta-adrenergic
blockers are not common treatment modalities for RF.
,A client is seen in the emergency room reporting 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?
Myocardial infarction
Abdominal aortic aneurysm
Pericarditis
Pneumonia - correct answer ✔✔Pericarditis
This client 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.
A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will
not respond to medications. The physicians suggest placing the client on a ventricular assist
device (VAD). The client asks what this equipment will do. The health care providers respond:
"Pull your blood from the right side of the heart and run it through a machine to oxygenate it
better, and then return it to your body."
"Measure the pressures inside your heart continuously to asses pumping ability of your left
ventricle."
"Have a probe at the end of a catheter to obtain thermodilution measures, so cardiac output
can be calculated."
"This device will decrease the workload of the myocardium while maintaining cardiac output
and systemic arterial pressure." - correct answer ✔✔"This device will decrease the workload of
the myocardium while maintaining cardiac output and systemic arterial pressure."
,Refractory heart failure reflects deterioration in cardiac function that is unresponsive to medical
or surgical interventions. Ventricular assist devices (VADs) are mechanical pumps used to
support ventricular function. VADs are used to decrease the workload of the myocardium while
maintaining cardiac output and systemic arterial pressure. This decreases the workload on the
ventricle and allows it to rest and recover. The rest of the distractors relate to the monitoring in
an ICU of cardiac functioning. Invasive hemodynamic monitoring may be used for assessment in
acute, life-threatening episodes of heart failure. With the balloon inflated, the catheter
monitors pulmonary capillary pressures (i.e., pulmonary capillary wedge pressure or pulmonary
artery occlusion pressure), which reflect pressures from the left ventricle. The pulmonary
capillary pressures provide a means of assessing the pumping ability of the left ventricle. One
type of pulmonary artery catheter is equipped with a thermistor probe to obtain thermodilution
measurements of cardiac output.
A 17-year-old athlete died suddenly during a track meet and it was subsequently determined
that he had heart disease. Which condition was the most likely cause of his heart failure?
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Mitral valve prolapse
Atrial regurgitation - correct answer ✔✔Hypertrophic cardiomyopathy
HCM is an autosomal dominant heart disease caused by mutations in the genes encoding
proteins of the cardiac sarcomere. HCM is the most common cause of sudden cardiac death
(SCD) in young athletes. Dilated cardiomyopathy, mitral valve prolapse, and atrial regurgitation
all lead to heart failure but much later in life.
A nurse is performing client health education with a 68-year-old man who has recently been
diagnosed with heart failure. Which statement demonstrates an accurate understanding of his
new diagnosis?
"I'll be sure to take my beta-blocker whenever I feel short of breath."
, "I'm going to avoid as much physical activity as I can so that I preserve my strength."
"I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on."
"I'm trying to think of ways that I can cut down the amount of salt that I usually eat." - correct
answer ✔✔"I'm trying to think of ways that I can cut down the amount of salt that I usually
eat."
Salt and fluid restrictions are indicated for most clients with heart failure (HF). Beta-blockers do
not address shortness of breath, and cardiac medications are not normally taken in response to
acute symptoms. Clients should be encouraged to maintain—and increase, if possible—physical
activity within the limits of their condition.
A 20-year-old college student being treated for a kidney infection developed a temperature of
104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was
low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is
experiencing which type of shock?
Septic
Neurogenic
Cardiogenic
Anaphylactic - correct answer ✔✔Septic
Septic shock can result with the body's response to a severe infection. Neurogenic shock is a
loss of sympathetic (adrenergic) control of systemic blood vessel tone. Cardiogenic shock is a
loss of cardiac efficiency, and anaphylactic shock is a severe allergic reaction.
A client is transported to the emergency department in respiratory distress after eating peanuts.
The following interventions are ordered by the health care provider. Which intervention should
the nurse complete first?
Start a normal saline infusion.
Comprehensive Study Guide and System-Based Review
Assessment of an older adult client reveals bilateral pitting edema of the client's feet and
ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation
level of 93% (0.93); and vital signs normal. What is this client's most likely health problem?
right-sided heart failure
pericarditis
cardiogenic shock
cor pulmonale - correct answer ✔✔right-sided heart failure
A major effect of right-sided heart failure is the development of peripheral edema. A client who
is in shock would not have stable vital signs. Cor pulmonale would be accompanied by
manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by
fever, precordial pain, dyspnea, and palpitations.
A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted
in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for
this child?
Cardiac catheterization and corticosteroid therapy
Implanted pacemaker and beta-adrenergic blockers (beta-blockers)
Antibiotics and anti-inflammatory drugs
Pain control and oxygen therapy - correct answer ✔✔Antibiotics and anti-inflammatory drugs
A diagnosis of rheumatic fever (RF) necessitates the use of antibiotics (usually penicillin) and
anti-inflammatory drugs. These measures supersede the importance of pain control and oxygen
therapy. Cardiac catheterization, corticosteroid therapy, pacemakers, and beta-adrenergic
blockers are not common treatment modalities for RF.
,A client is seen in the emergency room reporting 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?
Myocardial infarction
Abdominal aortic aneurysm
Pericarditis
Pneumonia - correct answer ✔✔Pericarditis
This client 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.
A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will
not respond to medications. The physicians suggest placing the client on a ventricular assist
device (VAD). The client asks what this equipment will do. The health care providers respond:
"Pull your blood from the right side of the heart and run it through a machine to oxygenate it
better, and then return it to your body."
"Measure the pressures inside your heart continuously to asses pumping ability of your left
ventricle."
"Have a probe at the end of a catheter to obtain thermodilution measures, so cardiac output
can be calculated."
"This device will decrease the workload of the myocardium while maintaining cardiac output
and systemic arterial pressure." - correct answer ✔✔"This device will decrease the workload of
the myocardium while maintaining cardiac output and systemic arterial pressure."
,Refractory heart failure reflects deterioration in cardiac function that is unresponsive to medical
or surgical interventions. Ventricular assist devices (VADs) are mechanical pumps used to
support ventricular function. VADs are used to decrease the workload of the myocardium while
maintaining cardiac output and systemic arterial pressure. This decreases the workload on the
ventricle and allows it to rest and recover. The rest of the distractors relate to the monitoring in
an ICU of cardiac functioning. Invasive hemodynamic monitoring may be used for assessment in
acute, life-threatening episodes of heart failure. With the balloon inflated, the catheter
monitors pulmonary capillary pressures (i.e., pulmonary capillary wedge pressure or pulmonary
artery occlusion pressure), which reflect pressures from the left ventricle. The pulmonary
capillary pressures provide a means of assessing the pumping ability of the left ventricle. One
type of pulmonary artery catheter is equipped with a thermistor probe to obtain thermodilution
measurements of cardiac output.
A 17-year-old athlete died suddenly during a track meet and it was subsequently determined
that he had heart disease. Which condition was the most likely cause of his heart failure?
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Mitral valve prolapse
Atrial regurgitation - correct answer ✔✔Hypertrophic cardiomyopathy
HCM is an autosomal dominant heart disease caused by mutations in the genes encoding
proteins of the cardiac sarcomere. HCM is the most common cause of sudden cardiac death
(SCD) in young athletes. Dilated cardiomyopathy, mitral valve prolapse, and atrial regurgitation
all lead to heart failure but much later in life.
A nurse is performing client health education with a 68-year-old man who has recently been
diagnosed with heart failure. Which statement demonstrates an accurate understanding of his
new diagnosis?
"I'll be sure to take my beta-blocker whenever I feel short of breath."
, "I'm going to avoid as much physical activity as I can so that I preserve my strength."
"I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on."
"I'm trying to think of ways that I can cut down the amount of salt that I usually eat." - correct
answer ✔✔"I'm trying to think of ways that I can cut down the amount of salt that I usually
eat."
Salt and fluid restrictions are indicated for most clients with heart failure (HF). Beta-blockers do
not address shortness of breath, and cardiac medications are not normally taken in response to
acute symptoms. Clients should be encouraged to maintain—and increase, if possible—physical
activity within the limits of their condition.
A 20-year-old college student being treated for a kidney infection developed a temperature of
104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was
low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is
experiencing which type of shock?
Septic
Neurogenic
Cardiogenic
Anaphylactic - correct answer ✔✔Septic
Septic shock can result with the body's response to a severe infection. Neurogenic shock is a
loss of sympathetic (adrenergic) control of systemic blood vessel tone. Cardiogenic shock is a
loss of cardiac efficiency, and anaphylactic shock is a severe allergic reaction.
A client is transported to the emergency department in respiratory distress after eating peanuts.
The following interventions are ordered by the health care provider. Which intervention should
the nurse complete first?
Start a normal saline infusion.
