HEART FAILURE NCLEX STYLE EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 HEART FAILURE NCLEX STYLE EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ The nurse is performing an assessment on a 57-year-old client with newly diagnosed heart failure. The product of which factors determine a client's cardiac output? Heart rate and ejection fraction Heart rate and urinary output Stroke volume and urinary output Stroke volume and heart rate Correct Answer: Stroke volume and heart rate A nurse is on orientation in the coronary care unit (CCU) and learning about the FrankStarling mechanism. Which statement by the nurse is correct? "The less the heart fills with blood, the stronger the force of cardiac contraction." "The more the heart fills with blood, the weaker the force of cardiac contraction." 2 "The Frank-Starling mechanism has no effect on the heart, only on the cardiac vessels." "The more the heart fills with blood, the stronger the force of cardiac contraction." Correct Answer: "The more the heart fills with blood, the stronger the force of cardiac contraction." A client recently admitted to the coronary care unit (CCU) with left heart failure complains of sudden dyspnea, anxiety, and feelings of "drowning." What is the most likely cause of these changes? Myocardial infarction Cardiogenic pulmonary edema Hyperglycemia Pulmonary embolism Correct Answer: Cardiogenic pulmonary edema The nurse is admitting a client to the coronary care unit (CCU) and is assessing risk factors for heart failure. What is the most concerning risk factor? 3 Body mass index (BMI) of 18.0 Influenza Blood pressure of 188/122 mm/Hg Total cholesterol of 184 mg/dL Correct Answer: Blood pressure of 188/122 mm/Hg A nurse is assessing a client and notices pitting edema in the lower legs. The client has a history of mild congestive heart failure (CHF), which is controlled with medication, and reports that the swelling has become worse lately. Which could the increased edema indicate? The client has increased physical activity. The client has not been compliant with medications. The client has been under stress. The client has a possible progression of CHF. Correct Answer: The client has a possible progression of CHF. 4 Rationale: Increased edema in a client with known congestive heart failure is common and can indicate a progression of the disease, as perfusion is further compromised. A client with increased edema may need medications adjusted or may need to have further lifestyle management. The nurse should encourage compliance and should stress the importance of avoiding foods and activities that could contribute to edema and decreased tissue perfusion. A nurse working in a community health center is developing an educational program for clients who are at risk for heart failure. Which modifiable risk factor should be included in this program? (Select all that apply.) Stress Gender Obesity Cigarette smoking Age Race Correct Answer: Stress 5 Obesity Cigarette smoking African Americans are more at risk for heart failure. What are the most important risk factors in this population? (Select all that apply.) Obesity Renal insufficiency Hypotension Hypertension Low levels of HDL Correct Answer: Obesity Renal insufficiency Hypertension 6 Low levels of HDL Rationale: Hypertension, renal insufficiency, obesity, and low levels of HDL (which increases risk of atherosclerosis) are all contributing risk factors for heart failure in the African-American population. Hypotension is not a risk factor for heart failure in any population. A client is learning about a low-sodium diet due to heart failure. Which food does the client select for lunch to demonstrate understanding of a low-sodium diet? Hot dog Ham Turkey breast Shrimp Correct Answer: Turkey Rationale: The best selection for the client is 3.5 ounces of turkey, as it contains between 63 and 76 mg of sodium. A client who has heart failure should not consume more than 2,000 mg of sodium per day. A 3.5-ounce piece of roasted ham contains 7 approximately 1,400 mg of sodium. A hot dog contains approximately 585 mg of sodium. Three ounces of shrimp contains 190 mg of sodium. An OB/GYN nurse is counseling women with heart failure about pregnancy and risk factors. The nurse recommends that the women prevent pregnancy. Which is the most important risk factor that contributes to this recommendation? Ejection fraction (EF) of 38% Blood pressure of 126/80 mmHg Previous miscarriages Cholesterol level of 220 mg/dL Correct Answer: Ejection fraction (EF) of 38% Rationale: A normal EF is 50-75%. An EF of less than 40% is a maternal risk factor for major cardiac complications. A blood pressure of 126/80 mmHg is within normal range. Previous miscarriages and a high cholesterol level of 220 mg/dL would not necessarily contraindicate pregnancy. An 86-year-old man visits the clinic and asks about risk factors for heart disease. Which modifiable risk factors would the nurse discuss with this client? (Select all that apply.) 8 Ethnicity Smoking Exercise Sex Nutrition Correct Answer: Smoking Exercise Nutrition A 68-year-old client is admitted to the coronary care unit with complaints of dyspnea at rest, orthopnea, weight gain, and inability to perform chores in the home due to severe weakness. According to the American Heart Association, what stage of heart failure does the nurse suspect? II 9 IV I III Correct Answer: IV Stage I (mild) heart failure is when the client has no limitations of physical activity and no shortness of breath with normal physical activity. A client with stage II (mild) heart failure has some physical limitations due to fatigue, shortness of breath, or palpitations; the client is comfortable at rest. In Stage III (moderate), a client has increased physical limitations with less than normal physical activity resulting in fatigue, shortness of breath, or palpitations; the client is comfortable at rest. Stage IV (severe) is the most debilitating and the client experiences symptoms of cardiac insufficiency at rest. A nurse is evaluating lab results on a 70-year-old client. The nurse notices an increased level of brain natriuretic peptide (BNP). What does this indicate? Increased left ventricular pressure Decreased vascular congestion Decreased gas exchange in lungs 10 Reduced cardiac workload Correct Answer: Increased left ventricular pressure Rationale: Brain natriuretic peptide (BNP) is a hormone released by the heart muscle in response to changes in heart muscle and has been shown to correlate with pressures in the left ventricle and the pulmonary vascular system. As heart failure worsens, BNP levels rise, and as the heart stabilizes, BNP levels decrease. Noting the trend of BNP levels provides information about cardiac output and the heart's pumping ability. BNP does not measure cardiac workload or gas exchange in the lungs. A client newly diagnosed with heart failure is prescribed digitalis, a positive inotropic drug. Which sign and symptom would the nurse instruct the client to report to the healthcare provider? (Select all that apply.) Confusion Weight loss Nausea Weight gain 11 Vision changes Correct Answer: Confusion Weight loss Nausea Vision changes Rationale: Digitalis increases the strength of myocardial contraction by increasing intracellular calcium concentrations. It also increases ventricular filling time by decreasing SA node automaticity and slowing the conduction time through the AV node. Since digitalis has a narrow therapeutic index, therapeutic levels are very close to toxic levels. Signs of digitalis toxicity include poor appetite, anorexia, nausea and vomiting, headache, altered vision, and confusion. Clients should be instructed to contact their healthcare provider if they experience any of these symptoms. Older adults are at a greater risk for digitalis toxicity than younger clients. A nurse is teaching a client about digitalis and dietary considerations. Which food should the nurse recommend? Bananas 12 Green leafy vegetables Potato chips Low-fat milk Correct Answer: Bananas Rationale: When taking digitalis, low potassium levels (hypokalemia) increase the risk of digitalis toxicity. Bananas are high in potassium, while low-fat milk, green leafy vegetables, and potato chips are low in potassium. Clients should be given a list of highpotassium foods, scheduled to have their digitalis levels checked frequently, and instructed to call with any symptoms of digitalis toxicity. A client is admitted to a medical unit with a diagnosis of congestive heart failure. The client's wife requests no physical therapy for the client because it "makes him tired." What is the nurse's most appropriate response? "Don't worry—our physical therapists will be careful." "That will only make him worse in the long run." "Moderate exercise is important to maintain his overall health." 13 "I'll make a note in the chart that he is refusing physical therapy." Correct Answer: "Moderate exercise is important to maintain his overall health." Rationale: Family members may worry if a client has activity intolerance. They may discourage any activity and try to do everything for the client. The nurse should provide information and support to families while encouraging as much activity for the client as tolerated. The family should be given encouraging information about optimizing heart function and perfusion, without being falsely reassured or have their concerns belittled. Assisting the client and family with activity tolerance optimizes perfusion and overall homeostasis. A nurse is implementing comfort measures for a client with class IV heart failure. What position is best for client comfort? Left lateral Supine Prone High-Fowler Correct Answer: High-Fowler 14 A nurse is caring for a client with stage IV heart failure. Which nursing diagnosis would be a priority? Cardiac Output, Decreased Knowledge, Deficient Activity Intolerance Fluid Volume: Excess Correct Answer: Fluid Volume: Excess Rationale: Compensatory mechanisms are activated in heart failure, specifically neuroendocrine responses. The cascade of decreased cardiac output and decreased renal perfusion stimulates the renin-angiotensin system, which stimulates the release of aldosterone from the adrenal cortex and ADH from the posterior pituitary. ANP and BNP are released and blood flow is redistributed to the heart and brain. As a result, there is salt and water retention by the kidneys and water excretion is inhibited, causing pulmonary congestion, renal vasoconstriction and decreased renal perfusion, and increased preload and afterload. According to Maslow's Hierarchy of Needs, oxygenation is the priority need for a client in stage IV heart failure, and therefore Fluid Volume: Excess is the priority diagnosis, since oxygenation is compromised with fluid overload in the lungs. The second one would be Cardiac Output, 15 Decreased, then Activity Intolerance and Knowledge, Deficient. (NANDA-I © 2014) A client with heart failure is prescribed an angiotensin-converting enzyme (ACE) inhibitor. What is the most important side effect that may interfere with compliance? Diarrhea Dry cough Rash Visual disturbances Correct Answer: Dry cough Rationale: Clients taking an ACE inhibitor may experience persistent dry cough. They may perceive this as annoying and stop the medication. It is important to advise them to continue with the medication and contact their healthcare provider. ACE inhibitors do not cause diarrhea, rash, or visual disturbances. 16 A client with heart failure is being discharged home with his wife. What is the priority goal for this client? To walk 5 miles per day To not gain more than 5 pounds in a week To consume a high-salt diet To lose 2 pounds every week Correct Answer: To not gain more than 5 pounds in a week Rationale: Clients with heart failure should be on a no-salt diet due to fluid retention. Walking 5 miles per day is not a safe or appropriate goal for a client with heart failure. Losing 2 pounds per week is not an appropriate goal, as the client could become fluid deficient. Gaining 2-3 pounds in 24 hours or 5 or more pounds in a week is not an appropriate goal for a client with heart failure and must be re-evaluated by a healthcare provider. A nurse receives a triage call from a client with newly diagnosed heart failure. Which statement indicates a worsening of the client's condition? "I've had two episodes of diarrhea this past week." 17 "I'm eating 6 small meals a day now." "I've gained 3 pounds in 24 hours." "I'm most comfortable sleeping with 2 pillows." Correct Answer: "I've gained 3 pounds in 24 hours." Rationale: Heart failure is a condition where the heart is unable to pump enough blood into circulation to meet the body's demands. When the heart is unable to eliminate extra fluid and wastes from the body, those fluids accumulate in the body, making the heart work harder. A weight gain of 3 pounds in 24 hours is approximately 1.3 liters of fluid and an indication of fluid volume retention. A client with heart failure would be expected to sleep with pillows to facilitate breathing. Two episodes of diarrhea in a week is not related to heart failure and not an indication of a worsening condition. Six small meals per day are encouraged to facilitate nutrition and consume energy. The nurse is performing an assessment on a 57-year-old client with newly diagnosed heart failure. The product of which factors determine a client's cardiac output? Heart rate and urinary output Stroke volume and heart rate 18 Stroke volume and urinary output Heart rate and ejection fraction Correct Answer: Stroke volume and heart rate Rationale: The correct formula for cardiac output (CO) is: CO = heart rate (HR) x stroke volume (SV). To increase blood circulation (CO), there needs to be an increased heart rate, increased stroke volume, or both. Stroke volume is the amount of blood exerted from the left ventricle per beat and can be altered by factors of preload, contractility, and afterload. A 56-year-old man with a history of coronary artery disease is admitted with reports of dyspnea and fatigue. Upon physical examination, the nurse auscultates crackles halfway up his lung fields. An echocardiogram reveals reduced cardiac output. Which response should the nurse provide to the patient when he asks why a heart problem makes it hard for him to breathe? "The right side of your heart is too weak to pump blood effectively, so the blood is backing up and congesting your lungs." "The left side of your heart is too weak to pump blood effectively, so the blood is backing up and congesting your lungs." 19 "The left side of your heart is too weak to pump enough blood to your lungs." "The right ventricle of your heart is not pumping properly." Correct Answer: "The left side of your heart is too weak to pump blood effectively, so the blood is backing up and congesting your lungs." A 75-year-old patient presents with high blood pressure, dyspnea on exertion, and a low tolerance from usual activity. The patient has lost 15 pounds since their last physical and states, "I just don't ever seem to feel like eating anymore." Which diagnosis should the nurse suspect for this patient? Heart failure Anorexia nervosa Deep vein thrombosis (DVT) Hypertension Correct Answer: Heart failure 20 The nurse asks a patient with heart failure about diet, level of activity (tolerance, dyspnea with exertion), episodes of paroxysmal nocturnal dyspnea, and recent weight gain or loss. The nurse also reviews current medications. Which question should the nurse ask to reveal relevant data not collected? "Do you live with anyone at home?" "Does your abdomen feel tender or firm when you push on it?" "What do you do for a living?" "Do you have a history of hypertension?" Correct Answer: "Do you have a history of hypertension?" The nurse is caring for a patient who presents with difficulty breathing and low blood pressure (BP). The patient is sweating excessively. The nurse suspects heart failure. Which patient is the nurse most likely caring for? A 25-year-old African American woman A 76-year-old man with type 2 diabetes A 55-year-old man with a history of hypertension 21 A 10-year-old girl with a poor appetite Correct Answer: A 10-year-old girl with a poor appetite Symptoms of heart failure in children present differently than in adults. Children may have difficulty breathing, excessive sweating, low BP, and poor feeding and growth. The other patients are adults and will present with various other symptoms, depending on the type of heart failure. The nurse is teaching a patient and their spouse about captopril, an angiotensinconverting enzyme (ACE) inhibitor medication. Which is the most important teaching point for this couple? Take captopril with an antacid. Take captopril 1 hour after meals. Take captopril with meals. Take captopril 1 hour before meals. Correct Answer: Take captopril 1 hour before meals. 22 Captopril (Capoten) should be taken 1 hour before meals to allow for full absorption of the medication into the body. It should be taken at the same time everyday and not with food or antacids, which can affect the absorption process. A patient reports dizziness, fatigue, and decreased exercise tolerance. Based on the reported symptoms, the nurse anticipates that the healthcare provider will diagnose the patient as having which classification of heart failure? Systolic Right-sided Diastolic Left-sided Correct Answer: Left-sided Fatigue, dizziness, and decreased exercise tolerance indicate left-sided heart failure. Diastolic, systolic, and right-sided heart failure present with different signs and symptoms. The nurse is explaining the phases of cardiac rehabilitation to a patient being prepared for discharge. 23 What is a goal of phase 2 for the patient? Progress from bedrest to ambulation. Perform independent exercises. Bathe independently. Improve psychosocial status. Correct Answer: Improve psychosocial status. Phase 2 of cardiac rehabilitation is characterized by increased activity, improvement of psychosocial status, and treatment of anxiety. Phase 1 has the patient moving from bedrest to providing self-care. An example of this is performing bathing without assistance. In phase 3, the patient is progressing independently in an exercise routine at home. The nurse is providing care to a patient diagnosed with heart failure. Which intervention is not necessary when monitoring the patient's fluid volume? Weighing the patient daily Auscultating lung sounds every 4 hours 24 Allowing for rest periods Monitoring intake and output Correct Answer: Allowing for rest periods A patient with suspected heart failure is being assessed by the nurse. Which set of clinical manifestations indicate that the patient is presenting with left-sided failure? Edema of the feet and legs, anorexia, and nausea Right upper quadrant pain, weakness, nausea, and vomiting Fatigue, dizziness, shortness of breath, and cough Distended veins of the neck and edema of lower limbs Correct Answer: Fatigue, dizziness, shortness of breath, and cough Common clinical manifestations of left-sided heart failure include fatigue, dizziness, shortness of breath, and cough. A patient presenting with symptoms such as anorexia, nausea, right upper quadrant pain, edema of the legs and feet, and distended veins of the neck is showing manifestations consistent with right-sided heart failure. 25 The nurse is teaching a patient who was recently diagnosed with heart failure about the need for a low-sodium diet. Which amount is the sodium limit that would be appropriate for this patient? 3.5—4 g/day 0.5—1 g/day 2.5—3 g/day 1.5—2 g/day Correct Answer: 1.5—2 g/day A patient who is treated at a clinic for low-income and at-risk adults reveals that they use alcohol every day and have been smoking and insufflating cocaine for the past 15 years. The patient reports feeling short of breath recently and states they have been feeling nauseated more frequently than not and, as a result, have not been eating much. With the goal of decreasing risk factors for heart failure, what is the nurse's priority intervention when discussing next steps with the patient? Telling the patient that they should quit using cocaine immediately 26 Advising that the patient participate in a program that offers financial assistance for nutritious food Providing information about rehabilitation and outpatient counseling for substance abuse Suggesting that the patient try to gain access to a health insurance plan with greater coverage so they can have regular medical care Correct Answer: Providing information about rehabilitation and outpatient counseling for substance abuse Which nursing intervention is most appropriate to meet the goal of preserving cardiac output in the patient with heart failure? Place the patient in the high Fowler position. Explain all procedures and tests. Maintain oxygenation of 90% or better. Measure and record intake and output. Correct Answer: Measure and record intake and output. 27 The nurse will measure and record intake and output to monitor the perfusion to the renal system, assessing cardiac output. The nurse will place the patient in shock position, a supine position with the legs elevated to approximately 20 degrees, the abdomen flat, and the head and shoulders elevated higher than the chest (approximately 10 degrees). The nurse will maintain the patient oxygenation of 94% or greater. The nurse will explain all tests and procedures; however, this is more focused on relieving patient anxiety, not preserving cardiac output. Which invasive method monitors blood volume and venous return? Pulmonary artery pressure Arterial blood gas Central venous pressure (CVP) Intra-arterial pressure Correct Answer: Central venous pressure (CVP) A 57-year-old man reports sudden shortness of breath and is producing pink, frothy sputum. Upon physical examination, the nurse notices that his breathing is labored and 28 his respiratory rate is 38 breaths/min. Upon auscultating his chest, the nurse hears fine crackles and faint wheezes throughout his lung fields. Which finding explains the patient's physical assessment findings? Hepatic engorgement Decreased pulmonary hydrostatic pressure Increased myocardial contractility Pulmonary edema Correct Answer: Pulmonary edema A patient with heart failure has weakened ventricular contractions and decreased cardiac output. The nurse should anticipate an order for which medication to improve cardiac contractility? Positive inotropic Loop diuretic Nitrate 29 Alpha blocker Correct Answer: Positive inotropic The nurse is caring for a 43-year-old mother of two sons. The patient and her partner want to conceive another child; however, the patient has had complicated pregnancies before and has recently been showing significant symptoms related to heart failure. Which is the most appropriate statement by the nurse in response to the patient and her partner regarding their plan to conceive a third child? "You may want to consider other options, such as adoption or surrogacy. Your symptoms indicate that you are in stage I heart failure right now, and, unfortunately, pregnancy is contraindicated in patients like you." "You had difficulties with your two previous pregnancies, which means you are going to experience worsening symptoms during the next pregnancy. I would not want to have another pregnancy if I were you." "We need to monitor your status carefully. If you are showing signs of being in stage III or stage IV heart f Correct Answer: "We need to monitor your status carefully. If you are showing signs of being in stage III or stage IV heart failure, pregnancy is contraindicated and the medical team here will advise you against getting pregnant." 30 The nurse is caring for a patient who has been slowly showing signs of heart failure over the past year. The patient reports recently being very tired, having shortness of breath, being unable to walk their dog, and feeling palpitations. The patient says that they are able to sleep just fine. The nurse suspects the patient is in which stage of heart failure? IV I II III Correct Answer: II Fatigue, shortness of breath, physical limitations due to fatigue, and undisturbed sleep are all marks of stage II heart failure. Which patient is most likely to receive a diagnosis of heart failure? 31 A 34-year-old woman who is 3 weeks postpartum and is being seen by the healthcare provider for follow-up on the preeclampsia she experienced while pregnant A 3-year-old who presents with a stage II pulmonary heart murmur, whose mother reported that she had preeclampsia while pregnant with the child A 62-year-old who has been working with a nutritionist for the past 5 years to help lose weight and keep type 2 diabetes under control A 75-year-old smoker with a history of hypertension and anxiety who retired 5 years ago after a long career in law enforcement Correct Answer: A 75-year-old smoker with a history of hypertension and anxiety who retired 5 years ago after a long career in law enforcement A patient states that they can barely get the mail without becoming totally winded and out of breath, but they are able to sleep comfortably at night. The nurse should suspect that the patient is most likely in which stage of heart failure? III IV I 32 II Correct Answer: III In Stage III heart failure, patients show increased physical limitations due to fatigue. Less than normal physical activity results in fatigue, shortness of breath, or palpitations. In stage III, the patient is still able to sleep comfortably at night. A patient with severe heart failure is beginning a new medication treatment and will be taking furosemide, a loop diuretic. Which warning should the nurse give the patient before beginning the treatment? "This medication will increase your risk of having a low potassium level." "You will most likely experience decreased urinary output." "Call your doctor if you notice any vision changes." "Call your doctor if you develop a dry, persistent cough." Correct Answer: "This medication will increase your risk of having a low potassium level." 33 The nurse is teaching a patient about an angiotensin-converting enzyme (ACE) inhibitor that was newly prescribed for heart failure. Which statement by the nurse describes the effect of this medication? "This drug will help increase your heart rate in order to have it pump more blood throughout your body." "This drug will cause your heart muscle to have stronger contractions, which will increase the amount of blood your heart can pump." "This drug is very effective at narrowing your blood vessels in order to push more blood to your heart." "This drug will help relax and open your blood vessels, which will lower your blood pressure and make it easier for your heart to pump." Correct Answer: "This drug will help relax and open your blood vessels, which will lower your blood pressure and make it easier for your heart to pump." The nurse is describing the pathophysiology of heart failure to a colleague. Which statement by the nurse is accurate regarding the compensatory mechanism in the development of heart failure? 34 "Hypertension causes the cardiac muscles to overstretch and cause temporarily increased cardiac output." "Gradual compensatory changes are initially benign but lead to decreased cardiac and renal functioning." "Increased renal function that occurs with aging causes a change in other systems to improve functioning." "Kidneys that are poorly perfused as a result of increased CO produce renin, which eventually decreases blood pressure (BP) and sodium retention." Correct Answer: "Hypertension causes the cardiac muscles to overstretch and cause temporarily increased cardiac output." Hypertension causes the cardiac muscles to overstretch and cause temporarily increased cardiac output. This is a compensatory change that occurs in the development of heart failure. Decreased, not increased, renal function that occurs with aging causes a change in other systems to improve functioning. Gradual compensatory changes are initially benign but lead to increased, not decreased, cardiac and renal functioning. Kidneys are poorly perfused as a result of decreased, not increased, CO and produce renin, which eventually decreases BP and sodium retention. 35 Which action is part of the physical assessment that the nurse would perform for a patient with heart failure? Observing shortness of breath Discussing history of hypertension Asking about recent weight gain Inspecting for presence and degree of edema Correct Answer: Inspecting for presence and degree of edema Which correctly describes the effect on the body of the Frank-Starling mechanism? ANSWER Increased cardiac output (CO) caused by an increased cardiac contractile force Increased vascular resistance due to decreased CO Inhibition of water excretion and salt and water retention in the kidneys Hypertrophy of myocardial muscle due to increased cardiac workload 36 Correct Answer: Increased cardiac output (CO) caused by an increased cardiac contractile force Which correctly describes an appropriate expected outcome of an evaluation of patient progress? The patient is able to identify a caregiver who can assist with activities of daily living (ADLs). The patient is able to select healthy, appropriate foods from a menu. The patient is able to prepare at least three separate meals that fit into dietary guidelines. The patient is able to explain what each medication is prescribed for and how each medication works in the body. Correct Answer: The patient is able to select healthy, appropriate foods from a menu. An appropriate expected outcome of patient progress is for a patient to be able to select appropriate foods from a menu. It is not expected that patients will able to prepare several different meals that fit into their diet; cooking may not be a skill they have. Patients should be able to describe the medication they take each day, as well as be 37 aware of the side effects that they should report to the healthcare provider. Expecting more details about complex pharmaceuticals is excessive. The patient should be able to execute ADLs independently as well as be able to identify appropriate increments of rest throughout the day; identifying someone to help them may be helpful, but it is not an expected outcome indicating patient progress. The nurse preceptor asks a new graduate to describe the pathophysiology of heart failure. Which response by the new graduate demonstrates a need for further teaching of the compensatory mechanisms involved in the development of heart failure? "Hypertension causes the cardiac muscles to overstretch and cause temporarily increased cardiac output." "Increased cardiac output stimulates the sympathetic nervous system to increase heart rate." "The ventricles in the heart remodel and develop hypertrophy because of the chronic increase in fluid volume." "Atrial natriuretic peptide is released by the cardiac cells to help delay cardiac decompensation." 38 Correct Answer: "Increased cardiac output stimulates the sympathetic nervous system to increase heart rate." Decreased, not increased, cardiac output stimulates the sympathetic nervous system (SNS) to increase heart rate. Compensatory mechanisms play a large role in the development of heart failure. Initially, cardiac output is increased because the cardiac muscles are able to accommodate the additional workload. This situation cannot last. Over time, the cardiac muscle will weaken, and cardiac output will begin to decrease. Decreased cardiac output causes the aortic baroreceptors to stimulate the sympathetic nervous system. The heart develops structural changes to accommodate additional fluid volume. The heart chambers and heart muscles enlarge to accommodate the additional fluid. As the cardiac output decreases, perfusion to the kidneys decreases. The kidneys respond by releasing renin to increase the vascular volume and venous return. Atrial natriuretic peptide is released by the cardiac cells to help delay cardiac decompensation. Atrial natriuretic peptide is a hormone that helps balance the effects of other hormones.