NUR 239 Final Exam Questions With Complete Solutions
Describe right sided heart failure.
-Ventricles must maintain equal output to function effectively
-Long-term heart failure usually involves both sides
-Caused by conditions restricting blood flow from right ventricle
into lungs
-Examples: stenosis or regurgitation of tricuspid or pulmonic
valves, pulmonary diseases (Cor Pulmonale)
-Often consequence of left-sided failure
-Isolated right-side failure uncommon- occurs in patients with
pulmonary hypertension or lung disease
-Results in:
^Decreased pumping of deoxygenated blood from systemic
circulation into pulmonic circulation
^Accumulation/congestion/back-up of blood in venous system
leading to fluid retention, edema in peripheral tissues, abdominal
organs
^Leads to systemic fluid backup causing JVD, edema, ascites
(venous congestion in portal vein), and weight gain.
What medications are used to help with heart failure?
-Diuretics: thiazides, furosemide (Lasix)
-Beta-Adrenergic Blockers: carvedilol, bisoprolol, metoprolol
-Ace-Inhibitor or ARB: captopril, enalapril, lisinopril, losartan,
valsartan
-Vasodilators: nitrate, hydralazine
,-Aldosterone antagonists: potassium sparing diuretic
-Cardiac Glycosides (Digitalis): digoxin
What is the class, actions, priority adverse effects, and nursing
implications of digoxin?
-Cardiac glycosides (digitalis)
-2nd line
-Very dangerous
-Digoxin (Lanoxin)
-Positive inotropic effect (increase contractility)
-Negative chronotropic effect (slows SA/AV node impulses)
-Pt diagnosed with HF - digoxin slows HR & increases
contractility = increases efficiency
-Increased BUN/Creatinine = renal (kidney problems) - watch
carefully for hyperkalemia (reduce digoxin dose to avoid
toxicity)
-digoxin + furosemide = increased risk of digoxin toxicity
What is shock/circulatory failure?
-Hypo-perfusion of organs and tissues resulting in an
insufficient supply of oxygen and nutrients for cellular function
and accumulation of waste products
-Sympathetic nervous system provides an important reflex
mechanism to support hypo-perfusion state as well as RAA
system to try to maintain CO and BP
-These mechanisms can only sustain body's tissues and organ for
short time
What are the types of shock?
,-Hypovolemic
^Loss of blood
^Loss of plasma
^Loss of extracellular fluid
-Cardiogenic
^Myocardial damage (MI, Contusion)
^Sustained arrhythmia
^Acute valve damage, ventricular septal wall defect
^Cardiac surgery
-Obstructive
^Cardiac tamponade (heart not filling)
^Obstruction of outflow from the heart (PE, cardiac tumor,
pneumothorax, dissecting aneurysm)
-Distributive
^Neurogenic shock
^Anaphylactic shock (Type I hypersensitivity reaction)
^Septic shock
What are the clinical manifestations of shock?
-Thirst
-Increased Heart Rate
-Cool and Clammy skin
-decreased BP (interesting point, compensatory mechanisms
often preserve BP until late shock is relatively advanced)
-Oliguria (decreased Urine output): one of the best indicators of
blood to vital organs is urine output
-Change in mentation
-In shock it is important to assess vital signs and urine output
-"shock" is referring to hypovolemia unless otherwise stated
, How does the sympathetic nervous system relate to the heart?
-Beta 1 receptors
-Speeds up heart rate and contractility (epinephrine and
norepinephrine)
What disease does Michael J Foxx have?
Parkinson's disease.
How is TB diagnosed?
TB skin test and then a culture confirms it.
What are the key points about hemophilia?
-Occurs when a person has a mutation in one of the clotting
factor genes.
-Approximately 90% have a mutation in the Factor VIII gene
(hemophilia A), 9% have a mutation in the Factor IX gene
(hemophilia B), and 1% have a mutation in another clotting
gene.
-Hemophilia is inherited by male children from the female
carrier
-Daughters of affected males carry the gene
-X- linked recessive pattern
-1 in 4,000 males are born with the disorder- possible for
females but very rare
Signs and symptoms:
-unexplained and excessive bleeding from cuts, injuries, or
following surgery
-multiple large or deep bruises
Describe right sided heart failure.
-Ventricles must maintain equal output to function effectively
-Long-term heart failure usually involves both sides
-Caused by conditions restricting blood flow from right ventricle
into lungs
-Examples: stenosis or regurgitation of tricuspid or pulmonic
valves, pulmonary diseases (Cor Pulmonale)
-Often consequence of left-sided failure
-Isolated right-side failure uncommon- occurs in patients with
pulmonary hypertension or lung disease
-Results in:
^Decreased pumping of deoxygenated blood from systemic
circulation into pulmonic circulation
^Accumulation/congestion/back-up of blood in venous system
leading to fluid retention, edema in peripheral tissues, abdominal
organs
^Leads to systemic fluid backup causing JVD, edema, ascites
(venous congestion in portal vein), and weight gain.
What medications are used to help with heart failure?
-Diuretics: thiazides, furosemide (Lasix)
-Beta-Adrenergic Blockers: carvedilol, bisoprolol, metoprolol
-Ace-Inhibitor or ARB: captopril, enalapril, lisinopril, losartan,
valsartan
-Vasodilators: nitrate, hydralazine
,-Aldosterone antagonists: potassium sparing diuretic
-Cardiac Glycosides (Digitalis): digoxin
What is the class, actions, priority adverse effects, and nursing
implications of digoxin?
-Cardiac glycosides (digitalis)
-2nd line
-Very dangerous
-Digoxin (Lanoxin)
-Positive inotropic effect (increase contractility)
-Negative chronotropic effect (slows SA/AV node impulses)
-Pt diagnosed with HF - digoxin slows HR & increases
contractility = increases efficiency
-Increased BUN/Creatinine = renal (kidney problems) - watch
carefully for hyperkalemia (reduce digoxin dose to avoid
toxicity)
-digoxin + furosemide = increased risk of digoxin toxicity
What is shock/circulatory failure?
-Hypo-perfusion of organs and tissues resulting in an
insufficient supply of oxygen and nutrients for cellular function
and accumulation of waste products
-Sympathetic nervous system provides an important reflex
mechanism to support hypo-perfusion state as well as RAA
system to try to maintain CO and BP
-These mechanisms can only sustain body's tissues and organ for
short time
What are the types of shock?
,-Hypovolemic
^Loss of blood
^Loss of plasma
^Loss of extracellular fluid
-Cardiogenic
^Myocardial damage (MI, Contusion)
^Sustained arrhythmia
^Acute valve damage, ventricular septal wall defect
^Cardiac surgery
-Obstructive
^Cardiac tamponade (heart not filling)
^Obstruction of outflow from the heart (PE, cardiac tumor,
pneumothorax, dissecting aneurysm)
-Distributive
^Neurogenic shock
^Anaphylactic shock (Type I hypersensitivity reaction)
^Septic shock
What are the clinical manifestations of shock?
-Thirst
-Increased Heart Rate
-Cool and Clammy skin
-decreased BP (interesting point, compensatory mechanisms
often preserve BP until late shock is relatively advanced)
-Oliguria (decreased Urine output): one of the best indicators of
blood to vital organs is urine output
-Change in mentation
-In shock it is important to assess vital signs and urine output
-"shock" is referring to hypovolemia unless otherwise stated
, How does the sympathetic nervous system relate to the heart?
-Beta 1 receptors
-Speeds up heart rate and contractility (epinephrine and
norepinephrine)
What disease does Michael J Foxx have?
Parkinson's disease.
How is TB diagnosed?
TB skin test and then a culture confirms it.
What are the key points about hemophilia?
-Occurs when a person has a mutation in one of the clotting
factor genes.
-Approximately 90% have a mutation in the Factor VIII gene
(hemophilia A), 9% have a mutation in the Factor IX gene
(hemophilia B), and 1% have a mutation in another clotting
gene.
-Hemophilia is inherited by male children from the female
carrier
-Daughters of affected males carry the gene
-X- linked recessive pattern
-1 in 4,000 males are born with the disorder- possible for
females but very rare
Signs and symptoms:
-unexplained and excessive bleeding from cuts, injuries, or
following surgery
-multiple large or deep bruises
