A client is awaiting the availability of a heart for transplant.
What option may be available to the client as a bridge to transplant?
Pacemaker.
Ventricular assist device (VAD).
Intra-aortic balloon pump (IABP).
Implanted cardioverter-defibrillator (ICD).
The Correct Answer is B
Choice A rationale
A pacemaker is a device used to treat electrical conduction disturbances, such as bradycardia or certain heart blocks. It does not provide the mechanical circulatory support required for a patient whose heart is failing while awaiting a transplant. While it manages rhythm, it cannot replace the pumping function of the heart. Therefore, it is not considered a bridge to transplant for end stage heart failure where the primary issue is pump failure.
Choice B rationale
A Ventricular Assist Device is a mechanical pump that is surgically implanted to help the weakened ventricles circulate blood throughout the body. It is the gold standard bridge to transplant because it effectively takes over the workload of the heart, allowing the patient to stabilize and sometimes even return home while waiting for a donor organ. It improves organ perfusion and functional capacity, making the patient a better candidate for the eventual surgery.
Choice C rationale
An Intra aortic balloon pump is a temporary device used primarily in acute settings, such as cardiogenic shock, to improve coronary perfusion and decrease afterload. It is usually short term and requires the patient to remain in an intensive care unit, often with limited mobility. While it supports the heart, it is generally not used as a long term bridge to transplant compared to the more durable and mobile ventricular assist devices available.
Choice D rationale
An Implanted Cardioverter Defibrillator is designed to detect and terminate life threatening ventricular arrhythmias by delivering a shock. While patients awaiting transplant often have these devices to prevent sudden cardiac death, the ICD does not provide any mechanical assistance to the failing heart muscle. It manages the risk of death from an electrical event but does not address the underlying hemodynamic failure or act as a functional bridge for circulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Dilation of coronary arteries actually facilitates increased blood flow and is a physiological response during exercise to meet metabolic demands. In coronary artery disease, the vessels are typically unable to dilate effectively due to atherosclerosis and endothelial dysfunction. Increased pressure within the vessel does not cause the typical manifestations of angina; rather, it is the obstruction and lack of flow through a narrowed lumen that leads to the clinical symptoms experienced by the client.
Choice B rationale
Coronary artery disease involves the buildup of plaque within the intimal layer of the vessel wall, a process known as atherosclerosis. This plaque accumulation progressively decreases the diameter of the artery, creating a physical obstruction. Consequently, during periods of increased myocardial oxygen demand, the restricted blood flow cannot deliver sufficient oxygen and nutrients to the myocardium. This imbalance between supply and demand results in myocardial ischemia, which is the underlying cause of anginal pain and potential infarction.
Choice C rationale
While chronic ischemia can eventually lead to weakening of the heart muscle, known as ischemic cardiomyopathy, the term weakening does not accurately describe the primary correlation in coronary artery disease. Perfusion is poor because of the physical narrowing and reduced elasticity of the coronary vessels, not because the vessels themselves are weak. Angina is specifically a symptom of oxygen deprivation caused by the arterial blockage rather than a generalized weakening of the cardiovascular structural components.
Choice D rationale
As individuals age, coronary arteries generally become less elastic and more rigid due to calcification and collagen deposition, a process termed arteriosclerosis. Increased elasticity would actually allow the vessels to better accommodate blood flow. The lack of oxygen reaching the heart in coronary artery disease is caused by the stiffening and narrowing of the lumen, which prevents the vessels from stretching or dilating to accommodate the blood flow necessary to meet the metabolic needs of the heart.
Correct Answer is C
Explanation
Choice A rationale
Cardiomyopathy refers to diseases of the heart muscle that affect its ability to pump blood. While cardiomyopathy can eventually lead to heart failure and subsequent B-type natriuretic peptide elevation, the peptide is not a specific diagnostic marker for the muscle disease itself. Diagnosis for cardiomyopathy typically requires imaging such as echocardiography or MRI to visualize structural changes. BNP is specifically a marker of hemodynamic stress and wall stretch rather than muscle pathology.
Choice B rationale
Valve dysfunction involves stenosis or regurgitation of the heart valves, which can be identified through physical exam findings like murmurs and confirmed via echocardiography. While chronic valve issues can lead to heart failure, a BNP test is not the primary tool for investigating the valves. BNP levels increase in response to the resulting volume overload and pressure, but they do not provide specific information about which valve is malfunctioning or why.
Choice C rationale
Heart failure causes the ventricles to stretch in response to volume overload and increased end-diastolic pressure. This mechanical stretch triggers the release of B-type natriuretic peptide into the bloodstream. Normal levels are typically below 100 pg/mL; levels above 400 pg/mL are highly suggestive of heart failure. Measuring this biomarker helps clinicians differentiate between cardiac causes of shortness of breath and pulmonary causes, as BNP remains lower in primary respiratory conditions.
Choice D rationale
Cardiogenic shock is a severe state of low cardiac output leading to systemic tissue hypoxia, often occurring after a massive myocardial infarction. While BNP levels will certainly be elevated in this state due to extreme ventricular strain, the diagnosis is primarily clinical, based on hypotension, cool extremities, and oliguria. BNP is used more frequently to screen for and monitor chronic heart failure or to evaluate acute dyspnea rather than as the primary diagnostic tool for shock.
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