A nurse is planning care for a client who has hypertrophic cardiomyopathy that has not improved after pharmacologic treatment. Which of the following procedures should the nurse anticipate the health care provider ordering?

A. Hypovolemic shock: Hypovolemic shock occurs due to a significant decrease in circulating blood volume, leading to inadequate tissue perfusion. Blood loss, such as that experienced by the client in the scenario, is a common cause of hypovolemic shock. The decrease in blood pressure observed over time is consistent with the compensatory mechanisms of hypovolemic shock, where the body attempts to maintain perfusion to vital organs despite decreased blood volume.

B. Septic shock: Septic shock results from a systemic inflammatory response to infection, leading to vasodilation, increased capillary permeability, and maldistribution of blood flow. While infection can lead to hypovolemia in some cases, the scenario does not provide evidence of infection or systemic inflammatory response as the cause of shock.

C. Obstructive shock: Obstructive shock occurs when there is obstruction to blood flow within the cardiovascular system, such as in cases of pulmonary embolism, cardiac tamponade, or tension pneumothorax. There is no evidence in the scenario to suggest an obstruction to blood flow as the cause of the client's shock.

D. Neurogenic shock: Neurogenic shock results from loss of sympathetic tone leading to vasodilation and relative hypovolemia. It is often associated with spinal cord injury or severe head injury. While neurogenic shock can lead to hypotension, the scenario does not indicate any neurological injury or insult as the cause of the client's shock.

A. "The heart and the coronary arteries weaken, leading to poor perfusion and resulting in angina": This statement is inaccurate. While angina can result from poor perfusion to the heart muscle, it is not typically due to weakening of the heart and coronary arteries. Angina often occurs due to coronary artery narrowing or blockage, leading to reduced blood flow and oxygen delivery to the myocardium.

B. "Coronary arteries become more elastic causing the arteries to stretch as individuals age causing the heart not to receive enough oxygen": This statement is incorrect. Coronary arteries do not become more elastic with age; in fact, they tend to become less elastic due to the development of atherosclerosis, which leads to arterial stiffening and decreased compliance. Atherosclerosis can cause narrowing or occlusion of the coronary arteries, resulting in reduced oxygen delivery to the heart muscle.

C. "Coronary arteries decrease in diameter leading to insufficient blood, oxygen, and nutrients reaching the heart muscle. Manifestations occur due to dilation of coronary arteries with increased blood flow causing increased pressure": This statement is partially incorrect. While it accurately describes the consequences of coronary artery narrowing (decrease in diameter) leading to insufficient blood, oxygen, and nutrient delivery to the heart muscle, the second part of the statement regarding dilation of coronary arteries with increased blood flow causing increased pressure is inaccurate. Coronary artery dilation is a compensatory response to increased demand for oxygen, aiming to improve blood flow to the myocardium. However, dilation alone does not increase pressure in the coronary arteries.

D. "Coronary arteries decrease in diameter leading to insufficient blood, oxygen, and nutrients reaching the heart muscle": This statement is accurate. Coronary artery disease (CAD) involves the progressive narrowing of the coronary arteries due to atherosclerosis, which reduces blood flow to the myocardium. As the arteries narrow, there is insufficient blood, oxygen, and nutrients reaching the heart muscle, leading to manifestations such as angina, myocardial ischemia, and potentially myocardial infarction.