A patient, with a steadily increasing preload was experiencing a corresponding increase in stroke volume but it has now begun to decrease. The nurse realizes that which of the following is occurring in this patient?
1. maximum preload has yet to be reached
2. there is something else going on with the patient that is effecting the stroke volume
3. the heart rate is increasing which is causing the drop in stroke volume
4. preload has reached the critical point and now stroke volume will decrease
4
Rationale: Until a critical point is reached, as preload increases, so does stroke volume. An optimal preload leads to an optimal stroke volume. Once past this point, an increase in preload results in a decrease in stroke volume. If the heart receives too much preload, it cannot effectively pump out that volume and stroke volume decreases. Stroke volume decreases because too much volume causes excessive stretching of the myocardial fibers and the ventricles cannot effectively contract. There is not something else going on with the patient that is affecting the stroke volume. There is no evidence to suggest that the patient's heart rate is increasing.
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