Cardiovascular System

Pathologic changes in the structure of the capillary and venular endothelium can result in the accumulation of fluid in interstitial space. What term refers to this accumulation?

Edema

Correlating ECG waves with whats happening in the heart.

The QRS complex represents depolarization of the bundle of His (Q) and the ventricles (RS). The P wave indicates impulses originating in the SA node as they pass through atrial tissue. The T wave represents repolarization of the ventricles. The PR interval reflects the normal delay of conduction at the AV node.

Your client has severe aortic valve disease. When educating your client about anatomy, you would include which of the following?

The aortic valve separates the left ventricle and aorta.

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina?

Unstable

Types of Angina

Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse?

"Removing the patch at night prevents drug tolerance while keeping the benefits."

As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function?

"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."

The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response?

"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease."

Most clients with Stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially? (Choose one)

2

Heparin therapy is usually considered therapeutic when the patient's activated partial thromboplastin time (aPTT) is how many times normal?

2 to 2.5 The amount of heparin administered is based on aPTT results, which should be obtained in follow-up to any alteration of dosage. The patient's aPTT value would have to be greater than .5 to 1 times normal to be considered therapeutic. An aPTT value that is 2.5 to 3 times normal would be too high to be considered therapeutic. The patient's aPTT value would have to be greater than .25 to .75 times normal to be considered therapeutic.

In order to be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)?

60 minutes The 60-minute interval is known as "door-to-balloon time" for performance of PTCA on a diagnosed MI patient. The 30-minute interval is known as "door-to-needle time" for administration of thrombolytics post MI. The time frame of 9 days refers to the time for onset of vasculitis after administration of streptokinase for thrombolysis in an acute MI patient. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.

What is Stage 2 Hypertension?

A client is diagnosed with Stage 2 hypertension when their systolic blood pressure is greater than or equal to 160 OR their diastolic blood pressure is greater than or equal to 100.

In which of the following situations would blood be most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up

After teaching a group of students about circulation, the instructor determines that the teaching was successful when the students identify it as which of the following?

A high to low pressure system

A nurse is explaining to a client the physiology of the heart with reference to the cardiac valves. Which statement by the client about the function of the cardiac valves demonstrates the correct understanding of the nurse's explanation?

Allow blood to flow in one direction only

A patient is receiving carvedilol to treat his hypertension. The nurse identifies this as which of the following?

Alpha and Beta blocker

Drug-Drug Interaction

An ACE inhibitor given with a NSAID can result in increased BP.

Mr. Emmeott is seen by the physician for follow-up for diabetic nephropathy. The physician prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to?

Angiotensin II receptor blockers

A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response?

Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age.

Which condition most commonly results in coronary artery disease (CAD)?

Atherosclerosis

The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack?

Avoid situations that contribute to ischemic episodes.

Aortic stenosis remains asymptomatic for several decades. However, once a client becomes symptomatic for aortic stenosis, life expectancy without further treatment is only 2 to 3 years. What is the treatment of choice for symptomatic aortic stenosis?

Balloon valvuloplasty

Which of the following heart valves controls the flow of blood between the left atria and the left ventricle?

Bicuspid valve

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which of the following modes of action helps losartan to bring about its antihypertensive effect?

By blocking the angiotensin II receptors

A 46-year-old man with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension by his primary care provider after serial blood pressure readings. The clinician has opted to begin the patient on captopril (Capoten). The patient's nurse should recognize that the therapeutic effect of this drug is achieved in what way?

By inhibiting the transformation of angiotensin I to angiotensin II

A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse?

CVP reading: 1 mmHg The central venous pressure (CVP) reading of 1 is low (2-6 mmHg) and indicates reduced right ventricular preload, commonly caused by hypovolemia.

Which of the following is the correct sequencing of returning blood back to the heart?

Capillaries - venules - veins - right atrium

Describe circulation.

Circulation is a closed system. Circulation involves a resistance and capacitance system. Circulation follows two courses, a systemic and a pulmonary courses.

Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin?

Clopidogrel (Plavix) Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI.

What does Conductivity refer to?

Conductivity refers to the heart cells being able to rapidly conduct an action potential of electrical impulse.

When reviewing a patient's ECG, the nurse identifies the QRS complex, understanding that this reflects which of the following?

Depolarization of the bundle of His and ventricles

Your 71-year-old male patient has recently been diagnosed with hypertension. Which of the following measurements is a partial indication of effective treatment and management?

Diastolic blood pressure below 90 mm Hg

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?

Elevated ST segment

The nurse assists and educates clients about blood pressure regulation. Which information is important to include in the review with clients about blood pressure?

Force exerted by the blood against the walls of the blood vessels

A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?

Heart

A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?

High afterload because of backpressure against the left ventricle

A nurse is caring for a patient post cardiac surgery. Upon assessment, the patient appears restless and is complaining of nausea and weakness. The patient's ECG reveals peaked T waves. The nurse reviews the patient's serum electrolytes anticipating which of the following abnormalities?

Hyperkalemia

When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which of the following electrolyte imbalances?

Hypermagnesemia

Which of the following is inconsistent as a condition related to metabolic syndrome?

Hypotension A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.

Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery?

Inadequate tissue perfusion

A client is receiving lisinopril (Prinivil) for the treatment of hypertension. The client began taking ibuprofen (Motrin) over the counter for arthritis pain. Which of the following is most likely to occur with this combination of medications?

Increased blood pressure

When preparing a plan of care for a client in hypovolemic shock, which of the following partial nursing diagnoses might be relevant to the patient's condition?

Ineffective Tissue Perfusion

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?

It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.

Arteries on the heart.

Left circumflex artery supplies most of the left ventricle. The right coronary artery supplies most of the right side of the heart. The left anterior descending artery feeds the septum and anterior areas including much of the conduction system. The left anterior descending artery feeds the septum and anterior areas including much of the conduction system.

When explaining blood supply to the heart muscle, the nurse explains that the left circumflex artery supplies which of the following?

Left ventricle

A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following?

Low BP

Proper function of the cardiovascular system relies on blood following the correct pathway through the heart. Valves within the heart separate the organ's chambers and prevent blood from flowing in the wrong direction. What valve separates the left atrium and left ventricle?

Mitral

A backflow of blood is noted in the left ventricle from the left atrium. The patient is suffering from a defect in which valve?

Mitral valve

A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders?

Nitroglycerin SL Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired and the nurse should anticipate administering nitroglycerin to assess if the chest pain subsides.

A patient is prescribed digoxin (Lanoxin), which affects the function of the sinoatrial node. Which of the following statements describes the function of the sinoatrial node?

Normal pacemaker

A nurse is explaining blood flow through the heart to a patient who has experienced a myocardial infarction. How would the nurse explain flow from the lungs to the heart?

Oxygenated blood from the lungs enters the left artium through the pulmonary veins.

Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome?

Pericardial friction rub The syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR.

A patient is prescribed trandolapril (Mavik). What adverse effect should the patient be instructed on that can occur with angiotensin-converting enzyme inhibitor (ACE inhibitor)?

Persistent cough

A client is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect?

Persistnt cough

A nurse is measuring the BP of a client. The client asks what the BP measures. What is the best response by the nurse about the measurement of BP?

Pressure of blood within the arteries

Medications to neutralize the unfractionated heparin.

Promatine Sulfate Protamine sulfate is known as the antagonist for unfractionated heparin (it neutralizes heparin).

Which of the following enzymes is produced in the kidney?

Renin

A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond?

Restore and maintain adequate tissue perfusion.

The pathway for blood flow through the heart is:

Right atria to right ventricle to pulmonary artery through lungs to pulmonary veins to left atria and then to left ventricle.

A patient is experiencing orthostatic hypotension that is due to his antihypertensive therapy. Which nursing diagnosis would be most appropriate?

Risk for injury

During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which of the following is the most likely consequence of renal impairment?

Secondary Hypertension

The nurse is reviewing a patient's ECG and notes that the ECG is normal, but the rate is 110 beats/minute. The nurse would identify this as which of the following?

Sinus tachycardia

ECG

Sinus tachycardia would be characterized by a normal appearing ECG, but a rate usually greater than 100 beats per minute. Atrial flutter is characterized by sawtoothed shaped P waves, often with 2 or 3 P waves occurring for every QRS complex. Atrial fibrillation would be characterized by many irregular P waves, depicting bombardment of the AV node in an unpredictable number causing the ventricles to beat in a fast, irregular, and often inefficient heart manner. Paroxysmal atrial tachycardia would be characterized by sporadically occurring runs of rapid heart rate.

A client who has been diagnosed with blood pressure problems is eager to know more about the condition. What should the nurse explain is one of the internal processes that attempt to maintain blood pressure within normal limits?

Special sensory receptors in blood vessel walls called baroreceptors are stimulated.

A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension? (Choose one)

Stage 2

The client has a blood pressure of 165/100 mmHg. The nurse knows that this client would be in classified as which stage of hypertension?

Stage 2

An instructor is describing an action of the heart, likening it to that of stretching a rubber band. The instructor is describing which of the following?

Starling's law of the heart

What is Automaticity?

The heart cells being able to generate an action potential without an external stimulus.

The nurse is reviewing with the client the three major layers of the heart wall and how they relate to the pericardium. What is the best description by the nurse to the client about the myocardium layer of the heart?

Thick, strong muscles making up the middle layer

A nurse is assessing the vital signs of a client. The client inquires about the functions of the arteries. What should the nurse include in the client education about the function of arteries?

To carry oxygenated blood to the body cells

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD?

To decrease workload of the heart

Renin

Transported to the liver to convert angiotensinogen to angiotensin I. Released from the kidneys.

Contraction of the right atrium sends blood through which of the following?

Tricuspid Valve

Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty?

Withhold anticoagulant therapy.

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur?

Worsening angina