Med Surg Ch 28 CV Function
A patient's QRS complex is becoming increasingly wider. What is occurring within the heart muscle that is reflected on this tracing? 1) The ventricles are repolarizing. 2) Atrial repolarization is occurring. 3) Ventricular depolarization is prolonged. 4) The atria depolarize and the impulse at the AV node is delayed.
ANS: 3 The QRS complex corresponds to ventricular depolarization. If the complex is widening, then ventricular depolarization is taking longer to complete.
A patient is prescribed to have capillary blood glucose readings every four hours. What should the nurse include when explaining capillaries to the patient? 1) It is a low-pressure vascular circuit. 2) Capillaries are the largest vessel within the arterial system. 3) The real work of the vascular system occurs at the capillary level. 4) They are flexible to adapt to changes in volume without large changes in pressure.
ANS: 3 The real work of the vascular system is done at the capillary bed.
The nurse notes that a patient has bilateral lower extremity edema. For which health problem should the nurse assess further? 1) Pericarditis 2) Cardiac tamponade 3) Lymph obstruction 4) Venous insufficiency
ANS: 4 Bilateral lower extremity edema generally indicates venous insufficiency.
The nurse is reviewing the anatomy of the heart with a patient scheduled for cardiac surgery. Which patient statement indicates additional teaching is required? 1) "Oxygenated blood returns to the left atrium through the pulmonary vein." 2) "The right atrium receives blood from the superior and inferior vena cava." 3) "Blood leaves the right ventricle and travels through the pulmonary vein to the lungs." 4) "Blood leaves the right ventricle and travels through the pulmonary artery to the lungs."
ANS: 4 Blood leaves the right ventricle and travels through the pulmonary vein to the lungs. Deoxygenated blood is delivered to the pulmonary circuit through the pulmonary artery.
The nurse is reviewing data collected during the assessment of an older patient. Which finding should the nurse consider as being an age-related change of the cardiovascular system? 1) First heart sound louder 2) Friction rub auscultated 3) Heart rate 64 and regular 4) Blood pressure 168/96 mm Hg
ANS: 4 Hypertension is a common cardiovascular health issues related to aging.
A patient is scheduled for a transesophageal echocardiogram (TEE). What information should the nurse expect to be provided from this test? 1) Cardiac filling pressures 2) Integrity of cardiac arteries 3) Heart function during stress 4) Presence of clots in the atria
ANS: 4 Information about the presence of clots in the atrium, a risk factor for stroke, is more easily viewed through TEE.
The nurse is preparing to determine a patient's cardiac output. Which measurement should be used for preload? 1) Heart rate 2) Blood pressure 3) Oxygen saturation 4) Central venous pressure
ANS: 4 Preload is reflected by measurements obtained through a centrally located IV line. For preload the central venous pressure is used.
A patient is recovering from a cardiac catheterization. For which finding should the nurse notify the health-care provider? 1) Warm right foot 2) Urine output 250 mL/2 hours 3) Discomfort lying flat for six hours 4) Hematoma formation at puncture site
ANS: 4 The puncture site should be monitored for hematoma formation. This could cause occlusion of the femoral artery and should be reported to the health-care provider.
A patient is being assessed for heart disease. For which laboratory test should the nurse instruct to avoid eating and drinking fluids for 12 hours? 1) Lipid panel 2) Homocysteine 3) C-reactive protein 4) Partial thromboplastin time
ANS: 1 A lipid panel requires the patient to fast for approximately 8 to 12 hours prior to the test.
A patient with a blood pressure of 88/50 mm Hg has a heart rate of 112 beats per minute. Which mechanism should the nurse realize is occurring in this patient? 1) Positive chronotropic effect 2) Negative chronotropic effect 3) Force of the mechanical contraction 4) Reaction to ventricular volume at the end of diastole
ANS: 1 Stimulus from the sympathetic nervous system initiated by information from baroreceptors in the aortic arch and the carotids that are sensitive to changes in BP increase the HR through the release of norepinephrine. This is called a positive chronotropic effect.
The nurse is preparing teaching about the coronary arteries for a group of patients scheduled for heart surgery. Which information should the nurse include in this teaching? 1) The coronary arteries originate in the cusps of the aortic valve. 2) The coronary arteries prevent the backflow of blood into the atria. 3) The coronary arteries respond to changes in pressure within the heart. 4) The coronary arteries prevent the backflow of blood into the ventricles.
ANS: 1 The left and right coronary arteries are the first arteries branching off of the aorta as it leaves the left ventricle and actually originate in the cusps of the aortic valve.
Which information should the nurse include when documenting the findings of a patient's heart sounds? Select all that apply. 1) Pitch 2) Clicks 3) Quality 4) Intensity 5) Location
ANS: 1, 3, 4, 5 1. When describing heart sounds it is important to note pitch. 3. When describing heart sounds it is important to note quality 4. When describing heart sounds it is important to note intensity. 5. When describing heart sounds it is important to note location.
The nurse is preparing content for a community health fair on risk factors for heart disease. What should the nurse include as nonmodifiable risk factors? Select all that apply. 1) Age 2) Weight 3) Alcohol intake 4) Ethnic background 5) Parents' health history
ANS: 1, 4, 5 1. Age is a nonmodifiable risk factor. 4. Ethnic background is a nonmodifiable risk factor. 5. Family history is a nonmodifiable risk factor.
An older patient is being evaluated for a cardiac click audible upon auscultation. Which age-related change should the nurse realize might be causing this heart sound? 1) Hypertension 2) Valve stenosis 3) Atrial fibrillation 4) Congestive heart failure
ANS: 2 A cardiac click is associated with valve stenosis.
The nurse notes that an older patient's point of maximum impulse is displaced to the left. What age-related change should the nurse suspect as causing this assessment finding? 1) Valvular stenosis 2) Left ventricular atrophy 3) Arterial wall narrowing 4) Fibrosis of heart chambers
ANS: 2 Aging produces a number of physiological changes in the anatomy and physiology of the cardiovascular system. Physical deconditioning can result in atrophy of the left ventricle, which would displace the point of maximum impulse.
While auscultating a patient's heart rate the nurse hears scratching sounds. What is most likely causing this sound? 1) Epicardium adhering to the heart surface 2) Low level of fluid in the pericardial cavity 3) Parietal pericardium adhering to the sternum 4) Endocardium adhering to the heart chambers
ANS: 2 Between the two layers of the heart is a pericardial cavity containing serous fluid that provides a lubricant that allows the heart to beat without friction.
The nurse notes that a patient is scheduled for a brain natriuretic peptide level to be drawn. What patient teaching should the nurse prepare for this patient? 1) Low-fat diet 3) Symptoms of a heart attack 2) Signs of heart failure 3) Symptoms of a heart attack 4) Lung versus heart problems
ANS: 2 Brain natriuretic peptide is released from overstretched ventricular tissue. Elevations are an indicator of heart failure.
After palpating a patient's radial pulses, the nurse proceeds to palpate the brachial, carotid, femoral, popliteal, and posterior tibial pulses. What condition caused the nurse to make this more thorough physical assessment? 1) Skin warm and dry 2) Various skin temperatures 3) Edema of the left lower extremity 4) Respiratory rate of 24 and labored
ANS: 2 Variations in temperature between different parts of the body may indicate vasoconstriction or vascular disease in the affected extremities. A more extensive examination includes femoral, popliteal, and posterior tibial pulses.
The nurse is preparing a teaching tool about the cardiac electrical conduction system. In which order should the nurse explain the route of the action potential? (Enter the number of each step in the proper sequence; do not use punctuation or spaces. Example: 1234) 1) Impulse travels to the bundle of His 2) Sinoatrial node fires in the right atrium 3) Impulse extends through Purkinje fibers 4) Impulse travels through bundle branches 5) Impulse travels to the atrioventricular node 6) Impulse spreads through atrial myocardium
ANS: 265143 The action potential begins in the sinoatrial node, which fires in the right atrium. Then the impulse spreads through the atrial myocardium and travels to the atrioventricular node. It then travels to the bundle of His, through the bundle branches, and extends through the Purkinje fibers.
A patient's blood pressure is 174/98 mm Hg. Which aspect of cardiac output is most affected by this elevated reading? 1) Preload 2) Heart rate 3) Afterload 4) Contractility
ANS: 3 Afterload is the resistance to flow the ventricle must overcome to open the semilunar valves and eject its contents. This is related to BP in that hypertension on the right or left is implicated in the negative effects of increased afterload.
The nurse suspects that a patient is experiencing a release of norepinephrine from the adrenal medulla. Which assessment finding did the nurse use to make this clinical decision? 1) Blood pressure 94/48 mm Hg 2) Heart rate 68 beats per minute 3) Heart rate 120 beats per minute 4) Blood pressure 180/10 mm Hg
ANS: 3 Chemicals that can increase HR include norepinephrine released from the adrenal medulla.
The nurse notes that a patient has a low serum potassium level. Which phase of the cardiac action potential will be most affected by this blood level? 1) Phase 0 2) Phase 1 3) Phase 3 4) Phase 4
ANS: 3 In phase 3 final repolarization occurs, which is caused by the closing of the Ca++ channels and the rapid outflow of K+.
The nurse is preparing to auscultate the heart sounds of a patient with mitral valve regurgitation. Which sound should the nurse expect to hear? 1) Rub 3) Murmur 2) Click 4) Atrial gallop
ANS: 3 Murmurs are usually caused by turbulent flow through the valves. That turbulence can be caused by regurgitation of blood through an incompetent valve.
The clinical trainer is reviewing the renin-angiotensin-aldosterone system with graduate nurses during orientation to the telemetry unit. In which order should the trainer discuss this system? (Enter the number of each step in the proper sequence; do not use punctuation or spaces. Example: 1234) 1) Sodium and water reabsorbed in the kidneys 2) Renin reacts with angiotensin to create angiotensin 1 3) Angiotensin I is converted to angiotensin II in the lungs 4) Kidneys release renin in response to a drop in blood pressure 5) Angiotensin II influences adrenal glands to release aldosterone
ANS: 42351 When the blood pressure drops, the kidneys respond by releasing the enzyme renin. Renin reacts with angiotensin to create angiotensin I. Angiotensin I is then converted in the lungs to angiotensin II via angiotensin-converting enzyme. Angiotensin II acts on the adrenal glands to release aldosterone. The release of aldosterone promotes sodium and water reabsorption in the kidneys, which increases circulating fluid volume.
A patient is prescribed a 12-lead electrocardiogram. In which order should the nurse apply the V leads? (Enter the number of each step in the proper sequence; do not use punctuation or spaces. Example: 1234) 1) Midaxillary line 2) Between V2 and V4 3) Midclavicular line 5th intercostal space 4) 4th intercostal space left of the sternum 5) 4th intercostal space right of the sternum 6) Between V4 and V6 anterior axillary line
ANS: 542361 The chest positions for the V leads are: V1: 4th intercostal space, just to the right of the sternum; V2: 4th intercostal space, just to the left of the sternum; V3: Between V4 and V2; V4: on the midclavicular line and 5th intercostal space; V5: between V6 and V4 on the anterior axillary line; and V6: on the midaxillary line, horizontal with V4.
