Wk 6: Cardiovascular, Peripheral Vascular Systems

The nursing instructor is talking with a nursing student about the superficial nodes of the lymphatic system that are accessible to inspection and palpation. Which statement by the nursing student indicates effective learning?

"Cervical nodes drain the head and neck." Cervical nodes are present in the neck, and they help to drain the lymph from the head and the neck. Axillary nodes are present in the axillary region and drain the breast and the upper arm. Epitrochlear nodes are present in the antecubital fossa and drain the hand and the lower arm. The inguinal nodes in the groin drain most of the lymph of the lower extremities, the external genitalia, and the anterior abdominal wall.

The instructor is verbally quizzing a nursing student about the difference between the arterial and venous systems. Which statement by the nursing student is an accurate response?

"The arteries are high-pressure systems, and the veins are low-pressure systems." Arteries carry oxygenated blood pumped by the heart to all the tissues. The blood pressure inside the arteries is greater than that in the veins. Therefore, arteries are the high-pressure systems. Veins do not have any mechanism to pump the blood; therefore, veins are low-pressure systems. The walls of the veins are thinner and the walls of the arteries are thicker. The veins contain intraluminal valves to maintain unidirectional blood flow. The arteries are devoid of these intraluminal valves. The diseases associated with veins build up metabolic wastes in the body. The diseases associated with arteries produce signs and symptoms of oxygen deficit.

A nursing instructor is teaching a nursing student about the functions of the lymphatic system. Which statements, if made by the nursing student, indicate effective learning? Select all that apply.

-"The lymphatic system is a major part of the immune system in the body." -"The lymphatic system helps in the absorption of lipids from the small intestine." -"The lymphatic system conserves the plasma proteins that leak out of the capillaries." The lymphatic system is a major part of the immune system that helps to destroy disease-causing microorganisms. The lymphatic system helps in the absorption of lipids from the small intestine and stores them in the lymphatic ducts. A major function of the lymphatic system is to collect the fluid and plasma protein that leak from the capillaries and convert them into lymph. The spleen stores the red blood cells and destroys old and nonfunctional red blood cells.

After conducting a cardiac examination, the nurse concludes that the patient has normal cardiopulmonary functioning. Which findings enabled the nurse to reach this conclusion? Select all that apply.

-Absence of cardiac murmur -S2 is louder at the base of the heart While conducting a cardiac examination, the nurse should evaluate the heart sounds; this helps to determine the cardiac functioning. Cardiac murmur is caused by abnormal blood flow. Therefore, the absence of cardiac murmur indicates that the patient has intact cardiac valves. The first heart sound (S1) and second heart sound (S2) are heart sounds that are produced by the opening or closing of the heart valves; it is normal for S2 to be louder when auscultating at the base of the heart. The presence of a loud or accentuated S1 heart sound indicates a prolapsed mitral valve. A diminished S2 heart sound indicates that the patient may have aortic stenosis. The absence of bilateral breath sounds indicates that the patient may have a pulmonary disorder and is not a normal finding.

Which disorders can cause calcification of the arteries? Select all that apply.

-Renal failure -diabetes mellitus Diabetes mellitus is associated with polyuria, which causes loss of fluids and electrolytes. This results in the calcification of the arteries. Renal failure may impair fluid and electrolyte balance causing calcification of the arteries. Hyperthyroidism, arthritis, and hepatic failure are not associated with loss of fluid and electrolyte imbalance. These medical conditions cause hypertension, joint pains, and alterations in metabolism, respectively, but they do not cause calcification of the arteries.

A nursing instructor is preparing a lecture about inguinal nodes of the lymphatic system. Which statements should the instructor include in the lecture? Select all that apply.

-The inguinal nodes drain the lymph of the lower extremities. -The inguinal nodes drain the lymph of the external genitalia. -The inguinal nodes drain the lymph of the anterior abdominal wall. The inguinal nodes of the lymphatic system are located in the groin. These nodes drain most of the lymph of the lower extremities, external genitalia, and anterior abdominal wall. The cervical nodes drain lymph of the head and neck, and the axillary nodes drain the lymph from the breast and upper arm.

After measuring pitting edema in a patient, the nurse documents it as +4 grade. Which findings support the nurse's documentation? Select all that apply.

-The patient has very deep pitting. -the patient has grossly swollen legs -the patient has indentation of long duration While determining the pitting edema in a patient, the nurse should check the intensity of the pitting, severity of the swelling, and duration of the indention. These factors help the nurse to document the proper grade and provide effective treatment to the patient. A grade of +4 indicates that the patient has very deep pitting with grossly swollen legs and indentation of long duration. If the patient has moderate pitting, then the nurse would document the pitting edema as +2, not as +4. If the indentation lasts for a short time, then the nurse would give a grade of +3.

Which findings should the nurse observe in a patient with left ventricular hypertrophy? Select all that apply.

-Visible apical heave -Diameter of the heart 3.5 cm Left ventricular hypertrophy is the thickening of the myocardium of the left ventricle. Apical heave occurs due to pressure loading in the left ventricular hypertrophy. Left ventricular hypertrophy will not increase the diameter of the heart, so a diameter of 3.5 cm is normal. Left ventricular hypertrophy does not cause dilation of the heart. Impalpable apical impulse is the sign of pulmonary emphysema. In heart failure, jugular venous pressure increases, the location of the heart changes because of enlargement, and the diameter of the heart increases more than 4 cm.

The nurse documents the pulse of the patient as weak and thready (1+). Which conditions in the patient does the nurse identify as the reason for such findings? Select all that apply.

-shock -peripheral artery disease (PAD) A weak, thready pulse (1+) occurs with shock and PAD. This is because shock and PAD may result in a decreased heart rate, thereby decreasing the pulse rate. Full, bounding pulses (3+) occur during hyperkinetic states such as fever and anxiety. They also occur if the patient is anemic. This is because these conditions are associated with an increase in pulse rate.

Which actions may aggravate the symptoms of venous insufficiency? Select all that apply.

-sitting -prolonged standing Venous diseases cause the signs and symptoms of metabolic waste buildup. Sitting and prolonged standing interfere with blood flow and inhibit the return of the blood to and movement away from the heart and to various tissues. These actions result in blood pooling in the lower extremities of the body. Therefore, these two conditions further aggravate the disease. Lying, walking, and elevation relieve the signs and symptoms of venous diseases.

The nurse is planning the cardiac assessment of a patient. Which patient positions are necessary during this assessment? Select all that apply.

-sitting -supine -left lateral recumbent The patient is positioned differently for assessing the different aspects of the cardiac health. During the assessment of the carotid artery, the patient should be placed in the sitting position. In order to assess the jugular veins and the precordium, the patient should rest in the supine position with the head and chest elevated between 30 and 45 degrees. The left lateral recumbent position is used to measure the blood pressure in a pregnant patient. This finding is significant in determining the functionality of the heart during pregnancy. The patient need not be placed in the right lateral semi-Fowler and the prone positions. Cardiac assessment is not performed in these positions.

Left ventricular hypertrophy

-thickening of the myocardium of the left ventricle -sustained apical impulse with increased force occurs. The duration is also increased, but no change in location is seen. Right atrial enlargement is a form of cardiomegaly, which can broadly be classified as either right atrial hypertrophy (RAH) or dilation. It can be diagnosed by an electrocardiogram (ECG). Sometimes these disorders create a sound like a whooshing or swishing noise. Rheumatic heart disease describes a group of short-term and long-term heart disorders that can occur because of rheumatic fever. Damage to the heart valves is a common outcome of rheumatic fever. Symptoms of coronary artery disease include angina. In angina, a characteristic chest pain on exertion and decreased exercise tolerance occurs.

The nurse finds a lift while assessing a patient presented for a cardiac checkup. Which statement describes a lift?

A lift is a sustained thrust of the ventricle of the heart. A lift is also called a heave. It occurs due to right ventricular hypertrophy and is felt as a diffused lifting impulse during the ventricular systole at the left lower sternal border. A lift may be associated with the retraction at the apex because the left ventricle is rotated posteriorly by the enlarged right ventricle. A thrill is a vibration felt by the nurse on the palpation of the chest. The presystolic thrill is felt just before the systole over the apex of the heart. The exaggerated pulse of the carotid artery is associated with the increased stroke volume of the left ventricle and a decreased peripheral resistance, leading to the widened pulse pressure of the aortic regurgitation. A low intensity, high-pitched heart murmur is best heard over the left sternal border or over the right second intercostal space, especially if the patient leans forward and holds the breath in full expiration.

Which statement describes a thrill?

A thrill is a palpation of the chest. A thrill is a vibration felt by the nurse on palpation of the chest. It is likened to the throat of a purring cat. The thrill signifies turbulent blood flow and directs the nurse to locate the origin of loud murmurs. The venous hum, a continuous murmur usually of maximum intensity in the supraclavicular area, is a common auscultatory finding in children. It is of no known pathologic significance and is not associated with a thrill. A thrill is an abnormal pulsation on the precordium and is not found over the apical impulse. The normal apical impulse is the result of the heart rotating, moving forward, and striking against the chest wall during the systole. A lift refers to a sustained thrust of the ventricles.

After measuring the distal calf of a patient, the nurse documents that the patient has moderate lymphedema. Which findings support this conclusion?

Asymmetry of calves measuring 4.0 cm Acute, unilateral, painful swelling and asymmetry of calves is a sign of a complication in the patient. The asymmetry of calves measuring 1 cm and above is abnormal. The asymmetry of calves measuring between 3 and 5 cm indicates moderate lymphedema. Therefore, asymmetry of the calves measuring 4 cm indicates moderate lymphedema. Asymmetry in the measurement of the calves of 0.5 cm is a normal finding. The patient with mild lymphedema may have asymmetry of the calves measuring 2.0 cm. Asymmetry of the calves of more than 5 cm occurs in patients with severe lymphedema, so asymmetry of the calves measuring 6.0 cm indicates that the patient has severe lymphedema.

Which site is most suitable for palpation of the popliteal pulse?

Below the knee The popliteal artery is located below the knee. In order to determine the popliteal pulse, the nurse should palpate the skin surface below the knee. In order to determine the radial pulse, the nurse should palpate the patient's wrist. The femoral pulse can be determined by palpating the inner side of the thigh. Palpating in front of the ear helps to determine the temporal pulse.

Where is the heart located in the human body?

Between the second and the fifth intercostal spaces from the right edge of the sternum to the left midclavicular line The heart is the muscular pump of the cardiovascular system. The heart extends from the second intercostal space to the fifth intercostal space and from the right border of the sternum to the left midclavicular line. It is not located between the right midclavicular line and the right border of the sternum and below the clavicle to the eighth rib. It lies anteriorly between the sternum and the anterior mediastinum. The space between the third to the sixth intercostal spaces at the left sternal border is the tricuspid region of the heart. This region is auscultated to listen to the heart sounds. The aortic region of the heart is located between the first and the fourth intercostal spaces.

While auscultating the precordium of a patient, the nurse hears the first heart sound (S1). What causes the first heart sound?

Closing of the mitral valve The first heart sound (S1) occurs with the closure of the AV valves. This signals the beginning of the systole. The mitral component of the first sound (M1) slightly precedes the tricuspid component (T1). However, the sounds of these two components are fused together as one sound. One can hear S1 over all the precordium, but usually it is the loudest at the apex. The closure of the aortic valve causes the first sound of the second heart sound (S2). The second sound of the second heart sound is produced due to the closure of the pulmonary valve. Ventricular filling causes the third heart sound (S3).

While assessing a patient with venous insufficiency, the nurse finds that the patient has edema in the lower extremities. The nurse also finds that the skin of the lower extremities is thick and has brownish discoloration. What could be the reason for such findings in the patient?

Degradation of red blood cells The patient may have edema in the lower extremities and the sensation of fullness in the legs because of venous insufficiency. Deposition of hemosiderin, which is a product of red blood cell degradation, may occur in the patient with venous insufficiency. This leads to the brownish discoloration and thickening of the skin. The occlusion of a deep vein causes unilateral edema in either upper or lower extremities. It is not associated with brownish discoloration of the skin. Bacterial invasion of poorly drained tissues may cause venous ulcers. The patient may have swelling and enlarged lymph nodes when there is an infection due to degradation of white blood cells.

The nurse is auscultating a patient's heart sounds. Which area is best for hearing the sound of the mitral valve?

Fifth left intercostal space at the midclavicular line There are four auscultatory areas where the heart sounds can be heard. The valve areas are not present across the actual anatomic locations of the valves. Ausculatory areas are the sites on the chest wall where sounds produced by the valves are best heard. The sound radiates with the direction of the blood flow. The fifth interspace around the left midclavicular line is the mitral valve area. Its sound can be heard over the entire precordium, although it is loudest at the apex. At the left lower sternal border, the sound of the tricuspid valve can be heard. The second left intercostal space is the area where the sound of the pulmonic valve is heard. The second right intercostal space is the aortic valve area.

The nurse is taking care of a patient with visible apical impulse in the sixth left intercostal space lateral to the midclavicular line. On palpation, the nurse finds that the impulse is approximately 4 cm in diameter and is more forceful than usual. Which disorder does the nurse suspect?

Left ventricular hypertrophy

The nurse is assessing the probability of deep venous thrombosis (DVT) in a patient. What should the nurse do to assess the probability of DVT in the patient?

Measure the calf circumference of both legs at the same place The nurse should measure the calf circumference of both the legs exactly at the same point to assess the probability of DVT in the patient. The nurse should measure at the same number of centimeters below the patella because doing so helps to avoid false results. Measuring the calf circumference of the suspected leg will not help the nurse to assess DVT. The nurse should assess the difference between the calf circumferences of both the legs to determine the probability of DVT. Measuring both legs at the same point gives a more accurate result than measuring at the site of the swelling. Nonstretchable tape should be used to ensure proper measurement of the calf circumference.

Which pathologic condition leads to the accumulation of lymph in the breasts and upper arms?

Obstruction of the axillary nodes The lymph from the breasts and the upper arms drains into the axillary nodes. Obstruction of the axillary nodes results in the accumulation of lymph in the breasts and the upper arms. Obstruction of the cervical nodes results in the accumulation of lymph in the head and the neck, because they drain the lymph from the head. Obstruction of the inguinal nodes results in the accumulation of lymph in the genitalia and the abdomen. This is because they drain the lymph from the external genitalia and the anterior abdominal wall. Obstruction of the epitrochlear nodes results in the accumulation of lymph in the hands and lower arms, because these nodes drain the lymph from the hands and the lower arms.

The nurse instructs a student nurse to palpate the carotid artery of a patient. Which action made by the student nurse needs correction?

Palpating both carotid arteries at once The nurse should palpate only one carotid artery at a time. Palpating both carotid arteries at the same time will compromise arterial blood supply to the brain. The nurse should instruct the patient to sit during carotid artery palpation because this position allows proper exposure of the neck. The nurse should refrain from excessive vagal stimulation and compression of the carotid sinuses because it slows the heart rate.

While assessing the cardiac health of a middle-aged patient, which finding would the nurse consider abnormal?

Presence of a third heart sound In middle-aged adults, the third heart sound (S3) or ventricular gallop is usually abnormal. The S3 indicates decreased compliance of the ventricles, and it may be the earliest sign of heart failure. The normal apical impulse is the result of the heart rotating, moving forward, and striking against the chest wall during the systole. Lateral or inferior displacement of the apex beat usually indicates the enlargement of the heart. The filling level of the jugular veins help to estimate the blood pressure. The pulse rate measured at the jugular vein provides a source of information about the state of the right atrium. The venous hum, a continuous murmur usually of maximum intensity in the supraclavicular area, is a common auscultatory finding in children; it is of no known pathologic significance.

Which sign would be present in a patient with atherosclerosis?

Presence of bruit sound Normally, a bruit is absent in a healthy patient. Atherosclerotic disease causes turbulence in the blood flow and results in a bruit sound. A low-pitched rumbling is a sign of mitral stenosis. Atherosclerosis would not weaken the walls of the ventricles. Weak contractions of the ventricles will occur in the patient with heart failure. Unilateral distention of the external jugular veins indicates an aneurysm.

What should the nurse assess first in the patient while doing a regional cardiovascular assessment?

Pulse and blood pressure During a regional cardiovascular assessment, the nurse should follow the proper order of assessment in order to obtain accurate results. The nurse should start the assessment peripherally and move in towards the heart. The nurse should assess the neck vessels and precordium after checking the peripheral pulses and blood pressure.

Which term can be used to describe the pacemaker of the heart?

Sinoatrial node Sinoatrial node is another term used for the pacemaker of the heart. The automaticity of the heart enables it to contract by itself, independent of any signals or stimulation from the body. The heart contracts in response to an electrical current conveyed by a conduction system. Specialized cells in the sinoatrial node near the superior vena cava initiate an electrical impulse. The sinoatrial node triggers electrical impulses at regular intervals to cause the heart muscles to beat in an orderly sequence; hence, it is the pacemaker. The atrioventricular node is present in the auricular septum; it helps in the conduction of the cardiac impulse. Lymph nodes are oval-shaped organs of the lymphatic system which are spread throughout the body, including the armpits and the stomach, and are linked by the lymphatic vessels. Ranvier's nodes are the regular constrictions of the myelinated nerve fibers. At such locations, the myelin sheath is absent and the axon is enclosed only by Schwann cell processes.

While the nurse is performing a peripheral vascular examination, the patient says, "I wake up in the middle of the night because of sudden pain in my legs." What does the nurse infer from the patient's statement?

The patient may have restless leg syndrome. The patient with restless legs syndrome may wake up at night because of pain. Restless legs syndrome is a neurologic disorder that affects the legs and causes an urge to move them. The patient who experiences severe pain in the legs when standing for longer periods may have varicose veins in the legs. Aortoiliac occlusion indicates erectile dysfunction, which is also known as Leriche syndrome. This does not interfere with the patient's sleep pattern. Arterial insufficiency occurs because of deficient iron uptake by the brain. The patient with restless legs syndrome might not have arterial insufficiency.