Cardiovascular System

What is indicated when the point of maximal impulse (PMI) is found in a lower location than expected during the cardiac assessment? Cardiac atrophy Pericardial effusion Increased cardiac contractility Cardiac hypertrophy (enlargement)

Cardiac hypertrophy (enlargement) If PMI is located lower than expected, this can indicate cardiac hypertrophy (cardiac enlargement) as heart takes up more space.

Which cardiac complication should cause changes in cardiac output (CO) after catheterization? Phlebitis Dysrhythmias Peripheral thrombus Vasospasm of catheterized vessel

Dysrhythmias Dysrhythmias can be hemodynamically compromising leading to decrease in cardiac output.

Which diagnostic test can be used for real-time visualization of both heart structures and function? Holter monitor Electrocardiogram (ECG) Ventilation-perfusion scan Echocardiography (ECHO)

Echocardiography (ECHO) ECHO generates an image of the heart and heart structures. In real-time, structures and functions can be evaluated.

Which cardiac catheterization complication directly causes occlusion of the blood vessel? Infection Hemorrhage Embolus formation Reaction to injected dye

Embolus formation A thrombus or embolus can cause occlusion of the blood vessel and prevent perfusion of tissue.

What information can be obtained by observing the integumentary system during a cardiac assessment? Evidence of cyanosis Evidence of decreased preload Evidence of coronary artery perfusion deficits Evidence of discrepancies between upper and lower extremity blood pressure (BP)

Evidence of cyanosis Cyanosis is evident upon observation of skin, mucosal membranes, conjunctiva, and nail beds.

Which structures allow the fetal heart to compensate for nonfunctioning lungs? Select all that apply. Liver Left ventricle Foramen ovale Ductus arteriosus Superior vena cava

Foramen ovale The foramen ovale is a vessel that allows blood to bypass the lungs, allowing for more efficient blood flow in the absence of functioning lungs. Ductus arteriosus The ductus arteriosus carries oxygenated blood from the placenta to the heart, allowing for oxygen delivery in the absence of functioning lungs.

Starting with the right atrium, trace the flow of blood through the heart to the left ventricle. Pulmonary arteries Left ventricle Pulmonary veins Right ventricle Left atrium Lungs

From the right atrium, blood flows through the tricuspid valve to the right ventricle, through the pulmonic valve to the pulmonary arteries and to the lungs. From the lungs, the blood returns to the heart through the pulmonary veins into the left atrium and then passes through the mitral valve into the left ventricle. To continue, blood passes through the aortic semilunar valve into the aorta, then distributes throughout the body before returning via the vena cava.

The nurse is auscultating the chest of a pediatric patient and identifies a clear heart murmur. Palpation does not identify a thrill. The nurse should note this as which grade of murmur? Grade 1 Grade 3 Grade 5 Grade 6

Grade 3 A grade 3 murmur is moderately loud using a stethoscope but is not accompanied by a palpable thrill.

Which diagnostic test should be most efficient for evaluating an active child who has cardiac symptoms that do not currently interfere with daily activities? Holter monitor Chest radiography Ventilation-perfusion scan Magnetic resonance imaging (MRI)

Holter monitor The Holter monitor continuously records heart rate and rhythm. A diary is kept to track correlations between symptoms and activities. The child remains active and data is collected during a variety of daily activities.

The nurse is assessing a pediatric patient with rhythm disturbance and decreased cardiac output (CO). What action should the nurse take? Immediately begin CPR Immediately notify the health care provider Maintain observation until a collapse rhythm develops Place child in Holter monitor, maintain 24-hour recordings

Immediately notify the health care provider Pediatric rhythm disturbances should be treated as emergencies if they compromise cardiac output or have the potential to degenerate into lethal (collapse) rhythms (e.g., ventricular fibrillation). The health care provider should be immediately notified.

What change in the neonate is directly responsible for the closure of foramen ovale? Increased blood flow to liver Increased pulmonary blood flow Increased pressure in left ventricle Increased pulmonary oxygen saturation

Increased pressure in left ventricle When the umbilical cord is clamped and the placental blood flow is stopped, pressure in the left ventricle rises and exceeds pressure in the right ventricle. This difference in pressure is responsible for closing the foramen ovale.

The nurse is assessing a child with a dysrhythmia and notes a slower than normal pulse. Which additional actions should the nurse perform to assess for possible complications of this bradydysrhythmia? Select all that apply. Measure respirations. Check oral temperature. Auscultate bowel sounds. Check range of motion (ROM) in extremities. Check color and skin temperature of extremities.

Measure respirations. If a child is having a dysrhythmia, breathing must be assessed. Chest compression and ventilation are indicated if the child stops breathing. Check color and skin temperature of extremities. If a child is having a dysrhythmia, circulation must be assessed. If the extremities are perfused and cyanosis is not noted, that indicates adequate perfusion; however, the presence of cool and cyanotic extremities would indicate poor perfusion secondary to the abnormal rate & rhythm.

Which cardiac valve is responsible for regulating the flow of oxygenated blood between ventricle and atrium? Aortic valve Mitral valve Tricuspid valve Pulmonary valve

Mitral valve The mitral valve is responsible for regulating the flow of oxygen-rich blood from the left atrium to the left ventricle to be released into the systemic circulation.

A 12-year-old patient with a history of heart surgery comes to the emergency department complaining of dizziness and chest discomfort. What electrocardiogram (ECG) finding lets the nurse know a patient is in supraventricular tachycardia (SVT)? Long Q-T interval Wide QRS interval Narrow QRS interval Lack of cardiac rhythm

Narrow QRS interval The presence of a narrow QRS on ECG with tachycardia indicates the impulse begins above (superior to) the ventricles and suggests SVT.

Following cardiac catheterization, what nursing assessments are necessary? Select all that apply. Palpate pulses Percussion of the chest Assess child's activity level Inspect catheter insertion site Assess pulmonary blood flow

Palpate pulses Following cardiac catheterization, distal pulses should be palpable, although they may be weaker than in the contralateral extremity. Nonpalpable distal pulses should be checked with Doppler technology. Inspect catheter insertion site The nurse should monitor the inspection site for bleeding and apply direct pressure for 5-10 minutes if noted. Additionally, the insertion site should be inspected for erythema and purulent drainage, indicating infection.

At birth, clamping of the umbilical cord and the first breath generates pressure changes in the neonate's circulation. This results in major changes in which aspects of the heart? Select all that apply. Path of blood flow Blood oxygenation Vascular resistance Right ventricle workload Function of superior vena cava

Path of blood flow The pressure changes result in closure of fetal valves, altering the flow of blood. Primarily, blood will now obtain oxygen from the lungs instead of the placenta. Blood will no longer be shunted away from the liver. Blood oxygenation The pressure changes result in closure of fetal valves, shifting the organ responsible for oxygenation of the blood. The lungs will now oxygenate the blood as the connection to the placenta is severed. This results in a distinct distribution of oxygenated blood so the right side of the heart contains primarily deoxygenated blood and the left side contains oxygenated. Vascular resistance The pressure changes result in decrease in vascular resistance and increase in pulmonary blood flow.

Which physiologic factors must be taken into consideration when determining cardiac output (CO)? Select all that apply. Preload Afterload Heart rate Respiratory rate Oxygen saturation

Preload Preload is an important factor for determining cardiac output as it is necessary to determine stroke volume, which is used to directly calculate cardiac output. Afterload Afterload is an important factor for determining cardiac output as it is necessary to determine stroke volume, which is used to directly calculate cardiac output. Heart rate Heart rate is a crucial factor that contributes to the calculation of cardiac output.

The nurse is caring for a child with incomplete closure of the aortic semilunar valve. How does the nurse describe the normal function of this valve to the patient's family? Facilitates blood flow into the atria Facilitates blood flow into the vena cava Prevents blood from flowing back into the ventricle Prevents blood from flowing into the pulmonary trunk

Prevents blood from flowing back into the ventricle The aortic semilunar valve regulates blood flow from the ventricles to the aorta. If this valve does not close, blood will flow back into the ventricles.

Which statement describes the relationship between the ductus arteriosus and blood flow in the fetus? Because pulmonary circulation pressure is high, the ductus arteriosus facilitates blood flow into the lungs. The blood returning to the heart from the vena cava is directed through the ductus arteriosus to the left atrium. The left atrium and left ventricle are nonfunctional in the infant. The ductus arteriosus diverts blood away from the left side of the heart. Pulmonary circulation pressure is high; the ductus arteriosus directs blood away from the lungs and into the aorta.

Pulmonary circulation pressure is high; the ductus arteriosus directs blood away from the lungs and into the aorta. Pulmonary circulation pressure is high in the fetus. The ductus arteriosus provides a pathway from the pulmonary trunk to the descending aorta, bypassing the lungs. As the blood has already been oxygenated in the placenta, passage through the lungs is unnecessary.

A normal rhythm appears on the electrocardiogram (ECG) rhythm strip, but when the nurse palpates for a pulse it is not present. Which condition does this patient likely have? Asystole Pulseless electrical activity (PEA) Supraventricular tachycardia (SVT) Primary cardiac bradydysrhythmia

Pulseless electrical activity (PEA) PEA indicates that the electrical events of cardiac conduction are occurring but cannot generate myocardial contraction and cardiac output. This results in a normal rhythm appearing on the ECG, but no palpable pulse.

Which factor influence the amount of blood that fills the ventricle immediately before contraction? Hypoxia Afterload Body temperature Rate of venous return

Rate of venous return Rate of venous return influences preload by altering the amount of blood returning to the heart.

In the electrical conduction system of the heart, where does the initial impulse start? AV node Bundle of His Purkinje fibers Sinus (SA) node

Sinus (SA) node The sinus node (SA node), a group of spontaneously depolarizing cells, sets the normal "sinus" rhythm.

A young child presents to the primary care clinic for a well-visit. During the cardiac assessment, the nurse hears a murmur during S2 and a heart rate of 90 bpm. The nurse notes that the child is below average height. Based on this information, what is the likely cause of the child's murmur? Trauma Structural defect Tachydysrhythmia Poor peripheral perfusion

Structural defect Pathologic murmurs reflect an abnormality in the heart structure such as with congenital heart disease (CHD). Additionally, this defect may impair the child's normal growth.

Auscultation is an important aspect of the cardiac assessment. Which sentence helps to explain why both the bell and the diaphragm of the stethoscope are used during the assessment? The bell is used to identify dysrhythmias; the diaphragm identifies murmurs. The bell is used to identify normal heart sounds; the diaphragm is used to identify murmurs. The bell is used to identify low-pitched sounds; the diaphragm is used to identify high-pitched sounds. The bell is used to identify high-pitched, normal heart sounds; the diaphragm identifies low-pitched murmurs.

The bell is used to identify low-pitched sounds; the diaphragm is used to identify high-pitched sounds. Both low- and high-pitched sounds are heard during auscultation of the heart. S1 is lower pitch, S2 is higher pitch. To clearly hear both heart sounds, both the bell and diaphragm should be used.

How do pressures in the fetal heart and pulmonary vasculature compare to neonatal? Select all that apply. The fetal heart has lower left ventricular pressure. The fetal heart has higher left ventricular pressure. The pulmonary vasculature has increased pressure. The fetal heart has lower right ventricular pressure. The pulmonary vasculature has decreased pressure. The fetal heart has higher right ventricular pressure.

The fetal heart has lower left ventricular pressure. The fetal heart has lower left ventricular pressure because it is partially bypassed due to fetal shunts that deliver blood directly to the aorta. The pulmonary vasculature has increased pressure. The pulmonary vasculature has increased pressure because the lungs are not yet inflated. The fetal heart has higher right ventricular pressure. The fetal heart has higher right ventricular pressure due to resistance in pulmonary trunk.

Which statement best summarizes the differences between the fetal and neonatal heart in terms of oxygen saturation? The oxygen saturation of the fetal heart constantly changes, whereas the oxygen saturation of the neonatal heart is consistent, albeit different, on each side. The fetal heart has moderate oxygen saturation throughout, whereas the neonatal heart has low oxygen saturation on the right side & high oxygen saturation on the left side. The fetal heart has very low oxygen saturation on the left side and very high oxygen saturation on the right, whereas the neonatal heart has low oxygen saturation on the right and high oxygen saturation on the left. Both the fetal and neonatal hearts differ in oxygen saturation based on the side of the heart, with the fetal heart having moderate oxygen saturation on the right side and the neonatal heart having high oxygen saturation on the right side.

The fetal heart has moderate oxygen saturation throughout, whereas the neonatal heart has low oxygen saturation on the right side & high oxygen saturation on the left side. Fetal blood is oxygenated by the placenta and receives moderate oxygen saturation. This blood is delivered to the heart. No change in oxygen saturation occurs in the fetal heart due to nonfunctional lungs. In the neonate, after the fetal shunts have closed, deoxygenated (low oxygen saturation) blood returns to the right side of the heart. The left side of the heart receives oxygenated (high oxygen saturation) blood from the lungs.

For what reasons is it essential to assess all four extremities while performing a cardiac assessment? Select all that apply. To determine temperature differences To assess the point of maximal impulse To assess capillary filling in the extremities To assess differences in the function of the heart valves To determine differences between the central and peripheral pulses To determine differences in blood pressure between upper and lower extremities

To determine temperature differences Temperature differences in the extremities can indicate perfusion problems. To assess capillary filling in the extremities Capillary filling differences in the extremities can indicate perfusion problems. To determine differences between the central and peripheral pulses Pulse differences in the extremities can indicate perfusion problems. Correct To determine differences in blood pressure between upper and lower extremities BP differences in the extremities can indicate perfusion problems and cardiac disease.

What findings during the cardiac assessment provide information about possible cardiac dysfunction? Select all that apply. Poor weight gain Excessive crying Decreased feeding Delayed cognitive milestones Respiratory pattern alterations

oor weight gain Poor weight gain may be related to feeding difficulties or an overall increase in cardiac workload. Decreased feeding Feeding difficulties (decreased intake or increased rest periods during feeding) can occur if the child has increased energy expenditure during feeding. This may indicate increased cardiac workload. Respiratory pattern alterations Altered respiratory patterns or distress are possible indicators of cardiac dysfunction.