Chapter 17 Patho
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
right- sided heart failure
A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the client that she has aortic stenosis. After the cardiologist has left the room, the client asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds:
"Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur."
A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The man's nurse has been educating him around his diagnosis and treatment and answering the numerous questions he has about his health problem. Which teaching point should the nurse include in this client teaching?
"The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently."
The cardiologist just informed a client that he has a reentry circuit in the electrical conduction system in his heart. This dysrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the client asks the nurse to explain this. Which statement mostaccurately describes what is happening?
"There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast."
A client is lying in a recumbent position. In this client, approximately how much total blood volume is in the central circulation?
25%-30%
The linear velocity of blood flow in the circulatory system varies widely. What is the linear velocity in the aorta?
30 to 35 cm/second
A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography?
55% - 75%
The semilunar valves of the heart open at the onset of the ejection period. Approximately what percentage of the stroke volume is ejected during the first quarter of systole?
60%
A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the client about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium?
A membranous sac that encloses the heart
Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply.
Abdominal Thoracic
A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which assessment should the nurse complete?
Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves.
The heart controls the direction of blood flow. What is the role of the aortic valve?
Controls the direction of blood flow from the left side of the heart to the systemic circulation
While intubated for surgery, a client has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?
Decreased heart rate as a result of parasympathetic innervation of the heart
A client is experiencing impaired circulation secondary to increased systemic arterial pressure. Which statement is the most relevant phenomenon?
High afterload because of backpressure against the left ventricle
Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability?
Histamine
A grandmother who works as a cook at a nearby school was recently hospitalized when she lost an extensive amount of blood in a work-related accident. The grandmother tells the nurse that she heard that she would keep feeling faint until the brain made more blood. The nurse knows that when the blood pressure dropped, the pressure in the carotid arteries decreased. This was detected by baroreceptors in the carotid arteries. What did the baroreceptors do?
Increase sympathetic stimulation of the heart and blood vessels
If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations?
Increased heart rate and increased contracibility
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?
Left ventricle
Which organ has larger capillary pores to allow the exchange of gases, nutrients, and/or waste products?
Liver
Considering the PQRST complex of an electrocardiogram (ECG), which letter designation represents atrial depolarization?
P wave
The nurse assesses the electrocardiogram for depolarization of the atria. What portion of the ECG will the nurse be assessing?
P wave above the baseline
The nurse is evaluating a client with cardiac problems and notes that the client's peripheral pulse is different than the apical pulse. To which physiologic response would the nurse attribute the difference in rates?
Premature beats not following normal conduction pathways
A nurse is caring for a client with right heart failure caused by pulmonary hypertension. Which hemodynamic parameter is most appropriate for the nurse to monitor?
Pulmonary arterial pressure(PAP)
The heart is a four-chambered pump. What is the function of the right ventricle?
Pumps blood to the lungs
When trying to explain to a client on dialysis the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:
Small
A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of:
Sympathetic nervous system
Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease?
The pulse decreases, rather than increases, in amplitude
A client is visiting the primary physician and appears extremely nervous. The intake nurse does his vital signs and notes an increase in both his heart rate and blood pressure. In an effort to better understand the client's presenting signs and symptoms the nurse asks the client about his concerns and the client states that the person who performed his pre-visit told him that he had a dysrhythmia. Which is the most therapeutic response about cardiac dysrhythmias that the nurse can make?
They can occur in diseased or healthy hearts
The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?
Ventricles contract and blood is ejected from the heart
A nursing student is studying the properties of cardiac rhythm to better understand what causes dysrhythmias to occur. The student begins to understand that there is a programmed ability for certain cells to conduct impulses. Interruption in this ability can result in abnormalities of cardiac rate and rhythm; this property would be:
conductivity
A client took a weight loss drug that activated the alpha-adrenergic receptors in the sympathetic nervous system. Which manifestations would the nurse expect to occur? Select all that apply.
increase blood pressure of cardiac contraction Increased cardiac cycle speed
The lymph system correlates with the vascular system without actually being a part of the vascular system. Among other things, the lymph system is the main route for the absorption of fats from the gastrointestinal system. The lymph system empties into the right and left thoracic ducts, which are the points of juncture with the vascular system. What are these points of juncture?
junctions of the subclavian and internal jugular veins
Which sequence is the correct pathway for blood flow through the heart?
right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
A nurse is evaluating a client to determine the effectiveness of medications given to reduce left ventricular afterload. Which hemodynamic parameter is most appropriate for the nurse to monitor?
systemic vascular resistance(SVR)
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as:
tunica media
There are three main atrial pressure waves that occur during the cardiac cycle. What are the three main atrial pressure waves? Select all that apply.
A, C, V
Which neurotransmitter is associated with the parasympathetic nervous system?
Acetylcholine
A nurse is teaching a client the correct technique for taking an arterial pulse. The nurse explains that the pulsations are:
Pressure pulses
A group of nursing students is discussing ventricular dysrhythmias and one student is unsure why a client with frequent premature ventricular complexes (PVCs) has an irregular radial pulse. One of the other students explains that premature ventricular complexes often do not produce a palpable pulse due to:
decreased ventricular filling time
In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the client has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of:
decreasing cardiac output due to less ventricular filling time.
