Chpt 30 Assessment of the Cardiovascular system Study guide

Which is the most common and normal response by a client to a cardiovascular illness? A. Denial B. Fear C. Loss of control D. Depression

A A common and normal response is denial, which is a defense mechanism that enables the client to cope with threatening circumstances. He or she may deny the current cardiovascular condition, may state that it was present but is now absent, or may be excessively cheerful. Denial becomes maladaptive when the client is noncompliant or does not adhere to the inter-disciplinary plan of care.

Which client has an abnormal heart sound? A. S3 in a 54-year-old B. S1 in a 45-year-old C. S2 in a 38-year-old D. S3 in a 25-year-old

A An S3 gallop in clients older than 35 years is considered abnormal and represents a decrease in left ventricular compliance. It can be detected as an early sign of heart failure or as a ventricular septal defect. An S3 heart sound is most likely to be a normal finding in those younger than 35 years. S1 and S2 are both nor-mal heart sounds.

Before administering which class of drugs would the nurse always check the client's heart rate? A. Beta blockers B. Diuretics C. Anticoagulants D. Nonsteroidal anti-inflammatories

A An increase in circulating catecholamines (e.g., epinephrine and norepinephrine) usually causes an increase in HR and contractility. Many cardiovascular drugs, particularly beta blockers, block this sympathetic (fight or flight) pattern by decreasing the HR. The nurse would check to be sure that the heart rate was not too slow before administering a beta blocker.

What possible causes would the nurse consider when assessing a client and finding a hyperkinetic pulse? Select all that apply. A. Sepsis B. Sedentary lifestyle C. Pain D. Fever E. Anxiety F. Thyrotoxicosis

A, C, D, E, F A hyperkinetic pulse is a large, "bounding" pulse caused by an increased ejection of blood. It occurs in clients with a high cardiac output (e.g., with exercise [not sedentary], sepsis, or thyrotoxicosis) and in those with increased sympathetic system activity (e.g., with pain, fever, or anxiety).

Which may be causes of a client's pericardial friction rub? Select all that apply. A. Myocardial infarction B. Pulmonary edema C. Cardiac tamponade D. Infection E. Inflammation F. Thoracotomy

A, C, D, E, F A pericardial friction rub originates from the pericardial sac and occurs with the movements of the heart during the cardiac cycle. They are usually transient and are a sign of inflammation, infection, or infiltration. They may be heard in clients with pericarditis resulting from MI, cardiac tamponade, or post-thoracotomy. Pulmonary edema is not a cause of a pericardial friction rub.

Which triad of symptoms would the nurse assess for in a woman at risk for cardiovascular disease? Select all that apply. A. Severe chest pain B. Feeling of abdominal fullness C. Chronic fatigue despite adequate rest D. Extremity pain E. Dyspnea or inability to catch her breath F. Intermittent claudication

B, C, E Some clients, especially women, do not experience pain in the chest but, instead, feel discomfort or indigestion. Women often present with a "triad" of symptoms. In addition to indigestion or a feeling of abdominal fullness, chronic fatigue despite adequate rest and feelings of an "inability to catch my breath" (dyspnea) are also common in heart disease.

Which questions would the nurse ask to assess a client's nicotine dependence? Select all that apply. A. "What brand of cigarettes do you smoke?" B. "Do you smoke even when you are ill?" C. "How soon after you wake up in the morning do you smoke?" D. "What happened the last time you tried to quit smoking?" E. "Do you wake up in the middle of the night to smoke?" F. "Do you find it difficult not to smoke in places where smoking is prohibited?"

B, C, E, F Determine nicotine dependence by asking questions such as: How soon after you wake up in the morning do you smoke?; Do you wake up in the middle of the night to smoke?; Do you find it difficult not to smoke in places where smoking is prohibited?; and Do you smoke even when you are ill?

Which client serum lipid tests suggest an increased risk for cardiovascular disease (CVD)? Select all that apply. A. HDL 65 mg/dL B. LDL 170 mg/dL C. Triglycerides 185 mg/dL D. Total cholesterol 175 mg/dL E. VLDL 39 mg/dL F. Total cholesterol 250 mg/dL

B, C, E, F See Laboratory Profile Cardiovascular Assessment Box in text. This box lists the normal results and states which lipid results increase the risk for CVD. The desired ranges for lipids are: Total cholesterol less than 200 mg/dL; Triglycerides between 40 and 160 mg/dL for men and between 35 and 135 mg/dL for women; HDL more than 45 mg/dL for men; more than 55 mg/dL for women ("good" cholesterol); and LDL less than 130 mg/dL; VLDL is 7-32 mg/dL or 0.18-0.83 mmol/L (SI units). A fasting blood sample for the measurement of serum cholesterol levels is preferable to a non-fasting sample.

What is the lowest mean arterial pressure (MAP) necessary to perfuse the major organs of the body? A. 90 to 100 mm Hg B. 80 to 90 mm Hg C. 70 to 80 mm Hg D. 60 to 70 mm Hg

D A MAP between 60 and 70 mm Hg is necessary to maintain perfusion of major body organs, such as the kidneys and brain. While all of these MAPs will maintain perfusion to the major organs, this question asks for the lowest MAP necessary to maintain major organ perfusion and therefore option D is the best response.

Which information from a client's medical history causes the nurse to check for abnormalities of the heart valves? A. Staphylococcal infections of the skin B. Yeast infections of the vagina C. Fungal infections on the toenails D. Streptococcal infections of the throat

D Ask clients about recurrent tonsillitis, streptococcal infections, and rheumatic fever because these conditions may lead to valvular abnormalities of the heart.

What is the best technique for assessing a client's right lower leg for arterial insufficiency? A. Palpate the peripheral arteries using a head-to-toe approach with side-to side comparison. B. Check all pulse points in the right leg in dependent and supine positions. C. Palpate the major arteries including the femoral, and observe for pallor. D. Use a Doppler to find the dorsalis pedis and posterior tibial pulses in the right leg.

A Assessment of arterial pulses provides information about vascular integrity and circulation. For clients with suspected or actual vascular disease, major peripheral pulses should be assessed for presence or absence, amplitude, con-tour, rhythm, rate, and equality. Palpate the peripheral arteries in a head-to-toe approach with a side-to-side comparison.

What would the nurse calculate the cardiac output to be when the client's heart rate is 68 beats/min and the stroke volume is 50 mL? A. 3400 L/min B. 4000 L/min C. 4400 L/min D. 4800 L/min

A Cardiac output (CO), is the amount of blood pumped from the left ventricle each minute. CO depends on the relationship between heart rate (HR) and stroke volume (SV); it is the product of these two variables: CO = SV X HR i.e., 50 X 68 = 3400 mL/min.

Which laboratory value test elevation does the nurse consider most significant in the diagnosis of a client's myocardial infarction (MI)? A. Troponin T and I B. Myoglobin C. Highly sensitive C-reactive protein D. Creatinine kinase MB

A Troponin is a myocardial muscle protein re-leased into the bloodstream with injury to myocardial muscle. Troponins T and I are not found in healthy clients, so any rise in values indicates cardiac necrosis or acute MI. Before the development of highly sensitive troponin levels, providers relied on creatinine kinase (CK), its isoenzyme (CK-MB), and myoglobin to assist with diagnosis of acute myocardial infarction. Highly sensitive C-reactive protein (hsCRP) has been the most studied marker of inflammation.

Which statement best describes the functional capability of a client who is categorized as New York Heart Association Class II? A. Ordinary physical activity results in fatigue, palpitations, dyspnea, and anginal pain. B. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. C. Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain. D. If any physical activity is undertaken, discomfort is increased.

A With regard to physical activity, the New York Heart Association Functional Classification of Cardiovascular Disability describes the four classes as follows: Class I, ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain; Class II, ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain; Class III, less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain; and Class IV, if any physical activity is undertaken, dis-comfort is increased.

Which American Heart Association guidelines would the nurse teach a client to fight obesity and improve cardiovascular health? Select all that apply. A. Don't consume more calories than you can use in a day. B. Consume foods that contain vitamins, minerals, and fiber. C. Choose foods that are healthy and low in calories. D. Avoid gas-producing vegetables such as cabbage or broccoli. E. Eat vegetables, fruit, and whole-grain foods. F. For calcium, choose whole milk dairy products.

A, B, C, E The American Heart Association provides guidelines to combat obesity and improve car-diac health, including ingesting more nutrient-rich foods that have vitamins, minerals, fiber, and other nutrients but are low in calories. To get the necessary nutrients, teach clients to choose foods such as vegetables, fruits, unre-fined whole-grain products, and fat-free (not whole milk) dairy products most often. Also teach clients to not eat more calories than they can burn every day. Vegetables such as cabbage and broccoli are good sources of nutrients.

Which techniques would the medical/surgical nurse use when inspecting a client's precordium? Select all that apply. A. Look at the chest from the side, at a right angle, and downward over areas of the precordium where vibrations are visible. B. Note any movement over the aortic, pulmonic, and tricuspid areas. C. Use percussion over the heart area to determine its size. D. Observe for the location of the point of maximal impulse (PMI) and note any shift. E. Palpate the areas over the aortic, pulmonic, and tricuspid valves. F. Listen to the heart sounds in a systematic order.

A, B, D Inspect the chest from the side, at a right angle, and downward over areas of the precordium where vibrations are visible. Cardiac motion is of low amplitude, and sometimes the inward movements are more easily detected by the naked eye. Note any prominent pulses. Movement over the aortic, pulmonic, and tricuspid areas is abnormal. Pulses in the mitral area (the apex of the heart) are considered normal and are referred to as the apical impulse, or the point of maximal impulse (PMI). The PMI should be located at the left fifth intercostal space (ICS) in the midclavicular line. If it appears in more than one ICS and has shifted lateral to the mid-clavicular line, the client may have left ventricular hypertrophy. Palpation and percussion are usually not performed by medical/surgical nurses. Listening to the heart sounds would be part of auscultation assessment.

Which instructions would the nurse give the LVN/LPN monitoring a client after cardiac catheterization by radial artery approach? Select all that apply. A. Monitor the client's vital signs every 15 minutes for 1 hour. B. Assess the insertion site for bloody drainage or hematoma. C. Keep the client in bed for at least 6 hours. D. Assess peripheral pulses and skin temperature and color with every vital sign check. E. Monitor intake and output. F. Provide oral fluids for adequate contrast excretion.

A, B, D, E, F All options except C are correct for safe recovery of the client after a cardiac catheterization. Keeping the client in bed for more than 2 hours is not necessary when the radial approach is used for the test.

Which assessment data would the nurse expect for a client diagnosed with angina? Select all that apply. A. Pain relieved at rest B. Sudden onset of pain C. Intermittent pain relieved by sitting upright D. Substernal pain that may spread across chest, back, and arms E. Sharp, stabbing pain that is moderate to severe F. Pain that usually lasts less than 15 minutes

A, B, D, F Angina pain is usually sudden in onset, in response to exertion, emotion, or extremes in temperature. It is usually located on the left side of chest without radiation but can be substernal and may spread across the chest and the back and/or down the arms. It usually lasts less than 15 minutes and is relieved with rest, nitrate administration, or oxygen therapy. See Table 30.1 in the text.

Which cardiovascular assessment changes would the nurse expect in an older client? Select all that apply. A. Presence of murmurs B. Atrial dysrhythmias C. Fewer premature ventricular contractions D. Very short QT interval on ECG E. Increased dizziness F. Positive orthostatic blood pressure

A, B, E, F Calcification of heart valves can cause murmurs. Pacemaker cells decrease in number which can lead to atrial dysrhythmias and in-creased (not fewer) premature ventricular con-tractions. The size of the left ventricle increases which can lead to widened QRS complexes and longer (not shorter) QT intervals. Baroreceptors become less sensitive which can lead to positive orthostatic blood pressure and dizziness as well as fainting.

Which assessment factors for a 62-year-old client would the nurse recognize as modifiable risk factors for heart disease? Select all that apply. A. History of smoking B. Age C. Obesity D. Ethnic background E. Sedentary lifestyle F. Gender

A, C, E Modifiable risk factors are personal lifestyle habits, including cigarette smoking, physical inactivity, obesity, and psychological variables. Nonmodifiable (uncontrollable) risk factors in-clude the client's age, gender, ethnic origin, and a family history of cardiovascular disease.

Which statements about intravascular ultrasonography (IVUS) are accurate? Select all that apply. A. A flexible catheter with a miniature transducer is introduced at the distal tip to view the coronary arteries. B. Injection of a contrast dye through a catheter permits viewing the coronary arteries. C. The catheter has a transducer which emits sound waves that reflect off the plaque and the arterial wall to create an image of the blood vessel. D. The catheter is advanced through either the inferior or the superior vena cava and is guided by fluoroscopy. E. IVUS can be used in vessels as small as 2 mm to assess the nature of plaques or vessel condition following an intervention. F. The cardiologist advances the catheter against the blood flow from the femoral, brachial, or radial artery up the aorta, across the aortic valve, and into the left ventricle.

A, C, E Options A, C, and E are accurate about the intravascular ultrasonography (IVUS) procedure. Options B, D, and F are descriptions related to the usual cardiac catheterization procedure.

Which mechanisms regulate and mediate blood pressure? Select all that apply. A. Kidneys B. Gastrointestinal system C. Autonomic nervous system D. Respiratory system E. Endocrine system F. Carbon dioxide elimination

A, C, E The three mechanisms that regulate and mediate blood pressure: the autonomic nervous system (ANS), which excites or inhibits sympathetic nervous system activity in response to impulses from chemoreceptors and baroreceptors; the kidneys, which sense a change in blood flow and activate the renin-angiotensin-aldosterone mechanism; and the endocrine system, which releases various hormones (e.g., catecholamine, kinins, serotonin, histamine) to stimulate the sympathetic nervous system at the tissue level.

Which statements about the structure of the heart are accurate? Select all that apply. A. The heart normally pumps about 5 L of blood per minute. B. A muscular wall called the septum separates only the ventricles of the heart. C. The pericardium is a covering that protects the heart. D. The left ventricle pumps deoxygenated blood to the lungs. E. The right ventricle pumps blood into the aorta and systemic arterial system. F. Coronary artery blood flow occurs primarily during diastole.

A, C, F Options A, C, and F are accurate. The septum separates the atria and the ventricles. The right ventricle pumps deoxygenated blood to the pulmonary artery and lungs, while the left ventricle pumps blood to the aorta and the systemic arterial system.

Which instruction would the nurse give a client who is to have an exercise electrocardiography test? A. "Someone must drive you home because of sedative effects of the medications." B. "Wear comfortable loose-fitting clothes and supportive, rubber-soled shoes." C. "Avoid smoking or drinking alcohol for at least a week before the test." D. "Do not eat or drink anything after midnight."

B Clients are advised to wear comfortable, loose clothing and rubber-soled, supportive shoes. Instruct the client to get plenty of rest the night before the procedure. He or she may have a light meal 2 hours before the test but should avoid smoking or drinking alcohol or caffeine-containing beverages on the day of the test. Usually cardiovascular drugs such as beta blockers or calcium channel blockers are withheld on the day of the test to allow the heart rate to increase during the stress portion of the test. Sedation drugs are not given with this test.

What is the best advice the nurse would give to a client with moderate-to-severe cramping sensation in their legs or buttocks associated with an activity such as walking? A. "Elevating the affected extremity may help relieve the pain." B. "Resting or lowering the affected extremity can relieve the pain." C. "Placing a nitroglycerine tablet under your tongue may relieve the pain." D. "Losing some weight can take pressure off the extremity and relieve the pain."

B Clients who report a moderate-to-severe cramping sensation in their legs or buttocks associated with an activity such as walking have intermittent claudication related to decreased arterial tissue perfusion. Resting or lowering the affected extremity to decrease tissue demands or to enhance arterial blood flow usually relieves claudication pain. Leg pain that results from prolonged standing or sitting is related to venous insufficiency from either incompetent valves or venous obstruction. Elevating the extremity may relieve this pain. Nitroglycerine is given to relieve angina. Weight loss will not relieve the pain of intermittent claudication.

Which action does the nurse perform to pre-vent kidney toxicity when caring for a client after cardiac catheterization? A. Assess pedal pulses every 15 minutes. B. Provide intravenous and oral fluids for 12 to 24 hours. C. Check the catheterization site every hour for 8 hours. D. Keep the catheterized extremity straight for 6 hours.

B Contrast-induced renal dysfunction can result from vasoconstriction and the direct toxic effect of the contrast agent on the renal tubules. Hydration pre-and post-study helps eliminate or minimize contrast-induced renal toxicity.

When the nurse assesses a client in the clinic for a physical examination and finds decreased skin temperature, what does this most likely indicate? A. Renal failure B. Arterial insufficiency C. Anemia D. Central cyanosis

B Decreased blood flow results in decreased skin temperature. It is lowered in several clinical conditions, including heart failure, peripheral vascular disease, and shock. It can be assessed for symmetry by touching different areas of the body with the dorsal (back) surface of the hand or fingers.

Which exercise regimen would the nurse teach an older adult is best to meet guidelines for physical fitness to promote heart health? A. Golfing for 4 hours once a week B. Brisk walk for 20 to 30 minutes each day C. Bike ride for 6 hours every Saturday D. Running for 15 minutes twice a week

B In the United States the recommended exercise guidelines are: 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week (or a combination of the two) plus completing muscle-strengthening exercises at least 2 days per week. Regular physical activity (not just once a week) promotes cardiovascular fit-ness and produces beneficial changes in blood pressure and levels of blood lipids and clotting factors.

What does the nurse suspect when assessing a client at risk for CVD who states, "my right foot turns very dark red when I sit too long and when I put my foot up, it turns pale?" A. Central cyanosis B. Arterial insufficiency C. Peripheral cyanosis D. Venous insufficiency

B Rubor (dusky redness) that replaces pallor in a dependent foot suggests arterial insufficiency. Central cyanosis involves decreased oxygenation of the arterial blood in the lungs and appears as a bluish tinge of the conjunctivae and the mucous membranes of the mouth and tongue. Peripheral cyanosis occurs when blood flow to the peripheral vessels is decreased by peripheral vasoconstriction. Venous insufficiency is a result of prolonged venous hypertension that stretches and damages the valves which can lead to backup of blood, edema, and decreased tissue perfusion.

What is the correct technique for the nurse to use to check a client's lower extremities using the ankle-brachial index? A. Blood pressure in the legs is measured with the client supine; then the client stands for 5 minutes and blood pressure is measured in the arms. B. A blood pressure cuff is applied to the lower extremities and the systolic pressure is measured by Doppler ultrasound at both the dorsalis pedis and posterior tibial pulses. C. The dorsalis pedis and posterior tibial pulses are manually palpated and compared bilaterally for strength and equality and compared to a standard index. D. A blood pressure cuff is applied to the lower extremities to observe for an exaggerated decrease in systolic pressure of more than 10 mm Hg during inspiration.

B The ankle-brachial index (ABI) can be used to assess the vascular status of the lower extremities. A BP cuff is applied to the lower extremity just above the malleolus. The systolic pressure is measured by Doppler ultrasound at both the dorsalis pedis and posterior tibial pulses. The higher of these two pressures is then divided by the higher of the two brachial pulses to obtain the ABI. Normal values for the ABI are 1.00 or higher because BP in the legs is usually higher than BP in the arms.

For which pathophysiological conditions can a normal healthy heart adapt to maintain perfusion to the body tissues? A. Menses and gastroesophageal reflux disease B. Stress and infection C. Kidney stones and peripheral vascular disease D. Bleeding and shortness of breath

B The healthy heart can adapt to various pathophysiologic conditions (e.g., stress, infections, hemorrhage) to maintain perfusion to the various body tissues.

Which statement best defines the cardiovascular concept of preload? A. Amount of resistance the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels B. Degree of myocardial fiber stretch at the end of diastole and just before the heart contracts C. The volume of blood ejected each minute by the heart D. Force of blood exerted against the vessel walls

B The stretch imposed on the muscle fibers results from the volume contained within the ventricle at the end of diastole. Preload is determined by the amount of blood returning to the heart from both the venous system (right heart) and the pulmonary system (left heart) (left ventricular end-diastolic [LVED] volume). Option A describes the concept of afterload. Option C describes the concept of cardiac output and Option D is the definition of blood pressure.

Which statement by a client to the nurse indicates an understanding of cigarette usage related to cardiovascular risks? A. "I don't smoke as much as I used to and I'm down to half a pack a day." B. "I need to be completely cigarette-free for at least 3 years." C. "I started smoking a few years ago but I plan to quit in a year or two." D. "I smoke to relax like when I go out with friends or when I drink."

B Three to four years after a client has stopped smoking, his or her CVD risk appears to be similar to that of a person who has never smoked. The client is still smoking in the other responses and is still at risk for CVD.

Which medications will the nurse expect the cardiologist to put on hold before an exercise stress test? A. Acetaminophen and bronchodilator B. Atenolol and diltiazem C. Vitamins and iron D. Colace and aspirin

B Usually cardiovascular drugs such as beta blockers (e.g., atenolol) or calcium channel blockers (e.g., cardizem) are withheld on the day of the test to allow the heart rate to increase during the stress portion of the test. The drugs listed in options A, C, and D do not generally affect heart rate.

Which questions would the nurse ask a client when a client is admitted reporting chest pain? Select all that apply. A. "How do you feel about the chest pain?" B. "How long does the pain last and how often does it occur?" C. "Where does the pain occur and what does it feel like?" D. "Have you had other symptoms that occur with the chest pain and what are they?" E. "What activities were you doing when the pain occurred?" F. "Is this episode of chest pain different from other episodes you have had?"

B, C, D, E, F If pain is present, ask whether it is different from any other episodes of pain. Ask the client to describe which activities he or she was doing when it first occurred, such as sleeping, arguing, or running (precipitating factors). If possible, the client should point to the area where the chest pain occurred (location) and describe if and how the pain radiated (spread). In addition, ask how the pain feels and whether it is sharp, dull, or crushing (quality of pain). To understand the severity of the pain, ask the client to grade it from 0 to 10, with 10 indicating severe pain (intensity). He or she may also re-port other signs and symptoms that occur at the same time (associated symptoms), such as dyspnea, diaphoresis (excessive sweating), nausea, and vomiting. Other factors that need to be addressed are those that may have made the chest pain worse (aggravating factors) or less intense (relieving factors). Asking how the client feels about the pain should be part of the psychosocial assessment.

Which statements about blood pressure are accurate? Select all that apply. A. The right ventricle of the heart generates the greatest amount of blood pressure. B. Diastolic blood pressure is primarily determined by the amount of peripheral vasoconstriction. C. Systolic blood pressure is the amount of pressure or force generated by the left ventricle to distribute blood into the aorta with each contraction of the heart. D. Diastolic pressure is the highest pressure generated during contraction of the ventricles. E. To maintain adequate blood flow through the coronary arteries, mean arterial pressure (MAP) must be at least 90 mm Hg. F. Paradoxical blood pressure is an exaggerated decrease in systolic pressure by more than 10 mm Hg during the inspiratory phase of the respiratory cycle.

B, C, F The left ventricle generates the greatest amount of blood pressure. To maintain adequate blood flow through the coronary arteries, MAP must be at least 60 mm Hg. Systolic pressure is the highest pressure during contraction of the ventricles. Options B, C, and F are accurate.

Which actions by an older adult are likely to cause the experience of syncope? Select all that apply. A. Walking briskly for 20 minutes B. Turning the head C. Laughing D. Performing a Valsalva maneuver E. Rapidly swallowing fluids F. Shrugging the shoulders

B, D, F Syncope in an older adult may result from hypersensitivity of the carotid sinus bodies in the carotid arteries. Pressure applied to these arteries while turning the head, shrugging the shoulders, or performing a Valsalva maneuver (bearing down during defecation) may stimulate a vagal response and syncope. Walking, laughing, or swallowing fluids does not usually cause syncope in older adults.

What action does the nurse plan to take prior to a cardiac catheterization when a client states he or she has an allergy to seafood and iodine-containing dyes? A. Inform the cardiologist because the test must be delayed for a week. B. Prepare to administer anticoagulation therapy before the test. C. Administer an antihistamine and/or a steroid before the test. D. Instruct the client that the test will be conducted using noncontrast dye.

C Before the procedure, question the client about any history of allergy to iodine-based contrast agents. An antihistamine or steroid may be given to a client with a positive history or to prevent a reaction. The test does not need to be delayed and contrast dye is necessary to see any coronary artery blockages. Anticoagulants would not be given because that would cause bleeding.

What is the nurse's first action when the health care provider prescribes orthostatic blood pressure checks for a client? A. Wait for 1 minute before auscultating blood pressure while the client is sitting. B. Instruct the client to sit on the side of the bed before checking blood pressure. C. Measure the blood pressure after the client has been supine for 3 minutes. D. Tell the client to change positions rapidly between blood pressure checks.

C Postural (orthostatic) hypotension occurs when the BP is not adequately maintained while moving from a lying to a sitting or standing position. It is defined as a decrease of more than 20 mm Hg of the systolic pressure or more than 10 mm Hg of the diastolic pressure and a 10% to 20% increase in heart rate. To detect orthostatic changes in BP, first, measure the BP when the client is supine. After remaining supine for at least 3 minutes, the client changes position to sitting or standing. Normally systolic pressure drops slightly or remains unchanged as the client rises, whereas diastolic pressure rises slightly. After the position change, wait for at least 1 minute before auscultating BP and counting the radial pulse. The cuff should remain in the proper position on the client's arm. Observe and record any signs or symptoms of dizziness. If the client cannot tolerate the position change, return him or her to the previous position of comfort.

Which tests will the nurse teach a client are routinely done for follow-up monitoring when the client is discharged with a prescription for warfarin? A. Complete blood count and platelet count B. Partial thromboplastin time (PTT) and serum potassium C. Prothrombin time (PT) and international normalized ratio (INR) D. Serum and urine electrolyte studies

C Prothrombin time (PT) and international normalized ratio (INR) are used when initiating and maintaining therapy with oral anticoagulants, such as sodium warfarin. They measure the activity of prothrombin, fibrinogen, and factors V, VII, and X. INR is the most reliable way to monitor anticoagulant status in warfarin therapy. The therapeutic ranges vary significantly based on the reason for the anticoagulation and the client's history. The normal INR is 0.8-1.1. An INR range of 2.0-3.0 is generally an effective therapeutic range for people taking warfarin.

When a client is hypovolemic, which tissue reacts and sends fewer impulses to the CNS? A. Baroreceptors B. Central chemoreceptors C. Stretch receptors D. Kidney receptors

C Stretch receptors in the vena cava and the right atrium are sensitive to pressure or volume changes. When a client is hypovolemic, stretch receptors in the blood vessels sense a reduced volume or pressure and send fewer impulses to the CNS. This reaction stimulates the sympathetic nervous system to increase the heart rate and constrict the peripheral blood vessels. Impulses from these baroreceptors inhibit the vasomotor center which results in a drop in BP. Central chemoreceptors in the respiratory center of the brain are also stimulated by hypercapnia (an increase in partial pressure of arterial carbon dioxide [Paco2]) and acidosis. The kidneys retain sodium and water so BP tends to rise because of fluid retention and activation of the renin-angiotensin-aldosterone mechanism.

What is the client's pulse pressure when the nurse finds that his or her blood pressure is 148/86 mm Hg? A. 48 mm Hg B. 56 mm Hg C. 62 mm Hg D. 86 mm Hg

C The difference between the systolic and diastolic values is referred to as pulse pressure. 148 - 86 = 62 mm Hg.

What common assessment finding would the nurse expect to find in an older adult with cardiovascular disease? A. Lower leg swelling B. Pericardial friction rub C. S4 heart sound D. Change in point of maximal impulse (PMI) location

C This question asks for a finding related to aging. An atrial gallop (S4) may be heard in clients with hypertension, anemia, ventricular hypertrophy, MI, aortic or pulmonic stenosis, and pulmonary emboli. It may also be heard with advancing age because of a stiffened ventricle. Edema, friction rubs, and PMI changes occur with CVD but are not just age related.

Which statement about the peripheral vascular system is accurate? A. The velocity of blood flow depends on the diameter of the blood vessel lumen. B. The parasympathetic nervous system has the largest effect on blood flow to organs. C. Veins have valves that direct blood flow to the heart and prevent backflow. D. Blood flow decreases and blood tends to clot as the viscosity decreases.

C Veins in the superficial and deep venous systems (except the smallest and the largest veins) have valves that direct blood flow back to the heart and prevent backflow. Skeletal muscles in the extremities provide a force that helps push the venous blood forward. Veins have the ability to accommodate large shifts in volume with minimal changes in venous pressure.

What is the nurse's best action when auscultating S1 for a client is difficult? A. Ask the assistive personnel (AP) to do a 12-lead electrocardiogram (ECG). B. Auscultate with the bell of the stethoscope instead of the diaphragm. C. Have the client lean forward or roll to his or her left side. D. Instruct the client to take deep breaths and hold them for 5 seconds.

C When there is difficulty hearing heart sounds, have the client lean forward or roll to his or her left side. These actions move the heart closer to the chest wall and can facilitate hearing the heart sounds more clearly.

What does the nurse suspect when a client states "I get short of breath whenever I lie down for several hours?" A. Dyspnea on exertion B. Orthopnea C. Paroxysmal nocturnal dyspnea D. Fatigue

C. Paroxysmal nocturnal dyspnea (PND) develops after the client has been lying down for several hours. In this position, blood from the lower extremities is redistributed to the venous system, which increases venous return to the heart. A diseased heart cannot compensate for the increased volume and is ineffective in pumping the additional fluid into the circulatory system. Pulmonary congestion results, and the client awakens abruptly, often with a feeling of suffocation and panic. He or she sits upright and dangles the legs over the side of the bed to relieve the dyspnea. This sensation may last for 20 minutes. Dyspnea associated with activity is dyspnea on exertion. Orthopnea is dyspnea whenever a client lies flat and may require three to four pillows for sleep. Fatigue is a feeling of tiredness as a result of activity.

What does the nurse suspect when a client who had a bruit on assessment during the previous 2 days does not have a bruit on assessment to-day? A. The prescribed antiplatelet therapy is working. B. The problem has resolved spontaneously. C. The previous findings may have been an anomaly. D. The occlusion of the blood vessel is now 90%.

D Bruits are swishing sounds that may occur from turbulent blood flow in narrowed or atherosclerotic arteries. Assess for the absence or presence of bruits by placing the bell of the stethoscope on the neck over the carotid artery while the client holds his or her breath. Normally there are no sounds if the artery has un-interrupted blood flow. A bruit may develop when the internal diameter of the vessel is narrowed by 50% or more, but this does not indicate the severity of disease in the arteries. Once the vessel is blocked 90% or greater, the bruit often cannot be heard.

What is the priority problem when a nurse assesses a client with CVD and notes skin that is pale, cool, and moist? A. Skin integrity B. Abnormal body temperature C. Peripheral neurovascular dysfunction D. Decreased perfusion

D Decreased perfusion is manifested as cool, pale, and moist skin. If there is normal blood flow or adequate perfusion to a given area in light-colored skin, it appears pink, perhaps rosy, and is warm.

Which parameter indicates to the nurse that a client's exercise electrocardiogram (ECG) should be stopped? A. Increase in heart rate B. Increase in blood pressure C. ECG shows P waves before every QRS complex D. ECG shows ST-segment depression

D Increases in heart rate and blood pressure are expected. P waves before each QRS complex is a normal finding. The client exercises until one of these findings occurs: a predetermined HR is reached and maintained; signs and symptoms such as chest pain, fatigue, extreme dyspnea, vertigo, hypotension, and ventricular dysrhythmias appear; or significant ST-segment depression or T-wave inversion occurs.

How many cigarette pack-years has this client smoked: Smoked half a pack a day for 6 years? A. 1⁄2 pack-year B. 1 pack-year C. 2 pack-years D. 3 pack-years

D Pack-years are the number of packs of cigarettes per day multiplied by the number of years the client has smoked. 1⁄2 x 6 = 3 pack-years.

What is the priority medical-surgical concept when the nurse is assessing a client with cardiovascular disease (CVD)? A. Acid-base balance B. Fluid and electrolyte balance C. Gas exchange D. Perfusion

D The priority concept when assessing for cardiovascular disease is perfusion. The interrelated concept for this chapter is fluid and electrolyte balance. Gas exchange and acid-base balance are more pertinent to respiratory and renal illnesses.