Patho Chapt 17
A client is lying in a recumbent position. In this patient approximately how much total blood volume is in the central circulation? a) 25% - 30% b) 15% - 20% c) 20% - 25% d) 30% - 35%
25% - 30%
Which of the following is called the pacemaker of the heart? a) Purkinje fibers b) Arterioventricular (AV) node c) Bundle of His d) Sinoatrial (SA) node
Sinoatrial (SA) node
A nurse is explaining the conduction system of the heart to a client who is experiencing an arrhythmia. Which would be the most appropriate explanation? a) Internodal pathways, AV node, sinoatrial node (SA), AV bundle, Purkinje fibers b) Sinoatrial node (SA), internodal pathways, AV node, AV bundle, Purkinje fibers c) Sinoatrial node (SA), AV bundle, internodal pathways, AV node, Purkinje fibers d) AV node, sinoatrial node (SA), AV bundle, Purkinje fibers, intermodal pathways
Sinoatrial node (SA), internodal pathways, AV node, AV bundle, Purkinje fibers
The venous system is a low pressure system that returns blood to the heart. What is the normal right atrial pressure? a) 10mm Hg b) 30mm HG c) 20mm Hg d) 0mm Hg
0mm Hg
A nurse educator is teaching a group of nurses at a long term care facility about atrial fibrillation in light of its prevalence in older adults. Which of the following statements by the nurses would the educator most want to correct? a) "It can be hard to measure at the bedside because not all ventricular beats make a palpable pulse." b) "The contraction of the ventricles and the atria can range from 400-600 beats per minute." c) "The electrical impulses go in chaotic directions and so the atria can't contract properly." d) "An ECG of someone in atrial fibrillation would be almost random in appearance."
"The contraction of the ventricles and the atria can range from 400-600 beats per minute."
As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function? a) "Recall that the heart sounds that we listen to as part of our assessments are the sounds of myocardium contracting." b) "Efficient heart function requires that the ventricles not retain any blood at the end of the cardiac cycle. c) "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." d) "Aortic pressure will exceed ventricular pressure during systole."
"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."
The cardiologist just informed a patient that they have a reentry circuit in the electrical conduction system in their heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to them. Which of the following statements most accurately describes what is happening? a) "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." b) "This means that the SA node (which is the beginning of your heart's electrical system) has been damaged and is no longer functioning normal." c) "For some reason, your electrical system is not on full charge so they will have to put in new leads and a pacemaker to make it work better." d) "You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart."
"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."
Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, "What does that mean?" The nurse will base her answer on which of the following physiologic principles? a) "You have a heart valve that is diseased." b) "You heart has been pumping your blood so hard, that the pressure has damaged your valves." c) "You have been exposed to an infection that went into your blood stream." d) "Your heart has enlarged, so naturally your valves had to enlarge as well."
"You have a heart valve that is diseased."
A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is: a) "You must have been taking a blood thinner for a long time." b) "With this amount of blockage, your red blood cells get through the vessel one-by-one and supply oxygen to the muscle." c) "You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." d) "You are just a lucky person since most people would have had a massive heart attack by now."
"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked."
A client has suffered chest injuries following a automobile accident. The chest injury has resulted in an increase in intrathoracic pressure. There can be a transient shift from the pulmonary to the systemic circulation of how much blood?
250 mL
The cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level. What is the normal young adult's percentage cardiac reserve? a) 100% - 200% b) 400% - 500% c) 200% - 300% d) 300% - 400%
300% - 400%
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? a) 60% b) 70% c) 50% d) 40%
60%
Blood flow in the circulatory system depends on a blood volume that is sufficient to fill the blood vessels and a pressure difference across the system that provides the force to move blood forward. What is the total blood volume in an adult? a) 80 to 85 mL/kg b) 90 to 95 mL/kg c) 60 to 65 mL/kg d) 70 to 75 mL/kg
70 to 75 mL/kg
The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:
Stroke volume × heart rate
In which of the following situations would blood be most likely to be rapidly relocated from central circulation to the lower extremities? a) A client undergoes a stress test on a treadmill. b) A client is helped out of bed and stands up. c) A client reclines from a sitting to supine position. d) A client does isotonic exercises in a wheelchair.
A client is helped out of bed and stands up.
A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the patient 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) The electrical conduction system of the heart b) The outer muscular layer of the heart c) A membranous sac that encloses the heart d) The innermost lining of the heart chambers
A membranous sac that encloses the heart
Which of the following neurotransmitters is associated with the parasympathetic nervous system?
Acetylcholine
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 of the following assessments should the nurse complete? a) Palpation of the pericardium for a heave or thrill b) Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves c) Monitor the blood pressure d) Auscultation for a extra heart sound due to incomplete semilunar valve closure
Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves
A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the: a) Pulmonic valve b) Bicuspid valve c) Aortic valve d) Tricuspid valve
Bicuspid valve
The efficiency of the heart as a pump often is measured in the amount of blood the heart pumps per minute. Which is the correct formula to figure out the cardiac output?
CO = SV x HR
Select the correct sequence of blood return to the heart. a) Capillaries, venules, veins, left atrium b) Capillaries, arterioles, veins, left atrium c) Capillaries, venules, veins, right atrium d) Capillaries, arterioles, arteries, right atrium
Capillaries, venules, veins, right atrium
The heart controls the direction of blood flow. What is the role of the aortic valve? a) Controls the direction of blood flow from the ventricles to the artia b) Controls the direction of blood flow from the atria to the ventricles c) Controls the direction of blood flow from the left side of the heart to the systemic circulation d) Controls the direction of blood flow from the left side of the heart to the lungs
Controls the direction of blood flow from the left side of the heart to the systemic circulation
A nurse is monitoring a patient with a consistent and regular heart rate of 128 beats/min. Which of the following physiologic alterations would be consistent with this finding? a) Decrease in ventricular filling time and blood pressure b) Decrease in blood pressure and increase in cardiac output c) Increase in respiratory rate and temperature d) Increase in ventricular filling time and decrease in cardiac output
Decrease in ventricular filling time and blood pressure
A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take? a) Administer IV push atropine b) Perform synchronized cardioversion c) Notify the patient's attending physician d) Defibrillate the patient
Defibrillate the patient
When explaining to a patient why they only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to: a) Good genetic makeup that allows occluded arteries to keep vasodilating to meet metabolic needs. b) Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually. c) The release of substances formed by special glands that transport the blood cell-by-cell through smaller spaces. d) The possibility that the person has elevated INR levels that prevents blood from backlogging in the vessel.
Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually.
The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system? a) Distribute oxygenated blood to the tissues b) Pump blood c) Exchange gases, nutrients and wastes d) Collect deoxygenated blood from the tissues
Exchange gases, nutrients and wastes
Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability? a) Serotonin b) Histamine c) Prostaglandins d) Arachidonic acid
Histamine
A client has suffered damage to his pericardium following a motor vehicle accident. Which consequence could be a possible complication of damaged pericardium that his care providers should assess for? a) Reduced protection from infectious organisms b) Impaired physical restraint of the left ventricular c) Increased friction during the contraction/relaxation cycle d) Impaired regulation of myocardial contraction
Impaired regulation of myocardial contraction
A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following? a) Increased heart rate and increased contractility b) Decreased contractility and decreased heart rate c) Decreased rate and force of contraction d) Increased heart rate and decreased contractility
Increased heart rate and increased contractility
Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)? a) It is an expensive diagnostic tool. b) It can interfere with the heart's conduction system. c) It is an invasive procedure. d) It documents only current cardiac function.
It documents only current cardiac function.
Which of the following is true regarding pulmonary circulation? a) It is a low-pressure system that allows for improved gas exchange. b) It is the larger of the two circulatory systems. c) It consists of the left side of the heart, the aorta, and its branches. d) The system functions with an increased arterial pressure to circulate through the distal parts of the body.
It is a low-pressure system that allows for improved gas exchange.
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another? a) Laminar b) Axially c) Crosswise d) Turbulent
Laminar
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation? a) Left atrium b) Right atrium c) Left ventricle d) Right ventricle
Left ventricle
When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart? a) Right atrium b) Left atrium c) Right ventricle d) Left ventricle
Left ventricle
The nurse determines that the capillary pore exchange of a client's gases, nutrients, and/or waste products would be best facilitated by which of the following? a) Bone b) Brain c) Liver d) Kidney
Liver
A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy one year ago. Which of the following does the nurse suspect is the problem?
Lymphedema
ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this? a) Most ECG-detected ischemic events are clinically silent. b) The ECG can look at ischemic events from different directions. c) ECG monitoring is reliable only when the client remains still. d) Most ECG-detected ischemic events cause a great deal of pain.
Most ECG-detected ischemic events are clinically silent.
Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Stimulation of the sympathetic nervous system during stress or exercise causes local constriction because of the release of which hormone? a) Epinephrine b) Angiotensin II c) Histamine d) Norepinephrine
Norepinephrine
Resistance to flow is determined by the diameter of the blood vessels and the blood vessel itself. An equation has been developed for understanding the relationship between the diameter of the blood vessel, the viscosity of the blood, and resistance. What is the equation called?
Poiseuille law
Which of the following occurs during repolarization? a) Positively charged Na+ moves into the cell membrane b) Positively charged K+ moves into the cell membrane c) Positively charged Na+ moves outward across the cell membrane d) Positively charged K+ moves outward across the cell membraneblood
Positively charged K+ moves outward across the cell membrane
A nurse is using a stethoscope and blood pressure cuff to manually measuring a client's blood pressure. The nurse knows that which of the following facts related to blood flow underlies the ability to hear blood pressure by auscultation (listening)? a) Turbulent flow of blood during systole produces sound while laminar flow during diastole is silent. b) The movement of smooth muscle surrounding vessels produces noise that is audible by stethoscope. c) Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP. d) The force of blood with each cardiac contraction produces friction on vessel walls that can be heard and felt.
Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP.
The heart is a four-chambered pump. What is the function of the right ventricle? a) Receives oxygenated blood from the lungs b) Receives blood returning to the heart from the systemic circulation c) Pumps blood into the systemic circulation d) Pumps blood to the lungs
Pumps blood to the lungs
The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium? a) Receives blood returning to the heart from the systemic circulation b) Pumps blood into the systemic circulation c) Receives oxygenated blood from the lungs d) Pumps blood to the lungs
Receives blood returning to the heart from the systemic circulation
A client who has just received angioplasty for a blocked coronary artery following a myocardial infarction has an order for 12-lead ECGs every morning for three days. On the second day the nurse reads the ECG and notices a distinct difference in the QRS morphology from the previous ECG. Which of the following would be the best action to take? a) Repeat ECG with proper lead placement. b) File the ECG in the chart. c) Call the physician immediately. d) Repeat the ECG more slowly.
Repeat ECG with proper lead placement.
The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?
Repolarization of the ventricles
A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct? a) Chest pain with angina only occurs during the day; MI pain is more likely at night. b) Pain is more severe and lasts longer with angina than with an MI. c) Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. d) Chest pain with angina only occurs at rest; MI pain occurs during a stressful time.
Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.
Which of the following is the correct sequence for blood flow through the heart? a) Right atrium - bicuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein -left atrium - tricuspid valve - left ventricle - aorta b) Left atrium - tricuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein -right atrium - mitral valve - right ventricle - aorta c) Left atrium - bicuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein -right atrium - tricuspid valve - right ventricle - aorta d) Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? a) Complete cardiac standstill b) Heart rate 150 beats/minute, labeled as supraventricular tachycardia c) Slowing of heart rate to below 60 beats/minute d) Disorganized ventricular fibrillation
Slowing of heart rate to below 60 beats/minute
When trying to explain to a new dialysis patient the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:
Small openings that allow large amounts of smaller molecular substances to filter through the gomeruli.
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 which of the following? a) Atrial ectopic foci b) Sympathetic nervous system c) Parasympathetic nervous system d) Vagal nerve
Sympathetic nervous system
An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG?
The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.
Select the client who may be at risk for developing an increase in resistance to blood flow. a) The client who is receiving intravenous fluids at a rate of 100 mL/h b) The client who is hypotensive c) The client admitted to the intensive care unit for extreme dehydration d) The client who is being treated for anaphylactic shock
The client admitted to the intensive care unit for extreme dehydration
Which client will the nurse assess first?
The client with premature ventricular contractions
The circulatory system is a closed system that is divided into two parts. Which statement is correct about the closed system? a) The high pressure systemic circulation system links circulation and gas exchange in the lungs b) The high pressure pulmonary circulation provides oxygen and nutrients to the tissues. c) The low pressure systemic circulation system provides oxygen and nutrients to the tissues. d) The low pressure pulmonary circulation links circulation and gas exchange in the lungs.
The low pressure pulmonary circulation links circulation and gas exchange in the lungs.
Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease? a) Downstream peripheral pulses are greater than upstream pulses. b) The pulse decreases rather than increases in amplitude. c) Downstream peripheral pulses are increased even more than normal. d) The reflected wave is transmitted more rapidly through the aorta.
The pulse decreases rather than increases in amplitude.
Hypoxia is said to have a negative inotropic effect on the heart, which means: a) There will be interference in the generation of ATP, which is needed for muscle contraction. b) The heart rate will slow down, so the atria and ventricles can fill better. c) The heart will adjust so that less time will be spent in diastole and filling of the ventricles will shorten. d) The cardiac output will decrease to cause less work for the heart.
There will be interference in the generation of ATP, which is needed for muscle contraction.
The troponin complex is one of a number of important proteins that regulate actin-myosin binding. Troponin works in striated muscle to help regulate calcium-mediated contraction of the muscle. Which of the troponin complexes are diagnostic of a myocardial infarction? a) Troponin A and troponin I b) Troponin T and troponin I c) Troponin A and troponin C d) Troponin C and troponin T
Troponin T and troponin I
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following? a) Tunica externa b) Tunica media c) Tunica intima d) Tunica adventitia
Tunica media
Which of the following vessel layers is made primarily of muscle? a) Tunica intima b) Tunica adventitia c) Tunica media d) Tunica externa
Tunica media
During an automobile accident where the patient is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need?
Veins
The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole? a) Atria contract and blood is ejected from the heart. b) Ventricles contract and blood is ejected from the heart. c) Atria relax and blood fills the heart. d) Ventricles relax and blood fills the heart.
Ventricles contract and blood is ejected from the heart.
Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?
Ventricular fibrillation
There are three main atrial pressure waves that occur during the cardiac cycle. Which wave occurs during the last part of diastole and is caused by atrial contraction? a) a b) b c) v d) c
a
A nursing student is studying the properties of cardiac rhythm to better understand what causes arrhythmias 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: a) automaticity. b) conductivity. c) excitability. d) refractoriness.
conductivity
An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:
many people live with atrial fibrillation without even knowing they have it.
Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply. a) Abdominal b) Femoral c) Carotid d) Thoracic
• Abdominal • Thoracic
As the needs of the body change, the heart's ability to increase output needs to change too. This ability in the heart depends on what factors? (Select all that apply.) a) Cardiac reserve b) Preload c) Heart rate d) Cardiac contractility e) Afterload
• Cardiac contractility • Heart rate • Preload • Afterload
A client admitted to the hospital with symptoms of Digoxin toxicity is told that a cardiac monitor will be necessary during the admission because the client may develop which of the following? Select all that apply.
• Failure of the SA node • Incessant atrial tachycardia • Atrial fibrillation
The heart consists of four valves. Which are the semilunar values? Select all that apply. a) Aortic b) Tricuspid c) Pulmonary d) Mitral
• Pulmonary • Aortic
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. a) The venous system collects deoxygenated blood from the tissues . b) The heart exchanges gases, nutrients and wastes. c) The capillaries pump blood. d) The arterial system distributes oxygenated blood to the tissues.
• The arterial system distributes oxygenated blood to the tissues. • The venous system collects deoxygenated blood from the tissues .
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.
• Tricuspid • Mitral