Patho PrepU Chp 17
Which of the following blood vessels function without the benefit of having walls comprised of three muscular layers?
Capillaries
Select the correct sequence of blood return to the heart.
Capillaries, venules, veins, right atrium
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
As part of pre-surgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which of the following teaching points best conveys an aspect of the human circulatory system?
"The blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation."
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?
"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."
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 of the following teaching points should the nurse include in this patient 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 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?
"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 local athlete is getting prepared for the upcoming national track and field championships. Since this athlete is performing extreme exercise, what would be the most probable cardiac output?
16 to 36 L/minute
The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body?
1800
A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention?
A 69-year-old woman who has entered ventricular fibrillation.
In which of the following situations would blood be most likely to be rapidly relocated from central circulation to the lower extremities?
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 membranous sac that encloses the heart
The intensive care nurse is evaluating a client with idiopathic cardiomyopathy and notes that the client's peripheral pulse is different than the apical pulse on the cardiac monitor, which reveals a normal sinus rhythm with the presence of frequent premature ventricular complexes. The nurse attributes the difference in rates to an inability of the heart to respond normally to the impulses initiated by the SA node and that premature ventricular complexes often do not initiate which of the following?
A normal mechanical response
When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?
An ejection fraction of 40%
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?
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:
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
The heart valves control the direction of blood flow. What is the function of the pulmonic valve?
Controls the direction of blood flow from the right side of the heart to the lungs
While intubated for surgery, a patient 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 admitted to the emergency department after experiencing a motor vehicle accident and sustaining multiple injuries with significant blood loss. The nurse predicts that the client will display which of the following?
Decreased urinary output
In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of:
Decreasing cardiac output due to less ventricular filling time. `
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?
Exchange gases, nutrients and wastes
Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability.
Histamine
Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability?
Histamine
The nurse is assisting a patient who had a myocardial infarction 2 days ago during a bath. The patient suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the patient was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. Which of the following is a priority intervention at this time?
Immediate defibrillation
A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?
Increased heart rate and increased contractility
Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?
It documents only current cardiac function.
Which of the following is true regarding pulmonary circulation?
It is a low-pressure system that allows for improved gas exchange.
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 of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?
Laminar
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?
Left ventricle
The physician states that a client has adequate collateral circulation. The nurse interprets this as:
Long-term compensatory regulation of blood flow
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
The nurse assesses the electrocardiogram for depolarization of the atria. What does the nurse expect to assess?
P wave above the baseline
A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart?
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
Which of the following factors represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?
Preload
The nurse is teaching a client diagnosed with heart failure about preload. Which of the following would be the most appropriate information to provide?
Preload represents the volume work of the heart.
The heart consists of four valves. Which are the semilunar values? Select all that apply.
Pulmonary Aortic
The heart is a four-chambered pump. What is the function of the right ventricle?
Pumps blood to the lungs
The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?
Receives blood returning to the heart from the systemic circulation
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?
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?
Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
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.
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
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues .
The heart and blood vessels receive both sympathetic and parasympathetic innervation from neural control. What controls the parasympathetic-mediated slowing of the heart rate?
The cardioinhibitory center
During an assessment of a client with ankle swelling, the nurse observes jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. Which of the following is the correct interpretation of this finding?
The client has increased pressure related to right heart failure.
Analysis has shown that a client's right atrial pressure is 30 mmHG. What is the most likely conclusion that the client's care team will draw from this piece of data?
The pressure is excessive given that the right atrium should be at atmospheric pressure.
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.
Local control of blood flow is regulated by mechanisms that match blood flow to the metabolic needs of the tissue. Over the short term autoregulation controls flow through the synthesis of vasodilators and vasoconstrictors. Which components of the vascular system are involved in the short term control of blood flow? Select all that apply.
Tissue Smooth muscle Endothelial cells
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.
Tricuspid Mitral
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.
Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?
Ventricular fibrillation
A nurse working with a client in heart failure is explaining why the symptoms of the heart failure were not evident for a long period of time. When describing the Frank--Starling mechanism, the nurse will explain:
the relationship between venous return and stroke volume.
A group of nurses is taking a critical care course in cardiac electrophysiology. The instructor is reviewing action potential and the risk of arrhythmias and states that if an electrical impulse fires just after the relative refractory period, during the supernormal excitatory period, cardiac arrhythmias could result. Locate the supernormal excitatory period on the first complex on the rhythm strip.
after first high peak
A group of nursing students is discussing ventricular arrhythmias 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.
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.
A physician is teaching a group of medical students about the physiological basis for damage to the circulatory and neurological system that can accompany hypotension. Which of the following responses by a student would warrant correction by the physician?
"Tension and vessel thickness increase proportionately."
A client has been placed on bed rest. Select the percentage of the blood volume that will be distributed to the client's pulmonary circulation.
25%
A client is lying in a recumbent position. In this patient approximately how much total blood volume is in the central circulation?
25% - 30%
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 distensibility of the blood vessel is the major factor in which of the vessel's characteristics?
Compliance
A client comes to the emergency department with symptoms of a "racing" heart and feeling "anxious." The nurse places the client on a heart monitor and observes a heart rate of 134. The nurse monitors for which of the following complications related to tachycardia? Select all that apply.
Decrease in blood pressure Decrease in oxygen levels Decrease in stroke volume Risk for angina
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?
Defibrillate the patient
A grandmother, 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
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?
Most ECG-detected ischemic events are clinically silent.
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
Right sided heart failure
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?
Sympathetic nervous system
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?
Tunica media
Which of the following vessel layers is made primarily of muscle?
Tunica media