Ch. 17 PrepU Quiz
sinoatrial node
Which of the following is called the pacemaker of the heart?
Tunica media
Which of the following vessel layers is made primarily of muscle?
Most ECG-detected ischemic events are clinically silent.
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?
Increase sympathetic stimulation of the heart and blood vessels
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?
the pulse decreases rather than increases in amplitude
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 client is helped out of bed and stands up
In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?
Capillaries, venules, veins, right atrium
Select the correct sequence of blood return to the heart.
Ventricles contract and blood is ejected from the heart.
The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?
Repolarization of the ventricles
The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?
Stroke volume × heart rate
The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:
Receives blood returning to the heart from the systemic circulation
The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?
"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."
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?
Ventricular repolarization
A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain. His subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?
A 69-year-old woman who has entered ventricular fibrillation.
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?
"The blood pressure varies widely between arteries and veins and between pulmonary and 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?
Cardiac contractility Heart rate Preload Afterload
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.)
P wave
Considering the PQRST complex of an electrocardiogram (ECG), which of the following letter designations represents atrial depolarization?
Histamine
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.
• Tissue • Smooth muscle • Endothelial cells
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.
Afterload
Of the following factors, which one represents the contractile force used by the muscle in order to move blood into the aorta?
300% - 400%
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?
Left ventricle
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?
30 to 35cm/second
The linear velocity of blood flow in the circulatory system varies widely. What is the linear velocity in the aorta?
Junctions of the subclavian and internal jugular veins
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?
Exchange gases, nutrients and wastes
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?
• Abdominal • Thoracic
Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply.
25% - 30%
A client is lying in a recumbent position. In this patient approximately how much total blood volume is in the central circulation?
PR interval >0.20 seconds
A nurse is monitoring the electrocardiogram (ECG) of a patient with a recent right ventricular infarction. The ECG reveals a first-degree arterioventricular (AV) block, which is characterized by which of the following?
• Failure of the SA node • Incessant atrial tachycardia • Atrial fibrillation
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.
Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves
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?
pressure pulses
A nurse is teaching a client the correct technique for taking an arterial pulse. The nurse explains that the pulsations are:
Monitor the patient and document the findings
A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?
the relationship between venous return and stroke volume.
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:
conductivity
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:
High afterload because of backpressure against the left ventricle
A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?
Defibrillate the patient
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?
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
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?
Relative refractory period ends
An intensive care unit nurse is caring for a 50-year-old client who was admitted 8 hours before, following an anterior wall myocardial infarction (MI). The nurse notes frequent premature ventricular complexes on the client's ECG monitor and is concerned that the client could develop a lethal arrhythmia if one of the premature ventricular complexes fires just after which of the following?
The pressure is excessive given that the right atrium should be at atmospheric pressure.
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?
70 to 75 mL/kg
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?
CO = SV X HR
Cardiac output (CO) is used to measure the efficiency of the heart as a pump. What is the equation used to express CO?
Depolarization of smooth muscle relies largely on extracellular calcium.
During a physiology lecture, a nursing student hears about the different forms of muscle tissue. Which description best describes vascular smooth muscle?
The client has increased pressure related to right heart failure.
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?
decreasing cardiac output due to less ventricular filling time.
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:
Nitric oxide
Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?
"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."
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?
Aorta Capillaries
The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply.
The low pressure pulmonary circulation links circulation and gas exchange in the lungs.
The circulatory system is a closed system that is divided into two parts. Which statement is correct about the closed system?
Right heart Pulmonary artery Pulmonary veins
The circulatory system is divided into two parts. What does the pulmonary circulation include? Select all that apply.
-tricuspid -mitral
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.
-aortic -pulmonary
The heart consists of four valves. Which are the semilunar values? Select all that apply.
Controls the direction of blood flow from the left side of the heart to the systemic circulation
The heart controls the direction of blood flow. What is the role of the aortic valve?
P wave above the baseline
The nurse assesses the electrocardiogram for depolarization of the atria. What does the nurse expect to assess?
Liver
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?
Tunica media
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?
• Constant R to R intervals • A p before every QRS wave • A rate between 60 and 100 beats per minute
The nurse is assessing a client said to be in sinus rhythm. What does the nurse expect to find when evaluating the electrocardiogram? Select all that apply.
Outer fibrous layer
The pericardium is a tri-layer sac. Which layer prevents acute dilation of the heart chambers and exerts a restraining effect on the left ventricle?
Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually.
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:
An ejection fraction of 40%
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?
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?
Decrease in blood pressure Decrease in oxygen levels Decrease in stroke volume Risk for angina
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.
Venous return to the heart
A client has a blood pressure of 68/38 and fainted after donating a unit of blood. The client is experiencing low preload from loss of blood volume. What is preload?
25%
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.
They can occur in diseased or healthy hearts.
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 an arrhythmia. Which is the most therapeutic response about cardiac arrhythmias that the nurse can make?
Decreased myocardial contraction Increased cardiac cycle speed
A client took a weight loss drug that activated the sympathetic nervous system. Which of the following manifestations would the nurse expect to occur? Select all that apply.
the first small lump after the BIG spike
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.
Central venous pressure
A nurse is assessing a client and becomes concerned that the client may be experiencing heart failure. Which of the following would be the best indicator to determine pressure being exerted on the right side of the heart?
many people live with atrial fibrillation without even knowing they have it.
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:
Veins
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?
1800
The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body?
pumps blood through the lungs
The heart is a four-chambered pump. What is the function of the right ventricle?
Troponin T and troponin I
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?
0mm Hg
The venous system is a low pressure system that returns blood to the heart. What is the normal right atrial pressure?
a c v
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
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 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin--angiotensin--aldosterone system.
Which client is most likely to be experiencing vasodilation?
Ventricular fibrillation
Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?
Laminar
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?
Capillaries
Which of the following blood vessels function without the benefit of having walls comprised of three muscular layers?
Histamine
Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability?
preload
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?
Right atrium - bicuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein -left atrium - tricuspid valve - left ventricle - aorta
Which of the following is the correct sequence for blood flow through the heart?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
55% - 75%
A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography?
Bicuspid valve
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:
Sympathetic nervous system
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?
Increased heart rate and increased contractility
A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?
AV nodal block
A client is admitted to the hospital with severe bradycardia, heart rate in low to upper 40s, after contracting Lyme disease. She asks the nurse why the heart rate is so slow. The most accurate response would be a possible disassociation between the atria and ventricles due which of the following?
• Irregular-irregular rhythm • Palpitations • Tachycardia
A 70-year-old client with a past medical history of diabetes type II and myocardial infarction (MI) is admitted to the hospital with sudden shortness of breath and palpitations. As the nurse is doing the admission assessment she notices that the apical pulse is very irregular with no pattern, vital signs include a heart rate of 130 and blood pressure of 100/60. The nurse suspects atrial fibrillation (AF) for which of the following reasons? Select all that apply.
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 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 patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds:
-Right sided heart failure
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
A membranous sac that encloses the heart
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?
Systemic vasoconstriction maintained the diastolic pressure.
A client says that when the hospital checked his blood pressure after he lost a lot of blood in a work-related accident, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. Why is this?
Repeat ECG with proper lead placement.
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?
resistance to ejection of blood from the heart.
A client with aortic insufficiency is experiencing an increase in afterload. The client will experience fatigue and activity intolerance due to:
decreased ventricular filling time
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:
"It facilitates the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction."
A nurse educator is explaining normal cardiac conduction and action potentials to a nursing cohort. How can the nurse best describe the term "slow response" (calcium current) to the students?
"The contraction of the ventricles and the atria can range from 400 to 600 beats/minute."
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?
Controls the direction of blood flow from the right side of the heart to the lungs
The heart valves control the direction of blood flow. What is the function of the pulmonic valve?
Immediate defibrillation
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?
• The arterial system distributes oxygenated blood to the tissues. • The venous system collects deoxygenated blood from the tissues .
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
Preload represents the volume work of the heart.
The nurse is teaching a client diagnosed with heart failure about preload. Which of the following would be the most appropriate information to provide?
Long-term compensatory regulation of blood flow
The physician states that a client has adequate collateral circulation. The nurse interprets this as:
60%
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?
It documents only current cardiac function.
Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?
It is a low-pressure system that allows for improved gas exchange.
Which of the following is true regarding pulmonary circulation?
Acetylcholine
Which of the following neurotransmitters is associated with the parasympathetic nervous system?
Liver
Which of the following organs has larger capillary pores to allow the exchange of gases, nutrients, and/or waste products?
A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.
Which statement describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
Decreased heart rate as a result of parasympathetic innervation of the heart
While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?
Systemic vascular resistance (SVR)
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?
Sinoatrial node (SA), internodal pathways, AV node, AV bundle, Purkinje fibers
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?
Lymphedema
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?
Increase the IV fluid infusion rate.
A nurse is caring for a client following surgery. The central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take?
"Tension and vessel thickness increase proportionately."
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?
Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.
An 81-year-old female client of a long term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition?
Pulmonary arterial pressure (PAP)
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?
It innervates the heart. Its effects are facilitated by the vagus nerve. Bradycardia is a result of this system.
Which of the following statements are true regarding the parasympathetic nervous system and its effect on the cardiac system? Select all that apply.
A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.
Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow.
Which of the following statements most accurately captures a principle of blood flow?