Ch. 31 Assessment of Cardiovascular System
A patient has a severe blockage in his right coronary artery. Which heart structures are most likely to be affected by this blockage (select all that apply)? a. AV node b. Left ventricle c. Coronary sinus d. Right ventricle e. Pulmonic valve
a. AV node b. Left ventricle d. Right ventricle Rationale: The right coronary artery (RCA) supplies blood to the right atrium, the right ventricle, and a portion of the posterior wall of the left ventricle. In 90% of people, the RCA supplies blood to the atrioventricular (AV) node, bundle of His, and part of the cardiac conduction system.
When collecting subjective data related to the cardiovascular system, which information should be obtained from the patient (select all that apply)? a. Annual income b. Smoking history c. Religious preference d. Number of pillows used to sleep e. Blood for basic laboratory studies
b. Smoking history c. Religious preference d. Number of pillows used to sleep Rationale: The health history should include assessment of tobacco use. The patient should be asked about any cultural or religious beliefs that may influence the management of the cardiovascular problem. Patients with heart failure may need to sleep with the head elevated on pillows or sleep in a chair.
The portion of the vascular system responsible for hemostasis is the a. thin capillary vessels b. endothelial layer of the arteries c. elastic middle layer of the veins d. smooth muscle of the arterial wall
b. endothelial layer of the arteries Rationale: The innermost lining of the arteries is the endothelium. The endothelium maintains hemostasis, promotes blood flow, and under normal conditions, inhibits blood coagulation.
When assessing the cardiovascular system of a 79-year-old patient, you may expect to find a. a narrowed pulse pressure b. diminished carotid artery pulses c. difficulty in isolating the apical pulse d. an increased heart rate in response to stress
c. difficulty in isolating the apical pulse Rationale: Myocardial hypertrophy and the downward displacement of the heart in an older adult may cause difficulty in isolating the apical pulse.
A patient with a tricuspid valve disorder will have impaired blood flow between the a. vena cava and right atrium b. left atrium and left ventricle c. right atrium and right ventricle d. right ventricle and pulmonary artery
c. right atrium and right ventricle Rationale: The tricuspid valve is located between the right atrium and right ventricle.
A P wave on an ECG represents an impulse arising at the a. SA node and repolarizing the atria b. SA node and depolarizing the atria c. AV node and depolarizing the atria d. AV node and spreading to the bundle of His
b. SA node and depolarizing the atria Rationale: The first wave, P, begins with the firing of the sinoatrial (SA) node and represents depolarization of the fibers of the atria.
Which nursing responsibilities are priorities when caring for a patient returning from a cardiac catheterization (select all that apply)? a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses c. Assisting the patient to ambulate to the bathroom to void d. Informing the patient that he will be sleepy from the general anesthesia e. Instructing the patient about the risks of the radioactive isotope injection
a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses Rationale: The nursing responsibilities after cardiac catheterization include assessment of the puncture site for hematoma and bleeding; assessment of circulation to the extremity used for catheter insertion and of peripheral pulses, color, and sensation of the extremity; and monitoring vital signs and electrocardiographic rhythm. Other nursing responsibilities are described in Table 31-6.
When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of a. baroreceptors that inhibit the sympathetic nervous system, causing vasodilation b. chemoreceptors that inhibit the sympathetic nervous system, causing vasodilation c. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation d. chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate
a. baroreceptors that inhibit the sympathetic nervous system, causing vasodilation Rationale: Baroreceptors in the aortic arch and carotid sinus are sensitive to stretch or pressure within the arterial system. Stimulation of these receptors sends information to the vasomotor center in the brainstem. This results in temporary inhibition of the sympathetic nervous system and enhancement of the parasympathetic influence, which cause a decrease in heart rate and peripheral vasodilation.
When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by a. dysrhythmias b. heart murmurs c. gallop rhythms d. pericardial friction rubs
a. dysrhythmias Rationale: A pulse deficit occurs if there is a difference between the apical and radial beats per minute. A pulse deficit indicates cardiac dysrhythmias.
The auscultatory area in the left midclavicular line at the level of the fifth ICS is the best location to hear sounds from which heart valve? a. Aortic b. Mitral c. Tricuspid d. Pulmonic
b. Mitral Rationale: The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth intercostal space (ICS).
