Chapter 17

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as: Tunica intima Tunica externa Tunica adventitia Tunica media

Tunica media

A nurse notes that the PR interval on a client's electrocardiogram tracing is 0.22 seconds. Which action should the nurse take? Monitor the client and document the findings. Administer oxygen via nasal cannula. Call the health care provider. Administer atropine and place external pacemaker on the client.

Monitor the client and document the findings.

A client has had an acute myocardial infarction (MI). The brother of the client has a history of angina. The client asks how he will know if his brother's pain is angina or if the brother is actually having an MI. Which statement is correct? Chest pain with angina only occurs during the day; MI pain is more likely at night. Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. Chest pain with angina only occurs at rest; MI pain occurs during a stressful time. Pain is more severe and lasts longer with angina than with an MI.

Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.

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? "It facilitates the entrance of calcium needed for cardiac muscle contraction." "It facilitates the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction." "The calcium current provides for the entrance of calcium that stimulates the AV node." "The calcium current provides for the binding of intracellular calcium for the repolarization of electrical activity."

"It facilitates the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction."

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 teaching point should the nurse include in this client teaching? "This is almost certainly a condition that you were actually born with, but that is just now becoming a serious problem." "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." "If left untreated, this would have put you at great risk for stroke or heart attack." "Because the normal electrical communication is lacking, the bottom parts of your heart are beating especially fast to compensate for inefficiency."

"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 client that he has a reentry circuit in the electrical conduction system in his heart. This dysrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the client asks the nurse to explain this. Which statement most accurately describes what is happening? "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." "You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart." "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." "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."

"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 client with high blood pressure has swollen ankles. Which physiologic factor could relieve this condition? An increase in the colloidal pressure in tissue that drives the fluid into the tissue An increase in the hydrostatic pressure that drives fluid into circulation A decrease in the hydrostatic pressure that drives fluid into the tissue An increase in the colloidal pressure in circulation that drives fluid into the tissue

A decrease in the hydrostatic pressure that drives fluid into the tissue

A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching th client 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? The electrical conduction system of the heart The innermost lining of the heart chambers The outer muscular layer of the heart A membranous sac that encloses the heart

A membranous sac that encloses the heart

While intubated for surgery, a client has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe? Decreased heart rate as a result of impaired acetylcholine reuptake Decreased vascular perfusion due to parasympathetic stimulation Decreased heart rate, contractility, and afterload Decreased heart rate as a result of parasympathetic innervation of the heart

Decreased heart rate as a result of parasympathetic innervation of the heart

A grandmother who works as 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 Stimulate the brain to form new red blood cells Inhibit renin release from the kidneys to promote fluid retention Increase parasympathetic stimulation of the heart and blood vessels

Increase sympathetic stimulation of the heart and blood vessels

The physician states that a client has adequate collateral circulation. The nurse interprets this as: Development of increased collagen Long-term compensatory regulation of blood flow Establishment of compensatory lymphatic drainage Anastomosis of the arterial and venous circulation

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 1 year ago. What does the nurse suspect is the problem? Venous stasis Arteriosclerosis Lymphedema Deep vein thrombosis

Lymphedema

The nurse assesses the electrocardiogram for depolarization of the atria. What portion of the ECG will the nurse be assessing? P wave above the baseline T wave above the baseline U wave above the baseline Q wave below the baseline

P wave above the baseline

The nurse assesses the electrocardiogram for depolarization of the atria. What portion of the ECG will the nurse be assessing? T wave above the baseline Q wave below the baseline U wave above the baseline P wave above the baseline

P wave above the baseline

The heart is a four-chambered pump. What is the function of the right ventricle? Receives oxygenated blood from the lungs Pumps blood to the lungs Pumps blood into the systemic circulation Receives blood returning to the heart from the systemic circulation

Pumps blood to the lungs

The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent? Repolarization of the atrium Repolarization of the ventricles Depolarization of the sinoatrial node Depolarization of the ventricular conduction system

Repolarization of the ventricles

A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins? Left-sided heart failure Right-sided heart failure Cerebrovascular accident (stroke) Shock

Right-sided heart failure

During a sleep study in the laboratory, the health care provider notices one client has a prolonged period of asystole. Which term will the nurse use to describe this event in the documentation? Long QT syndrome Sinus arrest Bradycardia-tachycardia syndrome Junctional rhythm

Sinus arrest

The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. The capillaries pump blood. The heart exchanges gases, nutrients, and wastes. The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues.

The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues.

Which sequence is the correct pathway for blood flow through the heart? right atrium - bicuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - tricuspid valve - left ventricle - aorta left atrium - tricuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein - right atrium - mitral valve - right ventricle - aorta left atrium - bicuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein - right atrium - tricuspid valve - right ventricle - aorta 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

The heart is a four-chambered pump. What is the function of the right ventricle? Pumps blood into the systemic circulation Receives blood returning to the heart from the systemic circulation Receives oxygenated blood from the lungs Pumps blood to the lungs

Pumps blood to the lungs

A client with a history of angina presents with uncharacteristic chest pain. The subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which aspects of the cardiac cycle? Ventricular depolarization Ventricular repolarization Atrial depolarization Depolarization of the atrioventricular node, bundle branches, and Purkinje system

Ventricular repolarization

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 client that she has aortic stenosis. After the cardiologist has left the room, the client asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds: "This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends." Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve just had to work too hard and it is weakening. "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." "Aortic stenosis is commonly seen in older adult clients. Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow."

"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 physician is teaching a group of medical students about the physiologic basis for damage to the circulatory and neurologic systems that can accompany hypotension. Which response by a student would warrant correction by the physician? "Smaller blood vessels require more pressure to overcome wall tension." "The smaller the vessel radius, the greater the pressure needed to keep it open." "As vessel wall thickness increases, tension decreases." "Tension and vessel thickness increase proportionately."

"Tension and vessel thickness increase proportionately."

The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body? 1800 1500 1600 1700

1800

A client is lying in a recumbent position. In this client, approximately how much total blood volume is in the central circulation? 15% - 20% 20% - 25% 30% - 35% 25% - 30%

25% - 30%

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? 60% 40% 70% 50%

60%

A number of clients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which client is most deserving of immediate medical attention? A 60-year-old woman who has just been diagnosed with a first-degree AV block A 69-year-old woman who has entered ventricular fibrillation A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia

A 69-year-old woman who has entered ventricular fibrillation

The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply. Right heart Capillaries Pulmonary artery Aorta

Aorta Capillaries

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? Point of maximum impulse is located midclavicular at the 5th intercostal space An ejection fraction of 40% Blood pressure of 146/80 A heart rate (HR) of 62 beats/minute

An ejection fraction of 40%

The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply. Capillaries Aorta Right heart Pulmonary artery

Aorta Capillaries

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 assessment should the nurse complete? Monitor the blood pressure. Palpate the pericardium for a heave or thrill. Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves. Auscultate for an 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: Tricuspid valve Aortic valve Pulmonic valve Bicuspid valve

Bicuspid valve

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? Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. Peripheral dilation is associated with decreased stroke volume and ejection fraction. Heart valves are not capable of preventing backflow in cases of atrial congestion. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.

Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.

Which blood vessels function without the benefit of having walls comprised of three muscular layers? Arteries Arterioles Veins Capillaries

Capillaries

Select the correct sequence of blood return to the heart. Capillaries, venules, veins, right atrium Capillaries, arterioles, veins, left atrium Capillaries, venules, veins, left atrium Capillaries, arterioles, arteries, right atrium

Capillaries, venules, veins, right atrium

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 systemic circulation 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 Controls the direction of blood flow from the right side of the heart to the lungs

Controls the direction of blood flow from the right side of the heart to the lungs

A client's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The client is unconscious and without a pulse. Which priority intervention should the nurse take? Administer IV push atropine Notify the client's attending physician Perform synchronized cardioversion Defibrillate the client

Defibrillate the client

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 Collect deoxygenated blood from the tissues Distribute oxygenated blood to the tissues Pump blood

Exchange gases, nutrients, and wastes

Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability? Prostaglandins Arachidonic acid Histamine Serotonin

Histamine

A client is experiencing impaired circulation secondary to increased systemic arterial pressure. Which statement is the most relevant phenomenon? Increased preload due to vascular resistance Impaired contractility due to aortic resistance Systolic impairment because of arterial stenosis High afterload because of backpressure against the left ventricle

High afterload because of backpressure against the left ventricle

The nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. The client suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. What is a priority intervention at this time? Applying a transcutaneous pacemaker Synchronized cardioversion Immediate defibrillation Administration of atropine

Immediate defibrillation

If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations? Decreased rate and force of contraction Increased heart rate and decreased contractility Decreased contractility and decreased heart rate Increased heart rate and increased contractility

Increased heart rate and increased contractility

Which of the following is true regarding pulmonary circulation? It is a low-pressure system that allows for improved gas exchange. It is the larger of the two circulatory systems. The system functions with an increased arterial pressure to circulate through the distal parts of the body. It consists of the left side of the heart, the aorta, and its branches.

It is a low-pressure system that allows for improved gas exchange.

The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation? Left ventricle Right ventricle Right atrium Left atrium

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? Left atrium Left ventricle Right atrium Right ventricle

Left ventricle

Considering the PQRST complex of an electrocardiogram (ECG), which letter designation represents atrial depolarization? P wave ST segment T wave QRS complex

P wave

Which of the following factors affect cardiac performance? Select all that apply. Preload Heart rhythm Afterload Myocardial contractility

Preload Afterload Myocardial contractility

The nurse is teaching a client diagnosed with heart failure about preload. Which principle would be most appropriate to provide to the client? Preload determines the frequency by which the ventricles contract and blood is ejected. Preload represents the volume work of the heart. Preload is the ability of the heart to change its force of contraction. Preload is the pressure or tension work of the heart.

Preload represents the volume work of the heart.

The heart consists of four valves. Which are the semilunar valves? Select all that apply. Mitral Aortic Pulmonary Tricuspid

Pulmonary Aortic

What is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction? AV node - bundle of HIS - bundle branches - SA node - Purkinje fibers SA node - AV node - bundle of His - bundle branches - Purkinje fibers SA node - AV node - bundle branches - Purkinje fibers - bundle of His AV node - SA node - bundle of His - bundle branches - Purkinje fibers

SA node - AV node - bundle of His - bundle branches - Purkinje fibers

When trying to explain to a client on dialysis the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have: Endothelial cells that are joined by tight junctions that form a barrier to medication filtration. Small openings that allow large amounts of smaller molecular substances to filter through the glomeruli. no capillary openings since this would lead to extensive hemorrhage. Large pores so that substances can pass easily through the capillary wall.

Small openings that allow large amounts of smaller molecular substances to filter through the glomeruli.

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? The heart rate increased with blood loss. The stroke volume increased with blood loss. Systemic vasodilation maintained the diastolic pressure. Systemic vasoconstriction maintained the diastolic pressure.

Systemic vasoconstriction maintained the diastolic pressure.

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. What is the correct interpretation of this finding? The client has decreased fluid volume. The client has increased pressure related to right-sided heart failure. The client has an increased cardiac output. The client has stenosis of the jugular veins.

The client has increased pressure related to right-sided heart failure.

The circulatory system is a closed system that is divided into two parts. Which statement is correct about the closed system? The high pressure pulmonary circulation provides oxygen and nutrients to the tissues. The low pressure pulmonary circulation links circulation and gas exchange in the lungs. The low pressure systemic circulation system provides oxygen and nutrients to the tissues. The high pressure systemic circulation system links circulation and gas exchange in the lungs

The low pressure pulmonary circulation links circulation and gas exchange in the lungs.

The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply. Mitral Aortic Pulmonary Tricuspid

Tricuspid Mitral

During an automobile accident where the client 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? Liver and pancreas Aorta Veins Kidneys

Veins

The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole? Atria relax and blood fills the heart. Ventricles contract and blood is ejected from the heart. Atria contract and blood is ejected from the heart. Ventricles relax and blood fills the heart.

Ventricles contract and blood is ejected from the heart.

A nursing student is studying the properties of cardiac rhythm to better understand what causes dysrhythmias 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: conductivity. refractoriness. excitability. automaticity.

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: the client will be placed on anticoagulants immediately. the client will experience severe palpitations. atrial fibrillation is a disorganized ventricular rhythm with recurrent circuits. many people live with atrial fibrillation without even knowing they have it.

many people live with atrial fibrillation without even knowing they have it.

A client took a weight loss drug that activated the alpha-adrenergic receptors in the sympathetic nervous system. Which manifestations would the nurse expect to occur? Select all that apply. Decreased myocardial contraction Increased blood pressure of cardiac contraction Decrease in respiration rate Increased cardiac cycle speed

Increased blood pressure of cardiac contraction Increased cardiac cycle speed

Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues? Antithrombin factor Calcium channel blocker Nitric oxide Platelet-aggregating factor

Nitric oxide

A physician has ordered the measurement of a cardiac client's electrolyte levels as part of the client's morning blood work. Which statement best captures the importance of potassium in the normal electrical function of the client's heart? The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential. Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells. The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions. Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation.

Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.

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 is diagnostic of a myocardial infarction? Troponin T and troponin I Troponin C and troponin T Troponin A and troponin I Troponin A and troponin C

Troponin T and troponin I

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 molecular structure of actin and myosin and their effect on contraction. the physiologic function of chemoreceptors and baroreceptors. the high oxygenation needs of cardiac muscle and the role of coronary circulation. the relationship between venous return and stroke volume.

the relationship between venous return and stroke volume.