Chapter 25: Assessment of Cardiovascular Function
Your client is being prepared for echocardiography when he asks you why he needs to have this test. What would be your best response? a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." b) "This test can tell us a lot about your heart." c) "This test will find any congenital heart defects." d) "Echocardiography will tell your doctor if you have cancer of the heart."
a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." Echocardiography uses ultrasound waves to determine the functioning of the left ventricle and to detect cardiac tumors, congenital defects, and changes in the tissue layers of the heart. All answers are correct. Option C is the best answer because it addresses the client's question without making him anxious or minimizing the question.
The nurse in a cardiac clinic is taking vital signs of a 58-year-old man who is 3 months status post myocardial infarction (MI). While the physician is seeing the client, the client's spouse approaches the nurse and asks about sexual activity. "We are too afraid he will have another heart attack, so we just don't have sex anymore." The nurse's best response is which of the following? a) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." b) "The medications will prevent your husband from having an erection." c) "It is usually better to just give up sex after a heart attack." d) "Having an orgasm is very strenuous and your husband must be in excellent physical shape before attempting it."
a) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." The physiologic demands are greatest during orgasm. The level of activity is equivalent to walking 3 to 4 miles per hour on a treadmill. Erectile dysfunction may be a side effect of beta-blockers, but other medications may be substituted.
A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching? a) Avoid heavy lifting for the next 24 hours. b) Take a tub bath, rather than a shower. c) Bend only at the waist. d) New bruising at the puncture site is normal.
a) Avoid heavy lifting for the next 24 hours. For the next 24 hours, the patient should not bend at the waist, strain, or life heavy objects. The patient should avoid tub baths, but shower as desired. The patient should call her the health care provider if she has any bleeding, swelling, new bruising, or pain from her procedure puncture site, or a temperature of 101.5 degrees Fahrenheit or more.
The nurse accompanies a client to an exercise stress test. The client can achieve the "target heart rate," but the ECG leads show an ST-segment elevation. The nurse recognizes this as a "positive" stress test, and will begin to prepare the client for which of the following procedures? a) Cardiac catheterization b) Transesophageal echocardiogram c) Pharmacologic stress test d) Telemetry monitoring
a) Cardiac catheterization An elevated ST-segment means an evolving myocardial infarction. A cardiac catheterization would be the logical next step.
The nurse is assessing the client newly prescribed Lasix 20mg daily for 3+ pitting edema. To evaluate the effectiveness of diuretic therapy, which of the following would be documented? a) Edema b) Blood pressure c) Urine output d) Weight
a) Edema The best method to evaluate the effectiveness of diuretic therapy is to note a decrease in edema. Weight, blood pressure, and urine output all are affected by diuretic therapy, but the therapeutic goal is to decrease the edema.
Identify which of the following as an age-related change associated with conduction system of the heart? a) Heart block b) Murmur c) Thrills d) Tachycardia
a) Heart block Age-related changes to the conduction system may include bradycardia and heart block. Age-related changes to the heart valves include the presence of a murmur or thrill.
The nurse is interviewing a client who is complaining of chest pain. Which of the following questions related to the client's history are most important to ask? Select all that apply. a) How would you describe your symptoms? b) Do you have any children? c) How did your mother die? d) Are you allergic to any medications or foods?
a) How would you describe your symptoms? c) How did your mother die? d) Are you allergic to any medications or foods? During initial assessment, the nurse should obtain important information about the client's history that focuses on a description of the symptoms before and during admission, family medical history, prescription and nonprescription drug use, and drug and food allergies.
The nurse is caring for a patient in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the patient's CVP as 8 mm Hg. The nurse understands that this finding indicates the patient is experiencing which of the following? a) Hypervolemia b) Excessive blood loss c) Overdiuresis d) Left-sided heart failure (HF)
a) Hypervolemia The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.
Age-related changes associated with the cardiac system include which of the following? Select all that apply. a) Increased size of the left atrium b) Myocardial thinning c) Endocardial fibrosis d) Increase in the number of SA node cells
a) Increased size of the left atrium c) Endocardial fibrosis Age-related changes associated with the cardiac system include endocardial fibrosis, increased size of the left atrium, decreased number of SA node cells, and myocardial thickening.
The nurse is caring for a client on the cardiac unit. Which change of condition may indicate potential increasing of right-side heart failure? Select all that apply. a) Increased weakness on ambulation b) Jugular vein distention c) Edema changed from a 3+ to a 1+ d) One-pound weight loss e) Increased palpitations f) Increased dyspnea
a) Increased weakness on ambulation b) Jugular vein distention e) Increased palpitations f) Increased dyspnea A change in assessment finding may indicate an increase in heart failure. Right-sided heart failure symptoms include jugular vein distention, increased dyspnea, increased palpitations, and an increased weakness on ambulation. Edema is a common sign of right-sided heart failure, but changing from a 3+ to 1+ is improvement in condition. Weight loss is also improvement in condition.
A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation? a) Irregularly irregular heart rate b) Increased PR interval c) Fourth heart sound (S4) d) Orthostatic hypotension
a) Irregularly irregular heart rate An irregularly irregular heart rate indicates atrial fibrillation and should be investigated further. It's normal for an elderly client to have a prolonged systole, which causes an S4 heart sound. It's also normal for an elderly client to have slowed conduction, causing an increased PR interval. As a person ages, it's normal for baroreceptors in the body to decrease their response to changes in body position, which can cause orthostatic hypotension.
A nurse is preparing to assess a patient for postural BP changes. Which of the following indicates the need for further education? a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR b) Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR) c) Obtaining the supine measurements prior to the sitting and standing measurements d) Taking the patient's BP with the patient sitting on the edge of the bed with feet dangling
a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR The following steps are recommended when assessing patients for postural hypotension: Position the patient supine for 10 minutes before taking the initial BP and HR measurements; reposition the patient to a sitting position with legs in the dependent position, wait 2 minutes then reassess both BP and HR measurements; if the patient is symptom free or has no significant decreases in systolic or diastolic BP, assist the patient into a standing position, obtain measurements immediately and recheck in 2 minutes; continue measurements every 2 minutes for a total of 10 minutes to rule out postural hypotension. Return the patient to supine position if postural hypotension is detected or if the patient becomes symptomatic. Document HR and BP measured in each position (e.g., supine, sitting, and standing) and any signs or symptoms that accompany the postural changes.
The nurse is screening a patient prior to a magnetic resonance angiogram (MRA) of the heart. Which of the following actions should the nurse complete prior to the patient undergoing the procedure? Select all that apply. a) Remove the patient's jewelry. b) Offer the patient a headset to listen to music during the procedure. c) Remove the patient's Transderm Nitro patch. d) Sedate the patient prior to the procedure. e) Position the patient on his/her stomach for the procedure.
a) Remove the patient's jewelry. b) Offer the patient a headset to listen to music during the procedure. c) Remove the patient's Transderm Nitro patch. Transdermal patches that contain a heat-conducting aluminized layer (e.g., NicoDerm, Androderm, Transderm Nitro, Transderm Scop, Catapres-TTS) must be removed before MRA to prevent burning of the skin. A patient who is claustrophobic may need to receive a mild sedative before undergoing an MRA. During an MRA, the patient is positioned supine on a table that is placed into an enclosed imager or tube containing the magnetic field. Patients are instructed to remove any jewelry, watches, or other metal items (e.g., ECG leads). An intermittent clanking or thumping that can be annoying is generated by the magnetic coils, so the patient may be offered a headset to listen to music.
The nurse is aware that age-related changes in the heart muscle put the elderly at risk for dyspnea, angina, and syncope. Which of the following is an age-related change in the cardiovascular system that affects the sympathetic nervous system? a) An increased contractility response to exercise b) A decreased response to beta-blockers c) Decreased time for the heart rate to return to baseline d) Tachycardia
b) A decreased response to beta-blockers The sympathetic nervous system exhibits structural and functional changes that are age-related. Heart rate will decrease, and it will take longer for the heart rate to return to baseline. Refer to Table 12-1 in the text.
Which of the following would be a factor that may decrease myocardial contractility? a) Administration of digoxin (Lanoxin) b) Acidosis c) Sympathetic activity d) Alkalosis
b) Acidosis Contractility is depressed by hypoxemia, acidosis, and certain medications, such as beta-adrenergic blocking medications. Contractility is enhanced by sympathetic neuronal activity, and certain medications, such as Lanoxin.
The nurse practitioner inspects the patient's skin during a physical examination. She is looking for any abnormalities, especially skin findings associated with cardiovascular disease. The nurse notes a bluish tinge in the buccal mucosa and the tongue. She knows this is probably due to: a) Intermittent arteriolar vasoconstriction. b) Congenital heart disease. c) Peripheral vasoconstriction. d) Blood leaking outside the blood vessels.
b) Congenital heart disease. Cyanosis is due to serious cardiac disorders. A bluish tinge in the tongue and buccal mucosa are signs of central cyanosis caused by venous blood passing through the pulmonary circulation without being oxygenated. In the absence of pulmonary edema and cardiogenic shock, this sign is indicative of congenital heart disease. Refer to Table 12-3 in the text.
A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? a) Call the physician and obtain an order for a fluid bolus. b) Continue to monitor the client as ordered. c) Call the physician and obtain an order for a diuretic. d) Rezero the equipment and take another reading.
b) Continue to monitor the client as ordered. Normal CVP ranges from 3 to 7 mm Hg. The nurse doesn't need to take any action other than to monitor the client. It isn't necessary to rezero the equipment. Calling a physician and obtaining an order for a fluid bolus would be an appropriate intervention if the client has a CVP less than 3 mm Hg. Administering a diuretic would be appropriate if the client had excess fluid, as demonstrated by a CVP greater than 7 mm Hg.
A nurse is completing a head to toe assessment on a patient diagnosed with right-sided heart failure. To assess peripheral edema, which of the following areas should be examined? a) Legs, Toes b) Fingers, hands c) Under the sacrum d) Lips, earlobes
b) Fingers, hands When right-sided heart failure occurs, blood accumulates in the vessels and backs up in peripheral veins, and the extra fluid enters the tissues. Particular areas for examination are the dependent parts of the body, such as the feet and ankles. Other prominent areas prone to edema are the fingers, hands, and over the sacrum. Cyanosis can be detected by noting color changes in the lips and earlobes.
Which of the following is a true statement regarding the role of baroreceptors? a) Increases in heart rate b) Initiates the parasympathetic response c) Initiates the sympathetic response d) Increases blood pressure
b) Initiates the parasympathetic response During elevations of blood pressure, the baroreceptors increase their rate of discharge. This initiates parasympathetic activity and inhibits sympathetic response, lowering the heart rate and blood pressure.
The nurse is providing discharge instructions to a client with unstable angina. The client is ordered Nitrostat 1/150 every 5 minutes as needed for angina. Which side effect, emphasized by the nurse, is common especially with the increased dosage? a) Rash b) Orthostatic hypotension c) Dry mouth d) Nausea
b) Orthostatic hypotension A common side effect of Nitrostat, especially at higher dosages, is orthostatic hypotension. The action of the medication is to dilate the blood vessels to improve circulation to the heart. The side effect of the medication is orthostatic hypotension. A rash, nausea, and dry mouth are not common side effects.
You are evaluating the expected outcomes on a client who is recovering from a cardiac catheterization. What is an expected outcome that you would evaluate? a) The client and family understands the need for medication. b) The client and family understands the discharge instructions. c) The client and family understands the need to restrict activity for 72 hours. d) The client and family understands the client's CV diagnosis.
b) The client and family understands the discharge instructions. The client is relaxed and feels secure. The test is performed uneventfully or the client is stabilized when complications are managed successfully. The client and family have an accurate understanding of the diagnostic testing process and discharge instructions. The scenario does not indicate that the client has a CV diagnosis, a need for medication, or a need to restrict their activity for 72 hours.
A 24-year-old obese woman describes her symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm his suspected diagnosis. What diagnostic would you expect him to prescribe? a) Radionuclide angiography b) Transesophageal echocardiography c) Electrocardiography d) Chest radiograph
b) Transesophageal echocardiography TEE involves passing a tube with a small transducer internally from the mouth to the esophagus to obtain images of the posterior heart and its internal structures from the esophagus, which lies behind the heart. TEE provides superior views that are not possible using standard transthoracic echocardiography. Clients whose chests are rotund or who are obese are candidates for TEE. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. The radionuclide technetium-99m is used to detect areas of myocardial damage. The radionuclide thallium-201 is used to diagnose ischemic heart disease during a stress test. Electrocardiography (ECG) is the graphic recording of the electrical currents generated by the heart muscle.
The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure? a) Sympathetic nerve fibers b) Vagus nerve c) Baroreceptors d) Chemoreceptors
c) Baroreceptors Baroreceptor sense pressure in nerve endings in the walls of the atria and major blood vessels. The baroreceptors respond accordingly to raise or lower the pressure. Chemoreceptors are sensitive to pH, CO2, and O2 in the blood. Sympathetic nerve fibers increase the heart rate. The vagus nerve slows the heart rate.
A nurse working in a cardiac step-down unit understands that the following drugs can affect the contractility of the heart. The nurse recognizes that contractility is depressed by which of the following drugs? a) Lanoxin b) Dobutrex c) Lopressor d) Intropin
c) Lopressor Contractility is depressed by beta-adrenergic blocking medications. The other choices all enhance contractility.
After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. During assessment, the nurse expects to hear a murmur that is: a) Quiet but readily heard. b) Easily heard with no palpable thrill. c) Loud and may be associated with a thrill sound similar to (a purring cat). d) Very loud; can be heard with the stethoscope half-way off the chest.
c) Loud and may be associated with a thrill sound similar to (a purring cat). Heart murmurs are characterized by location, timing, and intensity. A grading system is used to describe the intensity or loudness of a murmur. A grade 1 is very faint and difficult to describe, whereas a grade 6 is extremely loud. Refer to Box 12-3 in the text for a description of grades 1 to 6.
A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate? a) A pulse deficit b) Weak pulse c) Thready pulse d) Bounding pulse
c) Thready pulse The nurse is most correct to anticipate a thready (barely palpable) pulse quality. A bounding pulse indicates a strong cardiac output. A weak pulse indicates a lower pulse quality. A pulse deficit occurs when the pulses between the apex of the heart differs from the radial pulse.
The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred? a) CK-MB b) Brain natriuretic peptide (BNP) c) Troponin T and I d) Myoglobin
c) Troponin T and I After myocardial injury, these biomarkers rise early (within 3 to 4 hours), peak in 4 to 24 hours, and remain elevated for 1 to 3 weeks. These early and prolonged elevations may make very early diagnosis of acute myocardial infarction (MI) possible and allow for late diagnosis in patients who have delayed seeking care for several days after the onset of acute MI symptoms. CK-MB returns to normal within 3 to 4 days. Myoglobin returns to normal within 24 hours. BNP is not considered a cardiac biomarker. It is a neurohormone that responds to volume overload in the heart by acting as a diuretic and vasodilator.
The nurse is caring for a client anticipating further testing related to cardiac blood flow. Which statement, made by the client, would lead the nurse to provide additional teaching? a) "The first test I am getting is an echocardiography. I am glad that it is not painful." b) "I had an ECG already. It provided information on my heart rhythm. c) "I am able to have a nuclide study because I do not have any allergies." d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."
d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker." A magnetic resonance imaging (MRI) test is prohibited on clients with various metal devices within their body. External metal objects must be removed. All other options are correct statements not needing clarification.
The client states, "My doctor says that because I am now taking this water pill, I need to eat more foods that contain potassium. Can you give me some ideas about what foods would be good for this?" The nurse's appropriate response is which of the following? a) Bok choy, cooked leeks, alfalfa sprouts b) Cranberries, apples, popcorn c) Asparagus, blueberries, green beans d) Apricots, dried peas and beans, dates
d) Apricots, dried peas and beans, dates Apricots, dried peas and beans, dates, and kiwi contain high amounts of potassium. The other foods listed contain minimal amounts.
The health care provider documents that the patient's pulse quality is a +1 on a scale of 0 to 4. The nurse knows that this describes a pulse that is: a) Full, easy to palpate, and cannot be obliterated. b) Diminished, but cannot be obliterated. c) Strong and bounding and may be abnormal. d) Difficult to palpate and is obliterated with pressure.
d) Difficult to palpate and is obliterated with pressure. The quality of pulses is reported using descriptors and a scale of 0 to 4. The lower the number, the weaker the pulse and the easier it is to obliterate it. A +1 pulse is weak and thready and easily obliterated with pressure.
The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries? a) Thallium b) Ativan c) Diazepam d) Dobutamine
d) Dobutamine Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. Options A, B, and C would not dilate the coronary arteries.
Which of the following is an early warning symptom of acute coronary syndrome (ACS) and heart failure (HF)? a) Hypotension b) Change in level of consciousness c) Weight gain d) Fatigue
d) Fatigue Fatigue is an early warning symptom of ACS, heart failure, and valvular disease. Other signs and symptoms of cardiovascular disease are hypotension, change in level of consciousness, and weight gain.
A patient's heart rate is observed to be 140 bpm on the monitor. The nurse knows that the patient is at risk for what complication? a) A stroke b) Right-sided heart failure c) A pulmonary embolism d) Myocardial ischemia
d) Myocardial ischemia As heart rate increases, diastolic time is shortened, which may not allow adequate time for myocardial perfusion. As a result, patients are at risk for myocardial ischemia (inadequate oxygen supply) during tachycardias (heart rate greater than 100 bpm), especially patients with coronary artery disease.
Which of the following tests used to diagnose heart disease is least invasive? a) Cardiac catheterization b) Magnetic resonance imaging c) Coronary arteriography d) Transthoracic echocardiography
d) Transthoracic echocardiography Transthoracic echocardiography uses high-frequency sound waves that pass through the chest wall (transthoracic) and are displayed on an oscilloscope. MRI uses magnetism to identify disorders that affect many different structures in the body without performing surgery. While an MRI does not expose clients to radiation, it does require intravenous infusion to instill medication and contrast medium. Cardiac catheterization requires the insertion of a long, flexible catheter from a peripheral blood vessel in the groin, arm, or neck into one of the great vessels and then into the heart. This procedure requires the instillation of a contrast medium into each coronary artery.