patho phys ch 17/18
What 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
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 - 36 L/minute
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
Headache and confusion
A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease?
"I should have my LDL monitored."
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 statement by the nurses would the educator most want to correct?
"The contraction of the ventricles and the atria can range from 400-600 beats per minute."
The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.
140
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:
140/90
The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition?
A pulsating mass in the abdomen
Which statement describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
A slow depolarization occurs because of the particular permeability of the cellular membranes.
Which type of aortic aneurysm is the most common
Abdominal aortic (AAA)
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:
Apply sequential pneumatic compression devices to lower extremities.
A 70-year-old male client presents to the emergency department reporting pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which medical diagnosis/possible treatment plan listed below?
Atherosclerotic occlusive disease necessitating thrombolytic therapy
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?
Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves.
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?
Elevation of triglycerides
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall.
Baroreceptors
A client who was diagnosed with hypertension is now taking a medication that decreases heart rate and cardiac output. The nurse determines that the medication is a:
Beta adrenergic blocker
Which 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
A nurse is planning a community education program on hypertension. Which parameter should be included to explain the regulation of arterial blood pressure?
Cardiac output and systemic vascular resistance
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
The nurse is evaluating a client with cardiac problems and notes that the client's peripheral pulse is different than the apical pulse. To which physiologic response would the nurse attribute the difference in rates?
Premature beats not following normal conduction pathways
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 parasympathetic innervation of the heart
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
Which one of the following is an example of hyperemia?
Finger redness in Raynaud phenomenon
The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?
Going for a brisk walk with a friend and talking to him about continuing to exercise regularly
A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is:
Hypertension
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.
Inactive lifestyle High salt consumption Obesity
Which statement is characteristic of a thrombus?
It forms on the wall of a vessel.
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
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which lipoprotein is the main carrier of cholesterol?
LDL
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?
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 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 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.
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 nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer, thus resulting in decreased vessel lumen radius?
Norepinephrine
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?
Outer fibrous layer
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?
Pulmonary arterial pressure (PAP)
An intensive care nurse caring for a client who is diagnosed with an anterior wall myocardial infarction (MI) notes frequent premature ventricular complexes on the ECG monitor and is concerned the client could develop a lethal dysrhythmia if one of the premature ventricular complexes fires on which phase of the cardiac action potential?
Relative refractory period ends
Following angioplasty for a blocked coronary artery following a myocardial infarction, a client is prescribed serial 12-lead ECGs for three days. On the second day, the nurse notices a distinct difference in the QRS morphology from the previous ECG. Which is the best action for the nurse to take?
Repeat ECG with proper lead placement.
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 nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply.
Stop smoking. Limit alcohol consumption. Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake.
A client is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?
Sustained systolic pressure ≥160 mm Hg
A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which reason accounts for this lack of change in 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 increased pressure related to right-sided heart failure.
A physiotherapist is measuring the lying, sitting, and standing blood pressure of a client who has been admitted to the hospital following a syncopal episode and recent falls. Which fact about the client best relates to these health problems?
The client is 89 years old and takes a diuretic medication for his congestive heart failure.
The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading?
The client just smoked a cigarette.
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The client's physician would anticipate that which phenomenon is most likely occurring?
The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state: Select all that apply.
The systolic pressure is ≥140 mm Hg. The incidence increases with age. It is the most common cardiovascular disorder.
Local control of blood flow is regulated by mechanisms that match blood flow to the metabolic needs of the tissue. 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 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
A client is pregnant for the first time and is considered to be at high risk for preeclampsia. The care team should prioritize which intervention?
Vigilant blood pressure monitoring
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply.
Weight reduction if overweight Smoking cessation Dietary measures to reduce LDL levels
The heart consists of four valves. Which are the semilunar valves? Select all that apply.
aortic pulmonary
In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?
client is helped out of bed an stands up
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?
lymphedemea
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.
mitral tricuspid
Which sequence is the correct pathway for blood flow through the heart?
right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
right-sided heart failure
The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system?
sympathetic
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as:
tunica media
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?
"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?
"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 number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which teaching point is most accurate?
"Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure."
A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which teaching point should the participants try to integrate into their lifestyle after the teaching session?
"Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk."
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 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%
The nurse knows that mean arterial pressure is:
60% of diastolic pressure and 40% of systolic pressure
Which client is at greatest risk for orthostatic hypotension?
A 66-year-old postoperative client on bed rest
While working triage in the emergency department, which client report should alert the nurse to imminent danger and, thus, that client should be seen first?
A client holding the abdomen and reporting a tearing and ripping feeling inside.
When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate?
Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.
A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure?
Activation of the renin-angiotensin-aldosterone mechanism
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 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
A client is diagnosed with gestational hypertension. The nurse recognizes which findings are characteristics of this condition? Select all that apply.
Blood pressure back to normal by 12 weeks postpartum Blood pressure greater than 140/90 Development after 20th week of pregnancy
A client who stands upright but immobile for long periods at her job reports that her feet often become swollen. Which is the most likely etiology of the client's condition?
By standing and not walking, she has not used the muscular pump to assist with venous return
The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?
C-reactive protein
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have on the body to consequently decrease blood pressure?
Decrease vascular volume
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
A 35-year-old man presents to the emergency department reporting chest pain for the last 2 hours. He describes the pain as crushing, like a huge weight is on his chest. He also states that the pain goes up into his neck and down his left arm. An acute myocardial infarction (MI) is diagnosed. When taking his history, the following things are noted:● Hyperlipoproteinemia for past 7 years● Family history of early MI● Cholesterol deposits along the tendons (diagnosed 1 year ago)● Atherosclerosis (diagnosed 6 months ago)● Diabetes mellitus (type 1) diagnosed at age 16 The nurse suspects which diagnosis will be made?
Familial hypercholesterolemia (type 2A)
A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring?
HDL
A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which aspect of hyperlipidemia would the physician most likely take into account when teaching the client?
HDL cholesterol is often characterized as being beneficial to health.
Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?
Hypercholesterolemia
Which assessment finding of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa?
The man's blood pressure is 178/102 and he has abnormal liver function tests.
A nurse on a geriatric medicine unit has noted that a significant majority of the clients on the unit are prescribed antihypertensive medications. Which phenomenon is the nurse most justified in ruling out as a contributing factor?
Increased sensitivity of the renin-angiotensin-aldosterone system
The nurse is reviewing a client's history and recognizes that the client smokes cigarettes. The nurse is concerned because smoking does which of the following?
Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development
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?
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client?
Raynaud disease
A female client tells the health care provider that she has recently been experiencing episodes of changes occurring in the color of her fingertips, especially when she experiences cold temperatures. She further states that the tips become pale, turn a bluish color, and then become reddened. The client is most likely experiencing:
Raynaud phenomenon
Which of the following is the site of chylomicron synthesis?
Small intestine
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:
Small openings that allow large amounts of smaller molecular substances to filter through the glomeruli.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:
Tearing or ripping-type pain in the chest or back
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.
Which blood vessel layer is made primarily of muscle?
Tunica media
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:
Unknown
A client has a blood pressure of 68/38 mm Hg and fainted after donating a unit of blood. The client is experiencing low preload from loss of blood volume. What is preload?
Venous return to the heart
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.
An older adult client arrives to the health care provider's office complaining of a "sore" that won't heal on the lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the client that the usual treatment is:
compression therapy to help facilitate blood flow back to the vena cava.
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
In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the client has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of:
decreasing cardiac output due to less ventricular filling time.
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
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:
sympathetic nervous system
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.
The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body?
1800
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