Patho quiz chapter 23&24
A client's heart valve that is located between the right atrium and right ventricle is stenosed. The nurse will be caring for which client?
A client with a stenosed tricuspid valve The tricuspid valve is located between the right atrium and right ventricle, and it prevents blood in the right ventricle from returning to the right atrium during systole. The mitral valve, also known as the bicuspid valve, is not located between the right atrium and right ventricle but rather between the left atrium and left ventricle. The semilunar valves are the pulmonary and aortic valves, so they are not located between the right atrium and right ventricle.
A nurse hears in report that the team will be caring for a client with a low ejection fraction. The nurse will be caring for which client?
A client with ventricular failure A decrease in ejection fraction is a hallmark of ventricular failure. Deep vein thrombosis does not affect ejection fraction; it is a venous problem. A client with increased heart contractility and a client with an overactive sympathetic nervous system will tend to have increased, not decreased, ejection fraction.
Which enzymes are released by damaged myocardial muscle tissue? (select all that apply) A. CK-MB B. LDH C. AST D. Troponin I E. ALT
A. CK-MB B. LDH D. Troponin I AST and ALT are liver enzymes that indicate damage to the liver cells. The other three are all indicators of myocardial damage. Although LDH is also measured in liver function, it also has a purpose for AMI.
An increase in the release of renin is the result of which event? A. Decrease in blood pressure at the renal artery B. Decrease in the amount of sodium delivered to the kidney C. β-Adrenergic stimuli D. Low potassium concentration
A. Decrease in blood pressure at the renal artery
Which of the following represents the measure of time from the onset of atrial activation to the onset of ventricular activation? A. PR interval B. QRS complex C. ST interval D. QT interval
A. PR interval
Which item is a characteristic of the Frank-Starling law of the heart? A. Resting sarcomere length to tension generation B. Resting sarcomere length to end-diastolic volume C. Tension generation and left ventricular pressure D. Tension generation and diastolic filling pressures
A. Resting sarcomere length to tension generation
Which items are components of the heart's anatomy? (select all that apply) A. Two atria B. Two atrioventricular valves C. Two ventricles D. Two-layer heart wall E. Two semilunar valves
A. Two atria B. Two atrioventricular valves C. Two ventricles E. Two semilunar valves
Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses: a. left ventricular preload increases. b. systemic vascular resistance decreases. c. left end-diastolic volume decreases. d. pulmonary vascular resistance decreases
ANS: A Left ventricular preload increases in left heart failure because less blood is ejected from the left ventricle. Left heart failure does not lead to a decrease in systemic resistance; it leads to an increase in resistance. Left end-diastolic volume will increase. Pulmonary vascular resistance will increase.
A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure? a. Significant edema to both lower legs and feet b. Hypertension c. Decreased urine output d. Dyspnea
ANS: A Right-sided failure allows blood to back up into the systemic circulation, leading to peripheral edema. Since it is backed up into the venous system, hypertension is less likely. Right-sided failure leads to edema and a greater venous blood volume, which would lead to increased urinary output. Dyspnea upon exertion is more indicating of left-sided failure.
A patient was admitted to the intensive care unit with a diagnosis of acute myocardial infarction (MI) and is being treated for shock. The primary cause of shock is most likely: a. rapid heart rate. b. decreased cardiac contractility. c. increased capillary permeability. d. decreased afterload due to vasodilation.
ANS: B MI leads to decreased cardiac contractility due to a damaged myocardium and would lead to shock. A rapid heart rate would not cause shock. Increased capillary permeability would not lead to shock. Decreased afterload will not lead to shock associated with MI.
A 73-year-old has increased pulmonary pressure resulting in right heart failure. A potential cause for the right heart to fail is: a. hypertension. b. left heart failure. c. acute pneumonia. d. pericarditis.
ANS: B Right-sided failure often follows left-sided failure when pulmonary congestion forces backward flow of blood into the left ventricle. It is not due to hypertension, pneumonia, or pericarditis.
A 65-year-old male with a history of untreated hypertension is now experiencing left heart failure. A nurse recalls his untreated hypertension led to: a. ventricular dilation and wall thinning. b. myocardial hypertrophy and ventricular remodeling. c. inhibition of renin and aldosterone. d. alterations in alpha and beta receptor function.
ANS: B With hypertension comes increased afterload and resistance to ventricular emptying and more workload for the ventricle, which responds with hypertrophy of the myocardium and ventricular remodeling. Ventricular dilation can occur, but the wall will thicken, not thin. Renin and aldosterone release are increased, not inhibited. Alterations in alpha and beta functioning may occur, but the response to hypertension is myocardial hypertrophy and ventricular remodeling.
When a person is in shock, a nurse remembers impairment in cellular metabolism is caused by: a. release of toxic substances. b. free radical formation. c. inadequate tissue perfusion. d. lack of nervous or endocrine stimulation.
ANS: C In shock, impaired cellular metabolism is caused by inadequate tissue perfusion. Impairment of cellular metabolism is the result of inadequate tissue perfusion; toxic substances could develop, but it would be secondary to the inadequate perfusion. Free radicals are not the cause of impaired cellular metabolism. The lack of nervous control would lead to vasodilation, but perfusion still occurs.
A patient with left heart failure starts to have a cough and dyspnea. Pulmonary symptoms common to left heart failure are a result of: a. inflammatory pulmonary edema. b. decreased cardiac output. c. pulmonary vascular congestion. d. bronchoconstriction.
ANS: C The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Pulmonary edema does occur, but it is not due to inflammation. Decreased cardiac output does occur, but the pulmonary symptoms are related to pulmonary congestion. Pulmonary symptoms are not due to bronchoconstriction.
Which condition should cause the nurse to assess for high-output failure in a patient? a. Metabolic alkalosis b. Hypothyroidism c. Hypovolemia d. Anemia
ANS: D Common causes of high-output failure include anemia, not metabolic alkalosis, not hypothyroidism, and not hypovolemia.
What should the nurse monitor to determine a client's afterload?
Aortic systolic pressure Aortic systolic pressure is a good index of afterload. Temperature can help determine infectious processes, not afterload. Electrolyte tests can help determine fluid and electrolyte levels, not afterload. Arterial blood gases help determine pH of the blood.
Which is the MOST common complication of an acute myocardial infarction (AMI)? A. Dressler syndrome B. Arrhythmia C. Pericarditis D. Heart failure
B. Arrhythmia All of these answer choices are true complications of AMI; however, the most common is arrhythmia.
Which term describes the occlusion of a blood vessel from a bolus of circulating matter in the bloodstream? A. Thrombus B. Embolus C. Thrombophlebitis D. Foam cell
B. Embolus An embolus detaches from the wall of a vessel and circulates within the vascular system until it reaches a vessel small enough for it to occlude. A thrombus is a blood clot that remains attached to the vessel wall. Thrombophlebitis is the inflammation caused by a thrombus. Foam cells are lipid-laden cells that contribute to fatty streaks.
Which symptoms are typically observed with the presence of an acute myocardial infarction (AMI)? (select all that apply) A. Cough B. Unrelenting indigestion C. Diaphoresis D. Substernal pain E. Cool, clammy skin
B. Unrelenting indigestion C. Diaphoresis D. Substernal pain E. Cool, clammy skin A patient may experience substernal chest pressure or pain, nausea, vomiting, abdominal pain, or indigestion. Sweating and cool and clammy skin are also typical. A cough is not considered a sign of an MI.
What is the effect of angiotensin II on blood vessels? A. A potent vasodilator B. Vascular vasoconstriction C. Inhibition of aldosterone D. Excretion of sodium by the kidney
B. Vascular vasoconstriction
Which statement regarding arteriosclerosis is TRUE? Arteriosclerosis is: A. an acute process of heart muscle degeneration. B. thickening and hardening of the vessel wall. C. plaque caused by accumulation of hormones. D. fatty streaks and foam cells that are identical.
B. thickening and hardening of the vessel wall. Arteriosclerosis is a chronic degeneration of blood vessel walls. A plaque is caused by collagen over a fatty streak that is composed of a large number of lipid-laden foam cells that deposit on the vessel wall.
A nurse is discussing pressure receptors located in the aortic arch and carotid arteries that affect a client's heart rate and blood pressure. Which reflex is the nurse describing?
Baroreceptor reflex The baroreceptor reflex facilitates both blood pressure changes and heart rate changes. It is mediated by tissue pressure receptors (called pressoreceptors or baroreceptors) in the aortic arch and carotid arteries. Distention of the atria causes stimulation of atrial receptors (for example, when intravascular volume is increased by intravenous infusions). This causes activation of the Bainbridge reflex, which increases heart rate. The Frank-Starling and Poiseuille eponyms refer to various concepts, including laws, curves, and spaces, but not to reflexes. The Frank-Starling law of the heart describes the length-tension relationship of preload to myocardial contractility (as measured by stroke volume). The Poiseuille law shows the relationship among blood flow, pressure, and resistance. Resistance in a vessel is inversely related to blood flow—that is, increased resistance leads to decreased blood flow.
hich complication occurs secondary to hypertension? A. Cardiovascular muscle atrophy B. Hypoglycemia C. Congestive heart failure D. Decreased demand for coronary perfusion
C. Congestive heart failure Complications of hypertension include ventricular hypertrophy, angina pectoris, congestive heart failure, coronary artery disease, myocardial infarction, and sudden death. There is no research to support the remaining options as occurring as a result of hypertension.
Which two factors determine cardiac output? A. Parasympathetic and sympathetic activity B. Preload and afterload C. Heart rate and stroke volume D. Right and left atrial pressure
C. Heart rate and stroke volume
Which statement regarding cellular injury of the myocardium is correct? A. Cardiac cells can withstand ischemic conditions for about 40 minutes. B. ECG changes are visible after approximately 120 seconds. C. Myocardial cells remain viable if blood flow returns within 20 minutes. D. After 20 seconds of decreased blood flow, myocardial cells become cooler.
C. Myocardial cells remain viable if blood flow returns within 20 minutes. Correct Cardiac cells can withstand ischemic conditions for about 20 minutes. ECG changes are visible after 30-60 seconds of hypoxia. After 8-10 seconds of blood flow, the myocardial cells are already cooler.
A patient experiences a rapidly progressive hypertension with a diastolic pressure of 146 mm Hg. Which is the correct term for this condition? A. Primary hypertension B. Secondary hypertension C. Complicated hypertension D. Malignant hypertension
D. Malignant hypertension Hypertensive crisis (or malignant hypertension) is rapidly progressive hypertension in which diastolic pressure is usually greater than 140 mm Hg. It can occur in those with primary hypertension, but the reason why some people develop this complication and others do not is unknown. As hypertension becomes more severe and chronic, tissue damage can occur in the blood vessels and tissues leading to target organ damage in the heart, kidney, brain, and eyes. Primary hypertension is the term used to identify hypertension that has no known cause. Secondary hypertension is the term used to identify hypertension caused by altered hemodynamics. There is no tertiary hypertension.
Which is a characteristic of cardiac preload? A. Impedance to ejection of blood from the left ventricle B. Wall tension related to internal blood vessel radius C. A lower than normal tension curve D. Pressure generated by the end-diastolic volume
D. Pressure generated by the end-diastolic volume
A client has a drop in cardiac output. Which assessment finding does the nurse expect to observe?
Decreased mean arterial blood pressure A decrease in the cardiac output causes an immediate drop in the mean arterial blood pressure and arteriolar flow. An increase in cardiac output without a decrease in peripheral resistance will cause both arterial volume and arterial pressure to increase. Overall, the renin-angiotensin system is activated after volume depletion or hypotension (decreased cardiac output) and is suppressed after volume repletion.
A nurse is describing the part of the cardiac cycle in which the ventricles are filled during relaxation. What is the nurse discussing?
Diastole The heart muscle relaxes and allows blood to flow through it as it fills passively during diastole. The heart muscle contracts to move blood through the chambers during systole. Ventricular ejection refers to the blood being moved out of the ventricles. Mechanically, the isovolumic phase of ventricular systole is defined as the interval between the closing of the atrioventricular valves and the opening of the semilunar valves.
The peripheral vascular system supplies blood to which area in a client's body?
Feet The peripheral vascular system is an imprecise term used to describe the part of the systemic circulation that supplies the skin and the extremities, particularly the legs and feet. Pulmonary circulation provides blood to the lungs. Coronary circulation carries blood to the heart. The carotid artery supplies blood to the brain.
A coworker asks a nurse how cardiac output is determined. How should the nurse respond?
It is the product of stroke volume and heart rate The product of the stroke volume and the heart rate provides the amount of cardiac output. None of the other options (MAP, SVR, or pulse pressure) are factors in cardiac output.
A client's muscular arteries constrict. How should the nurse interpret this finding?
Less blood flow through the vessels Contraction narrows the vessel lumen (the internal cavity of the vessel), which diminishes flow through the vessel (vasoconstriction). When the smooth muscle layer relaxes, more blood flows through the vessel lumen (vasodilation). The same amount and no change in blood flow do not occur with vasoconstriction.
A nurse is describing blood flow through the heart and describes the valve that directs blood flow from the left atrium to the left ventricle. Which term, if used by the client, will indicate to the nurse that the teaching about the valve was successful?
Mitral The mitral valve directs blood from the left atrium to the left ventricle. The aortic valve lies between the left ventricle and the aorta. The pulmonic valve lies between the right ventricle and the pulmonary arteries. The tricuspid valve directs blood from the right atrium to the right ventricle.
A man reports that he had to have a pacemaker put in because his normal pacemaker would not work. This client asks the nurse what the normal pacemaker is. Which information by the client indicates teaching was successful?
The sinoatrial node The sinoatrial node is considered the pacemaker of the heart. The bundle of His helps conduct electrical impulses down the inner ventricles. The coronary sinus is a vein that drains blood from the cardiac veins into the right atrium, and it does not contain autorhythmic myocardial cells. The atrioventricular node initiates a signal that is conducted through the ventricular myocardium by way of the bundle of His and Purkinje fibers.
Which information from the client indicates teaching by the nurse was successful for systolic blood pressure?
This is the blood pressure when the ventricles contract The systolic blood pressure is the arterial blood pressure during ventricular contraction or systole. The diastolic blood pressure is the arterial blood pressure during ventricular filling or diastole. If the ventricles stopped there would be no blood pressure.
a patient presents to a primary care provider reporting chest pain and is diagnosed with atherosclerosis. this disease is caused by
abnormal thickening and hardening of vessel walls
49 year old male presents reporting chest pain. EKG reveals St elevation. He is diagnosed with a myocardial ischemia. Which of the following interventions would be most beneficial
apply oxygen to increase myocardial oxygen supply
most common cause of myocardial ischemia is
atherosclerosis
a patient presents with severe chest pain and SOB and is diagnosed with pulmonary embolism. the embolism most likely originated from the
deep veins of the leg
Most cases of combined systolic and diastolic hypertension have no known cause and are documented on the chart as ____ hypertension
primary
Which structure in a normal heart is responsible for electrical impulse stimulation?
Sinoatrial (SA) node
What term should the nurse use tp document a detached blood clot
thromboembolus
