Test 4 disorders of cardiac function, heart failure, and circulatory shock ch27, 12. CARDIAC CONDUCTION/RHYTHM, Porth's Ch 33 - Disorders of Cardiac Conduction & Rhythm, Pathophysiology Chapter 17 (Control of Cardiovascular Function) PrepU Quizzes, C...

The nurse knows that which statement regarding heart failure is most accurate?

In compensated failure, an increase in preload causes an increase in ventricular contractility.

Which statement regarding heart failure is true?

In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction.

Preload represents the volume work of the heart and is largely determined by:

Venous blood return

A patient who will be undergoing a Holter monitor examination would be given which of the following instructions?

"Keep a diary of your activities and symptoms throughout the examination." During the period of a patient wearing a Holter monitor (usually 48 hours), the patient will be instructed to maintain a diary of activities and symptoms so that the recorded electrocardiographic reading can be correlated with the diary events. The other options are not instructions appropriate for a Holter monitor examination

A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which explanation is most appropriate to share?

"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."

Which instructions should the nurse give to a client with a new prosthetic mitral valve? Select all that apply.

"Expect to take prophylactic antibiotics for dental work." "Lifelong anticoagulants are necessary to prevent blood clots."

The venous system is a low pressure system that returns blood to the heart. What is the normal right atrial pressure?

0mm Hg

What 4 things describe Metabolic syndrome aka Syndrome X?****

1. HTN 2. High blood sugar 3. High cholesterol 4. Obesity

The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:

20 mL/hour

A client is lying in a recumbent position. In this patient approximately how much total blood volume is in the central circulation?

25% - 30%

Onset of chest pain until the time patients reach hospital is usually how long?

4 hours

A client is having blood work done. What percentage of red blood cells represents the formed elements of the blood?

40 - 45%

Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?

51-year-old man who has been diagnosed with glomerulonephritis

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%

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminary Lee indicative of myocardial infarction. Which of the following client is least likely to have an ST segment myocardial infarction or STEMI?

71-year-old man who has my skin, fever, and chest pain is excruciating when he moves but relieved when he rest

Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction?

80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose

An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short term and long term compensatory Mechanisms are least likely to decrease the symptoms of his heart failure?

AV node pacemaking activity and vagal nerve suppression

A patient 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 of the following has most likely resulted in the patient's increased blood pressure?

Activation of the renin-angiotensin-aldosterone mechanism The largest single cause of secondary hypertension is renal disease. The reduced renal blood flow that occurs with renovascular disease causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II and raising blood pressure. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta.

What makes Prinzmetal's angina so "spontaneous?"

Always fluctuating- sometimes symptoms improve with exertion

For patients are admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experience myocardial infarction?

An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST segment elevation with inverted T-wave and abnormal keyways; levels of cardiac markers of secretly rose.

A client has been diagnosed with atrial flutter. What assessment finding does the nurse expect?

An atrial heart rate above 240 beats per minute

A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows that which of the following complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply. A) Profound dyspnea due to acute respiratory distress syndrome B) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces C) Formation of plaque within vessels supplying blood to the heart causing muscle damage and chest pain D) Acute renal failure due to decreased/impaired renal perfusion as a result of low BP E) Flushed skin and pounding headache that coincides with each heart beat

Ans: A, B, D

An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure? A) An increase in preload via the Frank-Starling mechanism B) Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine C) Activation of the renin-angiotensin-aldosterone system and secretion of brain natriuretic peptide (BNP) D) AV node pacemaking activity and vagal nerve suppression

Ans: D

A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child?

Antibiotics and anti-inflammatory drugs

A female adult older client has presented with new onset of shortness of breath and her physician has ordered measurement of her BNP levels along with other diagnostic test. What is the most accurate rationale for the physicians choice of blood work?

BNP is released as a compensatory mechanism during heart failure and measuring it can differentiate the clients dyspnea from a respiratory pathology

A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?

Blacks and South Asians A 2006 Canadian study showed that the ethnic groups consisting of South Asians (30%) and blacks (31%) in Canada are more likely to have hypertension in comparison to the primarily Caucasian population (21%) and East Asians are the least likely to have hypertension (19%).

A nurse who works on pediatric cardiology unit of the hospital is providing care for an infant with diagnosis of tetralogy of fallot. Which of the following pathophysiologic results should the nurse anticipate

Blood outflow into the pulmonary circulation is restricted by Pulmonic valve stenosis.

In pregnancy, which of the following data are diagnostic for pre-eclampsia and eclampsia?

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Pre-eclampsia and eclampsia are defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (≥300 in 24 hours) developing after 20 weeks of gestation.

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 Preeclampsia-eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing after 20 weeks of gestation.

Myocarditis causes what two cardiac conditions?*

CHF & CMD (cardiac muscle dysfunction)

The efficiency of the heart as a pump often is measured in the amount of blood the heart pumps per minute. Which is the correct formula to figure out the cardiac output?

CO = SV x HR

Which of the following 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

What cardiac condition is a disease in which the contraction and relaxation of myocardial muscle fibers are impaired?*

Cardiomyopathy

A nurse educator is explaining normal cardiac conduction and action potentials to a nursing cohort. When she uses the term "calcium current" a student stops her and asks for clarification. Which is the best response? A) "The calcium current provides for the entrance of calcium for the repolarization of electrical activity with muscle contraction." B) "The calcium current provides for the entrance of calcium needed for muscle contraction." C) "The calcium current provides for the entrance of calcium for the fast depolarization of the myocardium." D) "The calcium current provides for the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction."

D) "The calcium current provides for the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction."

What is the primary issue in systolic heart failure?*

Decrease in contractility Decreased ejection fraction **forward failure**

A 66-year-old client echocardiogram report reveals a hyper trophy left ventricle. The healthcare provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client had aortic stenosis? Select all that apply

Decrease in exercise tolerance, exertional dyspnea, syncope

What decreases in subendocardial MI?

Decreased filling phase (diastolic pressure)- sometimes blood doesn't even get to the endocardial layer

Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long-term care home as organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate?

Displays of aggression, confusion and restlessness when the resident has no history of such behavior can be a sign of heart failure

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? A) Antihypertensive, diuretic, antiplatelet aggregator B) Diuretic, ACE inhibitor, beta-blocker C) Anticoagulant, antihypertensive, calcium supplement D) Beta-blocker, potassium supplement, anticoagulant

Diuretic, ACE inhibitor, beta-blocker

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggested that the patient has a diagnosis of heart failure?

Diuretic, ace-inhibitor, beta-blocker

Which of the following statements provided blood work results and rationale that would be most closely associated with acute coronary syndrome?

Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation

Which of the following changes associated with aging contributes to Hartville your development an older adults,? Select all that apply

Elevated diastolic blood pressure, increased vascular stiffness

Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?

Emotional stress

The nurse is assisting a patient who had a myocardial infarction 2 days ago during a bath. The patient suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the patient was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. Which of the following is a priority intervention at this time?

Immediate defibrillation

The nurse must achieve which clinical objectives for a client in cardiogenic shock? Select all that apply.

Improve cardiac output Regulate blood volume Increase coronary perfusion Correct pulmonary edema

What does R ventricular failure lead to? (consequences)*

Increased R ventricular EDV Jugular vein distension (JVD) Liver engorgement (swelling) Ascites (high BP in the veins) Peripheral edema

Which of the following phenomena would be most likely to be a company increased myocardial oxygen demand (MVO2)?

Increased aortic pressure

A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?

Increased sympathetic stimulation of the heart and blood vessels

Which intervention will the nurse anticipate being prescribed to treat an adult admitted to the ICU with acute respiratory distress syndrome (ARDS)?

Increasing oxygen concentration in the inspired air

A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process?

Infective endocarditis

Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?

Inherent spontaneous action-potential

What are the 3 I's in the evolution of an MI?

Ischemia -- Injury -- Infarct

A 28-year-old client is admitted to the hospital for severe dehydration following a marathon, with fatigue the only complaint. Admission vital signs include a heart rate of 38, blood pressure 98/60, RR 16. Cardiac monitor reveals regular QRS complexes preceded by normal P waves. Which of the following does the nurse determine is the most likely cause for the bradycardia?

Large stroke volume This client most likely has a large stroke volume related to the exercise training necessary to participate in a marathon. Trained athletes can potentially develop a normal physiologic cardiomegaly. There are no signs or symptoms to support a reduction in cardiac output.

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often follows the vascular response in anaphylaxis?

Laryngeal edema

When teaching about heart attacks, the nursing instructor tells the students that most heart attacks (approximately 40 to 50 percent) affect which coronary artery?

Left anterior descending artery

The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states the blood is shunted to which part of the body?

Left side of the heart to the right side of the heart

A client has arrived in the emergency department in cardiogenic shock. Which assessment findings by the nurse would confirm this diagnosis? Select all that apply.

Less than 5 mL dark, concentrated urine in the past hour BP reading of 80/65 Difficult to arouse with changes in level of consciousness

The nurse administers nitroglycerin to a client with acute coronary syndrome. Which explanation is the best rationale for this intervention?

Limiting the size of the infarction

What are the causes of dilated cardiomyopathy?*

Long-term alcohol abuse Systemic HTN Infections Smoking Pregnancy Chemo

The physician states that a client has adequate collateral circulation. The nurse interprets this as:

Long-term compensatory regulation of blood flow

A 30-year-old client arrives with these vital signs: Blood pressure 50/30 mm Hg, pulse 100 beats/min, respiratory rate 12 breaths/min, temperature 101°F (38.3°C). The nurse interprets these results as the client being in shock based on which reading?

Low blood pressure

Increased secretion of renin in heart failure is caused by which event?

Low cardiac output

A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? A) Measurement of urine output and mental status assessment B) Pupil response and counting the patient's apical heart rate C) Palpation of pedal (foot) pulses and pain assessment D) Activity tolerance and integumentary inspection

Measurement of urine output and mental status assessment

A nurse educator in a geriatric medicine unit of the hospital is teaching a group of new grads specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurse prioritize in their practice?

Measurement of urine output and mental status assessment

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 nurse is assessing for cyanosis in a child who has a congenital heart defect. Select the mostimportant area for the nurse to assess.

Mucous membranes

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged, resulting in a pulmonary embolism. Which type of shock is this client at risk of experiencing?

Obstructive shock

A monitored hospitalized patient with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which of the following forms of AF is this?

Paroxysmal

Which type of angina is when ischemic cardiac pain always occur at rest? a. unstable b. stable c. prinzmetal

Prinzmetal's angina- may be associated with acute MI and cardiac arrhythmias

A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows which complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply.

Profound dyspnea due to acute respiratory distress syndrome (ARDS) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces Acute renal failure due to decreased/impaired renal perfusion as a result of low BP

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent:

Pulmonary embolism

The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?

QRS complex The QRS complex is representative of ventricular depolarization. The P wave is atrial depolarization, the T wave is ventricular repolarization, and the ST segment is the time to ventricular repolarization.

Describe the troponin I (TNI) lab value

Quick 1-hour test (*stays high for 10-15 days*) a little better than CPK

A nurse is evaluating hypertension risk factors with a black male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 lb (6.8 kg) in the past year. Which risk factors or hypertension are nonmodifiable? Select all that apply.

Race Family history

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?

Raising the head of the bed to a high Fowler's position

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

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 The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.

What are the effects of beta blockers*

Reduce myocardial O2 demand (helps with cardiac rhythm) Reduce myocardial damage due to decreased catecholemines Improved diastolic relaxation Inhibition of sympathetically mediated vasoconstriction

Which of the following is the correct sequence for blood flow through the heart?

Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta

The heart wall becomes thickened in hypertrophic cardiomyopathy secondary to what ?*

Secondary to heart being in *prolonged isometric contraction* -can be caused by uncontrolled sympathetic activity; mostly genetic causes

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock?

Septic

A patient in the intensive care unit has a blood pressure of 87/39 and his warm flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is the client most likely diagnosis

Septic shock

An emergency room nurse is caring for a client with cardiomyopathy who has chest pain and shortness of breath. Vital signs include: heart rate 100, blood pressure 84/62, RR 30 and temp 37.0. Cardiac monitor reveals an irregular rhythm with frequent premature ventricular complexes. The nurse understands that this client is at risk for which of the following?

Serious arrhythmias Cardiomyopathy is disease of the cardiac muscle and premature ventricular contractions increase the risk for more lethal arrhythmias to occur. Heart failure is also a possibility; however, there is not enough information in the question to support heart failure

Which condition does the nurse know can lead to right-sided heart failure?

Severe pneumonia

What is the primary cause of heart failure in infants and children?

Structural heart defects

A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?

When the client experiences chest pain

If a patient has anginal pain at rest, can you treat or no?

YOU *CANNOT* TREAT

Endocarditis is what?*

a bacterial/fungal infection of heart valves

A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client?

anaphylatic shock

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?

beta-adrenergic blocking drugs (beta-blockers)

An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:

blocking the conversion of angiotensin I to angiotensin II.

Compared to stable angina, unstable angina is used to denote what?

changes in anginal pattern OR angina at rest

What is angina itself?

chest pain (caused insufficient blood flow to heart sec. to narrowing of coronary artery)

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.

compensatory mechanisms

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

• Mitral • Tricuspid

Which of the following factors affect cardiac performance? Select all that apply.

• Preload • Afterload • Myocardial contractility

The heart consists of four valves. Which are the semilunar values? Select all that apply.

• Pulmonary • Aortic

The nurse knows that which of the following statements regarding sodium and hypertension are correct? Select all that apply.

• Reduction in sodium intake often produces a reduction in blood pressure. • Sodium may increase the responsiveness of the cardiovascular system to adrenergic (sympathetic) stimulation. • In the INTERSALT study, urinary sodium excretion and systolic blood pressure are closely correlated. The mechanism by which sodium contributes to hypertension is not clear. It may involve the responsiveness of the cardiovascular system to adrenergic stimulation. Reduction of salt intake will lower blood pressure. Older persons are more sensitive to the effect of salt on blood pressure. Seventy-five percent of sodium intake is from processed foods, 15 percent from cooking and table salt, and 10 percent from natural sodium content of foods

A clinically obese patient diagnosed with stage 2 hypertension is resistant to taking antihypertensive medication because he has no symptoms and "feels fine." The nurse will encourage this patient to attempt lowering his blood pressure in order to decrease the risk of developing which of the following? Select all that apply.

• Renal failure • Coronary artery disease • Dementia • Loss of vision Hypertension has many severe consequences. It fosters atherosclerosis of the coronary arteries and damages retinal blood vessels resulting in loss of vision. Nephrosclerosis and renal failure are frequent sequelae of hypertension. Damage to central nervous system blood vessels can lead to dementia. While hypertension is not a causative factor for diabetes, it frequently occurs together with hypertension and elevated LDL cholesterol. Each of these disorders is a risk factor for heart disease.

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 .

It is safe to keep stable angina patients how many beats below ischemic threshold?

10 beats below ischemic threshold

The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.

140 Systolic hypertension is a consistent systolic pressure of 140 mm Hg or higher with near normal diastolic pressure.

The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock?

Septic shock

What happens in subendocardial MI?

Subtotal occlusion of blood flow to endocardial layer (still some distal blood flow, but *limited*)

The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition?

"I should report episodes of dizziness or fainting."

What is the difference between hypertrophic and restrictive cardiomyopathies?*

*restrictive* = wall gets stiff, not thickened *hypertrophic* = wall gets stiff AND thick *both lead to impaired filling of ventricles*

The stroke volume is the amount of blood ejected with every contraction of the ventricle. It is broken down into quarters. What is the approximate amount of the stroke volume per quarter?

60%, 20%, 20%, and little blood

Assuming that they have not responded to drug therapy, which of the following clients is likely to be the best candidate for surgical cardiac ablation? A) A 62-year-old woman with peripheral vascular disease who has experienced multiple episodes of torsades des pointes B) A 75-year-old man with diabetes but no previous heart disease who suddenly develops ventricular tachycardia C) A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long Q-T syndrome D) A 22-year-old woman with an atrial septal defect who has recurrent paroxysmal supraventricular tachycardia

A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long Q-T syndrome

Which of the following patients is at greatest risk for orthostatic hypotension?

A 66-year-old post-surgery patient on bed rest Post-surgery patients who have been immobile are at greatest risk for developing othostatic hypotension. The 70-year-old female may also be at some risk: age is a risk factor, as is administration of some antihypertensive medications.

A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention?

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

In which of the following situations would blood be most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up.

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hypercyanotic attack brought on by periods of stress

A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the client's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 25 hours. Which of the following statements best captures an aspect of Holter monitoring? A) A Holter monitor is preferable to standard ECG because of its increased sensitivity to cardiac electrical activity. B) The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. C) Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording. D) Holter monitors are normally set to record the electrical activity of the heart at least once per hour.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?

Action decreases metabolic demands of the heart.

A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate? A) Immediate cardioversion followed by surgery to correct the atrial defect B) Anticoagulants, beta-blockers, and possibly digitalis C) Antihypertensives and constant cardiac monitoring in a high acuity unit D) Diuretics, total bed rest, and cardioversion if necessary

Anticoagulants, beta-blockers, and possibly digitalis

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this client?

Anticoagulation therapy and elevation of the leg Anticoagulants, immobilization, and elevation of the affected extremity are used in the treatment of DVT. Interventions that are used to prevent DVT (ambulation; compression stockings; compression devices) may be harmful when a DVT is present. Surgery is not normally required, and massage has the potential to dislodge a DVT.

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 of the following assessments should the nurse complete?

Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves

A nurse is monitoring a patient with a resting heart rate of 120 bpm. The patient has been diagnosed with sinus tachycardia, which is the result of an increase of which of the following characteristics of cardiac cells? A) Automaticity B) Excitability C) Conductivity D) Refractoriness

Automaticity

Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences?

Backflow from the left ventricle to left atrium

A client who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which manifestation alerts the nurse to a developing complication?

Decreased level of consciousness

What is the pathology of diastolic heart failure?*

Decreased wall compliance associated with hypertrophic cardiomyopathy --> *results in diminished stroke volume sec. to decreased EDV*

Following coronary artery bypass graft or CABG surgery for a massive myocardial infarction located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be an early stages of cardiogenic shock? Select all that apply

Decreasing mean arterial pressure or map, low blood pressure reading of 86/60, urine output of 15 mls last hour, periods of confusion

A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?

Defibrillate the patient

All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention with a nurse administer first

Epinephrine (adrenaline)

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

The nurse will monitor the client for which possible respiratory manifestations of heart failure? Select all that apply.

Exertional dyspnea Orthopnea Cheyne-Stokes respiration Chronic, dry cough

Why does the drug DIGOXIN make diastolic heart failures worse?*

If the heart already has trouble re-filling, you don't want to make it worse by increasing ejection fraction

When will the nurse plan to assess a patient's blood pressure to confirm the possible diagnosis of orthostatic hypotension?.

In the morning before arising from bed To confirm orthostatic hypotension, blood pressure should be assessed while the patient is supine and then after standing for one minute and 3 minutes. A fall of 20 mm Hg or more in systolic pressure, or 10 mm Hg or more in diastolic pressure are considered orthostasis.

If less blood is pumped out, more is left behind and then what happens?*

Increase LVEDP --> Increased L atrial pressure --> Increased pulmonary capillary pressure --> increased pulmonary artery pressure --> Increased R ventricle pressure --> increased R atrial pressure --> HIGH PRESSURE in venous system --> elevated pressure in jugular venous (neck veins)

A nurse is monitoring a client with a resting heart rate of 120 beats/minute who has been diagnosed with sinus tachycardia, which can result from a change in which characteristic of cardiac cells?

Increased automaticity

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 Increased sensitivity of the renin--angiotensin--aldosterone system is not a noted phenomenon among older adults. Stiffening of large arteries, increased peripheral vascular resistance, and decreased baroreceptor sensitivity and renal blood flow are all accompaniments of aging.

A newborn is diagnosed with Tetralogy of Fallot. Prior to surgery, which abnormality should be corrected to prevent a stroke?

Iron deficiency anemia

In which of the following patient situations with a physician be most justified and preliminary ruling out. Carditis as a contributing pathology to the patient's health problems?

Is 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and history of atrial fibrillation.

Which of the following is true regarding pulmonary circulation?

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

What is the pathophysiology behind prinzmetal's angina?

It's not like stable and unstable angina in that it is NOT caused by atherosclerotic narrowing. Prinzmetal's angina is caused by arteries suddenly spasming, which leads to vasoconstriction of coronary arteries --> ISCHEMIA. Worst in the AM.

The pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following?

Kawasaki disease Kawasaki disease involves large, medium-sized and small arteries (frequently the coronaries) and usually occurs in small children. Takayasu arteritis, a large vessel vasculitis, is a granulomatous inflammation of the aorta, usually in people younger than 50 years of age. Microscopic polyangiitis and Wegener's granulomatosis, both small vessel vasculitises, involve the respiratory and renal systems.

The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which of the following lipoproteins is the main carrier of cholesterol?

LDL LDL is the main carrier of cholesterol. HDL is 50 percent protein; VLDL carries a large amount of triglycerides. IDLs are fragments of VLDLs after the triglycerides are removed and can be recycled to form VLDLs or converted to LDLs.

What is the hallmark of L heart failure?*

Left ventricular end-diastolic pressure (LVEDP)

A patient is diagnosed with systolic hypertension. The nurse knows that this patient is at risk for which of the following?

Left ventricular hypertrophy Elevated systolic pressure forces the heart to work harder and can thus provoke left ventricular hypertrophy, increased myocardial oxygen demand, and eventual left-sided failure. Left-sided failure may lead to right-sided failure which can affect the kidneys. Systolic hypertension can exist apart from diastolic hypertension.

Which description sums up the basic pathophysiology of heart failure that the nurse would include when educating a client?

Low cardiac output due to reduced pumping ability

In diastolic heart failure, how is ejection fraction?*

NORMAL! (65%)

Is a zone of infarction likely to recover?

NOT AT ALL!

Considering the PQRST complex of an electrocardiogram (ECG), which of the following letter designations represents atrial depolarization?

P wave

The nurse knows that adequate levels of which of the following electrolytes has been shown to have a beneficial effect on blood pressure?

Potassium Persons with high daily consumption of potassium tend to have lower blood pressure. Sodium intake is correlated with higher blood pressure. The association of chloride and calcium with blood pressure is not established.

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

A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?

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

A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?

Right sided heart failure

If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern?

Slowing of heart rate to below 60 beats/minute

Dilated cardiomyopathy is seen in:*

Systolic heart failure with left ventricular cavity dilation

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?

The plaques it builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge self in a vessel

Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?

Transcutaneous The type of pacing described is transcutaneous because it is only form that is accessible externally.

A 66-year-old obese man with diagnosis of a Shanna car disease has been diagnosed with heart failure but his care team has characterized as attributed to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis

Ventricular dilation and wall tension are significantly lower than normal

Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?

Ventricular fibrillation

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?

Will prevent the conversion of angiotensin I to angiotensin II Among the drugs used in the treatment of hypertension are ACE inhibitors. The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.

What causes rheumatic fever?*

complication of inadequately treated strep throat or scarlet fever

cardiac tamponade is what?*

compression of the heart from fluid in pericardial sac causing *decreased SV*

The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is:

decreased afterload.

Injury is:

occluded vessel

Assessment of an older adult client reveals bilateral pitting edema of the client's feet and ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation level of 93% (0.93); and vital signs normal. What is this client's most likely health problem?

right-sided heart failure

A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. The nurse knows that the client's blood pressure would be classified as ________ according to American Heart Association guidelines?

stage 1 hypertension

Ischemia is:

temporary blood loss

Ischemic threshold aka anginal threshold is what?

the *HR* at which the patient gets chest pain

Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:

ventilation-perfusion mismatch.

What is the complication with restrictive cardiomyopathy?*

walls of the ventricles become stiff, but NOT necessarily thickened *resist normal filling with blood between heartbeats* *heart muscle gradually infiltrated or replaced by scar tissue*

The good thing about working with patients with stable angina is that....

you can predict the level of exertion (which is precipitated by exertion, stress, emotions, and heavy meals); pain usually lasts about several minutes and relieved by rest

Which of the following statements regarding alcohol consumption and hypertension are correct? Select all that apply.

• A decrease in heavy alcohol consumption may help to lower blood pressure. • Chronic excessive alcohol consumption can induce hypertension. • Moderate alcohol consumption may decrease risk for cardiovascular disease. Chronic excessive consumption of any alcoholic beverage can induce hypertension. Reducing consumption can help to lower blood pressure. The recommended safe amount of alcohol for women is one drink per day and for men is two drinks per day. While moderate consumption may decrease risk for cardiovascular disease, most authorities do not recommend alcohol consumption

Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply.

• Abdominal • Thoracic

The nurse knows that which of the following drugs can cause secondary hypertension? Select all that apply.

• Amphetamines • Decongestants • Oral contraceptives • Cocaine Amphetamines release norepinephrine from adrenergic nerve terminals and cocaine inhibits its reuptake; both actions cause cardiac stimulation and vasoconstriction that raise blood pressure. Decongestants often are vasoconstricting alpha adrenergic agonists. Oral contraceptives raise blood pressure via a mechanism that is not fully understood. Erythromycin is not associated with hypertension.

A patient is diagnosed with orthostatic hypotension. The nurse knows that drugs which can predispose a patient to orthostasis include which of the following? Select all that apply.

• Antihypertensives • Psychotropics • Diuretics Antihypertensive and psychotropic drugs and diuretics frequently cause orthostasis. The other options are not generally associated with orthostasis.

The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply.

• Aorta • Capillaries The systemic circulation includes the aorta and capillaries. The pulmonary circulation includes the right heart and pulmonary artery.

A patient has systolic hypertension. The nurse knows that systolic pressure is influenced by which of the following factors? Select all that apply.

• Heart rate • Compliance of arteries • Stroke volume • Contractile force Systolic pressure is influenced by the volume of blood forced into the systemic circulation with each heart beat (stroke volume). Faster heart rate and greater contractile force will increase systolic pressure. good arterial compliance or flexibility will result in lower systolic pressure. Venous resistance does not influence systolic pressure.

Although the etiology of essential hypertension is mainly unknown, several risk factors have been identified. These risk factors fall under the categories of constitutional risk factors and lifestyle factors. What are the primary risk factors for essential hypertension? (Select all that apply.)

• Race and excessive sodium chloride intake • Type 2 diabetes and obesity • Family history and excessive alcohol consumption The constitutional risk factors include a family history of hypertension, race, and age-related increases in blood pressure. Another factor that is thought to contribute to hypertension is insulin resistance and the resultant hyperinsulinemia that occurs in metabolic abnormalities such as type 2 diabetes. Lifestyle factors can contribute to the development of hypertension by interacting with other risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided

The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?

Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation

What should the nurse teach the pregnant woman about congenital heart defects?

Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant.

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

Constrictive pericarditis

A client diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which conditions are often associated with diastolic failure? Select all that apply.

Constrictive pericarditis Myocardial hypertrophy Ischemic heart disease

A client has been admitted after being resuscitated from a cardiac arrest. The client is stated to be in Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client?

Continuous cardiac monitoring The American Heart Association has published practice standards for electrocardiogram monitoring in hospital settings. The rating system has three categories. Class I clients require cardiac monitoring consistently. Class II clients may need monitoring but it is not essential. Class III clients do not have monitoring indicated.

A nurse is assessing a client in shock for complications of acute renal failure. Which assessment is priority for the nurse to obtain?

Continuously measuring urine output

Decreased ejection fraction + dilated cavity =

Dilated cardiomyopathy

What is the pathology of restrictive cardiomyopathy?*

Diastolic dysfunction which impairs filling of ventricles during diastole (like hypertrophic cardiomyopathy)

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

Mitral Tricuspid

In an infarct, the Q wave represents what?

Full thickness MI

A nurse is caring for a patient with an average heart rate of 56 beats/min. The patient has no adverse symptoms associated with this heart rate and is receiving no treatment. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate?

"Avoid bearing down while having a bowel movement." Bearing down during a bowel movement stimulates the vagus nerve and results in a slowing of the heart rate. Vagal stimulation as well as some medications decreases the firing rate of the sinoatrial node and conduction through the atrioventricular node to cause a decrease in heart rate.

Knowing the high incidence and prevalence of heart failure among older adults, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which teaching point is most accurate?

"Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure."

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." ntermittent claudication is the primary symptom of chronic obstructive arterial disease. The two goals of treatment are to decrease their considerable cardiovascular risk and to reduce symptoms. Walking (slowly) to the point of claudication is encouraged because it increases collateral circulation. Addressing blood pressure and high lipid levels are measures to reduce cardiovascular risk. People with diabetes mellitus (DM) develop more extensive and rapidly progressive vascular disease than do people who do not have DM.

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which statement demonstrates an accurate understanding of his new diagnosis?

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

A client who has been diagnosed with mitral valve prolapse asks the nurse if there are any dietary modifications that should be incorporated into her lifestyle. The best response would be:

"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."

A nurse is observing a patient's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating which of the following??

"The patient is experiencing premature atrial contractions (PACs)." PACs are contractions that originate in the atrial conduction pathways or atrial muscle cells and occur before the next expected SA node impulse. This impulse to contract usually is transmitted to the ventricle and back to the SA node. The location of the ectopic focus determines the configuration of the P wave. In general, the closer the ectopic focus is to the SA node, the more the ectopic complex resembles a normal sinus complex. Retrograde transmission to the SA node often interrupts the timing of the next sinus beat, such that a pause occurs between the two normally conducted beats.

A client asks the purpose of an exercise stress test. What is the nurse's best response?

"The test is used to measure functional status during stress."

The cardiologist just informed a patient that they have a reentry circuit in the electrical conduction system in their heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to them. Which of the following statements 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."

There are 3 different types of cardiomyopathies: what are they?*

1. Dilated cardiomyopathy 2. Hypertrophic cardiomyopathy 3. Restrictive cardiomyopathy

What are the 4 causes of L ventricular CHF?**

1. Intrinsic heart disease 2. Increased workload on heart 3. Cardiac arrhythmias 4. Iatrogenic damage (medical rx errors)

What are the causes of Right ventricular failure/CHF?*

1. L ventricular failure 2. Mitral valve disease 3. Pulmonary hypertension 4. Pulmonary disease (Cor pulmonale)

What are the classic signs and symptoms of acute heart failure (both systolic and diastolic)?*

-Pulmonary edema -Pitting edema -Increased jugular vein distension - Congestion/swollen

What is the treatment for systolic heart failure?* (3)

1. *ACE inhibitors!* - drug of choice 2. Diuretics 3. Digoxin (dec. HR, but increase EF)

What are the 3 criteria in diagnosing an MI? which gives you the most info?

1. Subjective story 2. ECG 3. Cardiac enzymes *subjective story*

Excessive afterload in L ventricular failure leads to what consequences?**

1. Systolic ventricular dysfunction 2. *Decreased* stroke volume/ejection fraction 3. *Increased* L ventricular EDV (pre-load) 4. *Increased* L atrial volume 5. *Increased* L atrial/pulmonary vein pressures 6. Pulmonary edema

By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood pressure of ____ mm Hg or higher.

140; 90 Hypertension is a consistent systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.

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.

What is the drug of choice for systolic heart failure?* a. digoxin b. beta-blockers c. ACE inhibitors d. calcium channel blockers

ACE inhibitors

What is the treatment for diastolic heart failures?*

ACE inhibitors Diuretics Decreased salt intake (<2 gms/day) *NOTE: Digoxin makes diastolic heart failures worse*

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

A patient taking an antihypertensive drug for several months comes to the physician's office with a dry, persistent cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?

Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors inhibit bradykinin degradation in the lungs, which can cause a common side effect of a dry, nonproductive cough.

11. Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be in the early stages of cardiogenic shock? Select all that apply. A) Decreasing mean arterial pressure (MAP) B) Low BP reading of 86/60 C) Urine output of 15 mL last hour D) Low pulmonary capillary wedge pressure (PCWP) E) Periods of confusion

Ans: A, B, C, E

A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? A) His resting blood pressure is normally in the range of 150/90, and an echocardiogram indicates his ejection fraction is 30%. B) His end-diastolic volume is higher than normal, and his resting heart rate is regular and 82 beats/minute. C) He is presently volume overloaded following several days of intravenous fluid replacement. D) Ventricular dilation and wall tension are significantly lower than normal.

Ans: D

Regarding the various forms of heart failure, the nurse knows that which statements are correct? Select all that apply.

Aortic stenosis can cause left-sided failure. Cardiomyopathy is a common cause of heart failure. Compensated heart failure may be clinically asymptomatic.

A female older adult client has presented with a new onset of shortness of breath, and her physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of blood work? A) BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology. B) BNP is an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure. C) BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. D) BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology.

It's 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with rapid heart rate and a feeling of impending doom. Based on the pathophysiologic principles, the nurse knows the rapid heart rate could

Be a result of catecholamines released from SNS that could increase the myocardial oxygen demand

What meds did we learn in pharm can be used to treat cardiomyopathies?*

Beta blockers!; *increase relaxation of heart ; control sympathetics*

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 The bicuspid valve, (also called the mitral) controls the flow of blood between the left atria and left ventricle. The aortic valve controls flow between the left ventricle and aorta. The tricuspid controls the flow between the right atria and ventricle. The pulmonic valve controls flow between the right ventricle and pulmonary artery

Which class of heart failure is when you are unable to carry out any physical activity; sx's of cardiac insufficiency even at rest?*

Class 4- severe :(

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 to decrease blood pressure?

Decrease vascular volume Diuretics, such as the thiazides, loop diuretics, and the aldosterone antagonist (potassium-sparing) diuretics, lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing salt and water excretion) and cardiac output.

The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the midcalf area. He has many of the manifestations of:

Deep vein thrombosis Venous insufficiency with deep vein thrombus formation is characterized by discoloration, edema, pain, tenderness, and warmth most commonly in the mid- or lower calf area of the legs. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present.

A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?

Defibrillate the patient Immediate defibrillation using a nonsynchronized, direct-current electrical shock is mandatory for ventricular fibrillation and for ventricular flutter that has caused loss of consciousness.

A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler? A) Breathlessness with activity B) Excessive crying C) Enlargement of the liver D) Increased urine output

Enlargement of the liver

A three-year-old child with right sided heart failure has been admitted for worsening in his condition. Which of the following assessment would be considered one of the earlier side of systemic venous congestion in his toddler?

Enlargement of the liver

The client with pancreatitis is noted to have a high triglyceride count. Which of the following medications could the practitioner initiate to decrease this level?

Gemfibrozil The fibrates (e.g. fenofibrate and gemfibrozil) decrease the synthesis of VLDL by the liver, but also enhance the clearance of triglycerides. Cholestyramine, a bile acid-binding resin, is used as an adjunct to statin therapy to reduce LDL and increase HDL. Simvastatin, an inhibitor of HMG CoA reductase, can reduce or block the hepatic synthesis of cholesterol. These drugs are cornerstones of LDL-reducing therapy.

Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability?

Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.

What is the primary issue in diastolic heart failure?*

Increase in LVEDP sec. to stiff ventricles *major major issue*

A nurse is caring for a client following surgery. The central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take?

Increase the IV fluid infusion per protocol.

A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?

Increased heart rate and increased contractility

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? A) Resolution of compensatory pulmonary edema and heart arrhythmias B) Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility C) Infusion of normal saline or Ringer lactate to maintain the vascular space D) Administration of oxygen and epinephrine to promote perfusion

Infusion of normal saline or Ringer lactate to maintain the vascular space

A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man?

Infusion of normal saline or Ringer's lactate to maintain the vascular space.

A nurse is monitoring a patient with sick sinus syndrome who is experiencing lightheadedness, dizziness, and syncope. Which of the following treatments will the nurse anticipate for this patient?

Insertion of a pacemaker The most common manifestations of sick sinus syndrome are lightheadedness, dizziness, and syncope. These symptoms are related to the bradyarrhythmias. Treatment depends on the rhythm problem and frequently involves implantation of a permanent pacemaker.

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 nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking?

Measure his blood pressure and show him how much higher it is when he is smoking. Although a relationship between smoking and hypertension has not been established, vasoconstriction from nicotine in cigarette smoke will raise blood pressure. Elevated blood pressure and cigarette smoking are independent risk factors for heart disease

A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which assessment is the nurse most justified in eliminating during a busy morning on the unit?

Measuring the pulse of a client taking an ACE inhibitor. ACE inhibitors act on the renin--angiotensin--aldosterone system and are thus not significant influences on heart rate. They can, however, induce hyperkalemia, and it would be prudent for the nurse to check potassium levels. Beta-adrenergic blockers affect a client's heart rate and diuretics can affect electrolyte levels

A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?

Monitor the patient and document the findings. First-degree atrioventricular block is characterized by a prolonged PR interval (>0.20 second). This condition usually produces a regular atrial and ventricular rhythm. Isolated first-degree heart block usually is not symptomatic, and temporary or permanent cardiac pacing is not indicated. The patient should be monitored.

A client has developed left-sided heart failure. Which symptom might have precipitated this condition?

Myocardial infarction

What is the pathology of dilated cardiomyopathy?*

Myocardial mitochondrial dysfunction--Leads to less effective heart pump --> increased ventricular EDV and pressure, which dilates the LV (valve stays open) ---*not pumping blood out from L ventricle, so blood pools there and builds up pressure, which makes the cavity larger*

A patient's electrocardiogram rhythm shows normal sinus rhythm followed by a complex of six premature ventricular contractions with a return to normal sinus rhythm. Which of the following is the nurse's interpretation of this finding?

Nonsustained ventricular tachycardia Ventricular tachycardia can be sustained, lasting more than 30 seconds and requiring intervention, or it can be nonsustained and stop spontaneously.

A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?

Renal artery stenosis ACEI are contraindicated in renal artery stenosis, a condition that relies on the renin-angiotensis system to maintain adequate renal perfusion. ACEI are used clinically in the management of heart failure. Coronary artery disease and diabetes do not contraindicate ACEI.

A teenager is seen in the emergency room with reports of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen 3 weeks before in the clinic and treated with antibiotics for strep throat. He was better for a few days but now he seems to have gotten worse in the last 2 days. What should the nurse suspect is wrong with this client?

Rheumatic fever

Which client will the nurse assess first?

The client with premature ventricular contractions

The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:

The condition is getting progressively worse.

Based on the 3 criteria of diagnosing an MI, which is the best one to use?

The subjective story!!! Patient is the best resource

True/False. As much as 50% blockage in a coronary artery does not produce symptoms at all!

True severe ischemia can produce significant sx's in some and none in others!

True/False. Pericarditis is usually benign and can be treated with meds, BUT make sure you discern from CAD!*

True!

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?

Tunica media

Which of the following vessel layers is made primarily of muscle?

Tunica media The outermost layer of a vessel is called the tunica externa or tunica adventitia. The middle layer is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The innermost layer is the tunica intima.

A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which assessment finding is inconsistent with his diagnosis?

Ventricular dilation and wall tension are significantly lower than normal.

Which of the following EKG patterns with the nurse observed in a patient admitted for arithmetic right ventricular cardiomyopathy/Dysplasia(ARVC/D)?Select all that apply

Ventricular tachycardia with left bundle branch block pattern, T-wave inversion in the right precordial leads

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

fills rapidly; compresses

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:

improving quality of life by relieving symptoms.

What is a primary cause of cardiomyopathy in patients?*

pathological processes in the heart muscle itself, which impairs the heart's ability to contract

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 The prevalence of hypertension in children and adolescents in increasing due to increases in obesity, and lifestyle factors such as lack of exercise and consumption of high-calorie, high-salt foods. Gender is not a factor nor is academic performance.

The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states which of the following?

"Capillaries permit the exchange of material between the blood and interstitial fluid." Capillaries have thin walls that permit the exchange of materials between blood and interstitial fluid. Arteries have a three-layer wall with a thick tunica media. Arterioles transport blood away from the heart and help control blood pressure. Veins have internal valves.

Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate? A) "Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure." B) "Heart failure will often first show up with persistent coughing and lung crackles." C) "Residents in early heart failure will often be flushed and have warm skin and a fever." D) "Complaints of chest pain are actually more often related to heart failure than to myocardial infarction."

"Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure."

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 of the following statements by the nurses would the educator most want to correct? A) "The electrical impulses go in chaotic directions, so the atria can't contract properly." B) "An ECG of someone in atrial fibrillation would be almost random in appearance." C) "The contraction of the ventricles and the atria can range from 400 to 600 beats per minute." D) "It can be hard to measure at the bedside because not all ventricular beats make a palpable pulse."

"The contraction of the ventricles and the atria can range from 400 to 600 beats per minute."

As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function?

"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."

A client in the nursing home wonders why he is having these signs and symptoms of left-sided heart failure. Which explanation will the nurse give the client?

"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."

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 on his diagnosis and treatment and answering the numerous questions he has about his health problem. Which of the following teaching points should the nurse include in this patient teaching? A) "This is almost certainly a condition that you were actually born with, but that is just now becoming a serious problem." B) "Because the normal electrical communication in lacking, the bottom parts of your heart are beating especially fast to compensate for inefficiency." C) "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." D) "If left untreated, this would have put you at great risk of stroke or heart attack."

"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."

A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client:

"This means your heart is not pumping as much blood out of the heart with each beat." Ejection fraction is the percentage of diastolic volume ejected from the heart [left ventricle] during systole. Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level.

What should the nurse teach the client prior to ergometry?

"This test evaluates cardiac function."

A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:

"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked."

A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:

"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. For example, persons with extensive obstruction of a coronary blood vessel may rely on collateral circulation to meet the oxygen needs of the myocardial tissue normally supplied by that vessel. There is no indication that the client is on a blood thinner.

A patient with persistent primary hypertension remains apathetic about his high blood pressure, stating, "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How would the nurse best respond to this patient's statement?

"You may not sense any problems, but it really increases your risk of heart disease and stroke." Hypertension is a highly significant risk factor for heart disease and stroke. It would be inappropriate to promote monitoring without promoting lifestyle modifications or other interventions to lower the patient's blood pressure, or teaching the patient about the deleterious effects of hypertension. It is likely unproductive to simply characterize the patient's hypertension as demonstrating that he does not "take care" of himself. Hypertension is not a risk factor for the development of diabetes mellitus.

A client with persistent, primary hypertension remains apathetic about his high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement?

"You may not sense any problems, but it really increases your risk of heart disease and stroke." Hypertension is a highly significant risk factor for heart disease and stroke. It would be inappropriate to promote monitoring without promoting lifestyle modifications or other interventions to lower the client's blood pressure, or teaching the client about the deleterious effects of hypertension. It is likely unproductive to simply characterize the client's hypertension as demonstrating that he does not "take care" of himself. Hypertension is not a risk factor for the development of diabetes mellitus.

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences? A) "You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." B) "Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young patients." C) "Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate." D) "Fever is a sign of heart failure in children that you are unlikely to see in older adults."

"You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."

What happens with patients with rheumatic fever in acute stage and chronic stage?*

*acute:* pancarditis = inflammation of myocardium, endocardium, and epicardium *chronic:* valvular fibrosis --> stenosis or insufficiency *can't see them until they get their valves replaced*

What are the 4 lab values used for MIs?

1. Creatine kinase (CPK), MB band 2. Troponin I (TNI) - a little better test than CPK 3. Myoglobin (not used so much anymore...) 4. Lactate dehydrogenase (LDH) - used more now

The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below which of the following?

140/90 The main objective of hypertension management is to achieve a pressure of 140/90, although persons with renal disease or diabetes are advised to aim for 130/80 or lower. Persons with blood pressure between 140/90 and 120/80 are considered to be prehypertensive and should be monitored at regular intervals to detect any rise in pressure.

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 normal left ventricular ejection fraction is usually 55 percent to 75 percent when determined by angiocardiography.

The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:

64 mm Hg The difference between the systolic and diastolic pressure is called the pulse pressure (approximately 40 mm Hg). The pulse pressure is calculated by deducting the diastolic pressure (82) from the systolic pressure (146). The difference is the pulse pressure.

The nurse knows that which of the following persons is at greatest risk for malignant hypertension?

A 25-year-old African-American man Malignant hypertension is a sudden extreme elevation in both systolic and diastolic pressure, producing life-threatening complications. Persons most at risk include young African-American men, women with toxemia of pregnancy, and persons with renal or collagen disease.

A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention? A) A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia B) A 69-year-old woman who has entered ventricular fibrillation C) A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation D) 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

In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up During a change in body position, blood is rapidly relocated from the central circulation (when the client is recumbent) to the lower extremities (when the client stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.

A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the patient 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?

A membranous sac that encloses the heart

The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which of the following initial signs of this condition?

A pulsating mass in the abdomen Most abdominal aortic aneurysms are asymptomatic. Because an aneurysm is of arterial origin, a pulsating mass in the abdomen may provide the first evidence of the disorder. The other options are signs and symptoms of aortic dissection.

The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in:

A reading that is too high The width of the bladder should be at least 40% of arm circumference and the length at least 80% of arm circumference. Undercuffing (using a cuff with a bladder that is too small) can cause an overestimation of blood pressure. This is because a cuff that is too small results in an uneven distribution of pressure across the arm, such that a greater cuff pressure is needed to occlude blood flow. Likewise, overcuffing (using a cuff with a bladder that is too large) can cause an underestimation of blood pressure.

Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node? A) A slow depolarization occurs because of the particular permeability of the cellular membranes. B) The cells are capable of responding to a greater-than-normal stimulus before the resting membrane potential is reached. C) The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity. D) The sodium-potassium pump transports sodium into the cell to help maintain the resting membrane potential.

A slow depolarization occurs because of the particular permeability of the cellular membranes.

A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm what does the nurse report the client has?

A symptomatic bradyarrhythmia This client is suffering from a symptomatic bradyarrhythmia as evidenced by a heart rate of 46 with normal P waves before every QRS, normal PR interval and symptoms of dizziness and syncope. Bradyarrhythmias can decrease oxygen delivery to the brain, along with other vital organs, causing symptoms such as dizziness, lightheadedness, fatigue and syncope

Major problem with hypertrophic cardiomyopathy is what?*

PRESSURE OVERLOAD--decreased compliance in ventricles / thicker

Hypoxia is said to have a negative inotropic effect on the heart, which means:

There will be interference in the generation of ATP, which is needed for muscle contraction

When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?

Conversion from aerobic to anaerobic metabolism

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% This ejection fraction is below normal (normal is about 55 to 75 percent) and indicates a poor prognosis. This low ejection fraction is a result of the complications of long-standing hypertension

A client presents with sinus bradycardia. What is the nurse's best action?

Assess the client's history The nurse needs to assess the client's history before determining if action is necessary. Sinus bradycardia is most often benign unless it is associated with a myocardial infarction, post resuscitation, or associated with hemodynamic decompensation. It is normal in an athlete, or someone who is well conditioned. After assessing the client's history the nurse can determine if other action is necessary

A nurse is caring for four patients. Which of the following patients is most at risk for atrial fibrillation (AF)?

An elderly male who is 2 days postcoronary artery bypass surgery AF can be seen in people without any apparent disease, or it may occur in people with coronary artery disease, mitral valve disease, ischemic heart disease, hypertension, myocardial infarction, pericarditis, congestive heart failure, digitalis toxicity, and hyperthyroidism. AF is the most common chronic arrhythmia, with an incidence and prevalence that increase with age. The incidence of AF increases with age. For example, it occurs in less than 0.5% of the population aged less than 50 years and increases by 2% at ages 60-69 years old. The prevalence is also greater in men than in women.

Which of the following patients should most likely be assessed for orthostatic hypotension?

An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom. Dizziness and syncope are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.

A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock?

Anaphylactic

What is the classical symptom of a stable angina?

Angina pectoris (ischemic chest pain)

A client presents with sinus tachycardia. What is an appropriate nursing action? Select all that apply.

Assess the client's temperature Assess the client's pain level Assess the client's vital signs

Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous membranes?

Cyanosis

Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?

Atherosclerosis and unstable angina

A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could A) decrease renal perfusion and result in the development of ascites. B) be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. C) desensitize the -adrenergic receptors leading to increase in norepinephrine levels. D) prolong the electrical firing from the SA node resulting in the development of a heart block.

Ans: B

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? A) Chest pain and intermittent ventricular tachycardia B) Dyspnea and crackles in bilateral lung bases C) Petechia and spontaneous bleeding D) Muscle cramping and cyanosis in the feet

Ans: B

Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is:

Atrial fibrillation

The purpose of a cardioversion device is the treatment of which of the following cardiac disorders?

Atrial fibrillation Explanation: Synchronized cardioversion and defibrillation are two reliable methods for treating ventricular tachycardia, and cardioversion is the definitive treatment for atrial fibrillation. The discharge of electrical energy that is synchronized with the R wave of the electrocardiogram is referred to as synchronized cardioversion, and unsynchronized discharge is known as defibrillation

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client A) has a distended bladder, facial edema, and nighttime difficulty breathing. B) complains of dyspnea and has adventitious breath sounds on auscultation (listening). C) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. D) has cyanotic lips and extremities, low urine output, and low blood pressure.

Ans: C

Which of the following changes associated with aging contributes to heart failure development in older adults? Select all that apply. A) Increased incidence of mitral stenosis B) Sludge buildup in the kidneys C) Elevated diastolic BP D) Increased vascular stiffness E) Inflammation in the joints due to arthritis

Ans: C, D

The nurse knows that acute regulation of blood pressure involves which physiologic processes? Select all that apply.

Arterial chemoreceptors Vagal nerve impulses Adrenergic (sympathetic) stimulation Carotid baroreceptors

The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?

Arterioles Arterioles can constrict or dilate selectively and control the resistance to blood flow into capillaries.

A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?

Venous return to the heart

A 30-year-old woman presents at a hospital after fainting at a memorial service, and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display? A) Faster than normal heart rate B) Pain C) Dry and warm skin D) Increased thirst

Dry and warm skin

An older adult woman presents arrives in the emergency department after fainting at the funeral of a loved one. She is diagnosed with shock as a result of impaired sympathetic outflow based on which clinical manifestations? Select all that apply.

Dry, warm skin Bradycardia

Select the correct sequence of blood return to the heart.

Capillaries, venules, veins, right atrium The correct pathway for blood returning back to the heart is the capillaries, venules, veins, and right atrium. The other options do not support normal blood flow.

A nurse educator explains a type of cardiac condition as "a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation and often lead to cardiovascular death or progressive heart failure." Which condition fits this definition?

Cardiomyopathy

Which type of cardiac patients need cardiac transplants?*

Cardiomyopathy patients!

Which statements regarding heart failure in older adults are true? Select all that apply.

Causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction. Sensitivity of beta-adrenergic receptors decreases, resulting in decreased ventricular contractility. It is more difficult to diagnose because of underlying chronic diseases.

Infarct is simply defined as:

Cell death

A 56-year-old male patient has been diagnosed with hypercholesterolemia. Which of the following are the lab results that support this diagnosis?

Cholesterol 250 mg/dL and HDL 32 mg/dL A diagnosis of hypercholesterolemia would be made based on a cholesterol level greater than 200 mg/dL and an HDL of greater than 30 mg/dL.

****HEART FAILURE CLASSIFICATIONS****

Class 1 - mild* = no limitation of physical activity Class 2- mild* = slight limitation of physical activity. Comfortable at rest, but ordinary physical activity leads to fatigue, palpitation, dyspnea Class 3- moderate* = marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity causes fatigue/palpitation/dyspnea Class 4- severe* = unable to carry out any physical activity without discomfort :( sx's of cardiac insufficiency at rest

CLASSIFICATION OF FATIGUE, DYSPNEA OR ANGINA

Class 1= patient with asymptomatic heart disease Class 2= symptoms occur on exertion but patient able to manage ADLs Class 3= symptoms develop when doing simple housework Class 4= symptoms occur at rest

Which class or classification of fatigue, dyspnea or angina is when symptoms occur on exertion but the patient is able to manage usual tasks of life?

Class 2

Which class of heart failure is when you have slight limitation of physical activity; comfortable at rest, but ordinary physical activity causes fatigue/palpitation/dyspnea?

Class 2- mild

Which class or classification of fatigue, dyspnea or angina is when symptoms develop when doing simple housework?

Class 3

Which class of heart failure is when you have marked limitation of physical activity; less than ordinary physical activity causes fatigue/palpitation/dyspnea; don't really do well with exercise?*

Class 3- moderate

Which class of classification of fatigue, dyspnea or angina is when symptoms occur at rest?

Class 4

The heart controls the direction of blood flow. What is the role of the aortic valve?

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

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

Brugada syndrome, an autosomal dominant disorder, manifests in adulthood as ST-segment elevation, right bundle branch block, and susceptibility to ventricular tachycardia. In Brugada syndrome, the timing of cardiac events is significant. When do these cardiac events typically occur?

During sleep or rest

An elderly patient is diagnosed with orthostatic hypotension. For which of the following clinical manifestations should the nurse assess?

Dizziness and fainting Orthostatic or postural hypotension is an abnormal drop in blood pressure on assumption of the standing position The presence of orthostatic symptoms (e.g., dizziness, syncope) is more relevant to the diagnosis that the actual blood pressure readings.

The shape of the QRS complexes on the ECG is determined by the direction of the electrical impulse in relation to the placement of the electrode on the chest wall. QRS complexes greater than 0.12 second could indicate which of the following?

Delayed conduction in the bundle branches A bundle branch block (BBB) is an interruption in the electrical impulse's ability to travel through the bundle of His at the normal rate, which would result in QRS complexes of 0.08 to 0.12 second. The physiologic consequence of a bundle branch block is that one ventricle contracts before the other because the impulse must travel through the cardiac muscle rather than the bundle of His.

If a patient comes into your clinic with stable angina, how would he likely describe his symptoms?

Described as pressure, heaviness, tightness over middle of chest (substernal); sometimes over the heart, shoulders, arm, throat jaw or teeth; *never sharp or shooting pain* -- need to differentiate between chest wall pain due to musculoskeletal issues and true anginal pain*

When explaining to a patient why they only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to:

Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually.

What is the pathology of hypertrophic cardiomyopathy?*

Diastolic dysfunction which impairs filling of ventricles during diastole; Increased LV EDV; eventually, *increases* left atrial, pulmonary artery, and pulmonary capillary pressures --> all lead to hypercontractility of LV

Hypertrophic cardiomyopathies are seen in:*

Diastolic heart failure

Which type of cardiomyopathy is the most common?*

Dilated cardiomyopathy

Which type of cardiomyopathy is when heart muscle fibers are stretched and chambers enlarged? What causes it?*

Dilated cardiomyopathy End result of myocardial damage produced by toxins, metabolic or infectious agents (alcohol and smoking)

The nurse knows that which group of antihypertensive drugs is usually the least expensive and is well tolerated?

Diuretics Diuretics are usually the least expensive, and are usually well tolerated by most patients.

A 30-year-old woman present to a hospital after fainting out of memorial service, and she Is diagnosed as being a neurogenic shock. Which of the following signs and symptoms is she most likely to display?

Dry and warm skin

What are the manifestations of L ventricular failure?**

Dyspnea Dry cough Orthopnea (pt. can't sleep flat) Paraoxysmal nocturnal dyspnea (PND) Fatigue, weakness Pulmonary crackles ("cardiac asthma") S3 ventricular gallop L ventricular dysfunction (LVD)

What are anginal equivalents?

Dyspnea (SOB) Light-headedness Belching brought on by exercise/stress Fullness in the throat/jaw Desire to cough

The nurse working in the ICU knows a chronic elevation of left ventricular end diastolic pressure will result in a patient displaying which of the following clinical manifestations?

Dyspnea and crackles in bilateral lung bases

During a class on cardiac disorders, a nurse educator is explaining the numerous diagnostic methods used in the care of cardiac patients. Which of the following could best diagnose sick sinus syndrome? A) Chemical stress test B) Exercise stress test C) ECG D) Cardiac ultrasound

ECG

As part of the diagnostic work out for a mail client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of test is most likely to provide the needed data for diagnosis and care?

Echocardiogram, PET Scan, ECG

A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The healthcare team wants to rule out endocarditis as a diagnosis. Stafford apartment one W. realistically anticipate which of the following sets of diagnostics?

Echocardiogram, blood cultures and temperature

14. All of the following interventions are ordered stat. for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first? A) Epinephrine (Adrenalin) B) Normal saline infusion C) Dexamethasone (Decadron) D) Diphenhydramine (Benadryl)

Epinephrine (Adrenalin)

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 The circulatory system consists of the heart which pumps blood, the arterial system which distributes oxygenated blood to the tissues, the venous system which collects deoxygenated blood from the tissues and returns it to the heart, and the capillaries where exchange of gases, nutrients and waste takes place.

Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in which of the following?

Fingers Raynaud disease is a disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes.

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

Fixed coronary obstruction

A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which reason? Select all that apply.

For its vasodilation effect To relieve coronary pain

What are some causes of hypertrophic cardiomyopathy?*

Genetically transmitted as an autosomal-dominant trait Genetic abnormal configuration of interventricular septum Abnormal sympathetic stimulation Subendocardial ischemia Abnormal calcium ion dynamics *basically genetic genetic genetic*

The nurse is teaching a class on reduction of cardiovascular disease. Which of the following 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 The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes. Therapeutic lifestyle changes include an increased emphasis on physical activities such as walking and exercise. Dietary measures to reduce LDL levels include decreasing the use of saturated fats and transfats. Testing for al hypercholesterolemia is not a modifiable risk factor.

813 old boy has had a sore throat for at least a week and has been vomiting for two days. His glands are swollen, and he moves differently because his joints hurt. His parents who believe in natural remedies, I have been treating him with various herbal preparations without success and are now seeking anabiotic treatment. Throat culture show infection with a group a streptococcus. Child is at high-risk for

Mitral valve stenosis

Pregnancy-induced hypertension is a serious condition affecting between 5% and 10% of pregnant women. The most serious classification of hypertension in pregnancy is preeclampsia-eclampsia. It is a pregnancy-specific syndrome that can have both maternal and fetal manifestations. What is a life-threatening manifestation of the preeclampsia-eclampsia classification of pregnancy-induced hypertension?

HELLP syndrome Liver damage, when it occurs, may range from mild hepatocellular necrosis with elevation of liver enzymes to the more ominous hemolysis, elevated liver function tests, and low platelet count (HELLP) syndrome that is associated with significant maternal mortality.

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized by being primarily right sided. Which of the following statements best describes a presentation that the nurse would anticipate? The client

Has pitting edema to ankles and feet bilaterally, decreased activity tolerance, and occasional right upper quadrant pain. (Right sided failures associated with peripheral Adema fatigue and on occasion upper right quadrant)

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 Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension

In restrictive cardiomyopathy, what is the major problem?*

Heart cannot relax and re-fill with blood, which leads to *increased* atrial pressure, which leads to *enlargement* of both atria!- R ventricle more affected than L ventricle

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 patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds:

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.

What is the most important factor in myocardial oxygen demand?

Heart rate

What does the drug DIGOXIN do?*

Helps with systolic heart failure; *Decreases* HR BUT.....*Increases* ejection fraction (get more blood out, which we want)

A health care provider suspects a client has heart failure. Which diagnostic procedure would give the staff information about pulmonary capillary pressures, which will lead to the most appropriate interventions?

Hemodynamic monitoring

A 31-year-old African-American female who is in her 30th week of pregnancy has been diagnosed with para part of cardio myopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy?

Her diagnoses might be attributable to a disorder immune response, nutritional factors, or infectious process

A patient comes to the clinic complaining of anorexia, weight loss, fever, fatigue along with paresthesias, pain, and weakness of the lower extremities. Assessment findings include reddish blue, mottled areas of discoloration to the skin of the lower extremities. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and abnormal liver function tests. A diagnosis of necrotizing vasculitis is confirmed through biopsy. The nurse anticipates treatment with which of the following medications?

High-dose corticosteroid therapy and cytotoxic immunosuppressant agents Clinical signs and symptoms may vary due to the widely varied vascular involvement. It usually begins complaints of anorexia, weight loss, fever, and fatigue often accompanied by signs of organ involvement. Myalgia, arthralgia, and arthritis are common, as are peripheral neuropathies such as paresthesias, pain, and weakness. Skin lesions may also occur and are highly variable. They include reddish blue, mottled areas of discoloration of the skin of the extremities called livedo reticularis, purpura (i.e., black- and-blue discoloration from bleeding into the skin), urticaria (i.e., hives), and ulcers. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and signs of organ involvement such as hematuria and abnormal liver function test results. Diagnosis is confirmed through biopsy specimens demonstrating necrotizing vasculitis of the small and large arteries. Treatment involves use of high-dose corticosteroid therapy and often-cytotoxic immunosuppressant agents (e.g., azathioprine, cyclophosphamide).

A 63-year-old male client has been diagnosed with a bundle branch block. How will this client's care team most likely expect his condition to be expressed diagnostically? A) His AV node will be performing the primary pacemaker role due to inadequacy of the SA node. B) His ECG will show a flattened P wave as a result of impaired atrial depolarization. C) Conduction from the Purkinje fibres to the bundle branches is compromised by inadequate conduction. D) His ECG will show an inordinately wide QRS complex because impulses are bypassing normal conduction tissue.

His ECG will show an inordinately wide QRS complex because impulses are bypassing normal conduction tissue.

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

History of cigarette smoking and elevated blood pressure

Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?

Inherent spontaneous action-potential The heart has four inherent properties essential in the development and conduction of cardiac rhythms. The property of automaticity is the ability of certain cells in the myocardium to automatically or spontaneously initiate an electrical impulse called an action potential. In a normally functioning heart the rate is controlled by the sinoatrial (SA) node.

A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting ECG reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?

Holter monitoring Because sick sinus syndrome frequently involves intermittent or alternating types of arrhythmias, Holter monitoring, which can record changes in rhythm that occur over a period of up to 48 hours, is likely to provide the best picture of the spectrum of cardiac changes in any particular client. Signal-averaged ECG is most useful for identifying specific arrhythmias that may not be clear on a traditional surface ECG. Exercise stress testing measures changes in rhythm specifically in response to exercise. Electrophysiologic studies are used diagnostically to determine a person's potential for arrhythmia formation.

What is an example of a secondary cause of cardiomyopathy?*

Hormones; ex: "broken heart" syndrome

A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure?

Hypertrophic cardiomyopathy

A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this?

Hypertrophic cardiomyopathy

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?

Hypertrophic cardiomyopathy (HCM)

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?

Hypertrophy

A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points to the physician include in his explanation of the man's new diagnosis?

I'm going to start you on a low-dose aspirin and it will help greatly if you can lose weight and keep exercising

A nurse is monitoring a client with a resting heart rate of 120 beats/minute. The client has been diagnosed with sinus tachycardia, which is the result of a change in which characteristic of cardiac cells?

Increased automaticity Sinus tachycardia is caused by an increase in the automaticity of the SA node. Changes in excitability, conductivity, and refractoriness do not have effects that would lead to sinus tachycardia.

In a client with hypovolemic shock, which assessment findings alert the nurse that compensatory mechanisms are attempting to support cardiac output. Select all that apply.

Increased heart rate Vasoconstriction Activitation of the renin-angiotensin-aldosterone system (RAAS)

A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?

Increased sympathetic stimulation of the heart and blood vessels When the baroreceptors in the carotid arteries detected the fall in blood pressure as blood volume was depleted, reflex sympathetic activity increased the rate and force of contraction via beta-1 receptors in the heart, and increased vasoconstriction via alpha-1 receptors in blood vessels. Both of these effects serve to support blood pressure and blood flow to vital organs

An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure?

Increased vascular stiffness

Describe the creatine kinase (CPK), MB band lab value

Increases 4-8 hours post-MI and stays high for 2-3 days Normal CPK = 0-50 with no bands/fractions attached to it

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What are media treatments are likely to benefit this man

Infusion of normal Saline or ringer lactate to maintain the vascular space (Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock)

A healthy 23-year-old college basketball player is brought to the emergency room following a syncopal episode while playing. On arrival the client was alert and oriented with a heart rate of 50 and regular, blood pressure 100/60, and no complaints. The paramedic giving report to the emergency room nurse describes that on arrival the client was attached to the school's automatic implantable cardioverter defibrillator (AICD) and the initial rhythm demonstrated a heart rate of 250 with differently shaped QRS complexes that also changed size. The rhythm spontaneously converted to normal sinus rhythm before the paramedics arrived. What does the nurse anticipate was the initial rhythm?

Inherited torsade de pointes This client most likely has inherited torsade de points, which is a ventricular arrhythmia that is often caused by a prolonged QT interval. The hallmark of this rhythm is wide QRS complexes that appear to be twisting around a point as it changes negativity. There are two forms; in the genetic form persons with the acquired form involves defects in either the potassium or sodium ion channel defects. The acquired form has a variety of causes, such as electrolyte imbalance, subarachnoid hemorrhage, cocaine use, and many antiarrhythmic medications. There is no information in the question to suggest an acquired form.

A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor?

Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction.

The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology?

Inhibition of the renin-angiotensin-aldosterone system

A child is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are most accurate? Select all that apply.

Inotropic agents such as digoxin may be used in children. Congenital defects are a risk factor. Symptoms include tachypnea and tachycardia.

A nursing instructor is explaining arterial circulation to a group of nursing students. Which of the following is the most appropriate information for the nurse to provide?

It contains one sixth of the total blood volume.

Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?

It documents only current cardiac function. The resting ECG is the first approach to the clinical diagnosis of disorders of cardiac rhythm and conduction, but it is limited to events that occur during the period the ECG is being monitored. The other options are not accurate statements regarding an ECG.

Which of the following is true regarding pulmonary circulation?

It is a low-pressure system that allows for improved gas exchange. The pulmonary circulation consists of the right heart and the pulmonary artery, capillaries, and veins. It is the smaller of the systems and functions at a lower pressure to assist with gas exchange.

The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?

It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.

A patient is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which of the following actions is important for the nurse to tell the patient to ensure accuracy in correlating dysrhythmias with symptoms?

It is important to keep a diary of activities and symptoms.

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?

Laminar

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?

Laminar Laminar blood flow reduces friction by allowing the blood layers to slide smoothly over one another, with the axial layer having the most rapid rate of flow. Axially, crosswise, and turbulent blood flow would result in increased friction. In turbulent flow, the laminar stream is disrupted and the flow becomes mixed, moving radially (crosswise) and axially (lengthwise).

Following an ST segment myocardial infarction or STEMI, the nurse should be assessing a patient for which of the following complications? Select all that apply

Large amount of pink, frothy sputum and new onset of murmur, tacky piña with respiratory distress, frequent ventricular arrhythmias unrelieved with Amiodarone drip, complaints of facial numbness and tingling

A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have?

Mitral valve stenosis

The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain?

Morphine

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. Persons with acute coronary syndrome are at risk for developing extension of an infarcted area, ongoing myocardial ischemia, and life-threatening arrhythmias. Research has revealed that 80% to 90% of ECG-detected ischemic events are clinically silent. Thus, ECG monitoring is more sensitive than a client's report of symptoms for identifying transient ongoing myocardial ischemia. Other answers are incorrect

Following cardiac surgery, the nurse suspects the client may be developing a cardiac tamponade. Which clinical manifestations would support this diagnosis? Select all that apply

Muffled heart tones Narrowed pulse pressure Low BP—84/60 mm Hg

Following cardiac surgery the nurse suspects the patient may be developing a cardiac Tampa nod. Which of the following clinical manifestations would support this diagnosis? Select all that apply

Muffled heart tones, Nero pulse pressure, low blood pressure of 84/60

The nurse is caring for a 75-year-old client with end-stage emphysema who is having severe dyspnea. The nurse is evaluating the client's cardiac rhythms and notes a very irregular rhythm with P waves before most if not all the QRS complexes with a rate of 140. With closer inspection of the cardiac rhythm the nurse notes the P waves all look different. Which of the following most accurately describes this rhythm?

Multifocal atrial tachycardia Multifocal atrial tachycardia (MAT) is the most accurate rhythm choice for the description. The hallmark sign of MAT is at least 3 different P wave morphologies and a rate over 100 beats/minute. Incessant and focal atrial tachycardias have P waves from the same ectopic focus and paroxysmal atrial fibrillation would have fibrillatory (f) waves. MAT is often seen in older adults with chronic obstructive pulmonary disease (COPD).

A pediatric nurse is assessing a newborn diagnosed with persistent patency of the ductus arteriosus. Which of the following findings are associated with this hard affect? Select all that apply

Murmur heard of the second intercostal space, during both Systole and diastole, Blood pressure 84/30 classified as wide pulse pressure

A client arrives at the doctor's office complaining of severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate which of the following?

Myocardial infarction The ST-segment elevation with myocardial infarction could be caused by a decrease in blood supply to that area of cardiac muscle. However, the mechanism of ST-segment elevation is not clearly understood. The other options with this question are the opposite of other causes of ST-segment elevation

When the electrocardiogram (ECG) of a client in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta-adrenergic blocker. Which factors in the client's history will cause the nurse to withhold medication pending discussion with physician? Select all that apply.

Myocardial infarction caused by cocaine use Third-degree heart block Shock

When does Prinzmetal's angina occur?

Oftentimes, first thing in the morning. Possibly due to more viscous blood in the morning *OR* from arterial spasming.

On a routine physical exam visit, the physician mentioned that he hears a new murmur. The patient gets worried and ask what does this mean? The physician response,

One of your heart valves is not a opening properly. We need to do an echocardiogram to see which valve is having problems

A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:

Onset of STEMI

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

The nurse assesses the electrocardiogram for depolarization of the atria. What does the nurse expect to assess?

P wave above the baseline

A monitored hospitalized patient with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which of the following forms of AF is this?

Paroxysmal AF is characterized as rapid disorganized atrial activation and uncoordinated contraction by the atria. It is classified into three categories: paroxysmal, persistent, and permanent. Paroxysmal AF self-terminates and lasts no longer than 7 days, whereas persistent lasts greater than 7 days and usually requires intervention such as a cardioversion. AF is classified as permanent when attempts to terminate are failed and the the person remains in AF. The symptoms of chronic AF vary. Some people have minimal symptoms, and others have severe symptoms, particularly at the onset of the arrhythmia.

The extended, severe exposure of the walls of the blood vessels to the exaggerated pressures that occur in malignant hypertension cause injuries to the walls of the arterioles. Blood vessels in the renal system are particularly vulnerable to this type of damage. Because hypertension is a chronic disease and is associated with autoregulatory changes in the blood flow to major organs, what would be the initial treatment goal for malignant hypertension?

Partial reduction in blood pressure to less critical values Because chronic hypertension is associated with autoregulatory changes in coronary artery, cerebral artery, and kidney blood flow, care should be taken to avoid excessively rapid decreases in blood pressure, which can lead to hypoperfusion and ischemic injury. Therefore, the goal of initial treatment measures should be to obtain a partial reduction in blood pressure to a safer, less critical level, rather than to normotensive levels.

Which of the following individuals is at greatest risk for developing a venous thrombosis resulting from venous stasis?

Patient on bed rest Bed rest or immobility causes a pooling of blood in the legs resulting in venous stasis. The other individuals are at risk for hyperreactive blood coagulation that can also result in venous thrombosis.

The nurse is reviewing the lipid results of four clients. Select the client at greatest risk for cardiovascular disease.

Patient with LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL Diagnosis of hyperlipidemia depends on a person's complete lipid profile (total cholesterol, LDL, HDL, and triglyceride levels) after an overnight fast. One person may have a favorable lipid profile with a HDL of 110 mg/dL, a triglyceride level of 175 mg/dL, and an LDL of 130 mg/dL, whereas, another person with a HDL of 40 mg/dL, a triglyceride level of 150 mg/dL, and LDL cholesterol of 205 mg/dL would be at much greater risk for cardiovascular disease.

Pericarditis is autoimmune and is inflammation of the pericardium, which causes what?*

Pericardial effusion --> cardiac compression --> cardiac tamponade Sx's: sharp chest pain, worse with deep breath, fever, worst when supine

A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?

Pericarditis

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?

Peripheral edema, weight gain

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes?

Peripheral vascular resistance The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.

An intensive care nurse is assessing a client just admitted from the emergency room status-post myocardial infarction (MI) and notes that the client's cardiac rhythm is a sinus bradycardia with a rate in the low 50s. The nurse is concerned that the client may have which of the following?

Poor prognosis Sinus bradycardia following a myocardial infarction is a sign that the infarction may have damaged the SA or AV nodes and the heart is not beating fast enough to meet the body's needs. If the bradycardia is hemodynamically significant, a temporary or permanent pacemaker may need to be inserted. The other options are incorrect because the rhythm, sinus bradycardia, was given in the question.

Persons with hypertension secondary to hyperaldosteronism may be treated with which of the following drugs?

Potassium-sparing diuretics Persons with hyperaldosteronism will exhibit hypokalemia as aldosterone stimulates renal sodium for potassium exchange. Potassium sparing diuretics such as spironolactone will inhibit this action of aldosterone and will increase sodium excretion and mitigate the loss of potassium. ACEI will not alter the excessive level of aldosterone, which emanates directly from an overactive adrenal gland or an adenoma. Alpha or beta antagonists will not affect the excessive sodium and water retention induced by aldosterone.

A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure?

Prehypertension Normal blood pressure is considered to be systolic below 120 mm Hg or diastolic below 80 mm Hg. Prehypertension is systolic 120-139 mm Hg and diastolic 80-89 mm Hg. This condition should be checked at least once yearly. Stage 1 hypertension is 140-159 mm Hg systolic or 90-99 mm Hg diastolic and should be confirmed within two months. Stage 2 is systolic equal to or greater than 160 mm Hg or diastolic equal to or greater than 100 mm Hg. Antihypertensive medication should be considered for Stage 1 and 2; lifestyle changes should be recommended as appropriate for any blood pressure higher than normal.

A physician is explaining to the evening nurse the underlying cause of a patient's sudden death. While explaining the contractile failure, she states that the cause of death originated from currents "that reduce the magnitude of outward repolarizing potassium currents, enhance the magnitude of the inward depolarizing sodium and calcium currents, or both. Thus, there is delayed repolarization of the ventricles with development of early depolarizing afterpotentials that initiate the arrhythmia" resulting in sudden cardiac failure. What condition is she explaining? A) Cardiomyopathy B) Myocardial infarction C) Long QT syndrome D) Premature ventricular contractions

Premature ventricular contractions

Variant, atypical angina is known as?

Prinzmetal's angina

A client has many residual health problems related to compromise circulation following a recovery from septic shock. The nurse knows that which of the following complications listed below a result of being diagnosed with septic shock and therefore could be assessed frequently? Select all that apply

Profound dyspnea due to acute respiratory distress syndrome, atelectasis resulting in Injury to endothelial lining a pulmonary vessels, which allow fluid plasma to build up in the alveolar spaces, acute renal failure due to decreased impaired renal perfusion as a result of low blood pressure

A patient experiencing a sinus arrest would demonstrate which of the following symptoms or findings?

Prolonged periods of asystole demonstrated on an electrocardiogram The patient with sinus arrest refers to failure of the sinoatrial node to discharge and results in an irregular pulse, prolonged periods of asystole, and predisposition to other arrthythmias. The other options do not demonstrate the symptoms demonstrated during a sinus arrest.

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be

Prompt diagnosis and treatment of streptococcal infections

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

Prompt diagnosis and treatment of streptococcal infections

The initial medical management for symptomatic patient with obstructive hypertrophic cardio myopathy (HCM)he would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?

Propranolol, a beta adrenergic blocker

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent which of the following?

Pulmonary embolism The most common site of a deep vein thrombosis (DVT) is in the venous sinuses in the soleus muscle and posterior tibial and peroneal veins. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT. The other options are caused by occlusions in the arterial system.

A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:

Pulmonary embolism : Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli.

Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention?

Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infants first week

The heart is a four-chambered pump. What is the function of the right ventricle?

Pumps blood to the lungs

The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?

QRS complex

A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?

Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. Rest and intake of nitroglycerin relieve chest pain with angina but not with an MI. Pain with angina and MI is an subjective symptom for each client. Pain with angina and MI can occur at a variety of times.

Which of the following 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 The atrial conduction begins with the sinoatrial (SA) node, serving as the pacemaker of the heart. Impulses originating in the SA node travel through the atria to the arterioventricular (AV) node. There are three internodal pathways between the SA node and the AV node, including the anterior (Bachmann), middle (Wenckebach), and posterior (Thorel) internodal tracts. These three tracts anastomose with each other proximally to the AV node. The AV junction connects the two conduction systems and provides for one-way conduction between the atria and the ventricles. The impulse travels through the nodal region into the natriuretic hormone region, which connects with the bundle of His (also called the AV bundle). The fibers of the AV node proceed to form the bundle of His, which extends through the fibrous tissue between the valves of the heart and into the ventricular system. The bundle of His penetrates into the ventricles and almost immediately divides into right and left bundle branches that straddle the interventricular septum. The bundle branches move through the subendocardial tissues toward the papillary muscles and then subdivide into the Purkinje fibers, which branch out and supply the outer walls of the ventricles. The Purkinje system, which initiates ventricular conduction, has large fibers that allow for rapid conduction. Once the impulse enters the Purkinje system, it spreads almost immediately to the whole ventricle.

A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis? A) Hypovolemic shock B) Septic shock C) Neurogenic shock D) Obstructive shock

Septic shock

A nurse witnesses an elderly woman sitting outside who suddenly faints and is helped to the ground by family. She is awake, although confused, heart rate 130, RR 28. The woman states that all of a sudden she felt dizzy, but denies other symptoms. She says that her husband died last week and she has been very upset. The nurse determines that which of the following is the most likely reason for the syncopal episode?

Severe anxiety This person is most likely suffering from severe anxiety following her husband's death, which would be a normal physiologic explanation for the tachyarrhythmia that may have contributed to the syncope. Although the other options are all potential causes of tachyarrhythmias, there is nothing in the question that supports that they would be the cause.

What are the classic symptoms of myocardial infarction?

Severe crushing chest pain *Levine sign* Diaphoresis Dyspnea Nausea Vomiting Lightheadedness Apprehension Severe weakness Denial

A 68-year-old man complains to his family physician that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times he feels that his heart is racing, and it also seems to pause at times. The man has also had occasionally lightheadedness and a recent syncopal episode. What is this client's most likely diagnosis and the phenomenon underlying it? A) Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias B) Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation C) Torsades de pointes as a result of disease of the bundle of His D) Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process

Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias

An 80-year-old client is brought to the emergency room following a syncopal episode at home. The client has a past medical history of atrial fibrillation, type II diabetes, and coronary heart disease. The nurse notes after the cardiac monitor is attached the lack of P waves and the presence of QRS complexes at a rate of 48-54. The nurse determines the presence of which of the following?

Sinus arrest with a junctional escape rhythm Explanation: This client is suffering from sinus arrest with a junctional escape rhythm, demonstrated by the lack of P waves and QRS complexes at a rate of 48-54, which is the escape rhythm. The inherent rate in the junction is 40-60 beats per minute; if the escape rhythm were ventricular the rate would be between 15-40 beats per minute. This client has at least one risk factor for the development of this rhythm and that would be congestive heart failure.

A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which of the following common dysrhythmias is the nurse aware this patient most likely has related to maintaining a large stroke volume?

Sinus bradycardia

A patient is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 sec preceding each QRS complex. Which of the following does the nurse determine the rhythm to be?

Sinus tachycardia Sinus tachycardia is a heart rate >100 bpm that has its origin in the sinoatrial node. A normal P wave and PR interval should precede each QRS complex. The mechanism of sinus tachycardia is enhanced automaticity, related to sympathetic stimulation or withdrawal of vagal tone. Sinus tachycardia is a normal response during any increase in metabolic activity such as fever, stress, anxiety, and the like

When trying to explain to a new dialysis patient 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 gomeruli.

Which type of angina is relieved by rest or nitroglycerin?

Stable

The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which diagnosis?

Stable angina

A nurse is administering medication to treat hypercholesterolemia. Which of the following medications reduces or blocks the hepatic synthesis of cholesterol?

Statins Inhibitors of HMG CoA reductase (e.g., atorvastatin, rosuvastatin, simvastatin), a key enzyme in the cholesterol biosynthetic pathway, can reduce or block the hepatic synthesis of cholesterol and are the cornerstone of low-density lipoprotein (LDL)-reducing therapy. Statins also reduce triglyceride levels and increase high-density lipoprotein (HDL) levels. Statin therapy has been shown to reduce the risk for acute coronary syndromes and stroke in secondary prevention.

Which of the following is the difference between the end-diastolic and end-systolic volumes?

Stroke volume Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Ejection fraction is the volume ejected from the left ventricle. Cardiac reserve is determined by cardiac output. (less)

The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:

Stroke volume × heart rate

Should the practitioner be: Aggressive or not aggressive for patients with subendocardial MI? Aggressive or not aggressive for patients with full-thickness MI?

Subendocardial MI= Must be LESS aggressive with these patients Full-thickness MI= Must be aggressive with these patients to shrink size of scar (sec. to inc. BF)

What is "Broken Heart" Syndrome?

Sudden emotional stress from fear, sorrow, anger, or shock that can cause chest pain and weakening of heart in healthy people; Temporary cardiomyopathy sec. to stress/anger (needs quick treatment!....meds) ; women more affected than men

A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?

Sustained systolic pressure equal to or greater that 160 mm Hg Stage 2 hypertension is systolic pressure greater than 159 mm Hg or diastolic pressure greater than 99 mm Hg. Systolic pressure of 140-159 mm Hg or diastolic pressure of 90-99 mm Hg are characteristic of stage 1 hypertension.

Females with onset of MI typically have what other sx's?

Sx's in shoulders, neck, jaw, back, abdomen; *PROFOUND FATIGUE*

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 which of the following?

Sympathetic nervous system

Select the client who may be at risk for developing an increase in resistance to blood flow.

The client admitted to the intensive care unit for extreme dehydration The viscosity of a liquid is largely related to its thickness or number of particles that it contains. The blood of the client who is extremely dehydrated will be more viscous and increase resistance to flow. Being treated for anaphylactic shock, being hypertensive, or receiving intravenous fluids at a rate of 100 mL/hour will decrease resistance to blood flow.

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 which of the following?

Sympathetic nervous system premature ventricular complexes can occur in healthy hearts in response to stimulation of the sympathetic nervous system. This client states nighttime studying (possibly with coffee intake) and stress over upcoming exams, both of which can stimulate the sympathetic nervous system.

And IV drug abuser walks into the ED telling the nurse that he is sick. He looks feverish and flushed, moist skin; dehydrated with dry lips mucous membranes; and fatigued. Yes that's what reveals a loud murmur. And echocardiogram was ordered that shows a large vegetation growth and his mitral valve. The patient has an ear to the ICU. The nurse will be assessing the patient for which possible life-threatening complication?

Systemic emboli, Especially to the brain

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.

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 A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated.

A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head?

Temporal

A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall (i.e., vasculitis). These disorders are common pathways for tissue and organ involvement in many different disease conditions. What is the most common of the vasculitides?

Temporal arteritis Temporal arteritis (i.e., giant cell arteritis), the most common of the vasculitides, is a focal inflammatory condition of medium-sized and large arteries. It predominantly affects branches of arteries originating from the aortic arch, including the superficial temporal, vertebral, ophthalmic, and posterior ciliary arteries. Neither polyarteritis nodosa nor Raynaud disease are the most common of the vasculitides. Varicose veins are not vasculitides.

How can the health care provider determine if the client has "aerobic fitness"?

Tests help to determine aerobic fitness by measuring heart rate while under the stress of exercise.

You are interpreting an electrocardiogram of a 65-year-old woman. Which of the following represents ventricular depolarization? A) The P wave B) The QRS complex C) the T wave D) The ST segment

The QRS complex

While studying the physiology of the heart, the nursing students have learned that which of the following influence the blood flow in the coronary vessels that supply the myocardium? Select all that apply.

The aortic pressure Autoregulatory mechanisms Compression of the intramyocardial vessels

A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which of the following characteristics of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle?

The cells have a poorly defined sarcoplasmic reticulum.

An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG? A) The electrical potential recorded by a lead on an extremity will vary significantly depending on where the lead is placed on the extremity. B) The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane. C) Limb leads measure the electrical activity of the heart indirectly through the activity of adjacent skeletal muscle. D) A total of 12 chest leads is necessary to attain the most accurate ECG.

The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.

A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was "so fast I couldn't even count it." The child was determined to be in atrial flutter, and his mother is seeking an explanation from the healthcare team. Which of the following points should underlie an explanation to the mother? A) The child is experiencing a reentry rhythm in his right atrium. B) The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions. C) The child is likely to have a normal ECG apart from the rapid heart rate. D) The boy's atria are experiencing abnormal sympathetic stimulation.

The child is experiencing a reentry rhythm in his right atrium.

Select the client who may be at risk for developing an increased resistance to blood flow.

The client in hypovolemic shock experiencing extreme dehydration

The nurse is providing care for a client who has just been diagnosed with long QT syndrome (LQTS). When planning this client's care, the nurse should recognize what implication of the diagnosis?

The client must be closely monitored for ventricular tachycardia The long QT syndrome (LQTS) is characterized by a prolongation of the QT interval that may result in a characteristic type of polymorphic ventricular tachycardia called torsades de pointes and possible sudden cardiac death (SCD). LQTS is not directly related to ACS or cardiomyopathy. Tachycardia is far more likely than bradycardia.

The post-operative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which of the following assessments would be a concern for the nurse?

The client states his hand is numb. Arterial spasm caused by arterial cannulation can be a cause of acute arterial occlusion. Occlusion in an extremity causes sudden onset of acute pain, numbness, tingling, weakness, pallor, and coldness of the affected limb. Pulses are absent below the level of the occlusion.

Which client will the nurse prioritize to assess first?

The client with sinus arrest The client with sinus arrest refers to failure of the SA node to discharge and results in an irregular pulse. An escape rhythm develops as other pacemakers take over, but it may result in prolonged periods of asystole and other abnormal rhythms. The client may need further interventions such as a pacemaker. The other clients need monitoring; however, their rhythm is not placing them in need of immediate assistance.

The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?

The disabling effects that result from involvement of heart valves

What happens in systolic heart failure?

The ejection fraction falls below 50% (severe: below 35%); Pulmonary edema / Dyspnea

A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment? A) Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role. B) Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker. C) Defibrillation must coincide with the R wave of the ECG in order to be successful. D) The goal is to depolarize the entire heart during the passage of current.

The goal is to depolarize the entire heart during the passage of current.

The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following?

The kidneys The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water. Neural (autonomic nervous system) and humoral mechanisms (renin-angiotensin-aldosterone system and vasopressin) exert short-term control of blood pressure. Hormonal influence involves release of epinephrine (which works through the sympathetic nervous system) from the adrenal glands.

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place? A) The man's - and -adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate. B) Hemolysis and blood pooling are taking place in the man's peripheral circulation. C) Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism. D) Intracellular potassium and extracellular sodium levels are rising as a result of sodium-potassium pump failure.

The man's - and -adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate.

Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease?

The pulse decreases rather than increases in amplitude.

A group of nurses is taking a critical care course in cardiac electrophysiology. The instructor is reviewing action potential and the risk of arrhythmias and states that if an electrical impulse fires just after the relative refractory period, during the supernormal excitatory period, cardiac arrhythmias could result. Locate the supernormal excitatory period on the first complex on the rhythm strip.

The supernormal excitatory period, which occurs during the "T" wave on the ECG, is a vulnerable time during the cardiac action potential when even a weak stimulus can initiate potentially lethal cardiac arrhythmias. The ability to accurately evaluate cardiac rhythms and identify potential rhythm concerns may prevent the development of arrhythmias and improve client outcomes.

A neonate is born with a congenital heart defect. The nurse realizes this defect most likely originated during which week of development?

The third week of development

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The mostappropriate response would be:

The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.

A nurse who provides care on a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive beta-adrenergic blocking medications, such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers? A) They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential. B) They inhibit the potassium current and repolarization, extending the action potential and refractoriness. C) They counteract arrhythmias and tachycardias by increasing vagal stimulation. D) They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions.

They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential.

What is the complication with hypertrophic cardiomyopathy?*

Thick AND stiff walls of the ventricles do not relax appropriately to allow the heart chambers to fill with blood. - becomes more severe when the heart beats quickly (as during exercise) because there is then even *less time for the heart to fill.* - Heart does not fill properly --> pumps less blood (sometimes leading to death b/c no blood flow out the heart) *can be seen in athletes*

Which serum biomarker is highly specific for myocardial tissue?

Troponin

Which of the following blood vessel layers is composed primarily of smooth muscle cells?

Tunica media The tunica media consists primarily of circumferentially arranged layers of smooth muscle cells. The tunica externa is composed of loose connective tissue and the tunica intima of endothelial cells. The endothelium is the lining of the vascular system and is composed of endothelial cells.

What is acute coronary syndrome?

Umbrella term used to cover any group of clinical symptoms that's like an acute MI (CAD, ischemia, coronary heart disease)

The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following?

Unknown Essential or primary hypertension has no identifiable cause, although there are many risk factors. The other options are causes of secondary hypertension, for which a cause can be identified and often treated.

Which type of angina reveals plaque rupture, ulceration or hemorrhage with thrombus formation?

Unstable

Which of the 3 types of angina is one that occurs with less exertion, lasts longer and becomes less responsive to meds? a. Unstable angina b. Stable angina c. Prinzmetal angina

Unstable Angina

A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this client about diagnosing a valvular defect?

Valvular defects usually are detected through cardiac auscultation.

A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as:

Valvular regurgitation

An older adult client asks the nurse why so many older people develop heart failure. The bestresponse would be increased:

Vascular stiffness

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Vasoconstriction

A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?

Vasodilating effects reducing preload and afterload

Although Raynaud's phenomenon and thromboangiitis are both characterized by ischemia, Raynaud's phenomenon and thromboangiitis obliterans are caused by which of the following?

Vasospasm; inflammation Raynaud's disease is caused by vasospasms of small distal arteries; thromboangiitis obliterans is caused by an inflammatory process that also affects veins and nerves.

Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?

Ventricular fibrillation Ventricular fibrillation represents severe derangements of cardiac rhythms that terminate fatally within minutes unless corrective measures are taken promptly. All of the other arrhythmias need to have further investigation into etiology, but are not immediately fatal.

The 40-year-old nurse is concerned that her job requires her to stand most of the day. Which of the following therapies could be implemented to prevent tissue injury?

Wearing correctly fitted, elastic support stockings The incidence of varicose veins is more common in females between 30 and 50 years of age and among people who stand for the majority of their day due to an occupation (e.g., nurses). Treatment measures for varicose veins focus on improving venous flow and preventing tissue injury. Support stockings prevent vein distention. Sclerotherapy is used in the treatment of small varicosities. Warfarin therapy and heat application are used to treat deep vein thrombosis

A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening?

Weight gain

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be: Select all that apply.

Weight reduction if overweight • Dietary measures to reduce LDL levels • Smoking cessation The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes; when these are unsuccessful, pharmacologic treatment may be necessary. Therapeutic lifestyle changes include an increased emphasis on physical activity, dietary measures to reduce LDL levels, smoking cessation, and weight reduction for people who are overweight. Increased intake of fats and sodium would cause weight gain and hypertension and result in a negative consequence

A pediatrician is teaching a group of medical students about some of the particularities of heart failure and children as compared with older adults. Which is a physicians following statements best captures an aspect of these differences?

You'll find that in pediatric patients pulmonary edema is more often interstitial rather than alveolar so you want to hear crackles

A client has been diagnosed with mitral valve stenosis fine his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to this client?

Your mitral valve isn't opening up enough for blood to flow into part of your heart that sends blood into circulation

Which zone of MI is when ST-segment depresses? Which zone is when ST-segment depresses then rises?

Zone of *ischemia* - depresses Zone of *injury* - depresses then rises

What is the difference between zone of ischemia and zone of injury?

Zone of ischemia is reversible; Zone of injury is ONLY reversible if you do proper exercises with the patient

What is myocarditis?

inflammation of the myocardium (middle layer); results in reduced heart pumping function and irregular rhythms; (viral infection most common)

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:

many people live with atrial fibrillation without even knowing they have it. Many people live with atrial arrhythmias, including atrial fibrillation, without knowing the arrhythmia exists. Atrial arrhythmias are typically less serious because they do not impact the ability of the ventricles to pump. This client is at high risk to develop atrial fibrillation due to his advanced age; the rates of atrial fibrillation begin to increase over the age of 60 and males have a greater prevalence. It is true that atrial fibrillation is a disorganized rhythm; however it is not ventricular. The client may or may not need anticoagulation; there are other considerations to be made before these medications would be considered

At 4 AM the hemodynamic monitoring for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure (MAP) is at the low end of the normal range; at 5 AM the client's MAP has fallen definitively below normal. The nurses should prioritize assessments for:

organ damage and hypovolemic shock. The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. The fact that this client's MAP is falling at a time when it should be at its daily peak is cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk. Low blood pressure does not normally result in aneurysms, edema, or ischemic stroke.

A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. The results suggest that the client's end-diastolic volume is insufficient. Which parameter of cardiac performance will directly decrease as a result of this finding?

preload

A preventive measure to decrease the risk of developing rheumatic heart disease includes:

prompt diagnosis of streptococcal infections with a throat culture.

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:

recording weight every day at the same time with same type of clothing.

A client is visiting the primary physician and appears extremely nervous. The intake nurse does his vital signs and notes an increase in both his heart rate and blood pressure. In an effort to better understand the client's presenting signs and symptoms the nurse asks the client about his concerns and the client states that the person who performed his pre-visit told him that he had an arrhythmia. Which is the most therapeutic response about cardiac arrhythmias that the nurse can make?

they can occur in diseased or healthy hearts.

Two months following a myocardial infarction (MI) a client visits the physician because of severe fatigue and shortness of breath. During the evaluation the client reports frequent episodes of palpitations over the past couple of weeks that cause the shortness of breath to increase. A 12-lead ECG reveals that the client has atrial fibrillation with a heart rate of 120. The practitioner should consider which of the following medications? Select all that apply.

• Anticoagulants • Antiarrhythmics Atrial fibrillation (AF) is a rhythm that involves quivering of the atrium rather than contracting rhythmically, causing pooling of blood in the atrium that can lead to the development of thrombi along with a decrease in cardiac output. Anticoagulants are used to decrease the ability of the blood pooling in the atrium to develop clots that could break off and become emboli that lodge in blood vessels elsewhere in the body causing ischemia, often to the brain causing strokes. Antiarrhythmics are used with atrial fibrillation to either convert the rhythm to normal sinus or to control the rate which gives the ventricles more time to fill.

The client has swelling in his right leg and foot and reports calf pain and tenderness. Pedal pulses are present. Which of the following tests could the practitioner order for this condition? Select all that apply.

• Ascending venography • Duplex ultrasonography • Plasma D-dimer • White blood cell count Several tests are useful for the detection of deep vein thrombosis (DVT). They are ascending venography, ultrasonography, and plasma D-dimer. The most common signs and symptoms of DVT are related to the inflammatory process. An elevated white blood cell count is an accompanying indication of inflammation. An echocardiogram is a test that evaluates heart structure and function.

Autonomic nervous system control of blood pressure is mediated through which of the following? Select all that apply.

• Baroreceptors in blood vessels • Carotid artery chemoreceptors • Pain and strong emotion • Aortic chemoreceptors Baroreceptors in blood vessels and heart sense pressure changes in the circulatory system, and chemoreceptors at the carotid arteries and in the aorta detect blood levels of oxygen, carbon dioxide and hydrogen. When pressure falls or blood gases change, the autonomic nervous system can activate reflex responses to maintain adequate blood flow to vital organs. Pain, emotion and cold also can activate the autonomic nervous system control of blood pressure. Hepatic function does not directly affect autonomic control of blood pressure

The nurse recognizes which of the following as normal age-related blood pressure? Select all that apply.

• Blood pressure at age 10 days is 78 mm Hg systolic. • Blood pressure at age 25 years is ideal at 120 mm Hg systolic. • Blood pressure in newborn infants is approximately 50 mm Hg systolic. Blood pressure of 50 mm Hg in newborn infants rises to approximately 78 mm Hg at 10 days of age. At the end of adolescence, around age 18 years, blood pressure usually has reached adult readings of 120 mm Hg. Beyond age 50 years, systolic pressure usually rises while diastolic pressure falls or remains the same.

The nurse knows that which of the following statements regarding the physiology of blood pressure are correct? Select all that apply.

• Blood pressure is very variable. • Constant elevation of blood pressure can be lethal. • A decrease in blood flow can be an immediate threat to life. Blood pressure is a very variable yet highly regulated function in healthy persons. Blood flow is most vital to heart, brain and kidneys; other tissues can better survive periods of decreased blood flow. Constant elevation of blood pressure (hypertension) can cause severe damage to heart, blood vessels and kidneys, leading to premature disability and death. A sudden decrease in blood flow, especially to the heart and brain, can rapidly be deadly: these organs, vital to survival, require a constant supply of oxygen to function effectively.

The nurse is caring for a young pregnant patient. Which of the following describe cardiovascular changes during a normal pregnancy? Select all that apply.

• Blood pressure rises during the third trimester. • Blood pressure falls during the first trimester. • Levels of angiotensin-II contribute to elevated blood pressure. Blood pressure falls during the first trimester and reaches its lowest level in the second trimester. Pressure gradually rises in the third trimester. Cardiac output is increased throughout pregnancy. Plasma levels of angiotensin-II increase, inducing vasoconstriction that contributes to increased blood pressure.

As the needs of the body change, the heart's ability to increase output needs to change too. This ability in the heart depends on what factors? (Select all that apply.)

• Cardiac contractility • Heart rate • Preload • Afterload

A client with a history of unstable angina is admitted for a knee replacement. He questions the nurse about why continuous ECG monitoring is necessary during this hospital admission. The nurse explains to the patient that with a history of unstable angina it is important to monitor the cardiac rhythms to ensure early detection of which of the following? Select all that apply.

• Cardiac muscle ischemia • Tachyarrhythmias • Bradyarrhythmias • Irregular rhythms For persons with acute coronary syndrome (ACS), which includes conditions that cause cardiac ischemia, ECG monitoring is extremely important in preventing complications that may arise, such as early ischemia and also arrhythmias, including tachyarrhythmias, bradyarrhythmias and irregular rhythms.

A patient brought to the emergency department has preeclampsia. The nurse knows that this disorder can progress to include which of the following complications? Select all that apply.

• Cerebral hemorrhage • Renal failure • Disseminated intravascular coagulation (DIC) • Hepatic failure Severe preeclampsia has risk for cerebral hemorrhage, hepatic and renal failure, and DIC. Platelet counts fall, with less than 100,000/mm2 diagnostic of serious disease.

In caring for clients with acute coronary syndromes (ACS) the nurse knows that without accurate assessments, including ECGs, these clients are at a much higher risk of complications, including which of the following? Select all that apply.

• Continuing myocardial ischemia • Increased area of infarction • Life-threatening arrhythmias 12-lead ECG monitoring is essential to avoid possible complications. Those complications could include; continuing myocardial ischemia, an increase in the size of the infarction along with life-threatening arrhythmias. In the presence of acute coronary syndromes ECG monitoring can detect continuing or new onset cardiac muscle ischemia more quickly and accurately than a client's report of symptoms. Other benefits of ECG monitoring are numerous and the American Heart Association has published practice guidelines to improve patient outcomes in clients with ACS

A patient with persistent primary hypertension is unhappy with the adverse effects of his current antihypertensive regimen. The nurse will tell the patient that there are several types of antihypertensive drugs having different mechanisms of action and different adverse effect profiles. The physician can vary regimens until an acceptable one is found. Which of the following are antihypertensive medications which the physician might select to use? Select all that apply.

• Direct acting vasodilators • Alpha adrenergic blockers • Centrally acting adrenergic agonists There are several groups of antihypertensive medications having different mechanisms of action. Alpha adrenergic blockers inhibit adrenergic stimulation of alpha one receptors that mediates vasoconstriction. Centrally acting adrenergic agonists decrease adrenergic stimulation emanating from the central nervous system. Direct acting vasodilators, as their name implies, mediate vasodilation by direct action on vascular smooth muscle. Combinations of these drugs are used frequently, as giving lower doses of two or three drugs working by different mechanisms will often achieve good blood pressure control with minimal side effects. Angiotensin receptor agonists and beta adrenergic agonists would raise rather than lower blood pressure.

A nurse is evaluating hypertension risk factors with an African American male who works as a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. He paternal grandfather had a stroke. He drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are modifiable risk factors associated with this diagnosis? Select all that apply.

• Excessive alcohol consumption • Obesity Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure and race. Modifiable risk factors are lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.

The nurse is discussing hypertension with a group of patients. The nurse knows that which of the following statements regarding hypertension are true? Select all that apply.

• Family history of hypertension is a risk factor for hypertension. • Diabetes can lead to secondary hypertension. Primary or essential hypertension refers to hypertension with no identifiable cause. Diabetes can result in renal damage and consequent activation of the renin-angiotensin system which can elevate blood pressure. Family history is a nonmodifiable risk for hypertension. Hypertension, because it causes increased workload on the myocardium, can result in left ventricular hypertrophy. Hypertension is most often asymptomatic.

The nurse recognizes that which of the following is true of the changes in blood flow through the systemic circulation? Select all that apply.

• Intermittent flow from the heart as it contracts and relaxes • Arterial compliance (pulsatile flow) as vessels expand and contract • Arteriolar resistance converts to steady flow Blood ejected with each heartbeat into the aorta and arteries forces these vessels to expand and then relax, with pulsatile flow. Arterioles provide resistance to flow, allowing for steady pressure through the capillaries. Pressure in the venous system is generally low.

A patient is diagnosed with pheochromocytoma. The nurse knows that which of the following procedures help to diagnose and manage this condition? Select all that apply.

• MRI and CT scans • Measurement of urinary catecholamines and metabolites • Radioisotope studies • Drugs to block catecholamine action Pheochromocytoma, a tumor of chromaffin cells, secretes catecholamines such as norepinephrine and epinephrine that produce an elevation in blood pressure. Measurement of urinary catecholamines and metabolites will detect excessive production of catecholamines. MRI and CT scans and radioisotopes that accumulate in chromaffin cells help to locate the aberrant tissue. If the tumor cannot be surgically removed, drugs that inhibit catecholamine secretion or action are administered. Diuretics will not address the root cause of hypertension due to pheochromocytoma

A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are NONmodifiable risk factors associated with this diagnosis? Select all that apply.

• Race • Family history Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure, and race. Modifiable risk factors are lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.

A nurse is planning a community education program on lifestyle modification to manage hypertension. Which of the following topics should be included in the teaching plan? Select all that apply.

• Reduce dietary sodium intake. • Limit alcohol consumption. • Stop smoking. • Consume a diet rich in fruits, vegetables, and low-fat dairy products. Explanation: Hypertension lifestyle modification included the maintenance of normal body weight (BMI, 18.5-24.9 kg/m2) 5-20 mm Hg/10 kg weight loss. Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan including consuming a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat 8-14 mm Hg. Dietary sodium reduction to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride) 2-8 mm Hg. Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day. Moderation of alcohol consumption; limiting consumption to no more than 2 drinks (1 oz or 30 mL ethanol) (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and 1 drink per day in women and lighter-weight persons.

The nurse knows that which of the following would put a patient at risk of developing hypertension, if everything else in the body remained unchanged? Select all that apply.

• Systemic vasoconstriction • Intravascular fluid retention • Elevated renin levels Explanation: Increased blood volume and systemic vasoconstriction will increase blood pressure. Elevated renin will increase levels of angiotensin II and aldosterone resulting in vasoconstriction and sodium and water retention. Reduced heart rate will lower blood pressure. Blood viscosity is not a major factor in regulating blood pressure.

The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.

• The venous system collects deoxygenated blood from the tissues . • The arterial system distributes oxygenated blood to the tissues. The circulatory system consists of the heart which pumps blood, the arterial system which distributes oxygenated blood to the tissues, the venous system which collects deoxygenated blood from the tissues and returns it to the heart, and the capillaries where exchange of gases, nutrients and waste takes place.

The nurse knows that systolic hypertension carries risk for which of the following cardiovascular events? Select all that apply.

• Thrombosis • Damage to elastic elements of blood vessel walls • Atherosclerosis • Risk for aneurysm With systolic hypertension, increased pulse pressure produces increased stretch of the arteries, resulting in damaged elastic elements and risk for aneurysm. Atherosclerosis and thrombosis as platelets begin to aggregate on rough endothelial surfaces. Systolic hypertension will cause left ventricular hypertrophy rather than right ventricular hypertrophy.