Brunner Nursing Concept - Perfusion

The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is air plethysmography. lymphoscintigraphy. lymphangiography. contrast phlebography.

contrast phlebography. Explanation: When a thrombus exists, an x-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In a lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.

A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? Tissue loss to that foot No arterial insufficiency Very mild arterial insufficiency Moderate to severe arterial insufficiency

Moderate to severe arterial insufficiency Explanation: Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? The abrupt stop can cause a myocardial infarction. The abrupt stop can trigger a migraine headache. The abrupt stop will precipitate internal bleeding. The abrupt stop can lead to formation of blood clots.

The abrupt stop can cause a myocardial infarction. Explanation: Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or the onset of a migraine headache.

The nurse is admitting a client with heart failure. What factor will worsen the client's myocardial function? potassium 3.9 mEq/L hemoglobin 11.9 g/dL blood urea nitrogen 22 mg/dL arterial pH 7.28

arterial pH 7.28 Explanation: Hypoxia, acidosis, renal failure, and electrolyte imbalance will decrease myocardial function for clients with heart failure. The pH of 7.28 is an acidosis. The BUN is normal at 22 mg/dL. The potassium of 3.9 mEq/L is within the normal range. A hemoglobin of 11.9 g/dL will not decrease myocardial function.

The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD? myocardial infarction diabetes mellitus atherosclerosis renal failure

atherosclerosis Explanation: Atherosclerosis (plaque formation) is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.

Which term describes the ability of the heart to initiate an electrical impulse? conductivity automaticity contractility excitability

automaticity Explanation: Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an electrical impulse. Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse. Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another. Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to respond to an electrical impulse.

Which is not a likely origination point for cardiac arrhythmias? atrioventricular node atria ventricles bundle of His

bundle of His Explanation: Cardiac arrhythmias may originate in the atria, atrioventricular node, or ventricles. They do not originate in the Bundle of His.

The nurse is teaching a client with heart failure about the ability for the heart to pump out blood. What diagnostic test will measure the ejection fraction of the heart? echocardiogram MRI nuclear angiography pulmonary arterial pressure

echocardiogram Explanation: The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan. An MRI, pulmonary arterial pressure, and nuclear angiography do not give diagnostic information about the heart's ejection fraction.

The nurse is caring for a client with heart failure who is receiving a diuretic medication. What implementation will help the nurse evaluate the client's response of the medication? asking the client about comfort level measuring intake and output obtaining cardiac output with a pulmonary catheter using mechanical ventilation

measuring intake and output Explanation: To evaluate response to a diuretic, intake and output are monitored. Mechanical ventilation helps maintain a normal breathing pattern. A pulmonary artery catheter helps estimate cardiac output. Asking the client about comfort level will not assess urinary output.

Which of the following nursing diagnoses is the nurse most correct to choose when caring for a client with long-standing hypertension? Risk for Decreased Cardiac Output Activity Intolerance Impaired Gas Exchange Altered Tissue Perfusion

Altered Tissue Perfusion Explanation: The nurse is most correct in choosing Altered Tissue Perfusion for the client with long-standing hypertension. In hypertension, the extra work increases the size of the heart muscle. Eventually, the heart cannot meet the body's metabolic needs limiting the perfusion to the tissues. Impaired Gas Exchange, Activity Intolerance, and a Risk for Decreased Cardiac Output may occur due to the ineffective perfusion.

The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse? Dizziness Syncope Extra heart sound Fatigue

Extra heart sound Explanation: Often the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound, referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapse.

The nurse is completing a cardiac assessment. Upon auscultation, the nurse hears a grating sound using the diaphragm of the stethoscope. How will the nurse best document this finding? Snap Murmur Friction rub Click

Friction rub Explanation: In pericarditis, a harsh, grating sound that can be heard in both systole and diastole is called a friction rub. A murmur is created by turbulent flow of blood. A cause of the turbulence may be a critically narrowed valve. An opening snap is caused by high pressure in the left atrium with abrupt displacement of a rigid mitral valve. An ejection click is caused by very high pressure within the ventricle, displacing a rigid and calcified aortic valve.

Which mitral valve condition generally produces no symptoms? Regurgitation Infection Stenosis Prolapse

Prolapse Explanation: Mitral valve prolapse is a deformity that usually produces no symptoms and has been diagnosed more frequently in recent years, probably as a result of improved diagnostic methods. Mitral valve stenosis usually causes progressive fatigue. Mitral valve regurgitation, in its acute stage, usually presents as severe heart failure. Mitral valve infection, when acute, produces symptoms typical of infective endocarditis.

Which of the following are alterations noted in Virchow's triad? Select all that apply. Tenderness Altered coagulation Stasis of blood Vessel wall injury Edema

Stasis of blood Vessel wall injury Altered coagulation Explanation: Three factors, known as Virchow's triad, are believed to play a significant role in the development of venous thrombosis. They are stasis of blood, vessel wall injury, and altered coagulation. Edema and tenderness are clinical manifestations of venous thrombosis, but are not part of the triad.

A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant? Ventricular assist device (VAD) Implanted cardioverter-defibrillator (ICD) Pacemaker Intra-aortic balloon pump (IABP)

Ventricular assist device (VAD) Explanation: VADs may be used for one of three purposes: (1) a bridge to recovery, (2) a bridge to transplant (3) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days.

A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about: kidney function. kidney structure. renal circulation. urine production.

renal circulation. Explanation: A renal angiography (renal arteriography) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.

Beginning warfarin concomitantly with heparin can provide a stable INR by which day of heparin treatment? 4 5 3 2

5 Explanation: Beginning warfarin concomitantly with heparin can provide a stable INR by day 5 of heparin treatment, at which time the heparin maybe discontinued.

A nurse would question the accuracy of a pulse oximetry evaluation in which of the following conditions? A client experiencing hypothermia A client sitting in a chair after prolonged bed rest A client receiving oxygen therapy via Venturi mask A client on a ventilator with PEEP

A client experiencing hypothermia Explanation: Pulse oximetry is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin. The reading is referred to as SpO2. A probe or sensor is attached to the fingertip, forehead, earlobe, or bridge of the nose. Values less than 85% indicate that the tissues are not receiving enough oxygen. SpO2 values obtained by pulse oximetry are unreliable in states of low perfusion such as hypothermia.

A client is receiving captopril for heart failure. During the nurse's assessment, what sign indicates that the medication therapy is ineffective? peripheral edema postural hypotension skin rash bradycardia

ACE inhibitor Explanation: Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics (Table 29-3). Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival (Fonarow et al., 2010). Calcium channel blockers are no longer recommended for patients with HF because they are associated with worsening failure (ICSI, 2011).

The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status? Pulse oximetry End-tidal CO2 Arterial blood gases Listening to breath sounds

Arterial blood gases Explanation: In left-sided heart failure, arterial blood gases may be obtained to assess ventilation and oxygenation.

A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? Complaints of nausea Blood pressure varying between 120/86 and 240/130 mm Hg Heart rate of 56-64 bpm Shivering

Blood pressure varying between 120/86 and 240/130 mm Hg Explanation: Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.

The nurse assesses a radial pulse rate of 48 beats per minute (bpm). Using critical thinking, what will be the best action for the nurse to take? Ask a fellow nurse to double-check your pulse rate assessment. Assess blood pressure with the client lying supine. Call the health care provider to get orders. Check the client's previous pulse rates to validate the findings.

Check the client's previous pulse rates to validate the findings. Explanation: Critical thinkers validate information to make sure that it is accurate or makes sense. In this case, the nurse will review previous rates to see if this finding is a deviation from the client's usual rate. Assessing the client's blood pressure is collecting more data, and this information would not help confirm whether the client ordinarily has a low pulse rate. Asking another nurse for help is fine, but is not an example of using critical thinking. The health care provider will need more client data.

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply. Toes mottled and cool Capillary refill less than 3 seconds Complaints of pins and needles in feet Absence of pain Dorsoplantar flexion strong

Complaints of pins and needles in feet Toes mottled and cool Explanation: Clinical manifestations of peripheral neurovascular dysfunction include coolness, mottling, weakness, complaints of paresthesia or a pins and needles sensation, and unrelenting pain. Capillary refill of less than 3 seconds is a normal finding.

A client presents to the ED following a motor vehicle collision. The client is suspected of having internal hemorrhage. The nurse assesses the client for signs and symptoms of shock. Which are signs and symptoms of shock? Select all that apply. Delayed capillary refill Increasing heart rate Increasing urine volume Decreasing blood pressure Cool, moist skin

Cool, moist skin Decreasing blood pressure Increasing heart rate Delayed capillary refill Explanation: Signs and symptoms of shock include cool, moist skin (resulting from poor peripheral perfusion), decreasing blood pressure, increasing heart rate, delayed capillary refill, and decreasing urine volume.

Which is a characteristic of arterial insufficiency? Superficial ulcer Pulses are present but may be difficult to palpate Aching, cramping pain Diminished or absent pulses

Diminished or absent pulses Explanation: A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.

A client is being scheduled for a stress test. The client is unable to exercise during the test. The nurse would include information about which medication used for pharmacologic stress testing? Thallium 201 Dipyridamole Lanoxin Cardiolite

Dipyridamole Explanation: If the patient is unable to exercise, a pharmacologic stress test is performed by injecting a vasodilating agent, dipyridamole or adenosine, to mimic the physiologic effects of exercise. The stress test may be combined with an echocardiogram or radionuclide imaging techniques to examine myocardial function during exercise and rest. Digoxin would not be used for stress testing. Thallium 201 and Cardiolite are radioisotopes used in myocardial perfusion scanning.

Which aneurysm results in bleeding into the layers of the arterial wall? Saccular Dissecting False Anastomotic

Dissecting Explanation: Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma. An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites.

Which diagnostic study is usually performed to confirm the diagnosis of heart failure? Blood urea nitrogen (BUN) Serum electrolytes Echocardiogram Electrocardiogram (ECG)

Echocardiogram Explanation: An echocardiogram is usually performed to confirm the diagnosis of heart failure. ECG, serum electrolytes, and a BUN are usually completed during the initial workup.

The nurse is caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression? Eyes Kidney Heart Musculoskeletal system

Eyes Explanation: Accelerated hypertension is defined as a markedly elevated blood pressure with symptoms of hemorrhages and exudates in the eyes. If the hypertension is untreated, accelerated hypertension progresses to malignant hypertension with symptoms of papilledema. Long-standing hypertension can produce changes in the kidney, heart, and musculoskeletal system.

Which colloid is expensive but rapidly expands plasma volume? Hypertonic saline Dextran Albumin Lactated Ringer solution

Albumin Explanation: Albumin is a colloid that requires human donors, is limited in supply, and can cause congestive heart failure. Dextran interferes with platelet aggregation and is not recommended for hemorrhagic shock. Lactated Ringer solution and hypertonic saline are crystalloids, not colloids.

A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? Document the findings and continue to monitor the client Obtain a 12-lead ECG and a portable chest x-ray Reposition the extremity and turn the client to left side Check the security of all connections and increase the milliamperage

Document the findings and continue to monitor the client Explanation: Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the client. Repositioning the client, placing the client on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape.

The nurse is teaching a client about lifestyle modifications after a heart failure diagnosis. What will be included in the teaching? Avoid any alcohol. Drink 3 liters of fluid per day. Restrict dietary potassium. Engage in exercise daily.

Engage in exercise daily. Explanation: Lifestyle recommendations after heart failure include restriction of dietary sodium; avoidance of excessive fluid intake, excessive alcohol intake, and smoking; weight reduction when indicated; and regular exercise. The restriction of potassium is not required. Drinking 3 liters of fluid per day would be excessive for a client with heart failure.

A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? Atenolol Amlodipine IV nitroglycerin IV morphine

IV morphine Explanation: IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.

A nurse is teaching a client newly diagnosed with arterial insufficiency. Which term should the nurse use to refer to leg pain that occurs when the client is walking? Orthopnea Dyspnea Thromboangiitis obliterans Intermittent claudication

Intermittent claudication Explanation: Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is difficulty breathing and is subjective. Orthopnea is the inability to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Buerger disease.

A patient with a history of valvular disease has just arrived in the PACU after a percutaneous balloon valvuloplasty. Which intervention should the recovery nurse implement? Keep the patient's affected leg straight. Evaluate the patient's endotracheal lip line. Monitor the patient's chest drainage. Assess the patient's chest tube output.

Keep the patient's affected leg straight. Explanation: Balloon valvuloplasty is performed in the cardiac catheterization laboratory. A catheter is inserted into the femoral artery. The patient must keep the affected leg straight to prevent hemorrhage at the insertion site. It is not an open heart surgery requiring chest tubes nor a chest dressing. ET tubes are placed when someone has general anesthesia, and this procedure is performed using light or moderate sedation.

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? Magnetic resonance imaging Radioisotope liver scan Electroencephalography Angiography

Radioisotope liver scan Explanation: A radioisotope liver scan assesses liver size and hepatic blood flow and obstruction. Magnetic resonance imaging is used to identify normal structures and abnormalities of the liver and biliary tree. Angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. Electroencephalography is used to detect abnormalities that occur with hepatic coma.

A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? Left ventricular hypertrophy Rebound hypertension Angina Isolated systolic hypertension

Rebound hypertension Explanation: Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Thus, patients should be advised to have an adequate supply of medication, particularly when traveling and in case of emergencies such as natural disasters. If traveling by airplane, patients should pack the medication in their carry-on luggage.

The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient? The patient is hypoxic from suctioning. The patient is in a hypermetabolic state. The patient is having a stress reaction. The patient is having a myocardial infarction.

The patient is hypoxic from suctioning. Explanation: Apply suction while withdrawing and gently rotating the catheter 360 degrees (no longer than 10-15 seconds). Prolonged suctioning may result in hypoxia and dysrhythmias, leading to cardiac arrest.

The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer? Carvedilol (Coreg) Digoxin (Lanoxin) Valsartan (Diovan) Metolazone (Zaroxolyn)

Valsartan (Diovan) Explanation: Valsartan (Diovan) is the only angiotensin receptor blocker listed. Digitalis/digoxin (Lanoxin) is a cardiac glycoside. Metolazone (Zaroxolyn) is a thiazide diuretic. Carvedilol (Coreg) is a beta-adrenergic blocking agent (beta-blocker).

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? Nitroglycerin Cimetidine Spironolactone Vasopressin

Vasopressin Explanation: Vasopressin may be the initial therapy for esophageal varices because it produces constriction of the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? decreased left ventricular pumping decreased right ventricular elasticity increased left atrial contractility increased right atrial resistance

decreased left ventricular pumping Explanation: Pulmonary edema is an acute event that results from heart failure. Myocardial scarring, resulting from ischemia, limits the distensibility of the ventricle, making it vulnerable to demands for increased workload. When the demand on the heart increases, there is resistance to left ventricular filling and blood backs up into the pulmonary circulation. Pulmonary edema quickly develops.

The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy? decreased peripheral perfusion to the extremities decreased left ventricular workload decreased right ventricular workload decreased renal perfusion

decreased left ventricular workload Explanation: The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The therapeutic effect is decreased left ventricular workload. The IABP does not change right ventricular workload. The IABP increases perfusion to the coronary and peripheral arteries. The renal perfusion is not affected by IABP.

A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload? dyspnea and hypertension confusion and diarrhea pulmonary congestion and muscle cramps hypertension and weight gain without edema

dyspnea and hypertension Explanation: Signs of fluid overload would include confusion, dyspnea, pulmonary congestion, and hypertension. Muscle cramps, diarrhea, and weight gain without edema would be indicative of hyponatremia.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: elevate the affected leg as high as possible. keep the affected leg level or slightly dependent. shave the affected leg in anticipation of surgery. place a heating pad around the affected calf.

peripheral edema Explanation: Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective. The individual will also most like experience tachycardia instead of bradycardia if the heart failure is worsening ang not responding to captopril.

Hypertension that can be attributed to an underlying cause is termed isolated systolic hypertension. primary hypertension. secondary hypertension. essential hypertension.

secondary hypertension. Explanation: Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).

Vasoactive drugs, which cause the arteries and veins to dilate, thereby shunting much of the intravascular volume to the periphery and causing a reduction in preload and afterload, include agents such as dopamine. sodium nitroprusside. furosemide. norepinephrine.

sodium nitroprusside. Explanation: Sodium nitroprusside is a vasodilator used in the treatment of cardiogenic shock. Norepinephrine is a vasopressor that is used to promote perfusion to the heart and brain. Dopamine tends to increase the workload of the heart by increasing oxygen demand; thus, it is not administered early in the treatment of cardiogenic shock. Furosemide is a loop diuretic that reduces intravascular fluid volume.

The nurse admits an adult female client with a medical diagnosis of "rule out MI." The client is very frightened and expresses surprise that a woman would have heart problems. What response by the nurse will be most appropriate? "A woman's resting heart rate is lower than a man's." "A woman's heart is smaller and has smaller arteries that become occluded more easily." "It takes longer for an electrical impulse to travel from the sinoatrial node to the atrioventricular node in a woman." "The stroke volume from a woman's heart is lower than from a man's heart."

"A woman's heart is smaller and has smaller arteries that become occluded more easily." Explanation: Because the coronary arteries of a woman are smaller, they become occluded from atherosclerosis more easily. The resting rate, stroke volume, and ejection fraction of a woman's heart are higher than those of a man. The electrical impulses from the sinoatrial node to the atrioventricular node are not different in the genders.

The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure? Avoid the intake of canned fruit and fruit juices. Encourage increased intake of red meat. Encourage increased intake of vegetables with natural sodium. Avoid the intake of processed and commercially prepared foods. SUBMIT ANSWER

Avoid the intake of processed and commercially prepared foods. Explanation: Until edema resolves, a client with severe heart failure requires restriction of sodium to 500 to 1,000 mg/day. Therefore, processed and commercially prepared foods are eliminated. Vegetables with natural sodium, for example, beets, carrots, and "greens," should be avoided. Fresh, frozen, and canned fruit and fruit juices are not restricted. Increased intake of red meat should not be encouraged; it should be restricted to 6 oz per day.

A health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling

Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours Explanation: Pitting edema is documented as a +1 when a depression is barely detectable on release of thumb pressure and when foot and leg contours are normal. A detectable depression of less than 5 mm accompanied by normal leg and foot contours warrants a +2 rating. A deeper depression (5 to 10 mm) accompanied by foot and leg swelling is evaluated as +3. An even deeper depression (more than 1 cm) accompanied by severe foot and leg swelling rates a +4.

The nurse is receiving a client from the emergency in cardiogenic shock. What mechanical device does the nurse anticipate will be inserted into the client? cardiac pacemaker hypothermia-hyperthermia machine defibrillator intra-aortic balloon pump

intra-aortic balloon pump Explanation: Counterpulsation with an intra-aortic balloon pump may be indicated for temporary circulatory assistance in clients with cardiogenic shock. The intra-aortic balloon pump increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock. Cardiac pacemakers are used to maintain the heartbeat at a predetermined rate. Hypothermia-hyperthermia machines are used to cool or warm clients with abnormalities in temperature regulation. The defibrillator is commonly used for termination of life-threatening ventricular rhythms.

A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next? "Are you having chest pain or shortness of breath?" "Do you have a dry mouth or nasal congestion?" "Have you taken your prescribed clonidine today?" "Did you take any medication for your headache?"

"Have you taken your prescribed clonidine today?" Explanation: The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? "My feet are bigger than normal." "I sleep on three pillows each night." "My pants don't fit around my waist." "I don't have the same appetite I used to."

"I sleep on three pillows each night." Explanation: Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing. Swollen feet, ascites, and anorexia are signs of right-sided heart failure.

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? "Walk to the point of pain, rest until the pain subsides, then resume ambulation." "If you feel pain during the walk, keep walking until the end of the hallway is reached." "As soon as you feel pain, we will go back and elevate your legs." "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

"Walk to the point of pain, rest until the pain subsides, then resume ambulation." Explanation: The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise.

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? Have the client limit physical activity. Monitor partial thromboplastin (PTT) time. Administer the prescribed enoxaparin (Lovenox). Encourage a diet high in vitamin K.

Administer the prescribed enoxaparin (Lovenox). Explanation: Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.

A client has been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions: (Select all that apply.) Apply pressure to the bleeding sites. Assist the client to a chair. Check intake and output records. Assess level of consciousness. Monitor vital signs once a shift.

Assess level of consciousness. Apply pressure to the bleeding sites. Check intake and output records. Explanation: The client may be experiencing disseminated intravascular coagulation (DIC) following the cancer experience and chemotherapy treatment. When the nurse notes the client is experiencing unexpected and abnormal bleeding, the nurse will assess level of consciousness (the client can be bleeding in the brain) and intake and output records (the client may experience decreased urinary output as a result of poor renal perfusion). The nurse applies pressure to venipuncture sites to decrease bleeding. The nurse will assess vital signs more frequently than once a shift. The nurse minimizes client activities to decrease risk for injury.

You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels? Enzymes Platelets RBC WBC

Enzymes Explanation: When tissues and cells break down, are damaged, or die, great quantities of certain enzymes are released into the bloodstream. Enzymes can be elevated in response to cardiac or other organ damage. After an MI, RBCs and platelets should not be elevated. WBCs would only be elevated if there was a bacterial infection present.

Which statement is accurate regarding Raynaud disease? The disease generally affects the client trilaterally. Episodes may be triggered by unusual sensitivity to cold. It affects more than two digits on each hand or foot. It is most common in men 16 to 40 years of age.

Episodes may be triggered by unusual sensitivity to cold. Explanation: Episodes of Raynaud disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.

Which of the following factors are implicated in the development of heart disease? Result of imbalances in serotonin Brain pathology Excess and low levels of dopamine Frequent activation of the sympathetic nervous system

Frequent activation of the sympathetic nervous system Explanation: Frequent activation of the sympathetic nervous system in persons prone to anger and hostility is a factor implicated in the development of heart disease. Brain pathology is seen as the major factor contributing to mental illnesses called psychobiologic disorders. Results of excess levels of dopamine imply disorganized thought patterns and bizarre behaviors of schizophrenia. Results of imbalances in serotonin imply depression, eating disorders, sleep disturbances, and obsessive-compulsive disorders.

The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence Lowering and controlling the blood pressure without adverse effects and without undue cost Instructing the patient to enter a weight loss program and begin an exercise regimen Making sure that the patient adheres to the therapeutic medication regimen

Lowering and controlling the blood pressure without adverse effects and without undue cost Explanation: The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells? The kidneys sense low oxygen levels in the blood and stimulate hemoglobin, stimulating the marrow to produce more red blood cells. The bone marrow is stimulated by low oxygen levels in the blood and stimulates erythropoietin, maturing the red blood cells. The brain senses low oxygen levels in the blood and stimulates hemoglobin, which binds to more red blood cells. The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells.

The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells. Explanation: If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (as with anemia), erythropoietin levels increase, stimulating the marrow to produce more erythrocytes (red blood cells).

The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is located? The exterior layer of the heart The heart's muscle fibers The inner lining of the heart and valves The thin fibrous sac encasing the heart

The thin fibrous sac encasing the heart Explanation: The heart is encased in a thin, fibrous sac called the pericardium, which is composed of two layers. Inflammation of this sac is known as pericarditis.

A nurse is preparing a teaching plan regarding biological tissue valve replacement. What is a disadvantage of this type of valve replacement? The valve has to be replaced frequently. The patient's infections are easier to treat. The patient must take lifelong anticoagulant therapy. There is a low incidence of thromboembolism.

The valve has to be replaced frequently. Explanation: Biological valves deteriorate and need to be replaced frequently. They do not necessitate accompanying anticoagulant therapy. Infections are easier to treat and the risk of thromboembolism is lower as compared with mechanical valves.

A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? Weighing the client daily at the same time each day Assessing the client's vital signs every 4 hours Measuring and recording fluid intake and output Checking the client's lungs for crackles during every shift

Weighing the client daily at the same time each day Explanation: Increased fluid volume leads to rapid weight gain — 2.2 lb (1 kg) for each liter of fluid retained. Weighing the client daily at the same time and in similar clothing provides more objective data than measuring fluid intake and output, which may be inaccurate because of omitted measurements such as insensible losses. Changes in vital signs are less reliable than daily weight because these changes usually are subtle during early stages of fluid retention. Weight gain is an earlier sign of excess fluid volume than crackles, which represent pulmonary edema. The nurse should plan to detect fluid accumulation before pulmonary edema occurs.

The nurse encourages the client diagnosed with hypertension to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain. help reduce the work required by the heart to resupply oxygen to the brain. help reduce the blood pressure to resupply oxygen to the brain. provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.

provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. Explanation: It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.

The nurse instructs a client with Raynaud phenomenon on actions to improve the symptoms. Which client statement indicates the need for additional instruction? "I will put on gloves before opening a cold car door." "I will avoid stressful situations." "I will wear gloves when taking food out of the freezer." "I will limit the amount of cigarettes I smoke."

"I will limit the amount of cigarettes I smoke." Explanation: Raynaud phenomenon is a form of intermittent arteriolar vasoconstriction that results in coldness, pain, and pallor of the fingertips or toes. Patients should avoid all forms of nicotine, which may induce attacks; this includes nicotine gum or patches used to aid smoking cessation. The client should be instructed to avoid situations that may be stressful as this could trigger an attack. Wearing gloves before opening a cold car door and when taking food out of the freezer should also be done as this could trigger vasoconstriction and an attack.

A client needs to have a cardiac valve replacement. The nurse offers client education about the procedures involved—including the benefits and risks. Which client statement indicates the need for more education? "Since the procedure is minimally invasive, there is less postoperative pain than with other techniques." "I'm anxious because I'll need to have cardiopulmonary bypass." "Since the procedure is minimally invasive, there is less surgical trauma." "I might lose some blood, but not likely a large quantity of it."

"I'm anxious because I'll need to have cardiopulmonary bypass." Explanation: Cardiopulmonary bypass is not normally required for valve replacement, though it is kept available as an option should the need arise. Minimally invasive techniques generally involve less pain, trauma, and blood loss than alternative techniques.

The nurse is teaching leg exercises to the client preoperatively. The client asks why the exercises are important. The best response by the nurse is: "Your intestinal tract slows down following surgery, and the exercises will help restore normal intestinal activity." "Leg exercises help prevent blood clots in your legs." "Clients are often on bed rest following surgery, and the exercises can help prevent pressure ulcers." "Leg exercises help prevent pneumonia while you are on bed rest."

"Leg exercises help prevent blood clots in your legs." Explanation: Leg exercises improve circulation of the lower extremities by preventing venous stasis, which can lead to deep vein thrombosis in the postoperative client.

A nurse assesses a client who is in cardiogenic shock. What statement best indicates the nurse's understanding of cardiogenic shock? A decrease of cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume. A decrease in cardiac output and evidence of inadequate circulating blood volume and movement of plasma into interstitial spaces. Generally caused by decreased blood volume. Due to severe hypersensitivity reaction resulting in massive systemic vasodilation.

A decrease of cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume. Explanation: Shock may have different causes (e.g., hypovolemic, cardiogenic, septic) but always involves a decrease in blood pressure and failure of the peripheral circulation because of sympathetic nervous system involvement. Option B could reflect dependent edema and sepsis. Option C reflects hypovolemia. Option D is reflective of anaphylactic or distributive shock.

A young female client has pale nailbeds. Her hemoglobin count is 10.2 gm/dL and her hematocrit count is 30%. She reports fatigue and states, "I'm tired all the time." The client also reports excessive menstrual flow. The nurse assesses further and determines the client's diet is balanced and provides adequate calories. The client is prescribed supplemental iron therapy. The highest nursing diagnosis is Altered nutrition: less than body requirements, related to inadequate intake of nutrients Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood Fatigue related to diminished oxygen-carrying capacity of the blood Deficient knowledge related to new information with no previous experience

Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood Explanation: All the nursing diagnoses are appropriate for this client who is experiencing anemia. Physiological needs take priority per Maslow's hierarchy of needs. Under physiological needs, airway, breathing, and then circulation take priority. Altered tissue perfusion would be classified under circulation, thus making it the priority over the other diagnoses listed.

An older adult seeks medical attention for a new onset of epigastric distress and bilateral arm pain. Which action will the nurse complete? Encourage the client to ambulate. Review the contents of the client's most recent meal. Assess cardiovascular function. Recommend taking an over-the-counter antacid.

Assess cardiovascular function. Explanation: Careful assessment of older adults is necessary because they often present with different symptoms than those seen in younger clients. Rather than the typical substernal chest pain associated with myocardial ischemia, older adults may report burning or sharp pain or discomfort in an area of the upper body. When a client reports symptoms related to digestion and breathing and upper extremity pain, cardiac disease must be considered. Because the absence of chest pain in an older client is not a reliable indicator of the absence of heart disease, the client should not be encouraged to ambulate or recommended to take an over-the-counter antacid. Time should not be wasted reviewing the contents of the client's most recent meal.

A client is postoperative following a graft reconstruction of the neck. What intervention is the most important for the nurse to complete with the client? Administer prescribed intravenous vancomycin at the correct time. Assess the graft for color and temperature. Reinforce the neck dressing when blood is present on the dressing. Cleanse around the drain using aseptic technique.

Assess the graft for color and temperature. Explanation: Assessing the graft for color and temperature addresses circulation and is most important for the nurse to complete. Reinforcing the neck dressing is important, but not the priority. Administering medication and cleansing the drain site are not most important interventions with the client after graft reconstruction of the neck.

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? Asystole Premature ventricular contraction Atrial flutter Ventricular fibrillation

Atrial flutter Explanation: Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart.

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? Avascular necrosis (AVN) Disseminated intravascular coagulation (DIC) Complex regional pain syndrome (CRPS) Fat embolism syndrome (FES)

Disseminated intravascular coagulation (DIC) Explanation: DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. AVN of the bone occurs when the bone loses its blood supply and dies. CRPS is a painful sympathetic nervous system problem. FES occurs when the fat globules released when the bone is fractured occludes the small blood vessels that supply the lungs, brain, kidneys, and other organs.

A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload? Supine with arms elevated on pillows above the level of the heart Head of the bed elevated 45 degrees and lower arms supported by pillows Prone with legs elevated on pillows Head of the bed elevated 30 degrees and legs elevated on pillows

Head of the bed elevated 45 degrees and lower arms supported by pillows Explanation: Preload refers to the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. The client is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the client may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the client's weight on the shoulder muscles.

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? Lung and arteries Brain and sympathetic nervous system Kidneys and autonomic nervous system Heart and blood vessels

Heart and blood vessels Explanation: Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP = CO (cardiac output) * PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels.

The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult? Exercise once a week. Sleep four hours each night. Keep weight stable. Add salt to foods for taste.

Keep weight stable. Explanation: Obesity can contribute to hypertension, so keeping weight stable is healthy. Salt can add to hypertension. The American Heart Association recommends exercising more than once a week for the older adult. Sleeping for four hours is not enough for rest.

Incomplete closure of the mitral valve results in backflow of blood from the: Right ventricle to the right atrium Left ventricle to left atrium Right atrium to right ventricle Left atrium to left ventricle

Left ventricle to left atrium Explanation: Incompetent closure of the mitral valve can result from disease processes that alter valve leaflets, mitral annulus, chordae tendineae, and the papillary muscle. When mitral valve leaflets thicken, fibrose, and contract, they cannot close completely during systole. This forces blood backward from the left ventricle into the left atrium during systole.

A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? History of increased aspirin use Recent pelvic surgery An active daily walking program A history of diabetes mellitus

Recent pelvic surgery Explanation: The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? Take the medication at the same time daily. Use a pillbox to store daily medication. Sit on the edge of the chair and rise slowly. Do not operate a motor vehicle.

Sit on the edge of the chair and rise slowly. Explanation: The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction, but not necessarily related to safety. When taking antihypertensive medications, there is no reason to restrict driving.

The client asked the nurse to describe Stage C heart failure. What is the best explanation by the nurse? a client who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity a client who reports symptoms of heart failure at rest and is a candidate for a heart transplant a client who reports no symptoms of heart failure at rest but has risk factors of heart disease a client who reports no symptoms of heart failure at rest but has a cardiac history and is taking medications

a client who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity Explanation: Once a patient has structural heart disease, the client has progressed from stage A to either stage B or stage C. The difference between B and C has to do with the presence of signs and symptoms of heart failure. When dyspnea and fatigue occur with exertion, heart failure Stage C is suspected. Stage D is a client with heart failure symptoms and maximal medical therapy.

The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse titrate to improve blood flow to vital organs? enalapril dopamine furosemide metoprolol

dopamine Explanation: Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock.

A client is brought into the ED with extensive traumatic injuries. The paramedic reports that the client has "shock." What are the etiologies of shock? Select all that apply. heart fails as effective pump blood volume decreases peripheral vascular dilation blunt force trauma nausea

heart fails as effective pump blood volume decreases peripheral vascular dilation Explanation: Shock is a life-threatening condition that occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. Shock develops as a consequence of one of three events: (1) blood volume decreases (2) the heart fails as an effective pump (3) peripheral blood vessels massively dilate

A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position? On the right side Trendelenburg High Fowler On the left side

keep the affected leg level or slightly dependent. Explanation: While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of pulmonary edema. myocardial infarction. pneumonia. pulmonary embolism.

pulmonary embolism. Explanation: Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction, whereby emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea.

The electrical conduction system of the heart has several components, all of which are instrumental in maintaining polarization, depolarization, and repolarization of cardiac tissue. Which of the conductive structures is known as the pacemaker of the heart? bundle of His bundle branches atrioventricular node sinoatrial node

sinoatrial node Explanation: The SA node is an area of nerve tissue located in the posterior wall of the right atrium. The SA node is called the pacemaker of the heart because it initiates the electrical impulses that cause the atria and ventricles to contract. When the impulse from the SA node reaches the AV node, it is delayed a few hundredths of a second. While the ventricles fill with blood, the impulse travels from the AV node to the bundle of His, to the right and left bundle branches, and eventually to the Purkinje fibers. Then, both ventricles contract. While the ventricles fill with blood, the impulse travels from the AV node to the bundle of His, to the right and left bundle branches, and eventually to the Purkinje fibers. Then, both ventricles contract.