Cardio

varicose veins

veins are dilated, tortuous veins of the lower extremities.

Endocarditis Streptococcal infection is a common cause of endocarditis

17-year-old female Symptoms: Acute streptococcal pharyngitis (i.e., strep throat), Peptic ulcer Which heart disease has this patient been diagnosed with? Pericarditis Endocarditis Neither

Endocarditis

2-week-old female Symptoms: Pulmonary artery stenosis, Infant respiratory distress syndrome (IRDS), Fever 103 Which heart disease has this patient been diagnosed with? Pericarditis Endocarditis Neither

Endocardium The endocardium is the innermost layer of the heart and covers the valves. The pericardium is the sac-like outer layer of the heart. The myocardium is the muscle layer of the heart. The tunica intima is the inner layer of blood vessels.

Which layer covers the heart valves? Endocardium Pericardium Myocardium Tunica intima

Pericarditis Hand, foot, and mouth disease is a coxsackie virus known to cause pericarditis

4 year old male, symptoms are: hand, foot, and mouth disease, Latex and food allergies Which heart disease has this patient been diagnosed with? Pericarditis Endocarditis Neither

LDL

Which lipoprotein is the main carrier of cholesterol? Very-low-density lipoprotein (VLDL) Intermediate-density lipoprotein (IDL) Low-density lipoprotein (LDL) High-density lipoprotein (HDL)

Pericarditis Rheumatoid arthritis (an autoimmune disease) and prior chest radiation make this patient susceptible to pericarditis

62-year-old female Symptoms: Rheumatoid arthritis, Diagnosed with breast cancer 2 years prior Which heart disease has this patient been diagnosed with? Pericarditis Endocarditis Neither

niether Hypertension and obesity do not directly cause peri/endocarditis

70-year-old male Symptoms: Lung cancer (recently diagnosed; untreated), Obese Which heart disease has this patient been diagnosed with? Pericarditis Endocarditis Neither

Scar tissue, Dead tissue, Weakened tissue

Which may occur from a myocardial infarction? Select all that apply. Scar tissue Dead tissue Regenerated tissue Weakened tissue

False

The type of cholesterol most harmful to health is HDL. FALSE TRUE

endothelial cells

cells form a continuous lining of the entire vascular system.

Oral and nasal piercing The patient had her tongue and nose pierced 6 weeks ago, which could facilitate infection leading to high fever. An underweight BMI, anorexia, and insufficiency are not causes of fever.

A 21-year-old female patient is admitted to the hospital with a temperature of 104°F, beginning 2 days ago. The patient complains of extreme fatigue. She had her tongue and nose pierced 6 weeks ago. A drug screen is negative. She presents with tricuspid insufficiency (regurgitation) murmur grade II. Her body mass index (BMI) is 18.2 and she has a history of anorexia. Which patient data are most likely related to the patient's fever? BMI of 18.2 Anorexia Oral and nasal piercing Tricuspid insufficiency

Vegetation on the tricuspid valve Rationale: An invading organism accumulates on the endocardium, usually on those with valves or areas that are deformed where the organism can 'stop and grow.' Infection sets in, causing clusters of platelets, fibrin, blood cells, and microorganisms that cluster and appear as vegetations on the valve. An echocardiogram may show a tricuspid valve not closing. Drug toxicity, cardiac tamponade, excessive fluid, and scar tissue are causes of inflammation of the tissue surrounding the outside of the heart rather than the valve covering.

A 21-year-old female patient is admitted to the hospital with a temperature of 104°F, beginning 2 days ago. The patient complains of extreme fatigue. She had her tongue and nose pierced 6 weeks ago. A drug screen is negative. She presents with tricuspid insufficiency (regurgitation) murmur grade II. Her body mass index (BMI) is 18.2 and she has a history of anorexia.What will an echocardiogram likely reveal? Cardiac tamponade Tricuspid valve not opening Scar tissue surrounding the myocardium Vegetation on the tricuspid valve

Endocarditis One of the most common causes of infectious endocarditis is infection. This infection most likely resulted from the oral and nasal piercing

A 21-year-old female patient is admitted to the hospital with a temperature of 104°F, beginning 2 days ago. The patient complains of extreme fatigue. She had her tongue and nose pierced 6 weeks ago. A drug screen is negative. She presents with tricuspid insufficiency (regurgitation) murmur grade II. Her body mass index (BMI) is 18.2 and she has a history of anorexia.Which inflammatory heart disease might this patient have? Endocarditis Pericarditis Myocarditis

Enlargement of the liver Rationale:With right ventricle function impaired, systemic venous congestion develops. Hepatomegaly due to liver congestion is often one of the first signs of systemic venous congestion in infants and children.

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

Venous insufficiency Rationale: The patient's symptoms indicate a leg venous disorder of vein pump, vein pressure, or a vein obstruction. Leg ulcers caused by arterial insufficiency or diabetes are usually located around the ankle or on the foot and surrounded by pale skin. No symptoms indicate respiratory insufficiency.

A patient complains of persistent leg cramps when at rest and has a leg ulcer at the medial malleoli surrounded by bluish-brown skin. The patient has hypertension. What is the cause of the leg ulcer? Arterial insufficiency Diabetes Venous insufficiency Respiratory insufficiency

Continue to monitor the patient. This patient is comfortable, not in distress, and has a blood pressure consistent with their baseline. Although this patient is hypotensive, they are stable, and the most appropriate action is continuing to monitor them.

A patient has a baseline blood pressure of 86/42 mm Hg and is resting comfortably in their room talking on their phone. Their current blood pressure is 84/42 mm Hg. What is the nurse's best course of action? Call a rapid response. Notify the provider. Continue to monitor the patient. Administer 500 mL intravenous bolus.

The patient is in systolic heart failure. An EF less than 40% indicates decreased cardiac output and pump failure, which means they have systolic heart failure. EF is preserved in diastolic heart failure. The heart is not optimally functioning, and the patient has already developed heart failure.

A patient has an ejection fraction (EF) of 35%. What does this indicate? The patient has an optimally functioning heart. The patient is in diastolic heart failure. The patient is in systolic heart failure. The patient is at risk for developing heart failure.

C. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours Rationale: Traumatic or prolonged (>10 minutes) cardiopulmonary resuscitation is a relative contraindication for the administration of fibrinolytic therapy.

A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which order should the nurse question? a. Oxygen at 4 L/min per nasal cannula b. Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved c. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours d. IV nitroglycerin at 5 mcg/minute and increase 5 mcg/minute every 3 to 5 minutes

Dobutamine Dobutamine is a medication used to improve contractility and is the drug of choice for cardiogenic shock. Dopamine, desmopressin, and diazepam are not indicated for improving contractility.

A patient is diagnosed with cardiogenic shock. Which medication will the RN expect to be prescribed? Dopamine Dobutamine Desmopressin Diazepam

Administration of blood products and intravenous fluids Hypovolemic shock requires blood products and/or fluids. Antibiotics are indicated for septic shock, and vitamin K and protamine sulfate are antidotes for warfarin and heparin. They will not help unless anticoagulants are the cause.

A patient is diagnosed with hypovolemic shock. What does the nurse anticipate being included in the plan of care? Administration of broad-spectrum antibiotics Administration of blood products and intravenous fluids Administration of vitamin K Administration of protamine sulfate

C. Blood pressure Afterload is affected by size of the ventricle, wall tension, and arterial blood pressure.

A patient is receiving a drug that decreases afterload. To evaluate the patient's response to this drug, what is most important for the nurse to assess? A. Heart rate B. Lung sounds C. Blood pressure D. Jugular venous distention

Diabetes, Viral infection Rationale:Diabetes complications (uremia) and viral infection (flu) can cause the symptoms of dyspnea and chest pain relieved by forward leaning and sitting. Atherosclerosis involves plaque buildup and wouldn't be relieved with repositioning. A friction rub (creaky or scratchy sound) is a symptom rather than a cause of heart inflammation. The prior treatment for prostate cancer is likely not a factor.

A 55-year-old patient presents to the emergency room with chest pain that worsens when lying down and with deep inspirations; it is relieved with forward leaning and sitting. A friction rub is heard most clearly at the left lower sternal border. The patient reported having recent flu symptoms. They have a history of type 2 diabetes mellitus and treatment for prostate cancer 2 years prior. A 12-lead echocardiogram (ECG) shows ST-segment elevation in all leads. Myocardial infarction is ruled out, and the patient is diagnosed with pericarditis.Which are likely causes of this patient's condition? Select all that apply. Diabetes Atherosclerosis Viral infection Friction rub

"This medication will improve your survival and symptoms of heart failure." Beta blockers improve symptoms of heart failure and extend survival. Beta blockers lower heart rates and help do more than managing symptoms. Diuretics may be used to get rid of extra fluid in the body.

A nurse is administering a beta blocker to a patient who has heart failure. Which statement may be part of the nurse's patient education? "This medication will help your heart beat faster." "This medication will help your symptoms only." "This medication will improve your survival and symptoms of heart failure." "This medication helps get rid of the extra fluid in your body."

4 Rationale: ST elevation on ECG indicates myocardial ischemia or injury with partial or total occlusion of a coronary artery. This assessment finding requires immediate action.

A patient returns to the cardiac observation area following a cardiac catheterization with coronary angiography. Which of the following assessments would require immediate action by the nurse? 1. Pedal pulses are 2+ bilaterally. 2. Apical pulse is 54 beats/minute. 3. Mean arterial pressure is 72 mm Hg. 4. ST-segment elevation develops on the ECG.

C. Pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain Rationale:Right-sided failure is associated with peripheral edema, fatigue, and occasionally upper right quadrant pain. Abdominal distention can occur with right-sided failure when the liver becomes engorged. Facial edema, pulmonary edema, peripheral cyanosis, low urine output, and low blood pressure are not associated with right-sided failure. Left-sided failure is primarily associated with pulmonary signs and symptoms like dyspnea, pulmonary edema, frothy pink sputum, and respiratory congestion.

A nurse will be providing care for a patient who has a diagnosis of heart failure characterized as primarily right-sided. Which description of the patient's presentation would the nurse anticipate? a. Distended bladder, facial edema, and nighttime difficulty breathing b. Dyspnea and adventitious breath sounds on auscultation c. Pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain d. Cyanotic lips and extremities, low urine output, and low blood pressure

Dyspnea and bilateral crackles Rationale:Although it may preserve the resting cardiac output, the resulting chronic elevation of left ventricular end-diastolic pressure is transmitted to the atria and the pulmonary circulation, causing pulmonary congestion which manifests in dyspnea and bilateral crackles. Skin discoloration or hemorrhaging is not a sign of left-sided heart failure. Increased urinary output is not a sign of left-sided failure. The patient would have decreased urinary output.

A nurse working in the intensive care unit (ICU) knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which clinical manifestation(s)? Increased urinary output Dyspnea and bilateral crackles Petechia and spontaneous bleeding Muscle cramping and cyanosis in the feet

A. Troponin Troponin is the biomarker of choice in the diagnosis of myocardial infarction. Troponin is a myocardial muscle protein released into the circulation after injury.

A patient arrives at an urgent care center after experiencing unrelenting substernal and epigastric pain and pressure for about 12 hours. The nurse reviews laboratory results with the understanding that at this point in time, a myocardial infarction would by indicated by peak levels of a. Troponin T. b. Homocysteine. c. Creatine kinase-MB. d. Type b natriuretic peptide.

Temporal

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

B. Rationale: The patient is experiencing acute decompensated heart failure with symptoms of both right- and left-sided heart failure. Left-sided heart failure prevents normal, forward blood flow and causes pulmonary congestion. Right-sided heart failure causes a backup of blood and results in venous congestion.

A patient with a history of chronic heart failure is hospitalized with severe dyspnea and a dry, hacking cough. Assessment findings include pitting edema in both ankles, blood pressure 170/100 mm Hg, pulse 92 beats/minute, and respirations 28 breaths/minute. Which explanation, if made by the nurse, is most accurate? a."The assessment indicates that venous return to the heart is impaired, causing a decrease in cardiac output." b."The manifestations indicate impaired emptying of both the right and left ventricles, with decreased forward blood flow." c."The myocardium is not receiving enough blood supply through the coronary arteries to meet its oxygen demand." d."The patient's right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation."

B. Rationale: Left-sided heart failure will prevent normal blood flow and will cause blood to back up into the left atrium and into the pulmonary veins. The increased pulmonary pressure causes fluid extravasation from the pulmonary capillary bed into the interstitium and then the alveoli, which manifests as pulmonary congestion and edema. The most important assessment to determine if the drugs are improving the patient's condition is to auscultate lung sounds. The other assessments are important, but the best indicator of improvement of left ventricular function is a reduction in adventitious lung sounds (crackles).

A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient's response to these drugs? a. Observe skin turgor b. Auscultate lung sounds c. Measure blood pressure d. Review intake and output

A. Risk for injury related to decreased sensation. Rationale: Peripheral neuropathy is caused by diminished perfusion to neurons and results in loss of both pressure and deep pain sensations. The patient may not notice lower extremity injuries. Neuropathy increases susceptibility to traumatic injury and results in delay in seeking treatment.

A patient with peripheral artery disease has marked peripheral neuropathy. An appropriate nursing diagnosis for the patient is: a. Risk for injury related to decreased sensation. b. Impaired skin integrity related to decreased peripheral circulation. c. Ineffective peripheral tissue perfusion related to decreased arterial blood flow. d. Activity intolerance related to imbalance between oxygen supply and demand.

3. The patient not adhering to therapy Side effects of antihypertensive drugs are common and may be so severe or undesirable that the patient does not comply with therapy.

A patient's blood pressure has not responded consistently to prescribed drugs for hypertension. The first cause of this lack of responsiveness the nurse should explore is 1. Progressive target organ damage. 2. The possibility of drug interactions. 3. The patient not adhering to therapy. 4. The patient's possible use of recreational drugs.

A patient with a STEMI who reports severe left arm pain.

An emergency department nurse is admitting four patients. Which patient is a candidate for immediate percutaneous coronary intervention (PCI)? A patient with a NSTEMI who needs a heparin infusion. A patient with coronary artery disease who is anxious. A patient with chest pain who ran out of nitroglycerin at home. A patient with a STEMI who reports severe left arm pain.

"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."

An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate? "If you slow down and rest more, your blood pressure will more than likely return to its normal level." "Your heart has to work harder to pump blood through your vessels as you get older." "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." "Everyone over the age of 50 tends to have their blood pressure creep up over the years."

False

Aortic dissection involves a "ballooning out" of a section of blood vessel wall. TRUE FALSE

False

Blood flow that has been lost as a result of myocardial infarction cannot be reestablished. FALSE TRUE

cardiac tamponade

Cardiac ___ is characterized by compression of the heart because of the accumulation of fluid, pus, or blood in the pericardial sac.

True

Cholesterol is dependent on other particles for its transport through the body. FALSE TRUE

Cyanotic

Congenital defects that result in shunting of blood from the right side of the heart to the left are known as ___ disorders.

ischemic

Coronary artery disease is often subdivided into chronic ___ heart disease and acute coronary syndrome.

Left-sided heart failure

Which type of heart failure is more common? Right or Left sided heart failure?

pulmonary embolism

Deep vein thrombosis constitutes an increased risk of ___ embolism.

True

Deep vein thrombosis most commonly occurs in the lower legs. FALSE TRUE

Hypertension is a frequent modifiable contributor to aneurysms. Rationale: Hypertension is associated with more than half of aneurysms. They are not related to diabetes, and while some are asymptomatic in early stages, this is not necessarily the norm and does not necessarily culminate in a rupture. Aneurysms normally require surgical repair.

During a routine physical examination of a 66-year-old patient, the nurse practitioner notes a pulsating abdominal mass and refers the patient for further treatment. The nurse practitioner is educating the patient about aneurysms. Which pathophysiologic aspect of aneurysm would support the patient teaching? a. Aneurysms are commonly a result of poorly controlled diabetes mellitus. b. Hypertension is a frequent modifiable contributor to aneurysms. c. Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. d. Aneurysms can normally be resolved with lifestyle and diet modifications.

Cerebral or pulmonary emboli Rationale: When a mural thrombus is dislodged from a myocardial injury site, it may travel to the brain or lungs and form an embolus (blood clot), where it can completely restrict blood flow. Extension of the original infarction would result from additional localized hypoxia. Ventricular aneurysms result from weakened tissue in the ventricular wall. Restlessness is a symptom of an impending myocardial infarction.

Dislodging of mural thrombi may result in which condition? Extension of the original infarction Cerebral or pulmonary emboli Ventricular aneurysms Restlessness

Increased cardiac output and vascular resistance Rationale: Essential hypertension is caused by increases in cardiac output, total peripheral resistance, or both. Pulmonary hypertension results from reduced blood oxygen. Hypertension causes damage to endothelial cells of blood vessels, rather than resulting from it. Blood clotting does not occur during the development of hypertension.

Essential hypertension is a result of what? Reduced oxygen in the bloodstream Intra-arterial pressure damaging the blood vessel Blood clotting around damaged endothelial cells Increased cardiac output and vascular resistance

blood clot

Formation of ___ from an artery rupture is the greatest risk posed by an aneurysm.

Increased blood volume

Increased sodium and water in the blood results in what? Renin production Arteriolar constriction Rapid blood flow Increased blood volume

True

More people die of cardiovascular disease than of any other pathology in the United States each year. TRUE FALSE

False

Most aneurysms are located in the venous components of the circulatory system. FALSE TRUE

Frank-Starling mechanism, Sympathetic nervous system

Of the following compensatory mechanisms, which two are the first to respond when the heart stops meeting the metabolic needs of the body? Frank-Starling mechanism Sympathetic nervous system Renin-angiotensin-aldosterone Natriuretic peptides Myocardial hypertrophy

Endocarditis Oral lesions and contaminated needles can introduce bacteria into the bloodstream, producing conditions for endocarditis

Patient 1: 28 year old male Symptoms: Untreated tooth abscess, history of intravenous drug use Which heart disease has this patient been diagnosed with? Pericarditis Endocarditis Neither

False

Septic shock is far less common in the past, given advances in prevention and treatment. TRUE FALSE

True

The body is able to initiate numerous mechanisms that can compensate for heart failure. FALSE TRUE

Cholesterol

The greatest risk factor for the development of atherosclerosis is high ___

Vasculitides

The group of vascular disorders that are marked by blood vessel necrosis and inflammatory injury is the

B. Rationale: Administration of furosemide increases excretion of potassium and may cause hypokalemia. The risk for digitalis toxicity increases if potassium levels are below normal and digoxin is administered. Signs and symptoms of digitalis toxicity include anorexia, nausea and vomiting, visual disturbances (such as "yellow" vision), and dysrhythmias.

The home care nurse visits a patient with chronic heart failure who is taking digoxin (Lanoxin) and furosemide (Lasix). The patient complains of nausea and vomiting. Which action is most appropriate for the nurse to take? a. Perform a dipstick urine test for protein. b. Notify the health care provider immediately. c. Have the patient eat foods high in potassium. d. Ask the patient to record a weight every morning.

True

The key components of the blood work used to diagnose myocardial infarction are the troponin assays. TRUE FALSE

Kidneys

The lungs, GI system, and ____ are most susceptible to damage as a result of shock.

B. Rapid institution of emergency services and procedures. Rationale: Rapid cardiopulmonary resuscitation and prompt defibrillation (with an automated external defibrillator) and early advanced cardiac life support can produce high long-term survival rates for a witnessed arrest.

The most significant factor in long-term survival of a patient with sudden cardiac death is a. Absence of underlying heart disease. b. Rapid institution of emergency services and procedures. c. Performance of perfect technique in resuscitation procedures. d. Maintenance of 50% of normal cardiac output during resuscitation efforts.

B, C, & D Rationale: Stage 2 hypertension is diagnosed when systolic blood pressure is greater than or equal to 160mm Hg, or diastolic blood pressure is greater than or equal to 100 mm Hg.

The nurse determines that the patient has stage 2 hypertension when the patient's average blood pressure is a. 155/88 mm Hg. b. 172/92 mm Hg. c. 160/110 mm Hg. d. 182/106 mm Hg.

4

The nurse determines that which of the following blood pressures would meet the criteria for a diagnosis of stage 2 hypertension? 1. 152/98 mm Hg 2. 118/84 mm Hg 3. 106/62 mm Hg 4.182/94 mm Hg

B. "Your family members should learn how to perform CPR and practice these skills regularly." Rationale: Rapid cardiopulmonary resuscitation, prompt defibrillation (with an automated external defibrillator), and early advanced cardiac life support can produce high long-term survival rates for a witnessed arrest.

The nurse is caring for a patient who survived a sudden cardiac death. What should the nurse include in the discharge instructions? a."Because you responded well to CPR, you will not need an implanted defibrillator." b."Your family members should learn how to perform CPR and practice these skills regularly." c."The most common way to prevent another arrest is to take your prescribed drugs." d."Since there was no evidence of a heart attack, you do not need to worry about another episode."

Unknown

The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is: Pheochromocytoma Hyperaldosteronism Unknown Decreased renal blood flow

- 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 Rationale: 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.

The nurse recognizes that which statements are true of the changes in blood flow through the systemic circulation? Select all that apply. Arterial compliance (pulsatile flow) as vessels expand and contract Venous high pressure flow back to heart Intermittent flow from the heart as it contracts and relaxes Pulsatile flow through capillaries Arteriolar resistance converts to steady flow

1.

The nurse takes blood pressures at a health fair. The nurse identifies which person as most at risk for developing hypertension? 1. A 52-year-old male who smokes and has a parent with hypertension 2. A 30-year-old female advertising agent who is unmarried and lives alone 3. A 68-year-old male who uses herbal remedies to treat an enlarged prostate gland 4. A 43-year-old female who travels extensively for work and exercises only on weekends

b. "I should cut back on my walks if it causes pain in my legs." Rationale: Patients should be taught to exercise to the point of discomfort, stop and rest, and then resume walking until the discomfort recurs. Smoking cessation and proper foot care are also important interventions for patients with peripheral arterial disease.

The nurse teaches a patient with peripheral arterial disease. The nurse determines that further teaching is needed if the patient makes which statement? a. "I should not use heating pads to warm my feet." b. "I should cut back on my walks if it causes pain in my legs." c. "I will examine my feet every day for any sores or red areas." d. "I can quit smoking if I use nicotine gum and a support group."

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

The student attends a health fair and has his serum cholesterol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol? It transports cholesterol away from cells to the liver for excretion. It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. It is associated with a low intake of saturated fats. It has a low cholesterol content.

False

True or false: Cardiogenic shock causes pulmonary edema. TRUE FALSE

True Rationale: It is accurate that most aortic aneurysms are discovered without the patient experiencing any prior symptoms.

True or false: Most aortic aneurysms are discovered with no prior symptoms. TRUE FALSE

FALSE Rationale: The organ that secretes renin is the kidney.

True or false: Reduction of blood flow to the kidneys causes the liver to secrete renin. TRUE FALSE

True

True or false: With systolic heart failure, an insufficient amount of blood gets pumped out for systemic circulation, eventually causing backup into the pulmonary circulation. TRUE FALSE

B. Rationale: An elevated blood pressure and cigarette smoking (causes vasoconstriction) increase the rate of atherosclerosis. Atherosclerosis increases the workload of the heart and increases myocardial oxygen demand.

Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are a. Obesity and smokeless tobacco use. b. Hypertension and cigarette smoking. c. Elevated serum lipids and diabetes mellitus. d. Physical inactivity and elevated homocysteine levels.

Essential hypertension

Type of HTN: Primary or idiopathic hypertension, it involves several interacting homeostatic mechanisms

Secondary hypertension

Types of HTN: Related to a systemic disease that raises peripheral vascular resistance or cardiac output.

Malignant hypertension

Types of HTN: Severe, fulminant form of the disorder

The patient's left side of the heart is affected.

Upon assessment, the nurse notes a patient has crackles and dyspnea. What does this indicate? The patient's right side of the heart is affected. The patient's left side of the heart is affected. The patient has systolic heart failure. The patient has diastolic heart failure.

Zone of injury, zone of ischemia, zone of necrosis

What are the three areas of damage in a myocardial infarction?

Blood is being shunted to vital organs to maintain nearly normal vital signs. During the compensatory stage of shock, the sympathetic nervous system is stimulated, and the body experiences the fight-or-flight response. The body shunts blood to vital organs, including the heart, brain, and lungs. Blood pressure and heart rate may be normal or show subtle changes. Organs fail during the irreversible stage. The heart is unable to meet oxygen demands during the progressive stage. The patient is asymptomatic with basic cellular changes during the initial stage.

What is happening in the compensatory stage of shock? The organs are failing and death is imminent. The heart is unable to meet oxygen demands. Blood is being shunted to vital organs to maintain nearly normal vital signs. The patient is asymptomatic but basic cellular changes have started.

Headache

What is not a symptom of myocardial infarction (MI)? Shortness of breath Heartburn Headache Nausea

Right atrium, tricuspid valve, right ventricle, pulmonic valve pulmonary, artery left ventricle, aortic valve, aorta

What is the blood flow of the heart?

Ischemic death of myocardial tissue Rationale: Myocardial infarction is the death of myocardial tissue. The invasion of the endocardium by pathogens that produce vegetative lesions on the endocardial surface refers to a disease process of the endocardium. An accelerated form of angina that is caused by subtotal or intermittent coronary occlusion is the definition of Prinzmetal angina. A progressive arterial disease characterized by the formation of fibrofatty plaques is the definition of atherosclerosis.

What is the definition of myocardial infarction? a. The invasion of the endocardium by pathogens that produce vegetative lesions on the endocardial surface b. Accelerated form of angina that is caused by subtotal or intermittent coronary occlusion c. Ischemic death of myocardial tissue d. A progressive arterial disease characterized by the formation of fibrofatty plaques

Ensure the patient is safe. Ensuring safety is the first priority since hypotension can put a patient at risk for falls. The nurse should make sure the patient is lying down and out of harm's way before proceeding with other interventions.

What is the first intervention when working with a patient who is hypotensive? Administer intravenous fluids. Identify the underlying cause. Ensure the patient is safe. Apply oxygen via nasal cannula at 2 L/min.

Aspirin, oxygen, morphine, nitroglycerin

What is the initial treatment for a patient experiencing myocardial infarction (MI)? Metoprolol, aspirin, oxygen, statin Clopidogrel, oxygen, nitroglycerin, magnesium Aspirin, oxygen, morphine, nitroglycerin Heparin, oxygen, intravenous fluids, statin

Coronary artery disease

What is the main cause of myocardial infarction (MI)? Coronary artery disease Vasospasm Cocaine ingestion Severe anemia

Intramuscularly

What is the preferred route to administer epinephrine during anaphylactic shock? Subcutaneously Orally Intramuscularly Intravenously

Conversion of angiotensinogen to angiotensin I Rationale: When an abnormal amount of renin is released in the bloodstream, the liver converts angiotensinogen to angiotensin I.

What results from the abnormal production of renin? Increased sodium in the bloodstream Conversion of angiotensinogen to angiotensin I Lung constriction Pulmonary dilation

Blood pressure 74/42 mm Hg and heart rate 48 bpm A patient in neurogenic shock is expected to be hypotensive and hypovolemic due to the unopposed parasympathetic nervous system. Their blood pressure would be low, as in a reading of 74/42 mm Hg, and their heart rate would also be low, as in a reading of 48 bpm.

Which are anticipated vital signs for a patient with neurogenic shock? Blood pressure 84/67 mm Hg and heart rate 112 bpm Blood pressure 120/80 mm Hg and heart rate 80 bpm Blood pressure 188/101 mm Hg and heart rate 125 bpm Blood pressure 74/42 mm Hg and heart rate 48 bpm

Pain when walking, Pallor, Gangrene Rationale: Arterial disease manifestations are related to decreased oxygen supply and an include pain when walking, pallor, and gangrene.

Which are clinical manifestations of arterial disease? (Select all that apply.) Dull, aching pain Pain when walking Pallor Gangrene Edema

Dull, aching pain, Edema

Which are clinical manifestations of venous disease? (Select all that apply.) Dull, aching pain Pain when walking Pallor Gangrene Edema

Viral, Bacteria Viruses and bacteria are the two most common causes of inflammatory heart diseases. Fibrosarcoma is a disease related to connective tissue. Cysts are not related to inflammatory heart disease.

Which are etiologies of inflammatory heart diseases? (Select all that apply.) Viral Bacteria Fibrosarcoma Cysts

Diminished pulse in the legs and feet, Discoloration

Which are symptoms of peripheral venous disease? Select all that apply. Numbness Intermittent claudication Diminished pulse in the legs and feet Discoloration

Pericardium, Myocardium, Endocardium

Which areas of the heart might a myocardial infarction affect? Select all that apply. Pericardium Myocardium Endocardium

D. Volume of blood ejected from the ventricle with each contraction

Which best describes stroke volume? a. The force that the contracting heart muscle must generate to eject blood from the ventricles b. Contractile performance of the heart c. Volume of blood that stretches the ventricle at end diastole d. Volume of blood ejected from the ventricle with each contraction

86/42 mm Hg

Which blood pressure reading is considered hypotensive? 174/94 mm Hg 102/76 mm Hg 94/56 mm Hg 86/42 mm Hg

Troponin

Which cardiac enzyme is the most cardiac specific? Myoglobin Creatine kinase Troponin Lactate

Stroke, Heart attack Rationale: Aortic dissection causes sudden chest pain, sometimes referred to as a tearing sensation similar to a heart attack. It also can present as numbness in one limb like a stroke. Diabetes does cause not acute pain. Atherosclerosis causes hypertension but not chest pain.

Which conditions have symptoms similar to an aortic dissection? Select all that apply. Stroke Heart attack Diabetes Atherosclerosis

SA node, AV node, bundle of His, right bundle branch, left bundle branch, Purkinje fibers

Which describes the normal progression of the electrical conduction system of the heart? a. Bundle of His, right bundle branch, left bundle branch, Purkinje fibers b. SA node, AV node, bundle of His, right bundle branch, left bundle branch, Purkinje fibers c. SA node, Purkinje fibers, right bundle branch, bundle of His, left bundle branch AV node d. AV node, SA node, bundle of His, left bundle branch, Purkinje fibers

The force that the contracting heart muscle must generate to eject blood from the ventricles

Which description best defines afterload? a. The force that the contracting heart muscle must generate to eject blood from the ventricles b. Contractile performance of the heart c. Volume of blood that stretches the ventricle at end diastole d. Volume of blood ejected from the ventricle with each contraction

Contractile performance of the heart

Which description defines myocardial contractility? a. The force that the contracting heart muscle must generate to eject blood from the ventricles b. Contractile performance of the heart c. Volume of blood that stretches the ventricle at end diastole d. Volume of blood ejected from the ventricle with each contraction

Angiotensin I conversion to angiotensin II

Which event causes vessel constriction? Angiotensin I conversion to angiotensin II Aldosterone secretion in the bloodstream Increased blood volume Peripheral vascular resistance

Dizziness

Which is a symptom of hypotension? Increased energy Polyuria Dizziness Dilated pupils

Activation of the sympathetic nervous system Rationale: Activating the sympathetic nervous system would increase blood pressure and heart rate rather than decreasing blood pressure. A vagal response, shock, and hypovolemia would all cause low blood pressure.

Which is not a cause of hypotension? Activation of the sympathetic nervous system Vagal response Shock Hypovolemia

Hypothyroidism Hypothyroidism is not a cause of heart failure. CAD, MI, and hypertension can all lead to heart failure.

Which is not a common cause of heart failure? Coronary artery disease (CAD) Myocardial infarction (MI) Hypertension Hypothyroidism

Pericardium The pericardium is the sac-like outer layer of the heart. The heart is covered by the pericardium. The endocardium is the inner most layer of the heart. The myocardium is the muscle layer of the heart. The tunica intima is the inner layer of blood vessels.

Which is the outer sac-like layer of the heart? Endocardium Pericardium Myocardium Tunica intima

Secondary Rationale: Secondary hypertension is defined as hypertension that is related to another disease process. In essential, or primary, hypertension, blood pressure is elevated in the without evidence of a separate disease process. Uncontrolled hypertension refers to a treatment state, not a cause.

Which of the term describes hypertension caused by another disease process? Essential Primary Secondary Uncontrolled

Kidneys Rationale: Aldosterone is originally secreted in the lungs and then passed along by the kidneys into the bloodstream causing water and sodium retention.

Which organ passes along aldosterone causing water and sodium retention? Kidneys Heart Liver Lungs

A 66-year-old client back pain and neck vein distention Rationale: Back pain and neck vein distention are associated with abdominal aortic aneurysms. Low red cells, pulmonary edema, and cognitive changes are not associated with abdominal aortic aneurysms.

Which patient is at the greatest risk for aortic aneurysm? A 60-year-old client with diminished oxygen saturation, low red blood cell levels, and pallor A 70-year-old client with jugular venous distention, shortness of breath, and pulmonary edema A 66-year-old client back pain and neck vein distention An 81-year-old client with acute cognitive changes as well as difficulty in speaking and swallowing

A. Rationale: The four major modifiable risk factors for coronary artery disease are elevated serum lipids, hypertension, tobacco use, and physical inactivity. Other risk factors include diabetes mellitus, metabolic syndrome, psychologic states, high levels of homocysteine, and substance abuse.

Which patient is most at risk for developing coronary artery disease? a. A hypertensive patient who smokes cigarettes b. An overweight patient who uses smokeless tobacco c. A patient who has diabetes and uses methamphetamines d. A sedentary patient who has elevated homocysteine levels

Brain natriuretic peptide (BNP) Rationale:A BNP level over 100 suggests heart failure. BUN is not specific to heart failure, and blood pressure and cardiac catheterization are not serum lab values.

Which serum lab value can assist in diagnosing heart failure? Brain natriuretic peptide (BNP) Blood urea nitrogen (BUN) Blood pressure Cardiac catheterization

The amount of blood the heart must pump with each beat

Which statement defines preload? a. The force that the contracting heart muscle must generate to eject blood from the ventricles b. The amount of blood the heart must pump with each beat c. Volume of blood that stretches the ventricle at end diastole d. Volume of blood ejected from the ventricle with each contraction

Pain with walking, Hairlessness of leg skin, Pallor of leg skin Rationale: Pain associated with peripheral arterial disease increases with walking because of the increased demand for oxygen. Pale, hairless, and shiny skin is a result of ischemia. Edema is symptomatic of peripheral venous disease.

Which symptoms indicate peripheral arterial disease? Select all that apply. Pain with walking Hairlessness of leg skin Pallor of leg skin Edema

Aneurysm

Which term describes a pathologic outpouching or sac-like dilation of an artery caused by the weakness of the vessel wall? Dissection Aneurysm Fusiform Infarction

Dissection

Which term describes a tearing of the vessel wall with developing blood chamber? Dissection Aneurysm Fusiform Infarction

Dissection

Which term describes the life-threatening splitting or rupture of an aneurysm? Dissection Necrosis Fusiform Infarction

Aortic artery Rationale: The aortic artery has no supporting tissue, making it prone to weakness and aneurysms.

Which type of blood vessel is prone to aneurysms because of lack of supporting tissue? Femoral artery Carotid artery Aortic artery Pulmonary artery

Peripheral venous disease, Peripheral arterial disease Rationale: The vascular system consists of arteries and veins; therefore, peripheral vascular disease must include both peripheral venous disease and peripheral arterial disease.

Which types of disease make up vascular disease? (Select all that apply.) Systemic arterial disease Peripheral venous disease Systemic venous disease Peripheral arterial disease

A

While performing blood pressure screening at a health fair, the nurse counsels which person as having the greatest risk for developing hypertension? a. A 56-year-old man whose father died at age 62 from a stroke b. A 3o-year-old female advertising agent who is unmarried and lives alone c. A 68-year-old man who uses herbal remedies to treat his enlarged prostate gland d. A 43-year-old man who travels extensively with his job and exercises only on weekends

Hypovelemic shock

_____shock results from acute blood loss.