Chapter 22: Cardio and Lymphatic system
Which information indicates the nurse has a correct understanding about direct end-effects of the renin-angiotensin-aldosterone system? Select all that apply.
Angiotensin II causes vasoconstriction (not vasodilation) and aldosterone secretion. The resultant increase (not decrease) in total peripheral resistance and sodium retention restores blood pressure. Volume repletion is a direct end-effect; it is not suppressed.
LIFESTYLE mnemonic
LIMIT salt, caffeine, etoh. INCLUDE K+ & Ca. FIGHT fat & cholesterol. EXERCISE regularly. STAY on your BP regimen. TRY to quit smoking. YOUR medications are to be taken daily. LOSE weight. END STAGE complications will be avoided.
A nurse is asked by a client what is in lymph. How should the nurse respond?
Lymph consists primarily of water and small amounts of dissolved proteins, mostly albumin, that are too large to be reabsorbed into the less permeable blood capillaries. Serotonin, sodium, potassium, blood, and white blood cells are not in lymph.
A nurse is teaching a client about the valves in the heart. Which area (see diagram) should the nurse choose to illustrate the mitral valve?
The left mitral valve has two cusps (leaflets), while the right tricuspid valve has three. The aortic and pulmonic are semilunar valves and connect the atria to the ventricles.
Which information from the client indicates teaching by the nurse was successful about the purpose of valves in veins?
Valves in veins regulate one-way flow of blood toward, not away from, the heart. Heart valves regulate the one-way flow of blood in the heart. Valves in veins do not regulate blood flow around the heart.
Which function of a client's endothelium stimulates vascular constriction through production of endothelin and angiotensin II?
Vasomotion stimulates vascular constriction through production of endothelin and angiotensin II. The clotting function of the endothelium stimulates or prevents clotting depending upon factor production. Inflammation allows expression of adhesion molecules, or expression of receptors, allowing for diapedesis, or entrance of oxidized lipoproteins, respectively. Filtration and permeability facilitate transport of molecules.
A nurse is teaching a client about ventricular contractions during the cardiac cycle. Which information should the nurse include?
Ventricular contraction is a step in the cardiac cycle during which blood is propelled out of the ventricles and into circulation. This is also termed systole. The cycle begins during relaxation; blood fills the ventricles, which is termed diastole. The ventricle fills rapidly during early and late diastole. Systole comes next. Contraction of the left ventricle is slightly earlier than that of the right.
A nurse hears in report that the team will be caring for a client with a low ejection fraction. The nurse will be caring for which client?
A decrease in ejection fraction is a hallmark of ventricular failure. Deep vein thrombosis does not affect ejection fraction; it is a venous problem. A client with increased heart contractility and a client with an overactive sympathetic nervous system will tend to have increased, not decreased, ejection fraction.
A client has a drop in cardiac output. Which assessment findings does the nurse expect to observe?
A decrease in the cardiac output causes an immediate drop in the mean arterial blood pressure and arteriolar flow. An increase in cardiac output without a decrease in peripheral resistance will cause both arterial volume and arterial pressure to increase. Overall, the renin-angiotensin system is activated after volume depletion or hypotension (decreased cardiac output) and is suppressed after volume repletion.
Which statement by the nurse indicates an understanding of the vascular protection property of insulin?
A protective property of insulin includes the decrease of levels of C-reactive protein. The protective property of insulin causes an increase in the following: endothelial cell production of nitric oxide, endogenous anticoagulant plasminogen activator inhibitor, and acetylcholine-mediated vasodilation; it does not decrease these functions.
When a client releases atrial natriuretic peptide (ANP), the nurse expects which effects to occur?
ANP decreases blood volume and blood pressure by increasing sodium loss, which leads to a large volume of dilute urine. ANP does not increase the blood pressure or the blood volume.
When a client's body converts angiotensin I to angiotensin II, the nurse expects which effect to occur?
Angiotensin II is a potent vasoconstrictor, not a dilator, and causes the stimulation of aldosterone. Aldosterone causes reabsorption of the sodium from the kidneys, not excretion.
What term should the nurse use when describing arginine vasopressin to a client? Correct 3 Antidiuretic hormone
Another name for antidiuretic hormone is arginine vasopressin. Atrial natriuretic peptide, angiotensin, and aldosterone are not other names for vasopressin.
What should the nurse monitor to determine a client's afterload?
Aortic systolic pressure is a good index of afterload. Temperature can help determine infectious processes, not afterload. Electrolyte tests can help determine fluid and electrolyte levels, not afterload. Arterial blood gases help determine pH of the blood.
A nurse teaches the staff about arterial vessels. Which information from the staff indicates teaching was effective?
Arterial walls are composed of elastic connective tissue, fibrous connective tissue, and smooth muscle. Capillaries are small but are very numerous—their total surface area may exceed 100 football fields. An artery becomes an arteriole when the diameter of the lumen is less than 0.5 mm, not 1 mm. Muscular arteries do have more muscle fibers than elastic arteries, and it is because they need less stretch and recoil, not more.
A client has an increase in blood volume. Which hormone does the nurse expect the client's body to release?
Atrial natriuretic peptide is released from atrial tissue in response to increases in blood volume. Epinephrine and norepinephrine are catecholamines and part of the sympathetic system; they increase the heart rate and contractility. Thyroid hormone enhances sympathetic activity.
secondary hypertension
BP has a known cause and when cause is treated BP would return to normal.
Which information indicates the client needs more teaching about the lymph system?
Because the lymph system is not pumped, the client needs more instruction to correct the misinformation. In this pumpless system, a series of valves ensures one-way flow of the excess interstitial fluid (now called lymph) toward the heart. The lymphatic veins are thin walled like the veins of the cardiovascular system. The lymphatic capillaries are closed at the ends.
Which information indicates the client needs more teaching about the lymph system? The lymph system is pumped through the body to the heart
Because the lymph system is not pumped, the client needs more instruction to correct the misinformation. In this pumpless system, a series of valves ensures one-way flow of the excess interstitial fluid (now called lymph) toward the heart. The lymphatic veins are thin walled like the veins of the cardiovascular system. The lymphatic capillaries are closed at the ends.
Combined Alpha & Beta Blockers Actions and Side Effects
Block alpha adrenergic receptor & decrease sympathetic nervous system response. SE: dizzienss, NVD, tinnitus, bradycardia, postural hypotension. Drugs: Carvidilol / Coreg, Normodyne
Angiotensin II Receptor Antagonists: Action and Side Effects
Block antiotensin II receptors. SE: dizziness, insomnia, diarrhea, cough. Drugs: valsartan (Diovan), losartan (Cozaar)
a nurse observes that a client's blood pressure is 110/70. Which factor is the major determinant of the client's diastolic blood pressure? Ventricular filling
Blood pressure during ventricular filling or diastole is diastolic blood pressure. Blood pressure during ventricular contraction is systolic pressure. The end-diastolic volume is determined by the amount of blood returned to the heart between contractions and is typically called the heart's preload. Heart rate is the number of times the heart contracts within a 60-second time frame.
The nurse teaches a client about the lymphatic system. Which information from the client indicates teaching was successful?
Capillary outflow exceeds venous reabsorption by about 3 L/day, so some fluid lags behind in the interstitium. To maintain sufficient blood volume in the cardiovascular system, this fluid must eventually rejoin the bloodstream; this is the function of the lymphatic system. Lymphatic vessels are thin-walled with valves and thus most resemble veins. Lymph consists primarily of water and small amounts of dissolved proteins, mostly albumin, that are too large to be reabsorbed. It is a pumpless system.
A nurse is teaching a class on circulatory topics that include the correct sequence of structures through which deoxygenated blood returns through the superior and inferior venae cavae to the lungs for reoxygenation. In which order should the nurse present the structures?
Deoxygenated (venous) blood from the systemic circulation enters the right atrium through the superior and inferior venae cavae. From the atrium, the blood passes through the right atrioventricular (tricuspid) valve into the right ventricle. In the ventricle, the blood flows from the inflow tract to the outflow tract and then through the pulmonary semilunar valve (pulmonary valve) into the pulmonary artery, which delivers it to the lungs for oxygenation.
How should the nurse respond when asked "What type of artery is the aorta?"
Elastic arteries have a thick tunica media with more elastic fibers than smooth muscle fibers. Examples include the aorta and its major branches and the pulmonary trunk. Muscular arteries are medium- and small-sized arteries and are farther from the heart than the elastic arteries. They contain more muscle fibers than the elastic arteries because they need less stretch and recoil. The capillary network is composed of connective channels, or thoroughfares, called metarterioles, and "true" capillaries. The capillary walls are very thin, making possible the rapid exchange of substrates, metabolites, and special products (e.g., hormones) between the blood and the interstitial fluid, from which they are taken up by the cells.
Complications from Hypertension
Heart failure, myocardial infarction, stroke, renal failure.
Which elevated levels of adipokines increase the risk of obesity and hypertension in clients? Select all that apply.
Leptin and resistin levels are increased in obesity and are associated with hypertension. Adiponectin is a protective factor for the cardiovascular system and is found in reduced levels in clients with obesity-related hypertension. Adrenomedullin and brain natriuretic peptides are not adipokines, but both play a role in fluid and electrolyte balance.
Vasodilators: Nursing Implications
Monitor BP for hypo/hypertension & increased HR. Treat headache with acetaminophen. Often given with diuretic to reduce edema resulting form water & sodium retention.
Angiotensin II Receptor Antagonists: Nursing Implications
Monitor for edema and decreased BP. Teach patient to report new onset cough & use sunscreen d/t photosensitivity.
ACE Nursing Implication
Monitor patient for edema with HR, decrease BP and new onset cough. Teach: rise slowly, report new onset cough, use sunscreen for photosensitivity, do not stop abruptly.
Aldosterone Receptor Antagonist: Nursing Implication
Monitor potassium levels. Decreased Na reabsorption.
Which term should the nurse use to describe new collateral vessel formation in a client?
New collateral vessels are formed through the process of angiogenesis. Cells of the larger vessels are nourished by the vasa vasorum, small vessels located in the tunica externa. A single tropomyosin molecule (a relaxing protein) lies alongside seven actin molecules. Automaticity, or the property of generating spontaneous depolarization to threshold, enables the sinoatrial and atrioventricular nodes to generate cardiac action potentials without any stimulus.
A nurse is teaching a client about the normal pacemaker of the heart. Which area (see diagram) will the nurse use to help the client locate the normal pacemaker?
Normally, electrical impulses arise in the sinoatrial node (SA node, sinus node), which is often called the pacemaker of the heart. The SA node is located at the junction of the right atrium and superior vena cava, just superior to the tricuspid valve. The atrioventricular node is the junction of the electrical transmission between the atria and the ventricles. The bundle of His is the next stop, and then the transmission branches to the right and left bundle branches. The terminal branches are the Purkinje fibers.
Which components should the nurse include when teaching about stroke volume? Select all that apply.
Preload, afterload, and contractility all interact with one another to determine stroke volume and cardiac output. The preload applies a stretch on the myocardium much like a rubber band is loaded when it is stretched. Afterload is the pressure that the heart has to overcome to eject blood to the body. Contractility is the force with which the heart muscle contracts to force the blood out of the ventricle. The tunica intima is the innermost, or intimal, layer of blood vessels. Nutrient exchange between the blood and tissues occurs in the capillaries.
A nurse must determine a client's pulse pressure. Which action should the nurse take?
Pulse pressure is the difference between systolic and diastolic pressures, not the sum. Mean arterial pressure is the average pressure in the arteries throughout the cardiac cycle, which partially depends on the mean volume of blood in the system.
Alpha Blockers Action and Side Effects
Reduces peripheral vascular resistance. SE: dizziness, hypotension, headache, increase HR, nasal stuffiness. Drugs: Minipress, Hytrin.
A nurse is asked by a coworker how calcium channel-blocking drugs work. How should the nurse respond? Correct 4 They block L-type channels in the heart
The L-type, or long-lasting, channels predominate and are the channels blocked by calcium channel-blocking drugs (e.g., verapamil, nifedipine, diltiazem). The T-type, or transient, channels are much less abundant in the heart. T-type channels are not blocked by currently available calcium channel-blocking drugs; therefore T-type channel blockers are being developed. There are no A- and I-type channels, but there are A bands (myosin) and I bands (actin) in the cardiac muscles.
A nurse is teaching the staff about electrocardiography and the reading of the electrocardiogram (ECG). Which term should the nurse use to describe the wave on the ECG that represents atrial depolarization?
The P wave represents atrial depolarization. The T wave represents ventricular repolarization. Q and R are components of the QRS complex, which represents ventricular depolarization.
A nurse is teaching a client about blood flow through the heart. In which order should the nurse present the blood flow, starting in the left atrium?
The blood flows from the left atrium through the mitral valve to the left ventricle, through the aortic valve, and to the aortic arch.
A nurse is teaching the new nurse about the conduction pathway of the heart. Which information should the nurse include?
The bundle of His gives rise to the right and left bundle branches. The sinoatrial (SA) node is the pacemaker of the heart. The Bachmann bundle conducts the impulse from the SA node to the left atrium. The Purkinje fibers extend from the ventricular apices to the fibrous rings and penetrate the heart wall to the outer myocardium.
A nurse is teaching the client about the basic components of the heart's anatomy. Which information from the client indicates teaching was successful? Select all that apply.
The heart consists of four chambers (two atria and two ventricles), four valves (two atrioventricular valves and two semilunar valves), and a muscular heart wall made up of three layers: the pericardium (outer layer), the myocardium (muscular layer), and the endocardium (inner lining).
A nurse is describing the part of the cardiac cycle in which the ventricles are filled during relaxation. What is the nurse discussing?
The heart muscle relaxes and allows blood to flow through it as it fills passively during diastole. The heart muscle contracts to move blood through the chambers during systole. Ventricular ejection refers to the blood being moved out of the ventricles. Mechanically, the isovolumic phase of ventricular systole is defined as the interval between the closing of the atrioventricular valves and the opening of the semilunar valves.
Which body systems are the intrinsic regulators of a client's heart and the blood vessels? Select all that apply.
The heart pumps blood continuously through the blood vessels with cooperation from other systems, particularly the nervous and endocrine systems, which are intrinsic regulators of the heart and blood vessels. Gaseous wastes of cellular metabolism are exhaled by the lungs and other wastes are removed by the kidneys (urinary). Nutrients and oxygen are supplied by the digestive and respiratory systems.
A nurse is teaching the staff about hematocrit. Which information should the nurse include in the teaching session?
The hematocrit is the ratio of the volume of red blood cells to the volume of whole blood and is measured as a percentage. Although length of the vessel and viscosity play roles in determining resistance in a single vessel, the radius or diameter of the vessel's lumen is the most important factor. High hematocrit decreases, not increases, blood flow through the microcirculation. Blood that contains a high percentage of red cells (high hematocrit level) is more viscous.
A nurse is teaching a client about the lymph system. Which area (see diagram) should the nurse choose to illustrate the duct that receives lymph from the entire left side and lower right side of the body?
The larger thoracic duct receives lymph from the majority of the body while the right lymphatic ducts drain lymph from the right arm and the right side of the head. The right tonsils and right axillary lymph nodes drain into the right lymphatic duct while the left side drains into the thoracic duct.
A nurse is teaching a client about the roles of the thoracic duct. Which information should the nurse include? Select all that apply.
The larger thoracic duct receives lymph from the rest of the body, whereas the smaller right lymphatic duct drains lymph from the right arm and the right side of the head and thorax. The right lymphatic duct and the thoracic duct drain lymph into the right and left subclavian veins, respectively. The thoracic duct does not drain blood; it drains lymph. The blood vessels, not the lymphatic vessels, are the major source of venous return to the heart.
A nurse is teaching a client about the anatomy of the heart. Which area (see diagram) should the nurse choose to illustrate the cardiac chamber with the thickest wall?
The left ventricle's myocardium is several times thicker than that of the right ventricle because the left ventricle myocardium must be strong enough to pump against the high pressure of the systemic arterial pressure (92 mm Hg). The right ventricle must only pump against the lower pressure pulmonary arterial pressure (15 mm Hg). The two atria have the thinnest walls because they are low-pressure chambers.
How should the nurse reply to this client's question, "What does the lymphatic system do for my heart?"
The lymphatic system protects the myocardium against infection and injury. The end of one cardiac cycle allows for expulsion of blood from the ventricles. The lymphatic system does not allow for the proper function of the sinoatrial node, the heart's natural pacemaker. Pericardial fluid provides lubrication of membranes that line the pericardial cavity.
A nurse teaches the staff about the metabolic hypothesis of autoregulation. Which information from the staff indicates teaching was effective about the location of where autoregulation originates?
The metabolic hypothesis of autoregulation proposes that the autoregulation of coronary vessels originates in the myocardium, not the endocardium or the visceral or parietal pericardium.
A client has mitral stenosis, and the nurse is teaching the client about the valve location. Which area (see diagram) will the nurse choose
The mitral valve is located between the left atrium and the left ventricle. The pulmonary valve is located between the right ventricle and the pulmonary artery. The aortic valve is located between the left ventricle and the aorta. The tricuspid valve is located between the right atrium and the right ventricle.
While checking diagnostic tests, a nurse observes that the client has an ejection fraction of 65%. How should the nurse communicate this finding during report?
The normal ejection fraction of the resting heart is about 60% to 75%. A decrease in ejection fraction is a hallmark of ventricular failure. Increases in preload can lead to peripheral edema. Chronic hypertension can lead to elevated afterload.
A nurse is reviewing cardiovascular assessment data for an adult. Which assessment finding does the nurse recognize as abnormal?
The normal location for generation of cardiac impulses is the sinoatrial (SA) node. Impulses are generated in the AV node if the SA node is not functional. The average heart rate in healthy adults is about 70 beats/min. This diminishes by 10 to 20 beats/min during sleep (normal client's heart rate was 70, so when sleeping can decrease to 60-50 beats/min) and can accelerate to more than 100 beats/min during muscular activity or emotional excitement. Heart rate increase during exercise is a normal function to meet increased oxygen demands.
Which physical reaction will occur in a client's cardiac system when the vagus nerve is stimulated?
The parasympathetic nervous system affects the heart through the vagus nerve, which releases acetylcholine, causing a decreased heart rate, and slows conduction through the atrioventricular node. Influx of calcium results from stimulation of the sympathetic nervous system by the release of norepinephrine.
A nurse is teaching a client about the functions of the pericardium. Which information should the nurse include? Select all that apply.
The pericardium is a double-walled membranous sac that encloses the heart and (1) prevents displacement of the heart during gravitational acceleration or deceleration, (2) serves as a physical barrier that protects the heart against infection and inflammation from the lungs and pleural space, and (3) contains pain receptors and mechanoreceptors to elicit reflex changes in blood pressure and heart rate. The two layers of the pericardium have fluid in the space to reduce friction as the heart beats. The endocardium is the lining that is continuous with the endothelium of the arteries, veins, and capillaries of the body.
A nurse taught a client about the roles of the circulatory system. Which information from the client indicates teaching was successful? Select all that apply. Transports oxygen and nutrients throughout the body Removes waste products found within the body
The primary functions of the circulatory system include the transportation of oxygen and nutrients within the body and the removal of metabolic waste products within the body. Movement of blood through the lungs is via the right side of the heart. Systemic blood flow is supplied by the left side of the heart. Nutrients are absorbed into the blood as it moves through the gastrointestinal tract via the splanchnic circulation, and oxygen uptake and the release of carbon dioxide occur in the specialized vascular bed of the pulmonary circulation.
Which information indicates the nurse has a correct understanding of the end-effect of the renin-angiotensin-aldosterone system? Sodium and water reabsorption in the renal tublues throught the effects of aldosterone.
The renin-angiotensin-aldosterone system causes sodium and water reabsorption in the renal tubules through the effects of aldosterone. Angiotensin II causes systemic vasoconstriction. Renin does not promote the renal excretion of sodium and water in the proximal tubules. Angiotensin I does not promote water excretion by the kidneys without affecting sodium reabsorption.
A man reports that he had to have a pacemaker put in because his normal pacemaker would not work. This client asks the nurse what the normal pacemaker is. Which information by the client indicates teaching was successful?
The sinoatrial node is considered the pacemaker of the heart. The bundle of His helps conduct electrical impulses down the inner ventricles. The coronary sinus is a vein that drains blood from the cardiac veins into the right atrium, and it does not contain autorhythmic myocardial cells. The atrioventricular node initiates a signal that is conducted through the ventricular myocardium by way of the bundle of His and Purkinje fibers.
A nurse is teaching about troponin. Which information should the nurse include?
The troponin complex has three components: troponin T, I, and C. Actin is the thin filament in a muscle; actin is not another name for troponin. Troponin molecules are released during myocardial infarction or other muscle injury into the bloodstream, where they can be measured; their release is not prompted by brain injury. ATP, not troponin, makes the energy for heart muscles.
A nurse is teaching the staff about the source of nutrients for a client's blood vessels. The nurse should identify which structure (see
The vasa vasorum are small vessels located in the tunica externa (adventitia). They provide nourishment to the cells of the larger vessels. The tunica intima is the inner layer; the tunica media, the middle layer; and the tunica externa, the outer layer.
Why are African Americans at greater risk for hypertension?
They have increased renin activity, causes increased sodium and water retention. Recommended treatment is Calcium channel blocker and thiazide diuretic.
A client has a blood pressure of 110/60. What is the client's mean arterial pressure using the following formula? Pd + ⅓(Ps-Pd). Record the answer as a whole number.
60 + ⅓ x 60 = 60 + 20 = 80. Mean arterial pressure can be approximated from the measured values of the systolic (Ps) and diastolic (Pd) pressures as follows: Pd + ⅓(Ps - Pd), where Ps - Pd is the pulse pressure.
primary hypertension
AKA essential hypertension. High blood pressure with unknown cause.
hypertension
AKA high blood pressure. Atleast 2 or more readings on different dates is above prehypertensive levels. S: 120-139, D: 80-89.
Which information from the staff indicates teaching by the nurse was successful about the location of arterial baroreceptors? Select all that apply.
Arterial baroreceptors are located in the aortic arch and the carotid arteries/sinus. Arterial baroreceptors are not located in the renal artery, circle of Willis, or the superior vena cava.
Angiotensin Converting Enzyme Inhibitors ACE Action & Side Effects
Block conversion of angiotensin I to angiotensin II. SE: cough, rash, hypotension, increased HR, dyspnea. Drugs: Benazepril HCl (Lotensin), captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril), fosinopril (Monopril), quinapril (Accupril)
Aldosterone Receptor Antagonist: Action & Side Effects
Blocks binding of aldosterone at receptor site. SE: headache, dizziness, angina, hyperkalemia, increased creatinine. Drugs: eplerenone (Inspra)
A nurse is teaching school-age children about blood flow through the body. The nurse will include that blood from the pulmonary circulation is received by which heart chamber?
Blood from the lungs returns to the left atrium by the pulmonary veins. The right atrium receives blood from the systemic circulation. The left ventricle receives blood from the left atrium. The right ventricle receives blood from the right atrium.
A nurse is teaching school-age children about blood flow through the body. The nurse will include that blood from the pulmonary circulation is received by which heart chamber? Left Atrium by Pulmonary Veins.
Blood from the lungs returns to the left atrium by the pulmonary veins. The right atrium receives blood from the systemic circulation. The left ventricle receives blood from the left atrium. The right ventricle receives blood from the right atrium.
Central Acting Adrengergic Inhibitors Nursing Implications
Caution pt from taking with alcohol. Check for BP and edema. Suggest gum or hard candy for dry mouth. Teach to rise slowly and do not stop abruptly.
Beta Blockers Nursing Implications
Check HR and BP before drug administration. Daily I&O and weights. Monitor for bronchospasm. Pt Ed: rise slowly. Do not stop abruptly, causes rebound hypertension, angina, or dysrhythmias.
A nurse administers epinephrine to a client. Which classification of drug did the nurse give?
Chemicals affecting contractility are called inotropic agents. The most important positive inotropic agents are epinephrine and norepinephrine, which are released from the sympathetic nervous system. The baroreceptor reflex facilitates both blood pressure changes and heart rate changes. It is mediated by tissue pressure receptors (pressoreceptors) in the aortic arch and carotid arteries.
A client's muscular arteries constrict. How should the nurse interpret this finding?
Contraction narrows the vessel lumen (the internal cavity of the vessel), which diminishes flow through the vessel (vasoconstriction). When the smooth muscle layer relaxes, more blood flows through the vessel lumen (vasodilation). The same amount and no change in blood flow do not occur with vasoconstriction.
Combined Alpha & Beta Blockers Nursing Implications
Daily I&O, daily weights. Check HR and BP before administration. Monitor edema, neck vein distention, lung sounds. Pt Ed: Rise slowly. Do not stop drug abruptly to avoid rebound HTN and angina.
Factors that increase BP
Decreased stretching of vessels Increased blood viscosity Increased fluid volume
Hypertension Nursing Dx
Deficient Knowledge Ineffective Self Health Management
Nursing Diagnoses from Hypertension
Deficient Knowledge Ineffective Self Health Management
A nurse is teaching the client about contraction and relaxation of the heart. The nurse uses the diagram (see picture) to illustrate which process?94786186
During diastole, blood flows into the atria, the atrioventricular valves are pushed open, and blood begins to fill the ventricles, while semilunar valves are closed. Atrial systole squeezes any blood remaining in the atria out into the ventricles. During ventricular systole, ventricles contract, pushing blood out through the semilunar valves into the pulmonary artery (from the right ventricle) and the aorta (from the left ventricle) while the atrioventricular valves are closed. Conduction is an electrical impulse through the heart to cause a contraction. The diagram illustrates relaxation, not contraction.
Which information indicates the nurse has a correct understanding about the function of elasticity in arterial vessels during cardiac diastole?
During diastole, elasticity promotes recoil of the arteries, maintaining blood pressure within the vessels. Vasoconstriction, not elasticity, retards blood flow into the capillaries. Valves in veins, not elasticity, regulate one-way flow of blood toward the heart. Endothelium remodels the network of blood vessels enabling motion of the blood, promoting tissue growth, motion, and repair.
A nurse is dividng a client's stroke volume by the end-diastolic volume. What is the nurse assessing? Ejection fraction
Ejection fraction is the percentage of blood in the ventricle that is ejected during systole and is calculated by dividing the stroke volume by the end-diastolic volume. Preload is determined by measuring the pressure of the blood in the ventricle at the end of diastole. Cardiac output is the volume of blood ejected from the heart in one minute, and is calculated by multiplying heart rate by stroke volume. Vascular resistance is a measure of how vasoconstricted or vasodilated the vessels are.
Side Effects for Men
Erectile dysfunction. Nurse is proactive to address and discuss with HCP for appropriate interventions.
If a client has problems with the exchange of nutrients between the blood and the tissues, which vessels are affected?
Exchange of nutrients between the blood and the tissues takes place in the capillaries. Venules deliver blood into the veins. Arterioles branch into the capillaries. Lymphatic vessels remove excess fluid and protein that accumulate in the tissues.
Which information indicates a nurse has a correct understanding of the deleterious effects hyperinsulinemia has on client's blood vessels?
Hyperinsulinemia increases the effect of platelet-derived growth factor. It increases, not decreases, sympathetic nervous system activity, and increases, not decreases, activity of insulin-like growth factor-1. It contributes to an increase, not a decrease, in blood pressure.
What term should the nurse use to describe fenestrations located in capillaries?
In some capillaries, the endothelial cells contain oval windows or pores, termed fenestrations, which generally are covered by a thin diaphragm. A vessel lumen is the internal cavity of the vessel. Cells of the larger vessels are nourished by the vasa vasorum, small vessels located in the tunica externa. The tunica externa or adventitia is the outermost, or external, layer of blood vessels.
When a client's abdominal pressure is increased, venous blood moves in which direction?
Increased abdominal pressure moves venous blood toward, not away from, the heart. Increased abdominal pressure does not have the specific role of moving the blood toward nor away from the lungs.
Diuretics: Thiazide & Thiazide Like Diuretics
Inhibit sodium reabsorption in the distal tubule. SE: hypokalemia, hyperglycemia, dizziness, fatigue, weakness. Diuril Zaroxoly, Loxol, HCTZ.
A nurse is teaching about cardiac muscles to a client who golfs. The nurse describes an image of a golf club with two large bulbous heads protruding from one end of a straight shaft. Which cardiac muscle component did the nurse describe?
Myosin resembles a golf club with two large bulbous heads that protrude from one end of a straight shaft. The myosin heads interact with actin filaments to produce muscle contraction. Thin filaments are composed of three proteins that include actin. Troponin and tropomyosin are relaxing proteins that form the troponin-tropomyosin complex, allowing myosin and actin to bind.
When a client releases norepinephrine, which effects does the nurse expect to occur on the blood vessels and heart rate? Select all that apply.
Norepinephrine increases heart rate, constricts blood vessels, and enhances myocardial contractility. Epinephrine dilates the vessels of both the liver and the skeletal muscle.
An adult client is resting. What is the normal cardiac output for this client? Record the answer as a whole number. __________ L/min
Normal cardiac output is about 5 L/min for a resting adult.
peripheral vascular resistence
PVR: ability of the vessels to stretch.
A nurse is describing the cardioinhibitory center. Which mechanism is the nurse explaining?
Parasympathetic excitation slows the heart rate; the portion of the medulla oblongata that generates it is often referred to as the cardioinhibitory center. Because parasympathetic excitation and simultaneous sympathetic inhibition generally depress cardiac function, the interneurons that generate them are often referred to as the cardioinhibitory center. The Bainbridge reflex causes the heart rate to increase after intravenous infusions of blood or fluid. The baroreceptor reflex facilitates blood pressure changes and heart rate changes. Sympathetic stimulation is generated by a vasomotor center often called the cardioexcitatory center because it causes the heart rate to increase.
What is a major determinant of a client's left ventricular afterload Correct 2 Peripheral vascular resistance
Peripheral vascular resistance is the main determinant of left ventricular afterload. Ventricular compliance affects ventricular preload rather than afterload. The left ventricle does not empty into the pulmonary circulation. Pulmonary vascular resistance is the primary factor affecting right ventricular afterload. Left ventricular end-diastolic pressure is a measure of left ventricular preload.
When asked by a client where Peyer patches are located, the nurse should use which area (see diagram) to illustrate the location?
Peyer patches are located in the intestinal wall, not the cervical lymph node, spleen, or inguinal lymph node.
Signs & Symptoms of Hypertension
Silent killer - often no signs or symptoms. May report headache, shortness of breath, anxiety.
Loop Diuretics
Stronger & Faster, rapid action, SE: hypokalemia, hyperglycemia, dizzienes, fatigue, weakness. Bumex & Lasix. Contraindicated if allergic to sulfonamides. Monitor potassium. Use sunscreen to prevent photo-sensitivity. Take with food or milk to prevent GI upset.
Alpha Blockers Nursing Implicatons
Take Hytrin at night to reduce SE of dizziness. Check HR and BP before drug administration. Teach to rise slowly.
Calcium Channel Blockers: Nursing Implications
Take pulse before administration. Check BP for hypotension, HR, dysrhythmias, angina. May increase blood levels of digoxin.
Diuretic Nursing Implications
Take with food, monitor I & O, daily weights, assess for edema and reduced BP. Take in the morning to reduce excessive urination during night hours.
Which correct structural order of an arterial wall, beginning at the innermost portion and moving outward, indicates the nurse has an accurate understanding of the anatomy of the arterial wall?
The arterial wall surrounds the lumen. The three layers of an arterial wall in order of the innermost portion to the outer most portion are tunica intima, tunica media, and tunica externa.
A nurse is teaching a client about the conduction system of the heart. Which area on the diagram (see picture) will the nurse choose to illustrate the atrioventricular node?
The atrioventricular node is located in the right atrial wall superior to the tricuspid valve and anterior to the ostium of the coronary sinus. The sinoatrial (SA) node is located at the junction of the right atrium and superior vena cava, just superior to the tricuspid valve. The tricuspid valve is located between the right atrium and right ventricle. The bundle of His then gives rise to the right and left bundle branches.
What is the average venous pressure for adults?
The average venous pressure for adults is 10 mm Hg. 30 , 50, and 70 mm Hg are incorrect (too high).
A nurse is discussing pressure receptors located in the aortic arch and carotid arteries that affect a client's heart rate and blood pressure. Which reflex is the nurse describing?
The baroreceptor reflex facilitates both blood pressure changes and heart rate changes. It is mediated by tissue pressure receptors (called pressoreceptors or baroreceptors) in the aortic arch and carotid arteries. Distention of the atria causes stimulation of atrial receptors (for example, when intravascular volume is increased by intravenous infusions). This causes activation of the Bainbridge reflex, which increases heart rate. The Frank-Starling and Poiseuille eponyms refer to various concepts, including laws, curves, and spaces, but not to reflexes. The Frank-Starling law of the heart describes the length-tension relationship of preload to myocardial contractility (as measured by stroke volume). The Poiseuille law shows the relationship among blood flow, pressure, and resistance. Resistance in a vessel is inversely related to blood flow—that is, increased resistance leads to decreased blood flow.
A client has plaque in the artery that travels in the coronary sulcus between the left atrium and the left ventricle. Choose the area (see diagram) that the nurse will use to help the client locate this artery.
The circumflex travels in the coronary sulcus between the left atrium and the left ventricle. The left coronary artery passes between the left atrial appendage and the pulmonary artery and generally divides into two branches. The right coronary artery originates from an ostium behind the right aortic cusp and travels behind the pulmonary artery. The left anterior descending artery (or anterior interventricular artery) travels down the anterior surface of the interventricular septum.
Which condition will cause the client's body to activate the renin-angiotensin-aldosterone system (RAAS)?
The primary factor that stimulates renin release is a drop in renal perfusion as detected by the juxtaglomerular cells. The RAAS is not activated by decreased perfusion to the brain, liver, or lungs.
A coworker asks a nurse how cardiac output is determined. How should the nurse respond?
The product of the stroke volume and the heart rate provides the amount of cardiac output. None of the other options (MAP, SVR, or pulse pressure) are factors in cardiac output.
A nurse encourages ambulation for a client to assist with venous return. What is the rationale for the nurse's action? Correct 2 Activates the muscle pump
The pumping action of skeletal muscles assists venous return when a person walks. When a person is in an upright position, such as when standing or walking, gravity opposes venous return in most parts of the body. Veins have only a thin layer of vascular smooth muscle, which does not assist venous return. Veins have one-way valves.
A nurse is teaching the client about the respiratory pump. Which information should the nurse include in the teaching session?
The respiratory pump acts during inspiration (not expiration), when the veins of the abdomen are partially compressed by the downward movement of the diaphragm. The skeletal muscle pump occurs during skeletal muscle contractions. The heart valves are not affected by the respiratory pump; it is venous return and venous pressure that are affected.
Which term should the nurse use to describe the myocardium's conduction system that is responsible for contracting both atria?
The sinoatrial node, in which electrical impulses arise, is responsible for causing both atria to contract. The Bachmann bundle conducts the impulse from the sinoatrial node to the left atrium. The atrioventricular node is responsible for mediating the conduction between the atria and ventricles. Conducting fibers from the atrioventricular node converge and form the bundle of His, conducting impulses to the right and left bundle branches.
Which information from the client indicates teaching by the nurse was successful for the layers of the heart, beginning on the inside?
The three layers of the heart wall in order, beginning on the inside, are endocardium, myocardium, and epicardium (serous pericardium). The supracardium is not a layer of the heart wall. The mesocardium is not a layer of the heart. The ventricles of the heart are separated by the interventricular septum.
plaque
a deposit of fatty material in the lining of arteries.
diastolic blood pressure
amount of blood pressure exerted on the wall of arteries when ventricle are at rest. Bottom number on BP.
Beta Blockers Action and Side Effects
block beta heart receptors, reduces heart rate & blood pressure. SE: bradycardia, dyspnea, fatigue, orthostatic hypertension, bronchospasm.
Calcium Channel Blockers: Action & Side Effects
blocks entry of calcium in to smooth muscles to reduce afterload with vasodilation. SE: headache, dizziness, peripheral edema, heart failure. Drugs: amlodipine, diltiazem, felodipine, nifedipine.
Modifiable Risk Factors
blood glucose level, activity level, smoking, salt & alcohol intake, insufficient sleep.
Which information indicates the nurse has a correct understanding of the end-effect of the renin-angiotensin-aldosterone system?
causes sodium and water reabsorption in the renal tubules through the effects of aldosterone. Angiotensin II causes systemic vasoconstriction. Renin does not promote the renal excretion of sodium and water in the proximal tubules. Angiotensin I does not promote water excretion by the kidneys without affecting sodium reabsorption.
essential hypertension
chronic elevation of BP from an unknown cause.
A client's vagus nerve is stimulated. Upon assessment, the nurse expects which cardiovascular effect?
decreased heart rate and slows conduction through the atrioventricular node. Acetylcholine also causes coronary vasodilation, not constriction. Angina occurs from ischemia.
Non-Modifiable Risk Factors
family history, age, ethnicity, diabetes mellitus.
hypertensive urgency
hypertensive emergency but without progression of target organ dysfunction. S/S: headaches, nosebleeds, shortness of breath, severe anxiety.
A client's body releases epinephrine and norepinephrine. Which physiologic effect will the nurse expect the client to experience?
increase heart rate and increase the strength of myocardial contraction. Acetylcholine will decrease heart rate. Epinephrine and norepinephrine increase the cardiac output. Epinephrine and norepinephrine do not increase hemoglobin levels.
hypertrophy
increase in the size of an organ. Increased BP can increase the size of the left ventricle.
systolic blood pressure
maximal pressure exerted on the arteries during contraction of the left ventricle of the heart. Top number of BP.
cardiac output
measure of blood pumped by the heart per minute.
normotensive
normal blood pressure. =<120/80
Potassium Sparing Diuretics
remove sodium but keep potassium. SE: hyperkalemia, hyponatremia, N/V/D. Aldactone, Spironalactone, Amiloride. Monitor postassium. Check BP before administration. Avoid potassium rich foods: bananas, oranges, salt substitutes. Triamterene: Take after meals, turns urine blue.
Central Acting Adrengergic Inhibitors Action & Side Effects
suppresses central nervous system. SE: drowsiness, dry mouth, sedation, constipation, weakness. Drugs: Catapres, Aldomet
hypertensive emergency
systolic BP over 180 & diastolic BP over 120-130. Risk for MI, HF, dissecting aortic aneurysm.
Isolated systolic hypertension ISH
systolic is greater than 140 mm Hg & diastolic is 90 mm Hg or less. Lifestyle changes first, then hypertensive medications.
viscosity
thickness of blood.
Vasodilators Action & Side Effects
vasodilates arteries, arterioles to reduce afterload. SE: headache, nausea, hypo or hypertension, arrythmias. Drugs: dydralazine, minoxidil
