Chapter 22: Introduction to the Cardiovascular System

A client has a stroke volume of 70 mL and a heart rate of 72 beats/min. The nurse evaluates that the client's cardiac output is? (Fill in the blank with a number.)

5040 The following formula is used to calculate cardiac output: Cardiac output = heart rate × stroke volume. 5040 = 72 X 70.

While auscultating heart sounds, the nurse hears "lub-dub-dee" and recognizes that this would be characterized as which heart sound? a. S3 b. S1 c. S2 d. S4

a An S3 heart sound is characterized as sounding like "Ken-tuck-y" or "lub-dub-dee." It follows S1 and S2 and is called a ventricular gallop. Although normal in children, it is often an indication of heart failure in an adult. S1 is the first normal heart sound; it sounds like "lub." S2 is the second normal heart sound; it sounds like "dub." An extra sound just before S1 is an S4 heart sound, or atrial gallop. Some say this sound resembles the word "Ten-nes-see" or "lub-lub-dub."

The nurse is calculating a cardiac client's pulse pressure. If the client's blood pressure is 122/76 mm Hg, what is the client's pulse pressure? a. 46 mm Hg b. 99 mm Hg c. 198 mm Hg d. 76 mm Hg

a Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg.

Central venous pressure is measured in which heart chamber? a. right atrium b. left atrium c. left ventricle d. right ventricle

a The pressure in the right atrium is used to assess right ventricular function and venous blood return to the heart. The left atrium receives oxygenated blood from the pulmonary circulation. The left ventricle receives oxygenated blood from the left atrium. The right ventricle is not the central collecting chamber of venous circulation.

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for receiving deoxygenated blood from the venous system? a. right atrium b. left atrium c. right ventricle d. left ventricle

a The right atrium receives deoxygenated blood from the venous system.

The heart has valves between the atrium and the ventricles. What valve separates the left atrium and ventricle? a. Mitral b. Pulmonic c. Aortic d. Tricuspid

a The valve on the left side of the heart, called the mitral or bicuspid valve, is composed of two leaflets or cusps. The pulmonic valve allows blood into the pulmonary artery. The aortic valve allows blood into the aorta. The tricuspid valve is the valve between the right atria and ventricle.

A nurse is preparing a client for cardiac catheterization. The nurse knows that which nursing intervention must be provided when the client returns to the room after the procedure? a. Withhold analgesics for at least 6 hours after the procedure. b. Assess the puncture site frequently for hematoma formation or bleeding. c. Inform the client that he or she may experience numbness or pain in the leg. d. Restrict fluids for 6 hours after the procedure.

b Because the diameter of the catheter used for cardiac catheterization is large, the puncture site must be checked frequently for hematoma formation and bleeding. The nurse should administer analgesics as ordered and needed. If the femoral artery was accessed during the procedure, the client should be instructed to report any leg pain or numbness, which may indicate arterial insufficiency. Fluids should be encouraged to eliminate dye from the client's system.

The critical care nurse is caring for a client with a central venous pressure (CVP) monitoring system. The nurse notes that the client's CVP is increasing. This may indicate: a. psychosocial stress. b. hypervolemia. c. dislodgment of the catheter. d. hypomagnesemia.

b CVP is a useful hemodynamic parameter to observe when managing an unstable client's fluid volume status. An increasing pressure may be caused by hypervolemia or by a condition, such as heart failure, that results in decreased myocardial contractility. Stress, dislodgment of the catheter, and low magnesium levels would not typically result in increased CVP.

The nurse is assessing heart sounds in a patient with heart failure. An abnormal heart sound is detected early in diastole. How would the nurse document this? a. S1 b. S2 c. S3 d. S4

c An S3 ("DUB") is heard early in diastole during the period of rapid ventricular filling as blood flows from the atrium into a noncompliant ventricle. It is heard immediately after S2. "Lub-dub-DUB" is used to imitate the abnormal sound of a beating heart when an S3 is present.

The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from? a. The AV node b. The Purkinje fibers c. The sinoatrial node d. The ventricles

c The sinoatrial node, the primary pacemaker of the heart, in a normal resting adult heart has an inherent firing rate of 60 to 100 impulses per minute; however, the rate changes in response to the metabolic demands of the body (Weber & Kelley, 2010).

The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition? a. Pulmonary embolism b. Myocardial infarction c. Pericarditis d. Heart failure

d An ejection fraction of less than 40% indicates that the patient has decreased left ventricular function and likely requires treatment for heart failure.

The nurse is performing an assessment of the patient's heart. Where would the nurse locate the apical pulse if the heart is in a normal position? a. Left 2nd intercostal space at the midclavicular line b. Right 2nd intercostal space at the midclavicular line c. Right 3rd intercostal space at the midclavicular line d. Left 5th intercostal space at the midclavicular line

d As a result of this close proximity to the chest wall, the pulsation created during normal ventricular contraction, called the apical impulse (also called the point of maximal impulse [PMI]), is easily detected. In the normal heart, the PMI is located at the intersection of the midclavicular line of the left chest wall and the fifth intercostal space (Bickley, 2009; Woods et al., 2009).

The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence? a. SA node to bundle of His to AV node to Purkinje fibers b. SA node to AV node to Purkinje fibers to bundle of His c. SA node to bundle of His to Purkinje fibers to AV node d. SA node to AV node to bundle of His to Purkinje fibers

d The normal electrophysiological conduction route is SA node to AV node to bundle of His to Purkinje fibers.

The nurse is caring for a client admitted with angina who is scheduled for cardiac catheterization. The client is anxious and asks the reason for this test. What is the best response? a. "Cardiac catheterization is usually done to assess how blocked or open a client's coronary arteries are." b. "Cardiac catheterization is most commonly done to detect how efficiently a client's heart muscle contracts." c. "Cardiac catheterization is usually done to evaluate cardiovascular response to stress." d. "Cardiac catheterization is most commonly done to evaluate cardiac electrical activity."

a Cardiac catheterization is usually used to assess coronary artery patency to determine if revascularization procedures are necessary. A thallium stress test shows myocardial ischemia after stress. An ECG shows the electrical activity of the heart.

A nurse hears bilateral crackles in a client's lungs. What could be a cause of crackles in the bases of the client's lungs? a. pulmonary congestion b. pulmonary hypertension c. heart palpitations d. mitral valve stenosis

a Crackles heard in the bases of the lungs are a sign of pulmonary congestion.

When assessing a patient with left-sided heart failure, what would be noted on auscultation of lungs? a. Wheezes with wet lung sounds b. Stridor c. High-pitched sound d. Labor

a If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound and wheezes and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does not reveal a high-pitched sound.

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? a. Friction rub b. Murmur c. Snap d. Click

a 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.

The physician orders medication to treat a client's cardiac ischemia. What is causing the client's condition? a. reduced blood supply to the heart b. pain on exertion c. high blood pressure d. indigestion

a Ischemia is reduced blood supply to body organs. Cardiac ischemia is caused by reduced blood supply to the heart muscle. It may lead to a myocardial infarction. Chest pain is a symptom of ischemia.

A resident of a long-term care facility has reported chest pain to the nurse. What aspect of the resident's pain would be most suggestive of angina as the cause? a. The pain is worse when the resident inhales deeply. b. The pain occurs immediately following physical exertion. c. The pain is worse when the resident coughs. d. The pain is most severe when the resident moves his upper body.

b Chest pain associated with angina is often precipitated by physical exertion. The other listed aspects of chest pain are more closely associated with noncardiac etiologies.

What does decreased pulse pressure reflect? a. tachycardia b. reduced distensibility of the arteries c. reduced stroke volume d. elevated stroke volume

c Decreased pulse pressure reflects reduced stroke volume and ejection velocity or obstruction to blood flow during systole. Increased pulse pressure would indicate reduced distensibility of the arteries, along with bradycardia.

Which term describes the amount of blood ejected per heartbeat? a. cardiac output b. ejection fraction c. stroke volume d. afterload

c Stroke volume is determined by preload, afterload, and contractility of the heart. Cardiac output is the amount of blood pumped by each ventricle during a given period and is computed by multiplying the stroke volume of the heart by the heart rate. Ejection fraction is the percentage of the end-diastolic volume that is ejected with each stroke, measured at 42% to 50% in the normal heart. Afterload is defined as the pressure that the ventricular myocardium must overcome to eject blood during systole and is one of the determinants of stroke volume.

The nurse cares for a client in the emergency department who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition? a. heart failure b. ventricular hypertrophy c. pulmonary edema d. myocardial infarction

a A BNP level greater than 100 pg/mL is suggestive of heart failure. Because this serum laboratory test can be quickly obtained, BNP levels are useful for prompt diagnosis of heart failure in settings such as the emergency department. Elevations in BNP can occur from a number of other conditions such as pulmonary embolus, myocardial infarction (MI), and ventricular hypertrophy. Therefore, the healthcare provider correlates BNP levels with abnormal physical assessment findings and other diagnostic tests before making a definitive diagnosis of heart failure.

When performing an ECG, it is also necessary to palpate a peripheral pulse in order to: a. assess the heart's mechanical activity. b. monitor the heart's electrical activity. c. assess for abnormal heart sounds. d. assess for temperature variations.

a A cardiac monitor reveals the heart's electrical activity, but not its mechanical activity. The ECG pattern may appear normal in some clients even when mechanical function is abnormal. This means the nurse must also palpate a peripheral pulse or auscultate the apical heart rate. Auscultation is used to assess for normal and abnormal heart sounds. The nurse inspects the client's skin, arms, and legs for variations in skin color and temperature and compares bilateral findings with other areas of the body.

A patient's gradual decline in activity tolerance and increased shortness of breath have prompted her health care provider to assess the structure and size of her heart. Which of the following diagnostic tests is most likely to yield these assessment data? a. Echocardiography b. Electrocardiography (ECG) c. Cardiac catheterization d. Angiography

a An echocardiogram yields a two-dimensional rendering of the heart's structure and mechanical function. An ECG indicates the heart's electrical activity, and angiography and cardiac catheterization are used to assess the patency of the coronary arteries.

The nurse working on a cardiac care unit is caring for a client whose stroke volume has increased. The nurse is aware that afterload influences a client's stroke volume. The nurse recognizes that afterload is increased when there is what? a. Arterial vasoconstriction b. Venous vasoconstriction c. Arterial vasodilation d. Venous vasodilation

a Arterial vasoconstriction increases the systemic vascular resistance, which increases the afterload. Venous vasoconstriction decreases preload thereby decreasing stroke volume. Venous vasodilation increases preload.

The cardiologist has scheduled a client for drug-induced stress testing. What instructions should the nurse provide to prepare the client for this test? a. You will receive medication via IV administration. b. You will need to wear comfortable shoes to the test. c. You will begin exercising at a slow speed. d. You may experience an onset of dizziness during the test.

a Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. Drugs may be used to stress the heart for clients with sedentary lifestyles or those with a physical disability, such as severe arthritis, that interferes with exercise testing. Drug-induced stress testing does not require the client to exercise. Instead, drugs are used to stress the heart. Clients performing exercise electrocardiography should report chest pain, dizziness, leg cramps, or weakness if they experience them during the test.

The nurse is conducting client teaching about cholesterol levels. When discussing the client's elevated LDL and lowered HDL levels, the client shows an understanding of the significance of these levels by stating what? a. "Increased LDL and decreased HDL increase my risk of coronary artery disease." b. "Increased LDL has the potential to decrease my risk of heart disease." c. "The decreased HDL level will increase the amount of cholesterol moved away from the artery walls." d. "The increased LDL will decrease the amount of cholesterol deposited on the artery walls."

a Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.

The nurse is providing discharge education for a client going home after cardiac catheterization. What information is a priority to include when providing discharge education? a. Avoid tub baths, but shower as desired. b. Do not ambulate until the healthcare provider indicates it is appropriate. c. Expect increased bruising to appear at the site over the next several days. d. Returning to work immediately is okay.

a Guidelines for self-care after hospital discharge following a cardiac catheterization include showering as desired (no tub baths) and avoiding bending at the waist and lifting heavy objects. The healthcare provider will indicate when it is okay to return to work. The client should notify the healthcare provider right away if bleeding, new bruising, swelling, or pain are noted at the puncture site. The client will be able to ambulate after the puncture site has clotted.

During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure? a. wheezes with wet lung sounds b. stridor c. high-pitched sounds d. laborious breathing

a If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound, wheezes, and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does not reveal a high pitched sound.

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? a. Dipyridamole b. Lanoxin c. Thallium 201 d. Cardiolite

a 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.

Low cardiac output increases the workload on the heart and causes the heart muscle to wear out. What is the average cardiac output per minute in a healthy adult? a. 5 L b. 8 L c. 6 L d. 10 L

a In a healthy adult, cardiac output ranges from 4 to 8 L/min (the average is approximately 5 L/min).

A client with a hypertensive history has fallen several times in the past two weeks. It is important for this client to rise slowly from a sitting or lying position because gradual changes in position: a. provide time for the heart to increase rate of contraction to resupply oxygen to the brain. b. help reduce the blood pressure to resupply oxygen to the brain. c. help reduce the heart's work to resupply oxygen to the brain. d. provide time for the heart to reduce rate of contraction to resupply oxygen to the brain.

a 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.

The nurse is assessing a patient who reports feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding? a. A heart rate of more than 20 bpm above the resting rate b. An unchanged systolic pressure c. An increase of 10 mm Hg blood pressure reading d. An increase of 5 mm Hg in diastolic pressure

a Normal postural responses that occur when a person moves from a lying to a standing position include (1) a heart rate increase of 5 to 20 bpm above the resting rate; (2) an unchanged systolic pressure, or a slight decrease of up to 10 mm Hg; and (3) a slight increase of 5 mm Hg in diastolic pressure. Postural (orthostatic) hypotension is a sustained decrease of at least 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP within 3 minutes of moving from a lying or sitting to a standing position (Freeman et al., 2011). It is usually accompanied by dizziness, lightheadedness, or syncope.

Following the morning assessment of an older adult patient, the nurse has documented, "Edema 3+ present to ankles and feet; dorsalis pedis and posterior tibial pulses palpable bilaterally." The nurse should recognize that this patient may be exhibiting symptoms of: a. Heart failure b. Angina pectoris c. Intermittent claudication d. Hypertension

a Peripheral edema is associated with heart failure and peripheral vascular diseases, such as deep vein thrombosis or chronic venous insufficiency. Angina and hypertension do not directly cause peripheral edema. Intermittent claudication is a symptom that represents arterial insufficiency.

The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate? a. international normalized ratio (INR) b. partial thromboplastic time (PTT) c. complete blood count (CBC) d. Sodium

a The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis. The other laboratory values are not used to evaluate the effectiveness of warfarin.

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? a. sinoatrial node b. atrioventricular node c. bundle of His d. bundle branches

a 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.

The nurse is preparing a client for transesophageal echocardiography (TEE). This procedure is used for which indication? a. determination of atrial thrombi b. determination of electrical activity of the heart c. evaluation of the response of the cardiovascular system to increased oxygen demands d. evaluation of myocardial perfusion at rest and after exercise

a The TEE is an important diagnostic tool for determining if atrial or ventricular thrombi are present in patients with heart failure, valvular heart disease, and dysrhythmias. The electrocardiogram (ECG) is a graphic recording of the electrical activity of the heart to determine dysrhythmias. Stress testing is used to evaluate the response of the cardiovascular system to increased demands for oxygen and nutrients. Thallium is used with exercise or pharmacologic stress testing to assess changes in myocardial perfusion at rest and after exercise.

The coronary arteries receive blood when? a. During diastole b. During systole c. When the heart is refractory d. When the aortic valve is open

a The coronary arteries receive blood during diastole, when the muscle is at rest and relaxed so that blood can flow freely into the muscle. When the ventricle contracts, it forces the aortic valve open, which in turn causes the leaflets of the valve to cover the openings of the coronary arteries.

The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure? a. Pulse pressure b. Auscultatory gap c. Pulse deficit d. Korotkoff sound

a The difference between the systolic and the diastolic pressures is called the pulse pressure.

The critical care nurse is caring for a client who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located? a. SA node b. AV node c. Bundle of His d. Purkinje cells

a The heart rate is determined by the myocardial cells with the fastest inherent firing rate. Under normal circumstances, the SA node has the highest inherent rate (60 to 100 impulses per minute).

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to all the cells and tissues of the body? a. left ventricle b. left atrium c. right ventricle d. right atrium

a The left ventricle pumps blood to all the cells and tissues of the body. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs to be oxygenated. The right atrium receives deoxygenated blood from the venous system.

The nurse cares for a client in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the client's CVP as 8 mm Hg and recognizes that this finding indicates the client is experiencing which condition? a. hypervolemia b. excessive blood loss c. overdiuresis d. left-sided heart failure

a The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right-ventricular preload, which is most often from hypovolemia.

A patient recently diagnosed with pericarditis asks the nurse to explain what area of the heart is involved. How does the nurse best describe the pericardium to the client? a. Thin fibrous sac that encases the heart. b. Inner lining of the heart and valves. c. Heart's muscle fibers. d. Exterior layer of the heart.

a The pericardium is a thin, fibrous sac that encases the heart. It is composed of two layers, the visceral and the parietal pericardium. The space between these two layers is filled with fluid.

A client's declining cardiac status has been attributed to decreased cardiac action potential. Interventions should be aimed at restoring what aspect of cardiac physiology? a. The cycle of depolarization and repolarization b. The time it takes from the firing of the SA node to the contraction of the ventricles c. The time between the contraction of the atria and the contraction of the ventricles d. The cycle of the firing of the AV node and the contraction of the myocardium

a This exchange of ions creates a positively charged intracellular space and a negatively charged extracellular space that characterizes the period known as depolarization. Once depolarization is complete, the exchange of ions reverts to its resting state; this period is known as repolarization. The repeated cycle of depolarization and repolarization is called the cardiac action potential.

The student nurse is preparing a teaching plan for a client being discharged status post MI. What should the nurse include in the teaching plan? Select all that apply. a. Need for careful monitoring for cardiac symptoms b. Need for carefully regulated exercise c. Need for dietary modifications d. Need for early resumption of prediagnosis activity e. Need for increased fluid intake

a, b, c Dietary modifications, exercise, weight loss, and careful monitoring are important strategies for managing three major cardiovascular risk factors: hyperlipidemia, hypertension, and diabetes. There is no need to increase fluid intake and activity should be slowly and deliberately increased.

A patient had a cardiac catheterization and is now in the recovery area. What nursing interventions should be included in the plan of care? (Select all that apply.) a. Assessing the peripheral pulses in the affected extremity b. Checking the insertion site for hematoma formation c. Evaluating temperature and color in the affected extremity d. Assisting the patient to the bathroom after the procedure e. Assessing vital signs every 8 hours

a, b, c The nurse should observe the catheter access site for bleeding or hematoma formation and assess peripheral pulses in the affected extremity (dorsalis pedis and posterior tibial pulses in the lower extremity, radial pulse in the upper extremity) every 15 minutes for 1 hour, every 30 minutes for 1 hour, and hourly for 4 hours or until discharge. Blood pressure and heart rate should also be assessed during these same time intervals, not every 8 hours. The nurse should evaluate temperature, color, and capillary refill of the affected extremity during these same time intervals. The patient should maintain bed rest for 2 to 6 hours after the procedure.

The nurse is caring for a client who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output? a. A change in position from standing to sitting b. A heart rate of 54 bpm c. A pulse oximetry reading of 94% d. An increase in preload related to ambulation

b Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.

The nurse is caring for an acutely ill client who has central venous pressure monitoring in place. What intervention should be included in the care plan of a client with CVP in place? a. Apply antibiotic ointment to the insertion site twice daily. b. Change the site dressing whenever it becomes visibly soiled. c. Perform passive range-of-motion exercises to prevent venous stasis. d. Aspirate blood from the device once daily to test pH.

b Gauze dressings should be changed every 2 days or transparent dressings at least every 7 days and whenever dressings become damp, loosened, or visibly soiled. Passive ROM exercise is not indicated and it is unnecessary and inappropriate to aspirate blood to test it for pH. Antibiotic ointments are contraindicated.

The physician has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a client. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis? a. Immunosuppression b. Inflammation c. Infection d. Hemostasis

b High-sensitivity CRP is a protein produced by the liver in response to systemic inflammation. Inflammation is thought to play a role in the development and progression of atherosclerosis.

The nurse's assessment of an older adult client reveals the following data: Lying BP 144/82 mm Hg; sitting BP 121/69 mm Hg; standing BP 98/56 mm Hg. The nurse should consequently identify what nursing diagnosis in the client's plan of care? a. Risk for ineffective breathing pattern related to hypotension b. Risk for falls related to orthostatic hypotension c. Risk for ineffective role performance related to hypotension d. Risk for imbalanced fluid balance related to hemodynamic variability

b Orthostatic hypotension creates a significant risk for falls due to the dizziness and lightheadedness that accompanies it. It does not normally affect breathing or fluid balance. The client's ability to perform normal roles may be affected, but the risk for falls is the most significant threat to safety.

The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer? a. Diltiazem b. Metoprolol c. Amiodarone d. Propafenone

b Patients may receive beta-blockers prior to the scan to control heart rate and rhythm.

During a shift assessment, the nurse is identifying the client's point of maximum impulse (PMI). Where should the nurse best palpate the PMI? a. Left midclavicular line of the chest at the level of the nipple b. Left midclavicular line of the chest at the fifth intercostal space c. Midline between the xiphoid process and the left nipple d. Two to three centimeters to the left of the sternum

b The left ventricle is responsible for the apical beat or the point of maximum impulse, which is normally palpated in the left midclavicular line of the chest wall at the fifth intercostal space.

A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult client who has been experiencing vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis? a. Pleurisy b. Heart failure c. Valve dysfunction d. Cardiomyopathy

b The level of BNP in the blood increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF. It is not specific to cardiomyopathy, pleurisy, or valve dysfunction.

The physical therapist notifies the nurse that a client with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a client with CAD may result in what? a. Development of an atrial-septal defect b. Myocardial ischemia c. Formation of a pulmonary embolism d. Release of potassium ions from cardiac cells

b Unlike other arteries, the coronary arteries are perfused during diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Clients, particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not usually result in a pulmonary embolism or create electrolyte imbalances. Atrial-septal defects are congenital.

A patient tells the nurse, "I was straining to have a bowel movement and felt like I was going to faint. I took my pulse and it was so slow." What does the nurse understand occurred with this patient? a. The patient may have had a myocardial infarction. b. The patient had a vagal response. c. The patient was anxious about being constipated. d. The patient may have an abdominal aortic aneurysm.

b When straining during defecation, the patient bears down (the Valsalva maneuver), which momentarily increases pressure on the baroreceptors. This triggers a vagal response, causing the heart rate to slow and resulting in syncope in some patients. Straining during urination can produce the same response. Myocardial infarction is damage to the heart and clients will experience pain or shortness of breath. Anxiety causes the heart rate to increase. The client with an abdominal aortic aneurysm will experience back or abdominal pain, not a decrease in heart rate.

The nurse is performing an intake assessment on a client with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment? a. Whether the client and involved family members understand the role of genetics in the etiology of the disease b. Whether the client and involved family members understand dietary changes and the role of nutrition c. Whether the client and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately d. Whether the client and involved family members understand the importance of social support and community agencies

c During the health history, the nurse needs to determine if the client and involved family members are able to recognize symptoms of an acute cardiac problem, such as acute coronary syndrome (ACS) or HF, and seek timely treatment for these symptoms. Each of the other listed topics is valid, but the timely and appropriate response to a cardiac emergency is paramount.

A nurse is preparing a client for scheduled transesophageal echocardiography. What action should the nurse perform? a. Instruct the client to drink 1 L of water before the test. b. Administer IV benzodiazepines and opioids. c. Inform the client that she will remain on bed rest following the procedure. d. Inform the client that an access line will be initiated in her femoral artery.

c During the recovery period, the client must maintain bed rest with the head of the bed elevated to 45 degrees. The client must be NPO 6 hours pre-procedure. The client is sedated to make her comfortable, but will not be heavily sedated, and opioids are not necessary. Also, the client will have a peripheral IV line initiated pre-procedure.

Which area of the heart that is located at the third intercostal space to the left of the sternum? a. aortic area b. pulmonic area c. Erb point d. epigastric area

c Erb point is located at the third intercostal space to the left of the sternum. The aortic area is located at the second intercostal space to the right of the sternum. The pulmonic area is at the second intercostal space to the left of the sternum. The epigastric area is located below the xiphoid process.

For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which data is necessary to collect if the client is experiencing chest pain? a. blood pressure in the left arm b. pulse rate in upper extremities c. description of the pain d. sound of the apical pulses

c If the client is experiencing chest pain, a history of its location, frequency, and duration is necessary. A description of the pain is also needed, including if it radiates to a particular area, what precipitates its onset, and what brings relief. The nurse weighs the client and measures vital signs. The nurse may measure blood pressure in both arms and compare findings. The nurse assesses apical and radial pulses, noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities.

A 52-year-old female patient is going through menopause and asks the nurse about estrogen replacement for its cardioprotective benefits. What is the best response by the nurse? a. "That's a great idea. You don't want to have a heart attack." b. "Current research determines that the replacement of estrogen will protect a woman after she goes into menopause." c. "Current evidence indicates that estrogen is ineffective as a cardioprotectant; estrogen is actually potentially harmful and is no longer a recommended therapy." d. "You need to research it and determine what you want to do."

c In the past hormone therapy was routinely prescribed for postmenopausal women with the belief that it would deter the onset and progression of coronary artery disease (CAD). However, based on results from the multisite, prospective, longitudinal Women's Health Initiative study, the American Heart Association (AHA) no longer recommends the use of hormone therapy as a prevention strategy for women. In the most recently published AHA guidelines for primary prevention of CAD in women, the use of hormone therapy (estrogen) is noted to be ineffective and potentially harmful (Mosca, Benjamin, Berra, et al., 2011).

A client has had a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. This client experienced damage to what area of the heart? a. Endocardium b. Pericardium c. Myocardium d. Visceral pericardium

c The myocardium is the layer of the heart responsible for the pumping action.

The nurse reviews discharge instructions with a client who underwent a left groin cardiac catheterization 8 hours ago. Which instructions should the nurse include? a. "You can take a tub bath or a shower when you get home." b. "Contact your primary care provider if you develop a temperature above 102°F." c. "Do not bend at the waist, strain, or lift heavy objects for the next 24 hours." d. "If any discharge occurs at the puncture site, call 911 immediately."

c The nurse should instruct the client to follow these guidelines: For the next 24 hours, do not bend at the waist, strain, or lift heavy objects if the artery of the groin was used; contact the primary provider if swelling, new bruising or pain from the procedure puncture site, or a temperature of 101°F or more occur. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The client should not drive to the hospital.

In preparation for transesophageal echocardiography (TEE), the nurse must: a. Instruct the patient to drink 1 L of water before the test b.Heavily sedate the patient c. Inform the patient that blood pressure (BP) and electrocardiogram (ECG) monitoring will occur throughout the test d. Inform the patient that an access line will be initiated in the femoral artery

c The patient will have BP and ECG monitored throughout the test and must be NPO 6 hours preprocedure. The patient is sedated to make him or her comfortable, but will not be heavily sedated. Also, the patient will have an IV line initiated preprocedure.

The nurse is caring for a client admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this client. The nurse should recognize what implication of this assessment finding? a. This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. b. Because the client has a history of unstable angina, this is a poor indicator of myocardial injury. c. This is an accurate indicator of myocardial injury. d. This result indicates muscle injury, but does not specify the source.

c Troponin I, which is specific to cardiac muscle, is elevated within hours after myocardial injury. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.

A 71-year-old woman has complained of chest pain that appears when she is doing housework or climbing stairs. The woman claims that the pain dissipates when she stops exerting herself and rests for a few minutes. The woman's history, combined with these complaints, prompted her primary care provider to order cardiac catheterization. What instructions should the nurse provide this patient in anticipation of her procedure? a. "After the test is done, you can resume your normal activity as soon as you feel ready." b. "You'll be put under general anesthetic for the procedure, and you'll wake up when it's done." c. "A small amount of bleeding from your puncture site is normal for a day or two after the procedure." d. "Make sure that you don't eat or drink before the procedure."

d Fasting is required for cardiac catheterization. Activity is resumed slowly after the procedure, which is not performed under general anesthetic. Bleeding from the puncture site requires prompt intervention.

The nurse auscultates the apex beat at which anatomical location? a. midsternum b. 5 cm to the left of the lower end of the sternum c. 2.5 cm to the left of the xiphoid process d. fifth intercostal space, midclavicular line

d The left ventricle is responsible for the apex beat or the point of maximum impulse, which is normally palpable in the left midclavicular line of the chest wall at the fifth intercostal space. The right ventricle lies anteriorly, just beneath the sternum. Use of inches to identify the location of the apex beat is inappropriate based upon variations in human anatomy. Auscultation below and to the left of the xiphoid process will detect gastrointestinal sounds, but not the apex beat of the heart.

A critically ill client is admitted to the ICU. The health care provider decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize? a. Fluctuations in core body temperature b. Signs and symptoms of esophageal varices c. Signs and symptoms of compartment syndrome d. Perfusion distal to the insertion site

d The radial artery is the usual site selected. However, placement of a catheter into the radial artery can further impede perfusion to an area that has poor circulation. As a result, the tissue distal to the cannulated artery can become ischemic or necrotic. Vigilant assessment is thus necessary. Alterations in temperature and the development of esophageal varices or compartment syndrome are not high risks.

A client is brought into the ED by family members who tell the nurse the client grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the client's cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate? a. Left-sided heart catheterization b. Cardiac telemetry c. Transesophageal echocardiography d. Hardwire continuous ECG monitoring

d Two types of continuous ECG monitoring techniques are used in health care settings: hardwire cardiac monitoring, found in EDs, critical care units, and progressive care units; and telemetry, found in general nursing care units or outpatient cardiac rehabilitation programs. Cardiac catheterization and transesophageal echocardiography would not be used in emergent situations to monitor cardiac function.