Chapter 31 Cardiovascular System Assessment - Complex

The nurse is assessing a patient who has suspected cardiac failure. Which questions would the nurse ask related to the patient's sleep-rest pattern? Select all that apply. "Do you need to sleep upright in a chair?" "How long does it take you to fall asleep?" "Do you fall asleep with the television on?" "How many pillows do you need to sleep at night?" "Do you exercise within two hours of going to bed?

"Do you need to sleep upright in a chair?" "How many pillows do you need to sleep at night?" Many patients with heart failure need to sleep upright in a chair or with several pillows. The nurse would note the number of pillows needed to sleep or the need to sleep upright (orthopnea) and whether this has changed recently. Indications of insomnia and sleeping habits (e.g., how long it takes to fall asleep, falling asleep with the television on, exercising before going to bed) are not part of the assessment for cardiovascular problems.

The nurse is performing a health history on a patient with cardiovascular disease. Which questions reflect the Health Perception-Health Management functional health pattern? Select all that apply. "Do you use recreational drugs?" "How long have you been married?" "Have you lost or gained any weight recently?" "Do you drink alcoholic beverages? How often?" "Do you use extra pillows when you sleep? How many?" "How many years have you smoked, and how many packs a day?"

"Do you use recreational drugs?" "Do you drink alcoholic beverages? How often?" "How many years have you smoked, and how many packs a day?" Questions about smoking history, alcohol use, and any use of habit-forming drugs, including recreational drugs, reflect the Health Perception-Health Management functional health pattern. Questions about marriage reflect the Role-Relationships functional health pattern. Questions about weight gain or loss reflect the Nutritional-Metabolic health pattern. The use of extra pillows for sleep may be indicative of heart failure and reflects the Sleep-Rest health pattern.

Which question would the nurse ask to assess a patient for orthopnea? "How many times do you get up at night to urinate?" "How many pillows do you use for sleeping at night?" "Do you get awakened by shortness of breath at night?" "Are you comfortable walking and talking at the same time?"

"How many pillows do you use for sleeping at night?"

A patient with a myocardial infarction is preparing for discharge following successful treatment. Which information is important for the nurse to include in the discharge teaching related to elimination? "A goal is to have a bowel movement only once a day." "It is important to avoid straining during bowel movements." "A goal is to not have bowel movements immediately after eating." "It will be necessary to take a medication daily to regulate the bowels."

"It is important to avoid straining during bowel movements." It is extremely important that the patient doesn't strain during bowel movements. Straining during bowel movements puts pressure on the heart for circulation of blood. This can aggravate heart troubles. Passing stools more than once a day and passing stools after eating are safe. Advising the patient to take unsupervised over-the-counter (OTC) drugs is not advisable because they can be detrimental to the patient's health.

Which instruction would the nurse give to a patient who is scheduled for Holter monitoring? "Keep a diary of all activities and symptoms." "Remove the monitor only to shower or bathe." "Refrain from exercising while wearing this monitor." "Connect the monitor whenever you feel symptoms."

"Keep a diary of all activities and symptoms." A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor. Normal patient activity is encouraged to stimulate conditions that produce symptoms. Event monitoring involves the starting of a recording as soon as symptoms begin or as soon thereafter as possible.

Which instructions would the nurse provide to a patient who is scheduled for a transesophageal echocardiogram (TEE)? Select all that apply. "Remove dentures prior to the test." "Refrain from tobacco use 24 hours before the test." "It is permissible to eat light meals between the scans." "Withhold caffeine products for 12 hours before the test." "Consume nothing by mouth for six hours before the test."

"Remove dentures prior to the test." "Consume nothing by mouth for six hours before the test." TEE is a diagnostic test for cardiovascular assessment in which a probe with a transducer at the tip is swallowed, and the health care provider controls the angle and depth. The patient should remove dentures prior to the test to prevent partial airway obstruction by dislodgement of dentures. The patient should be on NPO status for six hours before the test to minimize the risk of vomiting and aspiration. Patients should refrain from tobacco use for 24 hours before undergoing positron emission tomography (PET), not before TEE. Light meals can be taken between scans during exercise nuclear imaging, not during TEE. Caffeine products should be withheld for 12 hours before pharmacologic nuclear imaging, not before TEE.

The patient reports being confused about how there can be a blockage in the left anterior descending artery (LAD) although there is damage to the right ventricle. Which explanation would the nurse give? "The LAD blood vessel supplies all of the blood to both ventricles." "The left ventricle is supplied primarily by the right coronary artery." "The LAD supplies blood to the left side of the heart and part of the right ventricle." "It is actually on your right side of the heart, but we call it the left anterior descending vessel."

"The LAD supplies blood to the left side of the heart and part of the right ventricle." The lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole. Both ventricles are not completely supplied by the same vessel because there are three major vessels supplying the two ventricles. The left ventricle is supplied primarily by the LAD and circumflex arteries. The LAD is on the left side of the heart.

A patient with angina is scheduled for a stress test. Which instructions should the nurse give to the patient regarding the test? Select all that apply. "Wear comfortable clothes and shoes for the test." "Refrain from smoking for three hours before the test." "Do not engage in strenuous exercise for three hours before the test." "Do not consume caffeinated food or drinks for an hour before the test." "Report any uncomfortable symptoms that you experience during the test."

"Wear comfortable clothes and shoes for the test." "Refrain from smoking for three hours before the test." "Do not engage in strenuous exercise for three hours before the test." "Report any uncomfortable symptoms that you experience during the test." The patient scheduled for a stress test should not smoke for three hours before the test. Smoking may alter the oxygen-carrying capacity of the blood and result in an increased workload of the heart. This can interfere with accurate test results. Engaging in strenuous exercise also increases the activity of the heart and interferes with the stress test. The patient should wear comfortable clothes and shoes for walking and running during the test. The patient should immediately report any discomfort experienced during the test, which can indicate undue stress on the heart. In such a case, the test would need to be discontinued. Caffeine-containing foods and fluids should be avoided for 24 hours before the test because they can interfere with the test results.

A patient with a history of angina is being treated with nitrates and β-adrenergic receptor blockers (β-blockers). Which important information would the nurse give to the patient regarding sexuality? "Stop taking β-blockers because they can cause impotence." "Stop taking nitrates when planning to have sexual intercourse." "You cannot take erectile dysfunction (ED) drugs like sildenafil." "You cannot have sexual intercourse while taking these medicines."

"You cannot take erectile dysfunction (ED) drugs like sildenafil." The nurse should advise the patient to avoid taking ED drugs such as sildenafil. This is because the combination of ED drugs and nitrates can cause significant hypotension. β-Blockers may cause ED; however, the drug should not be stopped without consulting the health care provider. Discontinuing nitrates can worsen the angina. The patient should not be asked to avoid intercourse.

Which amount of time in seconds is considered normal for capillary refill? 1 4 6 8

1 The capillary refill test assesses arterial flow to the extremities. The fingernail is pressed, and the time required for the refilling of blood is noted. This refill is appreciated by the change in the color of the nail bed. This should occur in less than two seconds with normal tissue perfusion and cardiac output. Capillary refill times of four seconds, six seconds, and eight seconds indicate an underlying defect in circulation.

Which is the order in which the blood flows through the heart? 1. To the left atrium through the pulmonary veins 2. Through the mitral valve and into the left ventricle 3. Through the tricuspid valve into the right ventricle 4. Through the pulmonic valve into the pulmonary artery and to the lungs 5. Through the aortic valve into the aorta and then into the systemic circulation 6. From the inferior and superior venae cavae and the coronary sinus into the right atrium

1. From the inferior and superior venae cavae and the coronary sinus into the right atrium. 2. Through the tricuspid valve into the right ventricle. 3. Through the pulmonic valve into the pulmonary artery and to the lungs. 4. To the left atrium through the pulmonary veins 5. Through the mitral valve and into the left ventricle 6. Through the aortic valve into the aorta and then into the systemic circulation First, the deoxygenated blood from the inferior and superior venae cavae and the coronary sinus enters the right atrium. Then the blood flows through the tricuspid valve and enters the right ventricle. From the right ventricle, blood flows through the pulmonic valve into the pulmonary artery and to the lungs. Then the oxygenated blood enters into the left atrium through the pulmonary veins. After flowing through the mitral valve of the left atrium, the blood enters the left ventricle. From the left ventricle, the blood is ejected through the aortic valve into the aorta and then into the systemic circulation.

In which order would the nurse perform the actions to measure a patient's BP? 1. Place the appropriate-size cuff on the upper arm. 2. Lower the cuff pressure and auscultate the artery. 3. Note the diastolic pressure when the sound disappears. 4. Note the tapping sound as the systolic BP (SBP). 5. Inflate the cuff to 20 to 30 mm Hg above the estimated SBP.

1. Place the appropriate-size cuff on the upper arm. 2. Inflate the cuff to 20 to 30 mm Hg above the estimated SBP. 3. Lower the cuff pressure and auscultate the artery. 4. Note the tapping sound as the systolic BP (SBP). 5.Note the diastolic pressure when the sound disappear The nurse would first place the appropriate size of cuff on the upper arm. This is because the brachial artery is the recommended site for measuring the BP, and the wrong cuff size can give an inaccurate reading. The cuff is then inflated to a pressure 20 to 30 mm Hg above the most recently recorded SBP. This causes the blood flow in the artery to cease. The nurse would then lower the pressure in the cuff while auscultating the artery and also note the first phase of the Korotkoff sound. It is a tapping sound caused by the spurt of blood into the constricted artery. This is the SBP. Finally, when the sound disappears, the nurse notes the diastolic pressure.

In what order does blood flow through the heart? 1. Lungs 2. Left atrium 3. Right atrium 4. Mitral valve 5. Left ventricle 6. Right ventricle

1. R atrium R ventricle lungs L atrium mitral valve L ventricle Blood flows (from the body via the superior and inferior vena cava) into the right atrium. Blood passes from the right atrium (through the tricuspid valve) into the right ventricle, then (via the pulmonic valve into the pulmonic artery) the lungs. Blood flows back from the lungs (via the pulmonary veins) into the left atrium. Blood flows from the left atrium through the mitral valve into the left ventricle and then (via the aortic valve) to the aorta and the body.

Which anatomic feature of the heart directly stimulates ventricular contractions?

4 The Purkinje fibers (4) move the electrical impulse or action potential through the walls of both ventricles, triggering synchronized right and left ventricular contraction. The sinoatrial (SA) node (1) initiates the electrical impulse that results in atrial contraction. The atrioventricular (AV) node (2) receives the electrical impulse through internodal pathways. The bundle of His (3) receives the impulse from the AV node.

Which condition would increase the friction between the heart layers and manifest as a friction rub? An atrial myocardium thinner than the ventricle Different thicknesses in the walls of each chamber 5 mL of fluid in the space between the pericardial layers 12 mL of fluid in the space between the pericardial layers

5 mL of fluid in the space between the pericardial layers Pericardial fluid between the pericardial layers prevents friction between the layers as the heart contracts. Approximately 10 to 15 mL of pericardial fluid is sufficient to reduce the friction. Therefore 5 mL of pericardial fluid indicates that the patient experiences greater friction between the pericardial layers. If the atrial myocardium is thinner than the ventricle, it indicates normal heart anatomy. The wall of each chamber of a normal heart is a different thickness; it does not cause greater friction. Pericardial fluid of 12 mL is a normal finding and does not indicate friction between the pericardial layers.

A patient's systolic BP is 120 mm Hg, and the diastolic pressure is 60 mm Hg. Which value is the mean arterial pressure (MAP)? 40 mm Hg 60 mm Hg 80 mm Hg 100 mm Hg

80 mm Hg The MAP is the average pressure within the arterial system that is felt by organs in the body. It does not refer to the mean of systolic BP (SBP) and diastolic BP (DBP). The MAP can be calculated by (SBP + 2DBP) ÷ 3. Therefore if the SBP is 120 and the DBP is 60, the MAP should be (120 + 2 × 60)/3, which is equal to (120 + 120)/3 = 80 mm Hg.

Which patient condition is likely the cause of a heart murmur? Stiffened arteries A damaged valve Dependent edema in the legs Varicosities in the large veins

A damaged valve The turbulent flow of blood across a damaged valve results in a heart murmur. Stiffened arteries, edema, and varicosities do not cause murmurs.

Which objective data would the nurse expect to see in the health record when taking care of a patient with a diagnosis of acute coronary syndrome (ACS)? Acute heart palpitations A rise in troponin levels Shortness of breath, especially at rest Decreased levels of C-reactive protein (CRP

A rise in troponin levels Biomarkers are useful in the diagnosis of ACS, and troponin is the biomarker of choice. Acute heart palpitations and shortness of breath are subjective data used in the assessment of probable diagnosis of ACS. CRP has been linked with the presence of atherosclerosis and the prediction of future heart event risks in patients with myocardial infarction (MI).

How will the nurse document a weakly palpable pulse? 0 1+ 3 2+ 3+

A weak pulse in a patient with cardiovascular disease is indicated by 1+. The absence of a pulse is indicated by 0. A normal pulse rate is indicated by 2+, and 3+ indicates an increased, full, bounding pulse.

A patient who is wheelchair-bound is scheduled for a multigated acquisition (MUGA) scan to aid in the diagnosis of coronary artery disease (CAD). Which revisions in the test procedure will the nurse anticipate? Vital signs will be monitored more frequently. Adenosine will be administered IV. The degree of incline on the treadmill will be lower. A 12-lead electrocardiogram (ECG) will be performed.

Adenosine will be administered IV. A MUGA scan is a common nuclear imaging test for heart wall motion during systole and diastole. Because the patient is unable to exercise, IV adenosine (Adenocard) will be given to dilate the coronary arteries and simulate the effect of exercise. The nurse will monitor vital signs, but this is not the priority action at this time. The patient will not be prepared for the treadmill because he or she is unable to exercise. A 12-lead ECG is not performed as part of the MUGA scan.

A patient has blood regurgitating into the ventricles of the heart at the end of each ventricular contraction. Which structures would the nurse expect will show damage on the patient's two-dimensional echocardiogram report? Select all that apply. Aortic arch Aortic valve Pulmonic valve Papillary muscle Chordae tendineae

Aortic valve Pulmonic valve The semilunar valves (aortic valve and pulmonic valve) are one-way valves that separate the ventricles from major arteries. The aortic valve separates the left ventricle from the aorta, whereas the pulmonary valve separates the right ventricle from the pulmonary artery. As the ventricles contract, ventricular pressure exceeds arterial pressure, the semilunar valves open, and blood is pumped into the major arteries. Therefore damage to the semilunar valves can result in regurgitation of blood into the ventricles. The aortic arch receives blood from the left ventricle but does not prevent the regurgitation of blood into the ventricles. Chordae tendinea are anchored in the papillary muscles of the ventricles. This support system prevents the eversion of the leaflets into the atria during ventricular contraction.

Which conditions are accompanied by a thready pulse? Select all that apply. Hyperthyroidism Hyperkinetic states Aortic valve disease Cardiac dysrhythmias Peripheral arterial disease

Aortic valve disease Peripheral arterial disease A thready pulse is a weak, slowly rising pulse observed in patients with aortic valve disease and peripheral arterial disease. Hyperthyroidism and hyperkinetic states are associated with a bounding pulse. An irregular pulse is observed in patients with cardiac dysrhythmias.

Which effects of aging would the nurse consider in planning care for an 80-year-old person? Select all that apply. Heart valves become thicker. Arterial blood vessels become thin and fragile. The resting supine heart rate is markedly reduced. The number of pacemaker cells in the SA node decreases. There is a decreased response to physical and emotional stress.

Arterial blood vessels become thin and fragile. The number of pacemaker cells in the SA node decreases. There is a decreased response to physical and emotional stress. Heart valves become thicker and stiffer as a result of lipid accumulation, degeneration of collagen, and fibrosis. The number of pacemaker cells in the sinoatrial node decreases with age. By age 75, a person may have only 10% of the normal pacemaker cells. The autonomic nervous system control of the cardiovascular system changes with aging. The number and function of β-adrenergic receptors in the heart decrease with age; thus the older adult has a decreased response to physical and emotional stress. Arterial and venous blood vessels thicken and become less elastic with age. The resting supine heart rate is not markedly affected by aging.

A patient with pericarditis is admitted to the hospital. In which patient position would the nurse assess for a pericardial friction rub? Ask the patient to sit and lean forward. Place the patient in a standing position. Maintain the patient in a supine position. Place the patient in three positions: supine, sitting, and standing.

Ask the patient to sit and lean forward. In a patient with pericarditis, a high-pitched sound can be auscultated. This sound can be heard during heart sound S1 or S2 at the apex. The best position for hearing this sound is when the patient is in a sitting position and leaning forward. The sound is not well heard in other positions, such as supine or standing.

A patient is diagnosed with venous thromboembolism. Which assessment finding would the nurse expect? Abnormal capillary refill Unusually warm extremities Asymmetry in limb circumference Pitting edema of lower extremities

Asymmetry in limb circumference Venous thrombosis is the formation of clots and most commonly occurs in the pelvis or lower extremity—that is, in the deep veins of the legs. This condition results in asymmetry in limb circumference. Possible reduced arterial capillary perfusion and anemia cause abnormal capillary refill. Thyrotoxicosis results in unusually warm extremities. Interruption of venous return to the heart and right-sided heart failure are associated with pitting edema of the lower extremities.

Which factor could contribute to a patient's pedal pulse being absent? Atherosclerosis Hyperthyroidism Arteriovenous fistula Cardiac dysrhythmias

Atherosclerosis Atherosclerosis can cause an absent peripheral pulse. The feet would be cool also and may be discolored. Hyperthyroidism causes a bounding pulse. An arteriovenous fistula gives a thrill or vibration to the vessel, although this would usually not be found in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm.

What does the P wave in this figure represent? Atrial depolarization Ventricular depolarization Excitation of the Purkinje fibers Conduction through the atrioventricular (AV) valves

Atrial depolarization The P wave indicates atrial depolarization. The QRS complex represents depolarization from the AV node throughout the ventricles. The PR interval represents the time it takes the impulse to spread through the atria, AV node, bundle of His, bundle branches, and Purkinje fibers to the point immediately preceding ventricular contraction. The U wave, if seen, represents repolarization of Purkinje fibers, or the U wave may be associated with hypokalemia.

Which assessment would the nurse make to monitor a patient for an adverse effect of amitriptyline? Serum potassium levels Symptoms of thromboembolism Peripheral extremities for edema BP after standing up

BP after standing up Amitriptyline is used to treat depression. It causes orthostatic hypotension. Therefor, monitoring the patient's BP when the patient is in a standing position will help provide effective care. Amitriptyline does not increase the patient's risk of edema. Therefore the nurse will not check the patient for the symptoms of edema. Unlike corticosteroids, amitriptyline does not increase the elimination of potassium and does not cause hypokalemia. Amitriptyline does not impair clotting and does not obstruct blood flow in the vessels. Therefore the nurse will not check for the symptoms of thromboembolism.

The nurse provides education to a patient who is scheduled for a serum test for triglycerides and lipoproteins. Which information would the nurse include? Avoid alcohol for 12 hours before the test. Blood can be drawn in a nonfasting or a fasting state. The initial lipoproteins test result will be used for diagnosis and treatment. A triglyceride level of greater than 100 mg/dL would be considered to be high risk.

Blood can be drawn in a nonfasting or a fasting state. The nurse instructs the patient that both tests may be obtained in a nonfasting state or a fasting state. Consumption of alcohol should be restricted for at least 24 hours before the test. Because there are marked day-to-day fluctuations in the serum lipoprotein levels, more than one test is required for accurate diagnosis and treatment. The reference interval for triglycerides is less than 160 mg/dL for males and less than 135 mg/dL for females.

Which findings would indicate to the nurse that a patient is experiencing prolonged oxygen deficiency? Select all that apply. Erythematous rashes on the extremities Bluish or purplish tinge in the central areas of the tongue Pulse rate of 70 beats/minute and BP of 120/80 mm Hg Obliteration of the normal angle between the base of the nail and the skin Hands and feet warmer than normal and respiratory rate of 20 breaths/minute

Bluish or purplish tinge in the central areas of the tongue Obliteration of the normal angle between the base of the nail and the skin Prolonged oxygen deficiency is characterized by cyanosis and clubbing of the nails. Therefore the presence of a bluish or purplish tinge in the central areas of the tongue and obliteration of the normal angle between the base of the nail and the skin indicates that the patient has an oxygen deficiency. The presence of erythematous rashes on the extremities indicates that the patient has a skin infection but not an oxygen deficiency. A pulse rate of 70 beats/minute and a BP of 120/80 mm Hg are normal findings and do not indicate that the patient has an oxygen deficiency. A deficiency of oxygen results in hypothermia and may make the patient's hands and feet cooler than normal. A respiratory rate of 20 breaths/minute is a normal finding.

Which artery is recommended for checking a patient's BP? Radial Carotid Brachial Femoral

Brachial BP is recorded using a device known as a sphygmomanometer and a stethoscope. The ideal and correct site for checking the BP is the brachial artery. This artery is on the arm near the elbow. The radial artery is on the wrist. The carotid artery is in the neck region, and the femoral artery is around the groin. Any other site other than the brachial artery is not suitable for checking the BP with a sphygmomanometer.

Which blood component is a marker of inflammation reflecting an increased risk of cardiovascular disease? Myoglobin N-terminal pro-brain natriuretic peptide (NT-Pro-BNP) C-reactive protein (CRP) B-type natriuretic peptide (BNP)

C-reactive protein (CRP) CRP is a marker of inflammation that can predict the risk of cardiac events and cardiac diseases. Myoglobin is a low-molecular-weight protein that is sensitive to myocardial injury. NT-Pro-BNP helps in assessing the severity of heart failure. BNP is a peptide that causes natriuresis, and its elevation distinguishes a cardiac versus respiratory cause of dyspnea.

Which portion of the vascular system exchanges cellular nutrients and metabolic end products? Capillary vessels Smooth muscle of the arteriole Endothelial layer of the arteries Elastic middle layer of the veins

Capillary vessels The exchange of cellular nutrients and metabolic end products takes place through the thin-walled capillaries, which connect the arterioles and the venules. Exchange of cellular nutrients and metabolic end products does not occur in the arteriole, arteries, or veins.

Which are the major factors that influence BP? Select all that apply. Capillary refill Cardiac output Oxygen saturation Pulmonary pressure Systemic vascular resistance

Cardiac output Systemic vascular resistance The two main factors influencing BP are cardiac output and systemic vascular resistance. Capillary refill, oxygen saturation, and pulmonary pressure do not influence BP.

Which assessment finding would the nurse expect for a patient with ventricular hypertrophy? Hypotension Increased cardiac output Cardiac output of 4 L/min/m2 Increased size of the heart chambers

Cardiac output of 4 L/min/m2 The patient with ventricular hypertrophy has an enlargement of the heart muscle without an increase in cardiac output (CO) or the size of the chambers. The normal CO is 2.8 to 4.2 L/min/m2. The patient experiences elevated BP, not hypotension. If the arterial BP is elevated, the ventricles meet increased resistance to the ejection of blood, thus increasing the work demand of the heart, causing the muscles of the heart to enlarge. The enlargement occurs in the walls without an increase in the size of the chambers.

Which condition may be present if the nurse hears a patient's S4 heart sound? Hypertension Angina pectoris Cardiomyopathy Postural hypotension

Cardiomyopathy S4 is an extra heart sound caused by atrial contraction. It can be normal in older adults. The common pathologies that cause this sound are cardiomyopathy, left ventricular hypertrophy, atrial stenosis, and coronary artery disease (CAD). Hypertension is increased BP, and postural hypotension is a fall in BP after standing, and these conditions do not cause S4. Angina pectoris is pain in the chest region and is not accompanied by S4.

Which physiologic change of aging increases the risk of a 75-year-old patient experiencing a sinus dysrhythmia? Decreased pulse pressure Decreased systolic BP (SBP) Decreased resting supine heart rate (HR) Decreased number of pacemaker cells in the SA node

Decreased number of pacemaker cells in the SA node The number of pacemaker cells in the SA node decreases with age. By age 75, a person may have only 10% of the normal number of pacemaker cells. Arterial and venous blood vessels thicken and become less elastic with age. Arteries increase their sensitivity to vasopressin (antidiuretic hormone). With aging, both of these changes contribute to a progressive increase in SBP and a decrease or no change in diastolic BP (DBP). Thus an increase in the pulse pressure is found. The resting supine HR is not markedly affected by age.

Which action does the QRS complex represent in an electrocardiogram? Depolarization of the atria Repolarization of the ventricles Depolarization of both ventricles Repolarization of the Purkinje fibers

Depolarization of both ventricles An electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the cause of chest pain. The time taken for depolarization of both the ventricles is represented by the QRS interval. Depolarization of the atria is represented by the P wave. The T wave in the electrocardiogram should be upright, and it represents the time for ventricular repolarization. If present, the U wave indicates the repolarization of the Purkinje fibers.

Which instruction would the nurse provide to a patient who is scheduled for exercise testing? Stop smoking one hour before the test. Do not take β-adrenergic receptor blockers (β-blockers) 24 hours before the test. Avoid strenuous exercise six hours before the test. Avoid caffeine-containing foods three hours before the test.

Do not take β-adrenergic receptor blockers (β-blockers) 24 hours before the test. β-Blockers may be held 24 hours before the test because they blunt the heart rate (HR) and limit the patient's ability to achieve maximal HR. The nurse informs the patient not to consume caffeine-containing foods (and caffeine-containing fluids) for 12 hours before the test. The nurse also instructs the patient to avoid strenuous exercise and smoking for three hours before the test.

Which medication listed in a patient's health record is a potential cause of the patient's cardiomyopathy? Ibuprofen Prednisone Doxorubicin Chlorpromazine

Doxorubicin Doxorubicin is an anticancer medication that results in cardiomyopathy. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that results in hypertension, myocardial infarction, and stroke. Prednisone is a corticosteroid that causes hypotension, edema, and potassium depletion. Chlorpromazine is an antipsychotic medication that results in dysrhythmias and orthostatic hypotension.

While reviewing laboratory reports, the nurse notes that a patient's homocysteine level is 17 μmol/L. Which treatment would the nurse anticipate will be prescribed? Nesiritide infusion Estrogen + progestin infusion Vitamin C and vitamin K supplements Folic acid and vitamin B12 supplements

Folic acid and vitamin B12 supplements When a patient's homocysteine levels are greater than 10.4 μmol/L, it indicates that the patient has hyperhomocysteinemia. Hyperhomocysteinemia is caused by a deficiency in folic acid, vitamin B12, and vitamin B6; therefore administering folic acid and vitamin B12 supplements will be beneficial for the patient. Nesiritide helps to increase b-type natriuretic peptide (BNP), but it does not treat deficiencies of folic acid, vitamin B12, and vitamin B6. Estrogen + progestin helps to increase estrogen levels in the blood but does not reduce homocysteine levels. Homocysteine levels increase because of folic acid and vitamin B deficiencies but are unrelated to vitamins C and K.

A patient's baseline heart rate is 85 beats/min. Which heart rate would indicate sympathetic nervous system stimulation in this patient? Heart rate of 50 beats/min Heart rate of 70 beats/min Heart rate of 80 beats/min Heart rate of 110 beats/min

Heart rate of 110 beats/min Stimulation of the sympathetic nervous system increases heart rate. The normal heart rate is in the range of 60 to 100 beats/min. Therefore the patient with a heart rate of 110 beats/min has a stimulated sympathetic nervous system. Stimulation of the sympathetic nervous system does not decrease the patient's heart rate. Therefore the heart rate of 50 beats/min does not indicate stimulation of the patient's sympathetic nervous system. The heart rates of 70 and 80 beats/min are normal findings and do not indicate stimulation of the patients' sympathetic nervous systems.

The nurse is providing information about potential complications to a patient who is scheduled for a transesophageal echocardiography (TEE). Which information would the nurse include? Select all that apply. Hemorrhage Dysrhythmias Renal impairment Transient hypoxemia High levels of lactate dehydrogenase

Hemorrhage Dysrhythmias Transient hypoxemia TEE evaluates mitral valve disease and endocarditis vegetation in the patient. Complications of this procedure include tearing of the esophagus, hemorrhage, dysrhythmias, and transient hypoxemia. Some contrast media cause nephrotoxicity in patients; however, transesophageal echocardiography does not involve the injection of contrast medium into the patient's heart. Increased levels of lactate dehydrogenase are not a complication of the procedure.

A nurse is reviewing a patient's laboratory results: blood cholesterol level of 350 mg/dL, homocysteine level of 14 µmol/L, b-type natriuretic peptide (BNP) of 90 pg/mL, cardiac troponin I (cTnI) level of 0.3 ng/mL, myoglobin level of 16 mcg/L, and C-reactive protein of 4 mg/L. Which interpretation would the nurse reach from these laboratory results? Heart failure Pulmonary complications Myocardial infarction (MI) High risk of cardiac disease

High risk of cardiac disease The patient has a high risk of developing cardiovascular disease, as evidenced by the high cholesterol levels, the homocysteine levels, and the C-reactive protein level. High cholesterol levels directly impact the heart and the blood vessels. A high homocysteine level indicates amino acid production during protein catabolism. It can harm the endothelium. C-reactive protein is a marker of inflammation, and a level of 4 mg/L indicates a high risk of cardiac disease. A normal level of BNP also rules out pulmonary complications. The BNP level is normal, thus ruling out heart failure. The patient has normal levels of troponin and myoglobin, which are indicators of myocardial injury; therefore the patient has not had an MI.

Which condition would the nurse suspect if a U wave is present on a patient's electrocardiogram? Hypothermia Hypokalemia Hypocalcemia Hypothyroidism

Hypokalemia The U wave appears and exceeds the T-wave amplitude in the electrocardiogram if the serum potassium level in the blood is less than 3 mEq/L. Because the normal potassium levels in the blood are in the range of 3.5 to 5.0, the presence of a U wave indicates hypokalemia. The presence of a U wave does not indicate altered body temperature or hypothermia. A U wave may be seen during hypercalcemia but not during hypocalcemia. A U wave does not indicate decreased thyroxine levels or hypothyroidism.

A patient's pulmonary artery is blocked and damaged. Which consequence will the patient experience first? Impaired flow of deoxygenated blood to the lungs Impaired flow of oxygenated blood away from the lungs Impaired flow of oxygenated blood from the aorta to all body parts Impaired flow of deoxygenated blood from the right atrium to the right ventricle

Impaired flow of deoxygenated blood to the lungs The pulmonary artery carries deoxygenated blood from the right ventricle of the heart to the lungs. Therefore damage to the pulmonary artery leads to impaired flow of deoxygenated blood from the right side of the heart initially (on its way to the lungs). Subsequently, it impairs the flow of oxygenated blood away from the lungs and from the systemic aorta to all other body parts. Blood flow between the right atrium and the ventricle would not be affected unless blood begins to back up through the system later.

The nurse identifies a U wave on a patient's electrocardiogram. Which dietary instruction will be beneficial to the patient? Use raw coconut oil for cooking. Increase consumption of bananas. Increase consumption of milk products. Increase consumption of foods with omega-3 oils.

Increase consumption of bananas. The presence of a U wave in the patient's electrocardiogram may indicate hypokalemia or repolarization of the Purkinje fibers. Hypokalemia can be caused by excessive sweating, diarrhea, or excessive laxative use. Bananas are a rich source of potassium. Therefore increasing the consumption of bananas will be beneficial for the patient. Coconut oil increases digestion and bowel function. Raw and virgin coconut oil have a laxative effect and should not be recommended. Milk and milk products like cheese are rich in sodium but not in potassium. Omega-3 oils help flush toxins out of the body. Therefore increasing the consumption of omega-3 oils would produce a laxative effect in the patient and potentiate hypokalemia.

A patient at risk for cardiovascular disease has splinter hemorrhages. Which condition is consistent with this finding? Varicose veins Arteriosclerosis Vasoconstriction Infective endocarditis

Infective endocarditis Splinter hemorrhages are small, red-to-black streaks under the fingernails that indicate the presence of infective endocarditis. Ulcers in a patient with a risk for cardiovascular disease indicate varicose veins or arteriosclerosis. Peripheral cyanosis indicates vasoconstriction.

Which response occurs after a rupture on the endothelial surface of an artery? Initiates coagulation cascade Decreases viscosity of the blood Promotes blood flow in the artery Decreases platelet aggregation at the site

Initiates coagulation cascade The endothelium is the innermost layer of the arteries in the body. After damage to any part of the artery, it initiates cascade formation and aids in the formation of a fibrin clot to reduce the risk of bleeding. The endothelium does not decrease the viscosity of the blood in the artery in either normal or damaged conditions. The endothelium promotes blood flow in the artery during normal conditions but not after a rupture. The endothelium increases platelet aggregation at the ruptured site to repair the ruptured part of the epithelial surface.

The nurse provides postprocedural care to a patient admitted to an inpatient unit after cardiac catheterization. Which assessment is the highest priority? Determining the level of pain Checking for sensation in the feet Verifying the patency of the IV site Inspecting the procedure puncture site

Inspecting the procedure puncture site The highest priority for a patient who has undergone cardiac catheterization, upon arrival to the nursing unit, is to first assess the catheterization site for signs of hemorrhage. Assessments of pain, sensation, and the IV site are all important assessments, but they are of lower priority than checking the cardiac catheterization site.

The registered nurse observes another health care provider performing a cardiac assessment on a patient. Which activity by the health care provider would the nurse question? Documents a normal peripheral pulse as 2+ Identifies that a capillary refill of three seconds is abnormal Uses the diaphragm of the stethoscope to auscultate for S1 and S2 heart sounds Inspects the neck veins while swiftly moving the patient from supine to upright

Inspects the neck veins while swiftly moving the patient from supine to upright To assess for jugular vein distention, the health care provider should inspect the large veins in the neck while the patient is gradually moved from a supine position to an upright (30- to 45-degree position). The patient should not be repositioned too quickly. When a normal peripheral pulse is a normal force, it should be documented as 2+. A capillary refill should occur in less than two seconds with normal tissue perfusion and cardiac output (CO). S1 and S2 are heard best with the diaphragm of the stethoscope because they are high-pitched sounds.

The registered nurse observes another health care provider performing a cardiac assessment on a patient. Which activity by the health care provider would the nurse question? Documents a normal peripheral pulse as 2+ Identifies that a capillary refill of three seconds is abnormal Uses the diaphragm of the stethoscope to auscultate for S1 and S2 heart sounds Inspects the neck veins while swiftly moving the patient from supine to upright

Inspects the neck veins while swiftly moving the patient from supine to upright To assess for jugular vein distention, the health care provider should inspect the large veins in the neck while the patient is gradually moved from a supine position to an upright (30- to 45-degree position). The patient should not be repositioned too quickly. When a normal peripheral pulse is a normal force, it should be documented as 2+. A capillary refill should occur in less than two seconds with normal tissue perfusion and cardiac output (CO). S1 and S2 are heard best with the diaphragm of the stethoscope because they are high-pitched sounds.

A patient has a severe blockage in the left coronary artery. Which cardiac structures will likely be affected by the blockage? Select all that apply. Left atrium Left ventricle Bundle of His Interventricular septum Atrioventricular (AV) node

Left atrium Left ventricle Interventricular septum The left coronary artery arises from the aorta and divides into two main branches: the left anterior descending artery and the left circumflex artery. These arteries supply the left atrium, the left ventricle, the interventricular septum, and a portion of the right ventricle. The AV node and bundle of His are usually supplied by the right coronary artery.

Which area is the site of impaired blood flow for a patient who has a mitral valve disorder? Vena cava and right atrium Left atrium and left ventricle Right atrium and right ventricle Right ventricle and pulmonary artery

Left atrium and left ventricle The mitral valve is located between the left atrium and the left ventricle. Blood flow would not be impaired between the vena cava and right atrium, right ventricle and pulmonary artery, or right atrium and right ventricle in a patient with mitral valve disorder.

Which finding on an older adult's electrocardiogram indicates cellular aging and fibrosis of the conduction system? Regular cardiac rhythm Lengthened QT intervals Increased amplitude of QRS complex Shortened PR interval and shortened QRS complex

Lengthened QT intervals Lengthened QT intervals in an elderly patient's electrocardiogram indicate cellular aging and fibrosis of the conduction system. The patient with cellular aging and fibrosis of the conduction system is characterized by irregular cardiac rhythms, lengthened PR and QRS complex, and a decreased amplitude of the QRS complex.

The BP of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. Which age-related change contributes to this finding? Stenosis of the heart valves Decreased adrenergic sensitivity Increased parasympathetic activity Loss of elasticity in arterial vessels

Loss of elasticity in arterial vessels An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel, and hypertension results. The valvular rigidity of aging causes murmurs, and decreased adrenergic sensitivity slows the heart rate. BP is not raised. Increased parasympathetic activity would slow the heart rate.

An older adult presents to the emergency department with recent weight gain, pitting edema to the bilateral lower extremities, and distended neck veins. Which other assessment findings would the nurse expect? Select all that apply. Irregular heart rate Lower extremity cyanosis Third heart sound (S3) upon auscultation Displaced point of maximal impulse (PMI) High-pitched scratching sound during S1 or between normal heart sounds

Lower extremity cyanosis Third heart sound (S3) upon auscultation Displaced point of maximal impulse (PMI) Pitting bilateral lower extremity edema, weight gain, and jugular venous distention (JVD) are all hallmarks of heart failure. Lower extremity cyanosis, a third heart sound, and displaced PMI are all symptoms that are often found in the patient with heart failure. Irregular heart rate is a hallmark of atrial fibrillation. A high-pitched scratching sound during or between normal heart sounds is indicative of a pericardial friction rub and more commonly indicates pericarditis, not heart failure.

The nurse assesses a patient with cardiac problems and finds that one calf is larger than the other. Which conditions are possible explanations for this finding? Select all that apply. Lymphedema Hypertension Varicose veins Angina pectoris Venous thromboembolis

Lymphedema Varicose veins Venous thromboembolis There may be asymmetries in the circumference of two limbs in disorders like lymphedema, varicose veins, and thromboembolism. In these disorders, the affected limb is generally increased in circumference. Hypertension doesn't cause swelling of the limbs. Angina pectoris refers to pain in the chest and doesn't cause changes in the circumference of the lower extremities.

Which heart valve sounds are best heard at the left midclavicular line at the fifth intercostal space (ICS)? Aortic Mitral Tricuspid Pulmonic

Mitral The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth ICS. The aortic area is best heard at the right second intercostal space. The tricuspid area is assessed best at the midleft sternal border. The pulmonic valve is heard best at the left second intercostal space.

The nurse teaches a caregiver about the plan of care for an older adult patient who has orthostatic hypotension. Which action by the caregiver will the nurse emphasize? Monitoring for the risk of falls Encouraging laughter therapy Encouraging treadmill exercises Taking the patient out for recreation

Monitoring for the risk of falls Orthostatic hypotension, or postural hypotension, is low BP that occurs in patients when they stand up from sitting or lying down. Patients with orthostatic hypotension are at an increased risk of falls. Therefore the caregiver should monitor for falls in the patient. The caregiver can encourage laughter therapy and treadmill exercises, but these measures are not as beneficial as monitoring the patient for falls. The caregiver can take the patient out for recreation, but it is not as beneficial as monitoring the patient's risk of falls.

A patient's laboratory report reveals increased creatine kinase (CK-MB) enzymes. Which condition is consistent with this result? Stroke Myocardial infarction (MI) Coronary artery disease (CAD) Peripheral vascular disease (PVD)

Myocardial infarction (MI) CK-MB enzymes are present in the cardiac muscle and are released into the blood as a result of cell injury. An increase in CK-BB enzymes indicates brain injury. Homocysteine is an amino acid produced during protein catabolism; elevated levels of this amino acid are an indication of stroke, CAD, and PVD

A 78-year-old patient experiences sinus dysrhythmias. A reduction in which type of cells leads to this condition? Conduction cells in the bundle of His Conduction cells in the internodal tracts Conduction cells in the bundle branches Pacemaker cells in the sinoatrial (SA) node

Pacemaker cells in the sinoatrial (SA) node A reduction in the number of pacemaker cells in the SA node may account for sinus dysrhythmias in the older adult patient. Reductions in the number of conduction cells in the bundle of His, internodal tracts, and bundle branches contribute to the development of atrial dysrhythmias and heart blocks.

The nurse is preparing to take a new patient's BP using a sphygmomanometer and a stethoscope. Which action should the nurse take? Use the same-size cuff as used for all other patients. Wait until an automated BP machine is available. Palpate the brachial pulse and inflate the cuff until the pulse ceases. Apply extra pressure on the cuff manually to measure BP

Palpate the brachial pulse and inflate the cuff until the pulse ceases. While measuring BP with the sphygmomanometer and a stethoscope, if the systolic BP is not known, then the nurse should palpate the brachial pulse and inflate the cuff until the pulse ceases. When a BP measurement is scheduled, the nurse should be timely and take the patient's BP, using the appropriate technique rather than waiting to use a machine. Choosing the correct-size cuff for each patient's arm size gives accurate results for BP. Applying extra pressure can increase the pressure on the brachial artery, which can give inaccurate test results.

Which technique would the nurse use to assess for the presence of a pulse deficit? Ask the patient to take a deep breath and hold it. Position the patient supine and palpate the pedal pulses. Palpate the radial pulse while auscultating the apical pulse. Use the bell of the stethoscope when auscultating S1 and S2.

Palpate the radial pulse while auscultating the apical pulse. To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. Palpating the pedal pulses will not indicate a pulse deficit. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation. The diaphragm is more appropriate than the bell when auscultating S1 and S2.

Which term would the nurse use to document a patient's report of awakening during the night with sudden shortness of breath? Orthopnea Atrial fibrillation Intermittent claudication Paroxysmal nocturnal dyspnea

Paroxysmal nocturnal dyspnea Paroxysmal nocturnal dyspnea is defined as attacks of shortness of breath, especially at night, which awaken the patient. Orthopnea is the need to sleep in an upright position. Intermittent claudication affects the muscles of the leg during exercise related to decreased oxygen delivery to the muscle. Atrial fibrillation is a conduction abnormality of the heart.

A nurse reviews the medical records of four patients with cardiovascular disease. Which patient is likely to have jugular venous distention? Patient 1 Patient 2 Patient 3 Patient 4

Patient 2 Patient 2 has right-sided heart failure, which is associated with jugular vein distention. Patient 1 has reduced blood flow and is at increased risk of pressure injuries. Patient 3 has venous thromboembolism, which results in asymmetry in limb circumference. Patient 4 has an arterial obstruction, which is associated with arterial bruit.

The nurse is reviewing the BP values of four patients. Which patient would the nurse suspect to be at the highest risk for ischemia? Patient A Patient B Patient C Patient D

Patient A Mean arterial pressure (MAP) is determined using BP. MAP = (SBP + 2DBP) divided by 3. The MAP of patient A is less than 60, which indicates that the patient's organs are not adequately perfused. Therefore the nurse suspects that patient A has a risk of ischemia. The MAP of patient B is 60, the MAP of patient C is 70, and the MAP of patient D is over 110. A MAP between 60 and 100 indicates that the organs are adequately perfused. Therefore patients B, C, and D are not at risk for ischemia.

Which patient's mean arterial pressure (MAP) does the nurse calculate as potentially inadequate to perfuse organs? Patient A Patient B Patient C Patient D

Patient D The MAP refers to the average pressure within the arterial system that is felt by organs in the body. It is not the average of the diastolic blood pressure (DBP) and systolic blood pressure (SBP) because the length of diastole exceeds that of systole at normal heart rates. MAP is calculated as follows: MAP = (SBP + 2 DBP) ÷ 3. A MAP greater than 60 mm Hg is needed to perfuse the vital organs of an average person under most conditions. When the MAP is low for a period of time, vital organs are underperfused and will become ischemic. Patient D's MAP is 57.3 mm Hg; systolic BP of 88 + 2 x diastolic BP (42 + 42) = 172 ÷ 3 = 57.3. Patient A's MAP is 96 mm HG. Patient B's MAP is 67 mm Hg. Patient C's MAP is 117 mm Hg.

The nurse reviews the cardiac laboratory test results of four patients and suspects which patient had a recent myocardial infarction (MI)? Patient A Patient B Patient C Patient D

Patient D An elevated copeptin (normal <10 pmol/L), an elevated CK-MB (normal 4-6%) and an elevated Troponin I (normal <0.03 ng/dL) indicate a possible MI. C-reactive protein can also indicate an acute MI (high risk greater than 3 mg/dL) or risk for cardiac disease. BNP is not used as a biomarker for MI but is high in heart failure (normal <100 pg/mL). Homocysteine is considered a risk factor for cardiac disease (normal 4-14 µmol/L). Patient A, B and C's Copeptin, CK-MB, C-reactive protein and Troponin I are all within normal range.

The nurse reviews the cardiac laboratory test results of four patients and suspects which patient had a recent myocardial infarction (MI)? Patient A Patient B Patient C Patient D

Patient D An elevated copeptin (normal <10 pmol/L), an elevated CK-MB (normal 4-6%) and an elevated Troponin I (normal <0.03 ng/dL) indicate a possible MI. C-reactive protein can also indicate an acute MI (high risk greater than 3 mg/dL) or risk for cardiac disease. BNP is not used as a biomarker for MI but is high in heart failure (normal <100 pg/mL). Homocysteine is considered a risk factor for cardiac disease (normal 4-14 µmol/L). Patient A, B and C's Copeptin, CK-MB, C-reactive protein and Troponin I are all within normal range. p. 668

Which assessment findings would the nurse expect when assessing a patient with right-sided heart failure? Select all that apply. Peripheral cyanosis Splinter hemorrhages Pericardial friction rub Jugular vein distention Pitting edema of the lower extremities

Peripheral cyanosis Jugular vein distention Pitting edema of the lower extremities Reduced blood flow from heart failure may cause peripheral cyanosis. Jugular vein distention is the result of blood backup on the right side of the heart. Patients with right-sided heart failure may present with pitting edema of the lower extremities as a result of interruption of venous return to the heart. Splinter hemorrhages are often caused by infective endocarditis. A pericardial friction rub is indicative of pericarditis.

Which factors affect a patient's stroke volume? Select all that apply. Preload Afterload Contractility Cardiac index Cardiac output

Preload Afterload Contractility Increased or decreased preload, afterload, and contractility alter the stroke volume of the blood. The cardiac index and cardiac output are affected by stroke volume but do not affect the stroke volume of the blood.

The nurse performing a cardiovascular assessment on an 85-year-old patient expects which age-related finding? Presence of S4 Decreased resting supine heart rate Increased response to physical stress Slight shortening of QRS complex interval

Presence of S4 Due to changes in the heart with aging, a fourth heart sound (S4) might be heard. The supine heart rate is not affected by aging. The response to physical stress is decreased. The QRS complex interval may lengthen.

Which vessel carries oxygenated blood from the lungs to the heart? Pulmonary vein Pulmonary artery Inferior vena cava Superior vena cava

Pulmonary vein The pulmonary vein, in contrast to all other veins, carries oxygenated blood toward the heart from the lungs. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs. The inferior vena cava carries deoxygenated blood from the legs and abdomen to the right atrium of the heart. The superior vena cava carries deoxygenated blood from the arms and head to the right atrium of the heart.

A normal splitting of S2 is best heard in which auscultatory area on the diagram? Mitral Aortic Tricuspid Pulmonic

Pulmonic Normally no sound is heard between S1 and S2. An exception to this is a normal splitting of S2, which is best heard at the pulmonic area during inspiration. A splitting of S2 is not normally heard at Erb's point or the mitral, aortic, or tricuspid locations.

If a patient's BP is 120/80 mm Hg, what is the patient's pulse pressure? Fill in the blank using a whole number. __ mm Hg

Pulse pressure is calculated as the difference between the systolic BP (SBP) and the diastolic BP (DBP). It is normally about one third of the SBP. If the patient's BP is 120/80, the pulse pressure would be 120 - 80, which is equal to 40 mm Hg.

Which action would the nurse take to assess a patient for jugular venous distention? Place the patient in a supine position. Raise the patient to about 45 degrees. Place the patient in a sitting position, leaning forward. Observe the vein in three positions: supine, sitting, and standing

Raise the patient to about 45 degrees. Jugular venous distention can be seen in right-sided heart failure. In this condition, the large veins in the neck are distended as a result of the back pressure exerted by the blood. It is best appreciated when the patient is raised to approximately 45 degrees or slightly less. This exerts pressure and helps in the visualization of the jugular veins. Placing the patient in other positions, such as supine, sitting, leaning, or standing, does not help in clear visualization of jugular venous distention.

Which type of pulse would the nurse expect when assessing a patient who is anxious? Rapid Thready Irregular Pulsus alternans

Rapid A rapid pulse, tachycardia, is associated with anxiety caused by increased adrenaline. A thready pulse is associated with peripheral arterial disease, aortic valve disease, and decreased cardiac output. The pulse is irregular in patients with cardiac dysrhythmias. Pulsus alternans is observed in patients with heart failure and cardiac tamponade.

A nurse is preparing a patient for a transesophageal echocardiogram (TEE). Which intervention would the nurse perform? Inform the patient that skin irritation is likely. Remove dentures and place a bite block in the mouth. Provide lead shielding to areas that are exposed to radiation. Provide information about risks associated with general anesthesia.

Remove dentures and place a bite block in the mouth. While preparing a patient for a TEE, the nurse asks the patient to remove the dentures and places a bite block in the mouth. This is done because an ultrasound transducer will need to be swallowed and passed through the esophagus. When preparing the patient for a chest x-ray, the nurse provides lead shielding to areas that are exposed to radiation. If the patient is undergoing ambulatory ECG, then the nurse asks the patient to carefully observe possible symptoms of skin irritation. The patient will receive IV sedation; general anesthesia is not used for the procedure.

Which action does the T wave in a patient's electrocardiogram (ECG) represent? Depolarization of the atria Repolarization of the ventricles Repolarization of the Purkinje fibers Delayed repolarization in hypokalemia

Repolarization of the ventricles On an ECG, the T wave represents repolarization of the ventricles. Depolarization of the atria is represented by the P wave. The U wave, if present, can represent either repolarization of the Purkinje fibers or hypokalemia.

Which artery supplies the atrioventricular (AV) node and the bundle of His in most people? Circumflex artery Right coronary artery Left main coronary artery Left anterior descending artery

Right coronary artery The right coronary artery supplies blood to the bundle of His and the AV node in the heart for 90% of the population, and a blockage of this artery can affect the blood supply to the bundle of His. The circumflex artery, left main coronary artery, and left anterior descending artery do not supply blood to the bundle of His.

Which structure initiates the action potential in the heart? Bundle of His Purkinje fibers Sinoatrial node Left bundle branch

Sinoatrial node The sinoatrial node is called the pacemaker of the heart, and it initiates the electrical impulse, or action potential, in the heart. By way of the Purkinje fibers, the action potential moves through the walls of ventricles, but it is not initiated at this point. The action potential moves from the atrioventricular node through the bundle of His and the right and left bundle branches, but it is not initiated at these points.

A patient is admitted to the hospital with chest pain. Which diagnostic studies would the nurse expect to be prescribed? Select all that apply. Stress test Chest x-ray Funduscopy Electrocardiogram Electroencephalogram

Stress test Chest x-ray Electrocardiogram A patient with chest pain undergoes tests to assess cardiovascular status. A stress test shows the function of the heart under stress or exercise. A chest x-ray helps one to understand the status of structures in the chest and can assist in understanding any abnormality. An electrocardiogram helps one to understand the electrical activity of the heart and is extremely important while assessing a patient with cardiac troubles. A funduscopy is done to examine the eyes and is not related to the cardiovascular system. An electroencephalogram is done to examine the brain and neurologic system.

Which effects of aging on the cardiovascular system would the nurse anticipate when providing care for older adults? Select all that apply. Systolic murmur Diminished pedal pulses Decreased cardiac reserve Increased maximal heart rate Increased recovery time from activity

Systolic murmur Diminished pedal pulses Decreased cardiac reserve Increased recovery time from activity Well-documented cardiovascular effects of the aging process include valvular rigidity leading to systolic murmur, arterial stiffening leading to diminished pedal pulses or possible increased BP, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease with age as a result of cellular aging and fibrosis of the conduction system. The aging patient experiences decreased cardiac reserve as a result of myocardial hypertrophy, increased collagen and scarring, and decreased elastin.

Which symptoms would the nurse expect to find when assessing the cardiovascular system of an 83-year-old patient? Select all that apply. Systolic murmur Diminished pedal pulses A narrowed pulse pressure Increased systolic BP Difficulty in isolating the apical pulse

Systolic murmur Diminished pedal pulses Increased systolic BP Difficulty in isolating the apical pulse Gerontologic differences in the assessment of the cardiovascular system include the presence of a systolic murmur, diminished pedal pulses, increased systolic BP, and difficulty in isolating the apical pulse. The pulse pressure may be widened, not narrowed.

A patient's BP is 90/50. What is the patient's mean arterial pressure (MAP)? Record the answer by rounding to the nearest whole number. ____

The MAP is 63: (90 + 2(50))/3 = 63.

Which statement describes cardiac reserve? The amount of blood pumped by each cardiac ventricle in one minute The peripheral resistance against which the left ventricle must pump The ability to respond to health and illness demands by altering cardiac output The amount of blood in the ventricles at the end of diastole, before the next contraction

The ability to respond to health and illness demands by altering cardiac output The ability of the cardiovascular system to alter cardiac output in response to numerous situations in health and illness, such as stress, hypervolemia, and exercise, is known as cardiac reserve. The amount of blood pumped by each ventricle in one minute is called cardiac output. Afterload is the peripheral resistance against which the left ventricle must pump. Preload is the amount of blood in the ventricles at the end of diastole, before the next contraction.

A patient's heart rate is 72 beats/min. If 0.070 L of blood is ejected from the patient's ventricle with every heartbeat, what cardiac output value would the nurse document in the patient's medical record? Record the answer using a whole number. ___________ L/min

The amount of blood ejected from the ventricle with each heartbeat is known as the stroke volume. Therefore this patient's stroke volume is 0.070 L. Cardiac output (CO) is calculated by multiplying the stroke volume (SV) by the heart rate (HR), or CO = SV × HR. Therefore CO = 0.070 × 72 = 5.0 L/min.

The BP of a patient is 90/60 mm Hg. What should the nurse document as the patient's pulse pressure? Record the answer using a whole number. ________ mm Hg

The difference between the systolic BP (SBP) and diastolic BP (DBP) is the pulse pressure. The patient's SBP is 90, and the DBP is 60; therefore the pulse pressure is 90 - 60 = 30 mm Hg.

The nurse is teaching a group of nursing students about the anatomic characteristics of the heart. Which information would the nurse include? The right and the left atria are similar in size. The atrial myocardium is thicker than that of the ventricles. The right ventricular wall is three times thicker than the left ventricle. The left ventricle is thicker to pump the blood into the systemic circulation

The left ventricle is thicker to pump the blood into the systemic circulation. The left ventricle is thicker because it needs to pump the blood into circulation. The right and left atria are different sizes and have different wall thicknesses. The atrial myocardium is thinner than that of the ventricles. The left ventricular wall is two or three times thicker than the right ventricular wall.

A patient's stroke volume is 0.074 L, and the heart rate is 74 beats/minute. The systemic vascular resistance is 19 mm Hg/min/L. What mean arterial BP should the nurse enter in the patient's medical record? Record the answer using a whole number. ___________ mm Hg

The mean arterial pressure (MAP) BP is manually calculated by multiplying the cardiac output by systemic vascular resistance. Cardiac output is obtained by multiplying the stroke volume by the heart rate. Therefore the patient's cardiac output is 0.074 × 74 = 5.476, and MAP is 5.476 × 19 = 104 mm Hg.

A patient's systolic BP (SBP) is 100 mm Hg and diastolic BP (DBP) is 70 mm Hg. What number will the nurse document as the patient's mean arterial pressure? Record the answer using a whole number. ________ mm Hg

The mean arterial pressure (MAP) is calculated by using the formula MAP = (SBP + 2DBP)/3. Therefore MAP = (100 + 2(70))/3 = (100 + 140)/3 = 240/3 = 80 mm Hg.

Immediately after completing an exercise class, a patient's BP is 140/85 mm Hg. What number would the nurse document as the pulse pressure? Fill in the blank using a whole number. ____

The pulse pressure is the difference between the systolic BP and the diastolic BP; 140 - 85 = 55.

How many seconds does it take for the ventricular conduction system to deliver an electrical impulse? Use a leading zero, if applicable. Record the answer to the second decimal place. __ second(s)

The ventricular conduction system delivers the impulse within 0.12 second. The action potential is generated from the sinoatrial node. It travels through the conduction system, including the atrioventricular (AV) node, bundle of His, and the left and right bundle branches. The action potential moves through the walls of both ventricles by means of Purkinje fibers.

Which blood studies would the nurse expect to see prescribed in a focused evaluation of a patient with cardiac disease? Select all that apply. Troponin Homocysteine C-reactive protein Blood urea nitrogen Thyroid-stimulating hormone

Troponin Homocysteine C-reactive protein Troponin, homocysteine, and C-reactive protein are laboratory tests that may help provide clues to cardiovascular health and possible indicators for cardiac disease. Thyroid-stimulating hormone evaluates the thyroid, and blood urea nitrogen evaluates kidney function; these may not be pertinent initially to a focused cardiovascular assessment.

A patient presents to the emergency department reporting chest pain. Which component of the patient's blood work would most specifically indicate an acute myocardial infarction (MI)? Troponin Myoglobin Creatine kinase (CK) C-reactive protein (CRP)

Troponin Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of other markers. CK enzymes are found in a variety of organs and tissues. Myoglobin elevation is a sensitive indicator of very early myocardial injury but lacks specificity for MI. CRP levels are not used to diagnose acute MI; rather, an increased level has been linked with the presence of atherosclerosis.

Which finding in a patient's laboratory reports supports a conclusion that the patient is at high risk for myocardial injury? Creatine kinase (CK)-MB value of 2% Troponin I value of 3.5 ng/mL Cholesterol value of 250 mg/dL B-type natriuretic peptide (BNP) value of 140 pg/mL

Troponin I value of 3.5 ng/mL Troponin is a contractile protein released after a myocardial infarction. If the value of troponin I is greater than 2.3 ng/mL, it indicates that the patient is at high risk for myocardial injury. A CK-MB value greater than 4% to 6% indicates myocardial infarction. A cholesterol value of 250 mg/dL indicates cardiovascular heart disease. A b-type natriuretic peptide (BNP) value of 140 pg/mL indicates heart failure.

Which abnormality is likely to result in a heart murmur? Increased viscosity of the patient's blood Turbulent blood flow across a heart valve Friction between the heart and the pericardium A deficit in heart conductivity that impairs contractility

Turbulent blood flow across a heart valve Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity or conductivity. Friction between the heart and pericardium may cause an audible friction rub.

Which manifestation would the nurse expect in an elderly patient with arterial stiffening? Widened pulse pressure Decreased venous tortuosity Decreased systolic BP Thinning of the intima of the arteries

Widened pulse pressure Arterial stiffening in the elderly patient results in loss of arterial compliance and increases pulse wave velocity, resulting in widened pulse pressure. The presence of inflamed, painful, or cordlike varicosities indicates increased venous tortuosity. Arterial stiffening can result in increased systolic BP. Arterial stiffening is caused by a loss of elastin in arterial walls and subsequent thickening of the intima of the arteries.