Class 6- Intro to Perfusion NCLEX

A patient is being prepared for an arteriogram and questions are being asked in preparation for a smooth discharge process when the patient is stable after the procedure. Which question is most important for the registered nurse to ask? "How long will the drive take to get home?" "Do you have any pets at home?" "Where did you park your car?" "Does someone live with you who drives?"

"Does someone live with you who drives?" The patient will need assistance initially because it is unsafe to drive home after sedation. It is also not permitted to climb stairs alone for 24 hours after the procedure. The patient must avoid strenuous housework and lifting for 3 days. This would include things such as carrying baskets of laundry, lifting bags of groceries, and performing other activities of daily living.

5. ___________ is the amount of blood pumped by the left ventricle with each beat.* A. Cardiac output B. Preload C. Afterload D. Stroke volume

The answer is D. Stroke volume is the amount of blood pumped by the left ventricle with each beat.

A patient is questioning the nurse about circulation and perfusion. Which is the best response by the nurse? "Perfusion assists the cell by delivering oxygen and removing waste products." "Perfusion assists the body by preventing clots and increasing stamina." "Perfusion assists the heart by increasing the cardiac output." "Perfusion assists the brain by increasing mental alertness."

"Perfusion assists the cell by delivering oxygen and removing waste products." Perfusion delivers much needed oxygen to the cells of the body and then helps to remove waste products. Perfusion does not prevent clots, does not increase cardiac output, and does not increase mental alertness.

The patient tells the nurse that he does not understand how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. What is the best response by the nurse? "One coronary vessel curves around and supplies the entire heart muscle." "The LAD supplies blood to the left side of the heart and part of the right ventricle." "The right ventricle is supplied during systole primarily by the right coronary artery." "It is actually on the 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." Rationale: The best response is explaining that 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.

Which instruction by the nurse to a patient who is about to undergo Holter monitoring is accurate? "You may remove the monitor only to shower or bathe." "You should connect the monitor whenever you feel symptoms." "You should refrain from exercising while wearing this monitor." "You will need to keep a diary of your activities and symptoms."

"You will need to keep a diary of your activities and symptoms." Rationale: 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.

A patient is experiencing periods of confusion, and the family is concerned. The patient's son asks the nurse for an explanation and recommendation. Which is the best response by the nurse? "Talk with your father about past events, and that will help with the confusion." "Your father may be having mini-strokes; I will notify his physician." "Your father is just confused about some things since he is in the hospital." "The confusion will pass. Your father just has to get up and move around."

"Your father may be having mini-strokes; I will notify his physician." Periods of confusion may be related to mini-strokes, or transient ischemic attacks (TIAs). Confusion during hospitalization does not occur with every patient. Talking with the patient or thinking the confusion may pass is not a viable solution. The patient should be assessed and the reason for the confusion identified.

4. The nurse is performing discharge teaching for a patient with chronic obstructive pulmonary disease (COPD). What statement, made by the patient, indicates the need for further teaching? 1. "Pursed-lip breathing is like exercise for my lungs and will help me strengthen my breathing muscles." 2. "When I am sick, I should limit the amount of fluids I drink so that I don't produce excess mucus." 3. "I will ensure that I receive an influenza vaccine every year, preferably in the fall." 4. "I will look for a smoking-cessation support group in my neighborhood."

. Answer: 2. Patients need to make sure that they are adequately hydrated in order to liquefy secretions, making it easier to expectorate. Fluids should not be limited or else the mucus will become too thick. All the other answers indicate an understanding of the discharge plan

4. Which statement made by a patient who is at average risk for colorectal cancer indicates an understanding about teaching related to early detection of colorectal cancer? 1. "I'll make sure to schedule my colonoscopy annually after the age of 60." 2. "I'll make sure to have a colonoscopy every 2 years." 3. "I'll make sure to have a flexible sigmoidoscopy every year once I turn 55." 4. "I'll make sure to have a fecal occult blood test annually once I turn 45

4. Answer: 4. American Cancer Society guidelines state that for people of average risk, beginning at the age of 45, an annual fecal occult blood test is recommended. Flexible sigmoidoscopy is recommended every 5 years in this population. A colonoscopy is used every 10 years if recommended by the health care provider

7. The nurse is teaching a patient how to perform a testicular self-examination. Which statement made by the patient indicates a need for further teaching? 1. "I'll recognize abnormal lumps because they are very painful." 2. "I'll start performing testicular self-examination monthly after I turn 15." 3. "I'll perform the self-examination in front of a mirror." 4. "I'll gently roll the testicle between my fingers."

Answer: 1 The examination should be performed monthly in all men 15 years of age and older. Feel for small, pea-size lumps on the front and side of the testicle. Abnormal lumps are usually painless

7. The nurse is caring for a patient with a chest tube for treatment of a right pneumothorax. Which assessment finding necessitates immediate notification of the health care provider? 1. New, vigorous bubbling in the water seal chamber. 2. Scant amount of sanguineous drainage noted on the dressing. 3. Clear but slightly diminished breath sounds on the right side of the chest. 4. Pain score of 2 one hour after the administration of the prescribed analgesic.

Answer: 1. The bubbling in the water seal chamber can mean a new pneumothorax or tube dislodgment. The drainage could be related to the insertion procedure and is scant, so it does not require an immediate phone call to the provider. Answers 3 and 4 are expected findings for a patient with a chest tube.

1. The nurse prepares to conduct a general survey on an adult patient. Which assessment is performed first while the nurse initiates the nurse-patient relationship? 1. Appearance and behavior 2. Measurement of vital signs 3. Observing specific body systems 4. Conducting a detailed health history

Answer: 1. The first part of the general survey is assessment of the appearance and behavior of the patient. As you are initiating the nurse-patient relationship, observe gender and race, age, signs of distress, body type, posture, gait, body movement, hygiene and grooming, dress, affect and mood, speech, and signs of patient abuse

6. The nurse is assessing the cranial nerves. Match the cranial nerve with its related function. Cranial Nerves 1. XII Hypoglossal 2. V Trigeminal 3. VI Adducens 4. IV Trochlear 5. X Vagus Cranial Nerve Function a. Motor innervation to the muscles of the jaw b. Lateral movement of the eyeballs c. Sensation of the pharynx d. Downward, inward eye movements e. Position of the tongue

Answer: 1e, 2a, 3b, 4d, 5c

5. The nurse is teaching a patient to prevent heart disease. Which information should the nurse include? (Select all that apply.) 1. Add salt to every meal. 2. Talk with your health care provider about taking a daily low dose of aspirin. 3. Work with your health care provider to develop a regular exercise program. 4. Limit daily intake of fats to less than 25% to 35% of total calories. 5. Review strategies to encourage the patient to quit smoking

Answer: 2, 3, 4, 5. Teaching about prevention of heart disease focuses on risk factor reduction. Smoking, lack of regular aerobic exercise, and a diet high in sodium and fats are three major risk factors that can be modified. Quitting smoking, regular exercise, and a diet with lower sodium and fat intake are preventive measures. Low-dose aspirin has been shown to be beneficial in reducing the risk of heart disease

9. The nurse is performing tracheostomy care on a patient. What finding would indicate that the tracheostomy tube has become dislodged? 1. Clear breath sounds 2. Patient speaking to nurse 3. SpO2 reading of 96% 4. Respiratory rate of 18 breaths/minute

Answer: 2. Patient phonation is a sign that the TT is not in its proper place. All the other findings are normal assessment findings. Refer to Skill 41.2

3. The nurse is caring for a patient with pneumonia. On entering the room, the nurse finds the patient lying in bed, coughing, and unable to clear secretions. What should the nurse do first? 1. Start oxygen at 2 L/min via nasal cannula. 2. Elevate the head of the bed to 45 degrees. 3. Encourage the patient to use the incentive spirometer. 4. Notify the health care provider

Answer: 2. The HOB needs to be elevated to help increase lung expansion and ease work of breathing. Also this makes it easier for the patient to expectorate

10. The faith community nurse is teaching the community center women's group about breast cancer risk factors. Which factors does the nurse include? (Select all that apply.) 1. First child at the age of 26 years 2. Menopause onset at the age of 49 years 3. Family history with BRCA1 inherited gene mutation 4. Age over 40 years 5. Onset of menses before the age of 12 6. Recent use of oral contraceptives

Answer: 3, 4, 5, 6. These are all risk factors for development of breast cancer. Onset of menopause after the age of 55, not at the age of 49, is a risk factor. First child after the age of 30, not birth of a child at 26, is a risk factor

9. A patient has undergone surgery for a femoral artery bypass. The surgeon's orders include assessment of dorsalis pedis pulses. The nurse will use which of the following techniques to assess the pulses? (Select all that apply.) 1. Place the fingers behind and below the medial malleolus. 2. Have the patient slightly flex the knee with the foot resting on the bed. 3. Have the patient relax the foot while lying supine. 4. Palpate the groove lateral to the flexor tendon of the wrist. 5. Palpate along the top of the foot in a line with the groove between the extensor tendons of the great and first toes.

Answer: 3, 5. To palpate the dorsalis pedis pulses (located in the feet), ask the patient to relax the foot, and then palpate along the top of the foot in a line with the groove between the extensor tendons of the great and first toes. Placing fingers behind the medial malleolus is a technique for assessing the posterior tibial pulse. Having a patient slightly flex the knee is a technique for assessing the popliteal artery behind the knee. Palpation of the groove lateral to the flexor tendon of the wrist is the technique to assess the radial artery

8. The nurse is observing as the student nurse performs a respiratory assessment on a patient. Which action by the student nurse requires the nurse to intervene? 1. The student stands at a midline position behind the patient, observing for position of the spine and scapula. 2. The student palpates the thoracic muscles for masses, pulsations, or abnormal movements. 3. The student places the bell of the stethoscope on the anterior chest wall to auscultate breath sounds. 4. The student places the palm of the hand over the intercostal spaces and asks the patient to say "ninety-nine."

Answer: 3. Breath sounds should be auscultated using the diaphragm of the stethoscope. Auscultate in a systematic pattern over the posterior and anterior chest wall

The nurse is assessing a patient who returned 1 hour ago from surgery for an abdominal hysterectomy. Which assessment finding would require immediate follow-up? 1. Auscultation of an apical heart rate of 76 2. Absence of bowel sounds on abdominal assessment 3. Respiratory rate of 8 breaths/min 4. Palpation of dorsalis pedis pulses with strength of +2

Answer: 3. In healthy adults the normal respiratory rate varies from 12 to 20 respirations per minute. A rate of 8 breaths/min is too low and could be caused by anesthesia or opioid sedation effects

1. The nurse is preparing to perform nasotracheal suctioning on a patient. Arrange the steps in order. 1. Apply suction. 2. Assist patient to semi-Fowler's or high Fowler's position, if able. 3. Advance catheter through nares and into trachea. 4. Have patient take deep breaths. 5. Lubricate catheter with water-soluble lubricant. 6. Apply sterile gloves. 7. Perform hand hygiene. 8. Withdraw catheter

Answer: 7, 2, 6, 4, 5, 3, 1, 8. Refer to Skill 41.1 for the steps to this procedure.

8. The nurse has just witnessed her patient go into cardiac arrest. What priority interventions should the nurse perform at this time? (Select all that apply.) 1. Perform chest compressions. 2. Ask someone to bring the defibrillator to the room for immediate defibrillation. 3. Apply oxygen via nasal cannula. 4. Place the patient in the high Fowler's position. 5. Educate the family about the need for CPR

Answers: 1 and 2. Applying oxygen won't help the patient as he or she is not breathing. The patient needs to be supine for compressions to be effective. The family does need to be educated, but this is not the priority for the nurse at this time. The nurse could delegate this task to a member of the health care team who is not actively engaged in the resuscitation.

6. The nurse is caring for a patient with an artificial airway. What are reasons to suction the patient? (Select all that apply.) 1. The patient has visible secretions in the airway. 2. There is a sawtooth pattern on the patient's EtCO2 monitor. 3. The patient has clear breath sounds. 4. It has been 3 hours since the patient was last suctioned. 5. The patient has excessive coughing.

Answers: 1, 2, and 5. Refer to Skill 41.1. Clear breath sounds are normal and do not indicate the need for suctioning. Suctioning should be based upon assessment findings and not performed on a time-oriented basis

Which assessment findings indicate that the patient is experiencing an acute disturbance in oxygenation and requires immediate intervention? (Select all that apply.) 1. SpO2 value of 95% 2. Retractions 3. Respiratory rate of 28 breaths per minute 4. Nasal flaring 5. Clubbing of fingers

Answers: 2, 3, and 4, found in Table 41.2. SpO2 of 95% is normal and requires no intervention. Clubbed fingers are an assessment finding associated with chronic hypoxia; this does not require immediate intervention

2. Which skills can the nurse delegate to assistive personnel (AP)? (Select all that apply.) 1. Initiate oxygen therapy via nasal cannula. 2. Perform nasotracheal suctioning of a patient. 3. Educate the patient about the use of an incentive spirometer. 4. Assist with care of an established tracheostomy tube. 5. Reposition a patient with a chest tube.

Answers: 4 and 5. Assistive personnel (AP) are not allowed to initiate oxygen therapy, provide education, or perform NT suctioning on a patient. They are allowed to assist the nurse in performing tracheostomy tube care and with repositioning patients.

A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient? (Select all that apply.) Assess for return of gag reflex. Assess groin for hematoma or bleeding. Monitor vital signs and oxygen saturation. Position patient supine with head of bed flat. Assess lower extremities for circulatory compromise.

Assess for return of gag reflex. Monitor vital signs and oxygen saturation. Rationale: The patient undergoing a TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation are important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels. Therefore it is not necessary to monitor the patient's groin and lower extremities in relation to this procedure or to maintain a flat position.

The nurse determines that a patient's pedal pulses are absent. What factor could contribute to this finding? Atherosclerosis Hyperthyroidism Atrial dysrhythmias Arteriovenous fistula

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

A patient who has a history of heart failure and chronic obstructive lung disease is admitted with severe dyspnea. Which value would the nurse expect to be elevated if the cause of dyspnea was cardiac related? Serum potassium Serum homocysteine High-density lipoprotein B-type natriuretic peptide (BNP)

B-type natriuretic peptide (BNP) Rationale: Elevation of BNP indicates the presence of heart failure. Elevations help to distinguish cardiac versus respiratory causes of dyspnea. Elevated potassium, homocysteine, or HDL levels may indicate increased risk for cardiovascular disorders but do not indicate that cardiac disease is present.

The nurse is providing care for a patient who has decreased cardiac output due to heart failure. As a basis for planning care, what should the nurse understand about cardiac output (CO)? CO is calculated by multiplying the patient's stroke volume by the heart rate. CO is the average amount of blood ejected during one complete cardiac cycle. CO is determined by measuring the electrical activity of the heart and the heart rate. CO is the patient's average resting heart rate multiplied by the mean arterial blood pressure.

CO is calculated by multiplying the patient's stroke volume by the heart rate. Rationale: Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.

A patient recovering from a thoracentesis complains of chest pain when he takes in a breath. Which actions would be most important for the nurse to take at this time? Count the respiratory rate and pulse. Listen to the lung sounds and ask how he feels. Measure the abdominal girth and elevate his head. Check SpO2/tracheal deviation and vital signs.

Check SpO2/tracheal deviation and vital signs. If chest pain upon inspiration occurs after a thoracentesis, the lung could be perforated as a result of the procedure. Listening to the lung sounds would provide the most objective assessment of the air exchange of each lung. The respiratory rate most likely would be elevated, but this is not the best answer. The patient's response when asked how he felt would constitute subjective data and would not be as vital as findings of the lung auscultation. Measuring abdominal girth would be important if abdominal pain, not chest pain, was reported after the procedure.

Which aspect of the heart's action does the QRS complex on the ECG represent? Depolarization of the atria Repolarization of the ventricles Depolarization from atrioventricular (AV) node throughout ventricles The length of time it takes for the impulse to travel from the atria to the ventricles

Depolarization from atrioventricular (AV) node throughout ventricles Rationale: The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles.

A patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study? IV sedation may be administered to help the patient relax. Food and fluids are restricted for 2 hours before the procedure. Ambulation is restricted for up to 6 hours before the procedure. Contrast medium is injected into the esophagus to enhance images.

IV sedation may be administered to help the patient relax. Rationale: IV sedation is administered to help the patient relax and ease the insertion of the tube into the esophagus. Food and fluids are restricted for at least 6 hours before the procedure. Smoking and exercise are restricted for 3 hours before exercise or stress testing but not before TEE. Contrast medium is administered IV to evaluate the direction of blood flow if a septal defect is suspected.

What is the purpose of including exercise and activity in a cardiac rehabilitation program? (Select all that apply.) Select all that apply. Increase blood pressure Increase flexibility Increase cardiac output Increase muscle mass Increase serum lipids Increase blood flow through the arteries

Increase flexibility Increase cardiac output Increase muscle mass Increase blood flow through the arteries A cardiac rehabilitation program seeks to increase cardiac output, blood flow through the arteries, muscle mass, and flexibility. The rehabilitation program does not want to increase serum lipids or blood pressure.

The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy information is most important for the nurse to assess and document before this procedure? Iron Iodine Aspirin Penicillin

Iodine Rationale: The provider will usually use an iodine-based contrast to perform this procedure. Therefore, it is imperative to know whether the patient is allergic to iodine or shellfish. Knowledge of allergies to iron, aspirin, or penicillin will be secondary.

The blood pressure of an older adult patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that 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 Rationale: 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. Valvular rigidity of aging causes murmurs, and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate.

The nurse is assessing a female patient at the neighborhood clinic. The patient reports "feeling tired all the time." The nurse knows that fatigue may be an underlying symptom of which condition? Pneumonia Peptic ulcer disease Myocardial infarction Ischemia

Myocardial infarction Fatigue is an atypical symptom of myocardial infarction in women. Ischemia is associated with pain. Pneumonia is associated with pain and shortness of breath. Peptic ulcer disease is associated with pain and intestinal discomfort.

During insertion of a bronchoscope, the patient becomes diaphoretic, with a slow steady pulse and dizziness. Which assessments are most important for the nurse to monitor? Oxygenation saturation level and respiratory rate Capillary refill speed and presence of the gag reflex Blood pressure and central core temperature Lung sounds and bowel sounds

Oxygenation saturation level and respiratory rate The patient is having symptoms reflecting a vasovagal response caused by stimulation of baroreceptors during bronchoscope insertion. The nurse needs to make sure that the airway is supported and might lower the head of the table. Whenever the airway is a matter of concern, the nurse would assess those areas that would reflect airway status, such as oxygenation saturation levels, end-tidal CO2, and respiratory rate.

Which action should the nurse implement with auscultation during a patient's cardiovascular assessment? Position the patient supine. Ask the patient to hold their breath. 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. Rationale: To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold their breath during cardiac auscultation.

Which anatomic feature of the heart directly stimulates ventricular contractions? SA node AV node Bundle of His Purkinje fibers

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

What position should the nurse place the patient in to auscultate for signs of acute pericarditis? Supine without a pillow Sitting and leaning forward Left lateral side-lying position Head of bed at a 45-degree angle

Sitting and leaning forward Rationale: A pericardial friction rub indicates pericarditis. To auscultate a pericardial friction rub, the patient should be sitting and leaning forward. The nurse will hear the pericardial friction rub at the end of expiration.

What age-related cardiovascular changes should the nurse assess for when providing care to an older adult patient? (Select all that apply.) Systolic murmur Diminished pedal pulses Increased maximal heart rate Decreased maximal heart rate Increased recovery time from activity

Systolic murmur Diminished pedal pulses Decreased maximal heart rate Increased recovery time from activity Rationale: 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 blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age related to cellular aging and fibrosis of the conduction system.

A patient is being admitted for valve replacement surgery. Which assessment finding is indicative of aortic valve stenosis? Pulse deficit Systolic murmur Distended neck veins Splinter hemorrhages

Systolic murmur Rationale: The turbulent blood flow across a diseased valve results in a murmur. Aortic stenosis produces a systolic murmur. A pulse deficit indicates a cardiac dysrhythmia, most commonly atrial fibrillation. Right-sided heart failure may cause distended neck veins. Splinter hemorrhages occur in patients with infective endocarditis.

4. A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by:* A. decrease; decreasing preload B. increase, increasing preload C. increase, decreasing afterload D. decrease, increasing contractility

The answer is B. IV fluids will increase venous return to the heart. This will increase the amount of fluid that will fill the ventricles at the end of diastole...hence increasing preload and increasing cardiac output.

8. A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will?* A. Decrease the patient's blood pressure and increase cardiac afterload B. Decrease the patient's blood pressure and decrease cardiac afterload C. Decrease the patient's blood pressure and increase cardiac preload D. Increase the patient's blood pressure but decrease cardiac output.

The answer is B. The patient has a high systemic vascular resistance...as evidence by the patient's blood blood....there is vasoconstriction and this is resulting in the high blood pressure. Therefore, right now, the cardiac afterload is high because the ventricle must overcome this high pressure in order to pump blood out of the heart. If a vasodilator is given, it will decrease the blood pressure (hence the systemic vascular resistance) and this will decrease the cardiac afterload. The amount of the pressure the ventricle must pump against will decrease (cardiac afterload decrease) because the blood pressure will go down (hence the systemic vascular resistance).

1. Which statement below best describes the term cardiac preload? A. The pressure the ventricles stretch at the end of systole. B. The amount the ventricles stretch at the end of diastole. C. The pressure the ventricles must work against to pump blood out of the heart. D. The strength of the myocardial cells to shorten with each beat.

The answer is B. Cardiac preload is the amount the ventricles stretch at the end of diastole (the filling or relaxation phase of the heart).

2. Select the statement below that best describes cardiac afterload:* A. It's the volume amount that fills the ventricles at the end of diastole. B. It's the volume the ventricles must work against to pump blood out of the body. C. It's the amount of blood the left ventricle pumps per beat. D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

The answer is D. Cardiac afterload is the pressure the ventricles must work against to pump blood out of the heart by opening up through the semilunar valves. So, it's the pressure the ventricles must overcome to open the semilunar valves to push blood out of the heart.

10. True or False: Pulmonary and systemic vascular resistance both play a role with influencing cardiac afterload.* True False

The answer is True. If pulmonary vascular resistance or systemic vascular resistance is high, it will create an increased cardiac afterload. If pulmonary vascular resistance or systemic vascular resistance is low, it will create a decreased cardiac afterload.

3. What two factors are used to calculate cardiac output? Select all that apply:* A. Heart rate B. Blood pressure C. Stroke volume D. Mean arterial pressure

The answers are A and C. Cardiac output is calculated by taking the heart rate and multiplying it by stroke volume. CO = HR x SV

9. What conditions below can result in an increased cardiac afterload? Select all that apply:* A. Vasoconstriction B. Aortic stenosis C. Vasodilation D. Dehydration E. Pulmonary Hypertension

The answers are A, B, and E. Vasoconstriction increases systemic vascular resistance which will increase cardiac afterload. It will increase the pressure the ventricle must pump against to open the semilunar valves to get blood out of the heart. Aortic stenosis creates an outflow of blood obstruction for the ventricle (specifically the left ventricle) and this will increase the pressure the ventricle must pump against to get blood out through the aortic valve. Pulmonary hypertension increases pulmonary vascular resistance which will increase the pressure the right ventricle must overcome to open the pulmonic valve to get blood out of the heart....all of this increase cardiac afterload.

6. Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume:* A. Heart rate B. Preload C. Contractility D. Afterload E. Blood pressure

The answers are B, C, and D. Preload, afterload, and contractility all have a role with influencing stroke volume.

7. Which treatments below would decrease cardiac preload? Select all that apply:* A. IV fluid bolus B. Norepinephrine C. Nitroglycerin D. Furosemide

The answers are C and D. Nitroglycerin is a vasodilator that will dilate vessels, which will decrease venous return to the heart and this will decrease preload. Furosemide is a diuretic which will remove extra fluid from the body via the kidneys. This will decrease venous return to the heart and decrease preload. An IV fluid bolus and Norepinephrine (a vasoconstrictor) will increase venous return to the heart and increase preload.

What is an appropriate explanation for the nurse to give to a patient about the purpose of intermittent pneumatic compression devices after a surgical procedure? The devices keep the legs warm while the patient is not moving much. The devices maintain the blood flow to the legs while the patient is on bed rest. The devices keep the blood pressure down while the patient is stressed after surgery. The devices provide compression of the veins to keep the blood moving back to the heart.

The devices provide compression of the veins to keep the blood moving back to the heart. Rationale: Intermittent pneumatic compression devices provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings.

While auscultating the patient's heart sounds with the bell of the stethoscope, the nurse hears a ventricular gallop. How should the nurse document what is heard? Diastolic murmur Third heart sound (S3) Fourth heart sound (S4) Normal heart sounds (S1, S2)

Third heart sound (S3) The third heart sound is heard closely after the S2 and is known as a ventricular gallop because it is a vibration of the ventricular walls associated with decreased compliance of the ventricles during filling. It occurs with left ventricular failure. Murmurs sound like turbulence between normal heart sounds and are caused by abnormal blood flow through diseased valves. The S4 heart sound is a vibration caused by atrial contraction, precedes the S1, and is known as an atrial gallop. The normal S1 and S2 are heard when the valves close normally.

A patient presents to the emergency department reporting chest pain for 3 hours. What component of the blood work is most clearly indicative of a myocardial infarction (MI)? CK-MB Troponin Myoglobin C-reactive protein

Troponin Rationale: Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI.

The nurse is performing an assessment for a patient with fatigue and shortness of breath. Auscultation reveals a heart murmur. What does this assessment finding indicate? Increased viscosity of the patient's blood Turbulent blood flow across a heart valve Friction between the heart and the myocardium A deficit in conductivity impairs normal 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, conductivity, or friction between the heart and myocardium.

The nurse is assessing the sleep patterns of a patient when the patient reports he has trouble sleeping when lying flat. Which is the best response by the nurse? Use pillows to prop yourself up while sleeping. Use nasal strips to assist with breathing. Sleep in a side-lying position. Open a window to let fresh air into the room.

Use pillows to prop yourself up while sleeping. Using pillows to prop himself up during sleep allows the patient to breathe more easily and comfortably. Nasal strips will help with breathing, but they do not always bring relief when one is lying flat. Sleeping in a side position or opening a window does not help one to breathe more easily when one is lying flat.

A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? Women are less likely to delay seeking treatment than men. Women are more likely to have noncardiac symptoms of heart disease. Women are often less ill when presenting for treatment of heart disease. Women have more symptoms of heart disease at a younger age than men.

Women are more likely to have noncardiac symptoms of heart disease. Women often have atypical angina symptoms and nonpain symptoms. Women experience the onset of heart disease about 10 years later than men. Women are often more ill on presentation and delay longer in seeking care than men.