Combo with "555-CH 32: Cardiovascular System" and 1 other

Calculate the pulse pressure of a patient whose blood pressure is 140/85 mm Hg after exercise. Fill in the blank using a whole number.

55 Pulse pressure is the difference between the systolic blood pressure and the diastolic blood pressure. 140-85= 55. TEST-TAKING TIP: When taking the NCLEX exam, an on-screen calculator will be available for you to determine your response, which you will then type in the provided space.

Auscultation of a patient's heart reveals a murmur. This assessment finding is a result of A. increased viscosity of the patient's blood. B. turbulent blood flow across a heart valve. C. friction between the heart the myocardium. D. a deficit in heart conductivity that impairs normal contractility.

ANS: B 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. Reference: 726

The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? 1 Stenosis of the heart valves 2 Decreased adrenergic sensitivity 3 Increased parasympathetic activity 4 Loss of elasticity in arterial vessels

4 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. Text Reference - p. 691

The patient is admitted with reports of awakening during the night with sudden shortness of breath. The nurse documents this as: 1 Orthopnea 2 Atrial fibrillation 3 Intermittent claudication 4 Paroxysmal nocturnal dyspnea

4 Paroxysmal nocturnal dyspnea is defined as "attacks of shortness of breath, especially at night," which awakens the patient. Orthopnea is the need to sleep in an upright position. Atrial fibrillation is a conduction abnormality of the heart. Intermittent claudication affects the muscles of the leg during exercise related to decreased oxygen delivery to the muscle. Text Reference - p. 721

Which instruction given to a patient who is about to undergo Holter monitoring is most appropriate? 1 "You may remove the monitor only to shower or bathe." 2 "You should connect the monitor whenever you feel symptoms." 3 "You should refrain from exercising while wearing this monitor." 4 "You will need to keep a diary of all your activities and symptoms."

4 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. Text Reference - p. 700

While conducting a cardiac assessment for a patient who is 78 years old, the nurse notes that he is suffering from sinus dysrhythmias. A reduction in which type of cells leads to this condition? 1 Pacemaker cells in the sinoatrial (SA) node 2 Conduction cells in the internodal tracts 3 Conduction cells in the bundle of His 4 Conduction cells in the bundle branches

1 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 internodal tracts, bundle of His, and bundle branches contribute to the development of atrial dysrhythmias and heart blocks. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter. Text Reference - p. 691

In palpating the patient's pedal pulses, the nurse determines the pulses are absent. What factor could contribute to this result? 1 Atherosclerosis 2 Hyperthyroidism 3 Arteriovenous fistula 4 Cardiac dysrhythmias

1 Atherosclerosis can cause an absent peripheral pulse. The feet would be cool also 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. Text Reference - p. 696

The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse understand about cardiac output? 1 It is calculated by multiplying the patient's stroke volume by the heart rate. 2 It is the average amount of blood ejected during one complete cardiac cycle. 3 It is determined by measuring the electrical activity of the heart and the patient's heart rate. 4 It is the patient's average resting heart rate multiplied by the patient's mean arterial blood pressure.

1 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 one-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output. Text Reference - p. 689

A patient with a myocardial infarction is preparing for discharge, following successful treatment. What is important for the nurse to include in the discharge teaching related to elimination? 1 "Avoid straining during bowel movement." 2 "Avoid passing stools after having food." 3 "Avoid passing stools more than once a day." 4 "Take medicine for constipation."

1 It is extremely important that the patient doesn't strain during bowel movement. Straining during bowel movement puts pressure on the heart for circulation of blood. This can aggravate heart troubles. Passing stools after food and passing stools more than once a day are absolutely fine and do not affect the patient. Advising the patient to take unsupervised over-the-counter (OTC) drugs is not advisable as they can be detrimental to the patient's health. Text Reference - p. 693

During a physical examination of a patient, a nurse is able to hear murmurs on auscultation. How should the nurse interpret the finding? 1 The cardiac valves are affected 2 There is a decreased compliance of ventricles during filling 3 The patient has pericardial friction rub 4 The patient has high blood pressure

1 Murmurs are heard when the blood flow is turbulent due to dysfunctional valves. The valves may get affected due to accumulation of lipids, degeneration of collagen, and fibrosis. A decreased compliance of ventricles during filling would result in the S4 heart sound. A pericardial friction rub is usually heard as a high-pitched, scratchy sound. High blood pressure does not cause murmurs. Text Reference - p. 691

During a physical examination of a patient, the nurse performs a capillary refill test. What test finding should the nurse consider as normal? 1 Capillary refill time of 2 seconds 2 Capillary refill time of 4 seconds 3 Capillary refill time of 6 seconds 4 Capillary refill time of 8 seconds

1 The capillary refill test assesses the perfusion function of the body. The fingernail is pressed and the time required for refilling of blood is noted. This refill is appreciated by the change in color of the nail bed. Under normal circumstances, the capillary refill time is 2 seconds or less. More than 2 seconds indicates inadequate perfusion. Capillary refill times of 4 seconds, 6 seconds, and 8 seconds indicate an underlying defect in circulation. Text Reference - p. 695

A patient presents to an emergency department with angina. As prescribed, a nurse sends blood samples to the laboratory. Which parameters in the laboratory report indicates myocardial infarction? Select all that apply. 1 A high troponin level 2 A high creatinine kinase (CK-MB) level 3 A high cholesterol level 4 A high C-reactive protein level 5 A homocysteine level

1, 2 Many chemical parameters may indicate and confirm presence of myocardial infarction. Cardiac-specific troponin levels are specific to heart muscles. Their levels are usually very low, and any increase indicates myocardial injury. Creatinine kinase (CK) is a protein found skeletal muscle, brain and nervous tissue, and the heart. CK-MB is heart specific and high levels of this protein are indicative of myocardial infarction. Text Reference - p. 698

A patient is admitted to a hospital with chest pain and is scheduled for a stress test. What instructions should the nurse give to the patient regarding the test? Select all that apply. 1 "Refrain from smoking for 3 hours before the test." 2 "Do not engage in strenuous exercise for 3 hours before the test." 3 "Do not consume caffeinated food or drinks for an hour before the test." 4 "Wear comfortable clothes and shoes for the test." 5 "Report any uncomfortable symptoms that you experience during the test."

1, 2, 4, 5 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 work load 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, as they can interfere with the test results. Text Reference - p. 701

A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient? Select all that apply. 1 Assess for return of gag reflex. 2 Assess groin for hematoma or bleeding. 3 Monitor vital signs and oxygen saturation. 4 Position patient supine with head of bed flat. 5 Assess lower extremities for circulatory compromise

1, 3 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 also are important assessment parameters resulting from the use of sedation. Text Reference - p. 701

A patient's blood pressure is 180/100 mm Hg. To assess cardiovascular status, which question related to nutrition is appropriate for the nurse to ask? 1 "Do you consume a salad each week?" 2 "How much salt do you consume in an average day?" 3 "How much chili do you consume in an average week?" 4 "Do you consume meat each day?"

2 A person's food habits impact the cardiovascular system greatly. A patient with hypertension needs to limit consumption of salt, as salt is known to increase blood pressure. Hence, asking the patient about approximate consumption of salt in a day is important while assessing cardiovascular status. Consuming salads is good for overall health, but is not a definitive query for a patient with hypertension. Chili can cause gastrointestinal issues, but it is not an important factor in cardiovascular health. Meat is not an important factor for hypertension. Text Reference - p. 693

A patient is scheduled for cardiac catheterization. What does the nurse provide to the patient as the primary rationale for the procedure? 1 Bypassing obstructed vessels 2 Assessing the extent of arterial blockages 3 Opening and dilating blocked coronary arteries 4 Assessing the need for antianginal medications

2 Cardiac catheterization is performed to assess the extent and severity of coronary artery blockage. The results of a cardiac catheterization will facilitate decisions regarding the need for medical management, angioplasty, or coronary artery bypass surgery. Text Reference - p. 706

A patient with pericarditis is admitted to the hospital. The nurse recognizes that what is the best method of auscultation in this patient? 1 Maintain the patient in a supine position. 2 Ask the patient to sit and lean forward. 3 Place the patient in a standing position. 4 Place the patient in 3 positions - supine, sitting, and standing.

2 In a patient with pericarditis, 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. Text Reference - p. 696

The patient is confused about how there can be a blockage in the left anterior descending artery (LAD) but there is damage to the right ventricle. The nurse can help the patient understand this with which explanation? 1 "The one vessel curves around from the left side to the right ventricle." 2 "The LAD supplies blood to the left side of the heart and part of the right ventricle." 3 "The right ventricle is supplied during systole primarily by the right coronary artery." 4 "It is actually on your right side of the heart but we call it the left anterior descending vessel."

2 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. Text Reference - p. 698

A nurse is providing information to a new graduate about measuring the blood pressure in a cardiac patient. Which information should the nurse include? 1 Take the blood pressure in the right-lying and left-lying positions 2 Take the blood pressures in both the left and the right arms 3 A variation in blood pressure of 50 mm Hg from supine to standing is normal 4 A variation in blood pressure directly corresponds to a variation in respirations

2 The correct method of obtaining the blood pressure is by taking blood pressure on both arms. The blood pressure may vary in the arms. The arm with the higher blood pressure should be used for further measurements of blood pressure. The nurse should take the blood pressure in 3 positions—with the patient supine, sitting, and standing. There may be slight variations in the three readings. A variation of 20 mm Hg from supine to standing is normal. A variation in blood pressure does not correspond to a variation in respirations. Text Reference - p. 694

The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy is most important for the nurse to assess before this procedure? 1 Iron 2 Iodine 3 Aspirin 4 Penicillin

2 The health care provider usually will use an iodine-based contrast to perform this procedure . Therefore it is imperative to know whether or not the patient is allergic to iodine or shellfish. Knowledge of allergies to iron, aspirin, or penicillin will be secondary. Text Reference - p. 706

A patient with a mitral valve disorder will have impaired blood flow between the 1 Vena cava and right atrium 2 Left atrium and left ventricle 3 Right atrium and right ventricle 4 Right ventricle and pulmonary artery

2 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. Text Reference - p. 687

A patient has a history of angina and is being treated with nitrates and beta blockers. What important information should the nurse give to the patient regarding sexuality? 1 "You cannot have sexual intercourse while taking these medicines." 2 "You cannot take medicines like Viagra." 3 "Stop taking beta blockers as they can cause impotence." 4 "Stop taking nitrates when planning to have sexual intercourse."

2 The nurse should advise the patient to avoid taking erectile dysfunction (ED) drugs such as Viagra. This is because the combination of ED drugs and nitrates can cause significant hypotension. The patient should not be asked to avoid sex. Beta blockers may cause erectile dysfunction; however, the drug should not be stopped without consulting the primary healthcare provider. Discontinuing nitrates can worsen the angina. Text Reference - p. 694

A 59-year-old man has presented to the emergency department with chest pain. What component of the patient's blood work is most clearly indicative of a myocardial infarction (MI)? 1 Creatine kinase (CK)-MB 2 Troponin 3 Myoglobin 4 C-reactive protein (CRP)

2 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. Text Reference - p. 698

While obtaining objective data during the assessment of the cardiovascular system of a patient, what findings can be the cause(s) of concern for a nurse? Select all that apply. 1 Edema is absent in the extremities. 2 Hands and feet are cold to touch. 3 Capillary refill takes longer than 2 seconds. 4 Presence of a thready pulse. 5 Veins in the neck are not distended.

2, 3, 4 Hands and feet that are cold to the touch may indicate intermittent claudication, peripheral arterial disease, low cardiac output, or severe anemia. Capillary refill taking longer than 2 seconds indicates the possibility of reduced arterial capillary perfusion or anemia. Blood loss, decreased cardiac output, aortic valve disease, or peripheral arterial disease can result in a thready pulse. Absence of edema in the extremities and lack of distention of the veins in the neck are not causes for concern. Text Reference - p. 696

A nurse is assessing the vital signs of a patient admitted to a hospital. Which artery should be used to check the blood pressure? 1 Radial 2 Carotid 3 Brachial 4 Femoral

3 Blood pressure is recorded using a device known as a sphygmomanometer and a stethoscope. The ideal and correct site for checking blood pressure 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, while the femoral artery is around the groin. Any other site apart from the brachial artery is not suitable for checking blood pressure with a sphygmomanometer. Text Reference - p. 690

A nurse examines a patient with cardiovascular problems and assesses for the presence of pitting edema. What is the best location to assess for edema? 1 Face 2 Wrist 3 Ankle 4 Chest

3 Edema is a common and early symptom of cardiovascular conditions. This edema is commonly seen in dependent areas, such as on the feet and the ankle, due to gravity. Edema on the face, wrist, or chest may be due to other, noncardiac conditions. Text Reference - p. 693

A nurse is performing a cardiac assessment. How should the nurse assess for jugular venous distention in the patient? 1 Place the patient in a supine position 2 Place the patient in a sitting, leaning forward position 3 Raise the patient to approximately 45 degrees 4 Observe the vein in three positions-supine, sitting, and standing

3 Jugular venous distention can be seen in right-sided heart failure. In this condition the large veins in the neck are distended due to 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 visualization of jugular veins. Text Reference - p. 694

The nurse is reviewing basic electrocardiogram (ECG) interpretation. The T wave represents which action? 1 Hypokalemia 2 Depolarization of the atria 3 Repolarization of the ventricles 4 Repolarization of the Purkinje fibers

3 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. Text Reference - p. 704

While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement to assess the patient's pulse deficit? 1 Position the patient supine 2 Ask the patient to hold his or her breath 3 Palpate the radial pulse while auscultating the apical pulse 4 Use the bell of the stethoscope when auscultating S1 and S2

3 To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. A sitting or side-lying position is most appropriate for cardiac auscultation. 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. Text Reference - p. 697

When assessing a patient, you notice a pulse deficit of 23 beats. This finding may be caused by A. dysrhythmias. B. heart murmurs. C. gallop rhythms. D. pericardial friction rubs.

ANS: A A pulse deficit occurs if there is a difference between the apical and radial beats per minute. A pulse deficit indicates cardiac dysrhythmias. Reference: 726

When a person's blood pressure rises, the homeostatic mechanism that compensates for the elevation involves stimulation of A. baroreceptors that inhibit the sympathetic nervous system, causing vasodilation. B. chemoreceptors that inhibit the sympathetic nervous system, causing vasodilation. C. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation. D. chemoreceptors that stimulate the sympathetic nervous system, increasing the heart rate.

ANS: A Baroreceptors in the aortic arch and carotid sinus are sensitive to stretch or pressure within the arterial system. Stimulation of these receptors sends information to the vasomotor center in the brainstem. This results in temporary inhibition of the sympathetic nervous system and enhancement of the parasympathetic influence, decreasing the heart rate and peripheral vasodilation. Reference: 719

You are providing care for a patient who has decreased cardiac output related to heart failure. You recognize that cardiac output is A. calculated by multiplying the patient's stroke volume by the heart rate. B. the average amount of blood ejected during one complete cardiac cycle. C. determined by measuring the electrical activity of the heart and the patient's heart rate. D. the patient's average resting heart rate multiplied by the patient's mean arterial blood pressure.

ANS: A Cardiac output is determined by multiplying the patient's stroke volume by heart rate, 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. Reference: 718

Which is accurate related to factors affecting cardiac output? A. Contractility increases with epinephrine administration. B. Preload refers to the resistance from vasoconstriction. C. Afterload is the amount of blood in the ventricles at diastole. D. Cardiac output is mainly affected by absolute refractory period.

ANS: A Contractility is increased by epinephrine or norepinephrine, which are normally released by the sympathetic nervous system, but each can be administered as a drug. Preload is the volume of blood in the ventricles at the end of diastole, before the next contraction. Preload determines the amount of stretch placed on myocardial fibers. Afterload is the peripheral resistance against which the left ventricle must pump. It is affected by the size of the ventricle, wall tension, and arterial blood pressure. The absolute refractory period is a time in which cardiac muscles do not respond to any stimuli to recover excitability. Reference: 718

The patient asks you what an ejection fraction (EF) is. Which statement is the appropriate explanation? A. It provides information about left ventricular function during heart contraction. B. It helps to determine electrical impulse conduction through the heart. C. It allows visualization of the heart anatomy and coronary circulation. D. Provides information on cardiac wall movement and valves.

ANS: A The EF is the percentage of end-diastolic blood volume that is ejected during systole. It provides information about the function of the left ventricle during systole. Reference: 733

A patient has a severe blockage in his right coronary artery. Which cardiac structure is mostly likely to be affected by this? A. Atrioventricular (AV) node B. Left ventricle C. Coronary sinus D. Pulmonary valve

ANS: A The right coronary artery (RCA) supplies blood to the right atrium, the right ventricle, and a portion of the posterior wall of the left ventricle. In 90% of people, the RCA supplies blood to the AV node, the bundle of His, and part of the cardiac conduction system. Reference: 716

Which nursing responsibilities are priorities when caring for a patient returning from cardiac catheterization (select all that apply)? A. Monitoring vital signs and the electrocardiogram (ECG) B. Checking the catheter insertion site and distal pulses C. Assisting the patient to ambulate to the bathroom to void D. Informing the patient that he will be sleeping because of general anesthesia E. Instructing the patient about the risks of the radioactive isotope injection

ANS: A, B The nursing responsibilities after cardiac catheterization include assessing the puncture site for hematoma and bleeding; assessing circulation to the extremity used for catheter insertion and peripheral pulses, color, and sensation of the extremity; and monitoring vital signs and ECG rhythm. Other nursing responsibilities are described in Table 32-6. Reference: 732, 736

You are caring for a patient immediately after a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient (select all that apply)? A. Assess for return of the gag reflex. B. Assess the groin for hematoma or bleeding. C. Monitor vital signs and oxygen saturation. D. Position the patient supine with the head of the bed flat. E. Assess lower extremities for circulatory compromise.

ANS: A, C The patient undergoing TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, eliminating the gag reflex until the effects wear off. You must therefore assess for return of the gag reflex before allowing the patient to eat or drink. Vital signs and oxygen saturation are also important assessment parameters resulting from the use of sedation. TEE does not involve invasion of the circulatory blood vessels, and it is not necessary to monitor the patient's groin or lower extremities in relation to this procedure. Reference: 730, 734

Which cardiovascular effects of aging should you anticipate when providing care for older adults (select all that apply)? A. Arterial stiffening B. Increased blood pressure C. Increased maximal heart rate D. Decreased maximal heart rate E. Increased recovery time from activity

ANS: A,B,D,E Well-documented cardiovascular effects of the aging process include arterial stiffening, 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. Reference: 720

What are considered significant findings related to cardiac disease (select all that apply)? A. Paroxysmal nocturnal dyspnea B. Body mass index (BMI) of 22 kg/m2 C. History of streptococcal throat infections D. Nocturia E. Otitis media

ANS: A,C,D Attacks of shortness of breath, especially at night, that awaken the patient are associated with heart failure. History of improperly treated streptococcal sore throat can cause heart valve damage. Nocturia is a common finding with cardiovascular patients. A BMI of 22 kg/m2 is normal. There is no relationship between otitis media and cardiac disease. Reference: 720-721

Which patient assessment is most likely to have a negative effect on cardiac output? A. The heart rate is 104 beats/minute. B. The ECG indicates left ventricle ischemia. C. The T wave is peaked. D. A U wave is present.

ANS: B Cardiac output is the amount of blood ejected from the ventricle with each heartbeat. This is a result of the stroke volume times the heart rate (beats per minute). An ischemic left ventricle does not pump effectively. A heart rate of 100 beats/minute is within the normal range. A peaked T wave indicates hyperkalemia, but cardiac output should remain within normal limits if the heart rate and stroke volume are within normal limits. A U wave, if seen, may represent repolarization of the Purkinje fibers, or it may be associated with hypokalemia. Reference: 718

During a cardiac catheterization into the right side of the heart, a pulmonary artery wedge pressure is obtained. What is the purpose of this measurement? A. Determine efficiency of the right heart contraction B. Assess function of the left side of the heart C. Identify coronary lesions D. Measure the heart's afterload

ANS: B The catheter is advanced into the vena cava, the right atrium, and the right ventricle. The catheter is further inserted into the pulmonary artery, and pressures are recorded. The catheter is then advanced until it is wedged in position and looks forward through the pulmonary capillary bed to the pressure in the left side of the heart (wedge pressure). The wedge pressure is used to assess the function of the left side of the heart. Reference: 735

A P wave on an ECG represents an impulse A. arising at the SA node and repolarizing the atria. B. arising at the SA node and depolarizing the atria. C. arising at the AV node and depolarizing the atria. D. arising at the AV node and spreading to the bundle of His.

ANS: B The first wave, P, begins with firing of the SA node and represents depolarization of the fibers of the atria. Reference: 717

The portion of the vascular system responsible for hemostasis is the A. thin capillary vessels. B. endothelial layer of the arteries. C. elastic middle layer of the veins. D. smooth muscle of the arterial wall.

ANS: B The innermost lining of the arteries is the endothelium. The endothelium maintains hemostasis, promotes blood flow, and under normal conditions, inhibits blood coagulation. Reference: 718

The auscultatory area in the left midclavicular line at the level of the fifth intercostal space (ICS) is the A. aortic valve area. B. mitral valve area. C. tricuspid valve area. D. pulmonic valve area.

ANS: B The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth ICS. Reference: 724

A 59-year-old man has presented to the emergency department with chest pain. Which component of his subsequent blood work most clearly indicates a myocardial infarction (MI)? A. CK-MB B. Troponin C. Myoglobin D. C-reactive protein (CRP)

ANS: B 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. Reference: 727

Which is a correct aspect of a cardiac assessment? A. Auscultate the carotid artery to hear a thrill. B. The point of maximal impulse is at the fifth left intercostal space. C. Erb's point is located at the right second intercostals space. D. S1 and S2 cardiac sounds are best heard with the bell of the stethoscope.

ANS: B When the patient is supine, the mitral valve area is the point of maximal impulse (PMI), which is also known as the apical pulse. It reflects the pulsation of the apex of the heart and is located at the left midclavicular line in the fifth intercostal space. A thrill is assessed by touch, a bruit is heard by auscultation, and Erb's point is located at the third left intercostal space, near the sternum. It is where the S2 heart sound is normally heard best. S1 and S2 are best heard with the diaphragm of the stethoscope because they are high-pitched sounds. Reference: 726

When collecting subjective data related to the cardiovascular system, which data should be obtained from the patient (select all that apply)? A. Annual income B. Smoking history C. Religious preference D. Number of pillows used to sleep E. Blood for basic laboratory studies

ANS: B,C,D The health history should include assessment of tobacco use. The patient should be asked about cultural or religious beliefs that may influence management of the cardiovascular problem. Patients with heart failure may need to sleep with the head elevated on pillows or in a chair. Reference: 721-723

When assessing the cardiovascular system of a 79-year-old patient, you expect to find A. a narrowed pulse pressure. B. diminished carotid artery pulses. C. difficulty in isolating the apical pulse. D. an increased heart rate in response to stress.

ANS: C Myocardial hypertrophy and the downward displacement of the heart in an older adult may result in difficulty isolating the apical pulse. Reference: 720

The patient is positioned sitting upright and learning forward. After exhalation, you auscultate a high-pitched scratchy heart sound intermittently at the apex. What is the best interpretation of this sound? A. The patient has a I/VI heart murmur. B. An S4 atrial gallop is heard. C. Pericardial friction rub is caused by pericarditis. D. Normal splitting of the S2 cardiac sound is heard.

ANS: C Pericardial friction rubs are sounds caused by friction that occurs when inflamed surfaces of the pericardium (pericarditis) move against each other. They are high-pitched, scratchy sounds that are heard best at the apex with the patient upright and leaning forward and after expiration. A murmur is caused by turbulent blood flow across diseased heart values; a I/VI murmur is barely audible. An S4 heart sound is a low-frequency vibration that precedes the S1. Normal splitting of S2 is best heard at the pulmonic area during inspiration. Reference: 726

Which is a correct understanding of an electrocardiogram (ECG)? A. The U wave represents ventricular repolarization. B. The impulse to trigger ventricular contraction should take 1.2 seconds. C. The P wave indicates the impulse that is coming from the atrium. D. There is an absolute refractory period during the T wave.

ANS: C The P wave indicates the beginning of the firing of the sinoatrial (SA) node and represents depolarization of the fibers of the atria. Normally, there should be a P wave before every QRS. The U wave, if seen, may represent repolarization of the Purkinje fibers, or it may be associated with hypokalemia. The efficient ventricular conduction system delivers the impulse within 0.12 seconds to trigger a synchronized ventricular contraction. The T wave represents repolarization of the ventricles. Reference: 717

A patient with a tricuspid valve disorder has impaired blood flow between the A. vena cava and right atrium. B. left atrium and left ventricle. C. right atrium and right ventricle. D. right ventricle and pulmonary artery.

ANS: C The tricuspid valve is located between the right atrium and the right ventricle. Reference: 716

Which statement is accurate regarding blood work results in assessing cardiac function? A. C-reactive protein (CRP) is an independent risk factor for autoimmune diseases. B. Homocysteine is acquired from high dietary consumption of cholesterol. C. B-type natriuretic peptide (BNP) helps to differentiate between cardiac and respiratory causes of dyspnea. D. Myoglobin is the biomarker of choice in the diagnosis of myocardial infarction (MI).

ANS: C There are three natriuretic peptides. BNP is found in ventricles. BNP has emerged as the marker of choice for determining whether there is a cardiac or respiratory cause of dyspnea. CRP is a protein produced by the liver during periods of acute inflammation. It is emerging as an independent risk factor for coronary artery disease (CAD). Homocysteine is an amino acid produced during protein catabolism. Elevated levels can be hereditary or acquired from dietary deficiencies of B6, B12, or folate. Troponin is the biomarker of choice in the diagnosis of MI. Myoglobin is found in cardiac and skeletal muscles, and it is used as an indicator in early myocardial injury. Reference: 727

While assessing the cardiovascular status of a patient, you perform auscultation. Which practice should you implement into the assessment during auscultation? A. Position the patient supine. B. Ask the patient to hold his or her breath. C. Palpate the radial pulse while auscultating the apical pulse. D. Use the bell of the stethoscope when auscultating S1 and S2.

ANS: C To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm of the stethoscope 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 his or her breath during cardiac auscultation. Reference: 726

If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the A. atria. B. AV node. C. ventricles. D. bundle of His.

ANS: C The action potential of the electrical impulse diffuses widely through the walls of both ventricles by means of Purkinje fibers. Reference: 716

Which instruction given to a patient who is about to undergo Holter monitoring is most appropriate? A. You may remove the monitor only to shower or bathe. B. You should connect the monitor whenever you feel symptoms. C. You should refrain from exercising while wearing this monitor. D. You must keep a diary of all your activities and symptoms.

ANS: D A Holter monitor is worn 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. Reference: 729

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

ANS: D 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. Reference: 720

Which is accurate regarding measuring arterial blood pressure? A. Radial pulse should be used to detect Korotkoff sounds. B. Inflate cuff to previous systolic blood pressure when obtaining blood pressure values. C. When using Doppler, the point at which the sound disappears is the systolic pressure. D. Auscultatory gap is loss of sound between systolic and diastolic blood pressures.

ANS: D Auscultatory gap is the loss of sound between the systolic and diastolic blood pressures, and it occasionally is heard. Korotkoff sounds are the blood pressure measured externally by auscultating for sounds of turbulent blood flow through a compressed artery. The brachial artery is recommended. The cuff should be inflated to a pressure 20 to 30 mm Hg above the systolic pressure. With Doppler, the cuff is inflated 20 to 30 mm Hg above the point at which the sound disappears. When the sound returns during deflation, it is the systolic blood pressure. Reference: 719

Which is the best method to document a patient's tobacco use and risk of heart disease? A. Number of years smoked B. Number of cigarettes daily C. Number of forms of tobacco use D. Number of pack-years of tobacco use

ANS: D The most informative method is pack-years, which is the number of packs smoked per day multiplied by the number of years the patient has smoked. Reference: 721

You are admitting a patient who is scheduled to undergo a cardiac catheterization. Which allergies are most important for you to assess before this procedure? A. Iron B. Iodine C. Aspirin D. Penicillin

ANS:B The physician typically uses iodine-based contrast to perform this procedure. You must assess whether the patient is allergic to iodine or shellfish. Reference: 721, 732