Unit 3

The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?

Repolarization of the ventricles The P wave represents the depolarization of the sinoatrial node. The QRS complex represents the depolarization of the ventricles. The T wave represents repolarization of the ventricles, not the atrium.

Which of the following blood vessel cells form the predominant cellular layer in the tunica media and produce vasoconstriction and/or dilation of blood vessels?

Vascular smooth muscle cells (SMCs) Vascular SMCs, which form the predominant cellular layer in the tunica media, produce vasoconstriction and/or dilation of blood vessels.

By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood pressure of ____ mm Hg or higher.

140; 90 Hypertension is a consistent systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.

A local athlete is getting prepared for the upcoming national track and field championships. Since this athlete is performing extreme exercise, what would be the most probable cardiac output?

16 to 36 L/minute The average cardiac output in resting normal adults ranges from 4 to 6 L/minute. Less than this indicates cardiac disease. If a highly trained athlete is performing at an extreme exercise level, the heart may be required to pump four to six times this amount, or 16 to 36 L/minute.

The cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level. What is the normal young adult's percentage cardiac reserve?

300% - 400% The normal adult has a cardiac reserve of approximately 300 percent to 400 percent.

A client is having blood work done. What percentage of red blood cells represents the formed elements of the blood?

40 - 45% The red blood cells constitute 40 to 45 percent of the formed elements of the blood.

A client with a history of heart failure has been referred for an echocardiogram. Results of this diagnostic test reveal the following findings: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction?

50% Ejection fracture = stroke volume ÷ end-diastolic volume, whereas stroke volume equals the difference between end-diastolic and end-systolic volume. Therefore, EF = 60 ÷ 120, or 50%

Which clients would be at high risk for developing varicose veins? Select all that apply.

A 47-year-old waitress who works 12-hour shifts three or four times/week A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week Prolonged standing and increased intra-abdominal pressure are important contributing factors in the development of primary varicose veins. Because there are no valves in the inferior vena cava or common iliac veins, blood in the abdominal veins must be supported by the valves located in the external iliac or femoral veins. Immobility may cause DVTs (a secondary cause of varicose veins). Peritoneal dialysis has no effect on the development of varicose veins

Which client is most likely to be experiencing vasodilation?

A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin--angiotensin--aldosterone system Angiotensin is a potent vasoconstrictor, and medications that block this induce vasodilation. Epinephrine is also a vasoconstrictor. Histamine is a vasodilator, so antihistamine medications are likely to induce vasoconstriction. Serotonin is a vasoconstrictor, so medications that block its reuptake and increase free levels are apt to promote vasoconstriction.

In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up During a change in body position, blood is rapidly relocated from the central circulation (when the client is recumbent) to the lower extremities (when the client stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.

A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the patient about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium?

A membranous sac that encloses the heart The pericardium forms a fibrous covering around the heart, holding it in a fixed position in the thorax and providing physical protection and a barrier to infection. The pericardium is a tri-layer sac consisting of a tough, outer fibrous layer and a thin, inner serous layer.

Which of the following types of aortic aneurysms is the most common?

Abdominal aortic Aortic aneurysms may involve any part of the aorta: the ascending aorta, aortic arch, descending aorta, thoracoabdominal aorta or abdominal aorta. Abdominal aortic aneurysms, which are the most frequent form of aneurysm, are associated with severe atherosclerosis.

Which of the following neurotransmitters is associated with the parasympathetic nervous system?

Acetylcholine The actions of the autonomic nervous system are mediated by chemical neurotransmitters. Acetylcholine is the postganglionic neurotransmitter for parasympathetic neurons and norepinephrine is the main neurotransmitter for postganglionic sympathetic neurons. Sympathetic neurons also respond to epinephrine, which is released into the bloodstream by the adrenal medulla. The neurotransmitter dopamine can also act as a neurotransmitter for some sympathetic neurons.

When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?

An ejection fraction of 40% This ejection fraction is below normal (normal is about 55 to 75 percent) and indicates a poor prognosis. This low ejection fraction is a result of the complications of long-standing hypertension.

A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child?

Antibiotics and anti-inflammatory drugs A diagnosis of rheumatic fever (RF) necessitates the use of antibiotics (usually penicillin) and anti-inflammatory drugs. These measures supersede the importance of pain control and oxygen therapy. Cardiac catheterization, corticosteroid therapy, pacemakers, and ?-adrenergic blockers are not common treatment modalities for RF.

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be

Apply sequential pneumatic compression devices to lower extremities The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction.

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:

Apply sequential pneumatic compression devices to lower extremities The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction.

Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences?

Backflow from the left ventricle to left atrium The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility.

A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:

Bicuspid valve The bicuspid valve, (also called the mitral) controls the flow of blood between the left atria and left ventricle. The aortic valve controls flow between the left ventricle and aorta. The tricuspid controls the flow between the right atria and ventricle. The pulmonic valve controls flow between the right ventricle and pulmonary artery.

A client's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this agent achieve its therapeutic effect?

By decreasing vascular volume by increasing sodium and water excretion Diuretics lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing sodium and water excretion) and cardiac output. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I, and calcium channels blockers inhibit the movement of calcium into arterial smooth muscle. Common antihypertensives do not act directly on the pituitary.

The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?

C-reactive protein C-reactive protein is a serum marker for systemic inflammation. Elevated homosysteine levels inhibit elements of the anticoagulation cascade and are associated with endothelial damage. Lipoprotein(a) is similar to LDL and can cause atherosclerosis by promoting foam cell formation and the deposition of cholesterol in atherosclerotic plaques. Triglycerides are not associated with inflammation.

Select the correct sequence of blood return to the heart.

Capillaries, venules, veins, right atrium The correct pathway for blood returning back to the heart is the capillaries, venules, veins, and right atrium. The other options do not support normal blood flow.

A 56-year-old male patient has been diagnosed with hypercholesterolemia. Which of the following are the lab results that support this diagnosis?

Cholesterol 250 mg/dL and HDL 32 mg/dL A diagnosis of hypercholesterolemia would be made based on a cholesterol level greater than 200 mg/dL and an HDL of greater than 30 mg/dL.

The heart controls the direction of blood flow. What is the role of the aortic valve?

Controls the direction of blood flow from the left side of the heart to the systemic circulation The heart valves control the direction of blood flow from the atria to the ventricles (the AV valves), from the right side of the heart to the lungs (pulmonic valves) and from the left side of the heart to the systemic circulation (aortic valve).

A client consistently has an elevated systolic BP greater than 150 mm Hg but a diastolic pressure in the 80s. The health care provider should be assessing for which of the following complications?

Crackles in bilateral lung bases caused by left-sided heart failure Systolic hypertension has been defined as a systolic pressure of 140 mm Hg or greater and a diastolic pressure of less than 90 mm Hg. Elevated pressures during systole favor the development of left ventricular hypertrophy, increased myocardial oxygen demands, and eventual left heart failure. Peripheral edema and ascites are usually associated with right-sided failure. Confusion due to blockages in carotid arteries can occur independent of hypertension.

Following a hypertensive crisis, a client's family asks, "Why are the client's eyes so bloodshot?" The nurse responds that high arterial pressure:

Damages more fragile blood vessels like those in the eyes to the point of rupture Excessively high arterial pressure and tissue perfusion can be dangerous because they may damage the more fragile blood vessels (like those inside the eyes). The myogenic control mechanisms rely on stretch of the vascular smooth muscle in the vessel wall. Therefore, it has been proposed that when the arterial pressure stretches the vessel, this in turn causes reactive vascular constriction that reduces the blood flow nearly back to normal.

The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the midcalf area. He has many of the manifestations of:

Deep vein thrombosis Venous insufficiency with deep vein thrombus formation is characterized by discoloration, edema, pain, tenderness, and warmth most commonly in the mid- or lower calf area of the legs. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present.

The client has been diagnosed with impaired blood flow in the deep venous channels of her legs. The nurse explains that which of the following is the most common cause of this condition?

Deep vein thrombosis (DVT) Secondary varicose veins result from impaired blood flow in the deep venous channels. The most common cause of secondary varicose veins is DVT. Other causes include congenital or acquired AV fistulas, congenital venous malformations, and pressure on the abdominal veins caused by pregnancy or tumors.

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

History of cigarette smoking and elevated blood pressure The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.

Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?

Hypercholesterolemia The cause or causes of atherosclerosis have not been determined with certainty. However, epidemiologic studies have identified predisposing risk factors, which include a major risk factor of hypercholesterolemia. Other risk factors include increasing age, family history of premature coronary heart disease, and male sex.

The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which of the following lipoproteins is the main carrier of cholesterol?

LDL LDL is the main carrier of cholesterol. HDL is 50 percent protein; VLDL carries a large amount of triglycerides. IDLs are fragments of VLDLs after the triglycerides are removed and can be recycled to form VLDLs or converted to LDLs.

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?

Laminar Laminar blood flow reduces friction by allowing the blood layers to slide smoothly over one another, with the axial layer having the most rapid rate of flow. Axially, crosswise, and turbulent blood flow would result in increased friction. In turbulent flow, the laminar stream is disrupted and the flow becomes mixed, moving radially (crosswise) and axially (lengthwise).

When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart?

Left ventricle The aortic pressure reflects changes in the ejection of blood from the left ventricle, not the right ventricle or atrium.

A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy one year ago. Which of the following does the nurse suspect is the problem?

Lymphedema The lymphatic system filters fluid at the lymph nodes and removes foreign particles such as bacteria. When lymph flow is obstructed, a condition called lymphedema occurs. Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema.

Which of the following related circulatory complications can result from surgical treatment for metastatic breast cancer?

Lymphedema in the affected arm Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema. The other options are not related to the surgery that would have removed any affected lympth nodes.

The nurse is teaching a client diagnosed with heart failure about preload. Which of the following would be the most appropriate information to provide?

Preload represents the volume work of the heart. Preload is the distending force that stretches the heart muscle just prior to work of the onset of ventricular contraction. It represents the volume of blood stretching the ventricular muscle fibers at end of diastole (i.e., end-diastolic volume) and is the sum of the blood remaining in the heart at the end of systole (end-systolic volume) and the venous return to the heart. The pressure or tension work of the heart refers to afterload. The ability of the heart to change its force of contraction refers to cardiac contractility. The frequency that the ventricles contract and blood is ejected refers to heart rate.

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

Prompt diagnosis and treatment of streptococcal infections Rheumatic heart disease is normally caused by streptococcal infections; therefore, early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a client has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease, and the client should have regular dental examinations.

A patient presents to the emergency department with complaints of bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. Which of the following is a potential diagnosis for this patient?

Raynaud's disease The symptoms of this patient represent Raynaud's disease. Frostbite would most likely have affected the feet and the hands. The others apply more to the lower extremities.

Which of the following is the site of chylomicron synthesis?

Small intestine There are two sites of lipoprotein sythesis - the small intestine and the liver. The chylomicrons are synthesized in the wall of the small intestine.

A client says that when the hospital checked his blood pressure after he lost a lot of blood in a work-related accident, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. Why is this?

Systemic vasoconstriction maintained the diastolic pressure. Systemic vasoconstriction, not vasodilation, would maintain the diastolic pressure. The stroke volume and heart would not affect the diastolic pressure with blood loss.

The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.

Tricuspid Mitral The heart's atrioventricular valves are the tricupsid and the mitral. The semilunar valves are the pulmonary and aortic.

A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease?

"I should have my LDL monitored." Intermittent claudication is the primary symptom of chronic obstructive arterial disease. The two goals of treatment are to decrease their considerable cardiovascular risk and to reduce symptoms. Walking (slowly) to the point of claudication is encouraged because it increases collateral circulation. Addressing blood pressure and high lipid levels are measures to reduce cardiovascular risk. People with diabetes mellitus (DM) develop more extensive and rapidly progressive vascular disease than do people who do not have DM.

The nurse is teaching a patient with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which of the following statements by the patient shows that the patient understands this condition?

"I should report episodes of dizziness or fainting." Hypertrophic cardiomyopathy is defined as unexplained thickening of the left ventricle leading to reduced cardiac output and obstructive outflow. It can cause sudden cardiac death in athletes after exertion. Treatment includes beta blockers to reduce outflow obstruction. The calcium channel blocker verapamil may be used but is avoided in patients with severe outflow obstruction. Patients should pace activity and avoid alcohol. Episodes of dizziness or fainting could indicate reduced cardiac output and should be evaluated.

A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:

"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. For example, persons with extensive obstruction of a coronary blood vessel may rely on collateral circulation to meet the oxygen needs of the myocardial tissue normally supplied by that vessel. There is no indication that the client is on a blood thinner.

The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which of the following initial signs of this condition?

A pulsating mass in the abdomen Most abdominal aortic aneurysms are asymptomatic. Because an aneurysm is of arterial origin, a Which of the following types of aortic aneurysms is the most common?pulsating mass in the abdomen may provide the first evidence of the disorder. The other options are signs and symptoms of aortic dissection.

Which is an accurate statement about acute arterial occlusion ?

A quick forming arterial occlusion is more likely to cause tissue death. Acute arterial occlusion is a sudden event that interrupts arterial flow to the affected tissues or organ. A quick forming occlusion of the artery, such as an acute arterial occlusion, causes an increase in complications and infarction rate than a slower progressive occlusion. Most acute arterial occlusions are the result of an embolus or a thrombus.

ST-elevated myocardial infarction is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?

Action decreases metabolic demands of the heart. Although a number of analgesic agents have been used to treat the pain of STEMI, morphine is usually the drug of choice. It usually is indicated if chest pain is unrelieved with oxygen and nitrates. The reduction in anxiety that accompanies the administration of morphine contributes to a decrease in restlessness and autonomic nervous system activity, with a subsequent decrease in the metabolic demands of the heart. Morphine does not cause a feeling of depression to the client.

Select the priority of care for the medical management of a client with a dissecting aortic aneurysm.

Administration of sodium nitroprusside and β-adrenergic blocking medications Administration of nitroprusside and β-adrenergic blocking medications would be an expected treatment to lessen the force of systolic blood ejection from the heart. The client would be NPO for immediate surgery (not 1 week later), and the blood pressure needs to be lowered rather than elevated.

Which of the following is a nonmodifiable risk factor for the development of primary hypertension?

African American race Hypertension not only is more prevalent in blacks than whites, but also is more severe, tends to occur earlier, and often is not treated early enough or aggressively enough. Blacks also tend to experience greater cardiovascular and renal damage at any level of pressure. High salt intake and obesity are modifiable risk factors for hypertension. Male gender is not identified as a risk factor for hypertension.

Which of the following clients should most likely be assessed for orthostatic hypotension?

An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom Dizziness and syncope are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.

The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?

At the apex of the heart The murmur of mitral valve stenosis is heard during diastole when blood is flowing through the constricted valve; it is characteristically a low-pitched, rumbling murmur best heard at the apex of the heart. The other locations would not be effective.

Coronary artery bypass grafting (CABG) is a treatment modality for which of the following disorders of cardiac function?

Atherosclerosis and unstable angina Coronary artery bypass grafting (CABG) may be the treatment of choice for people with significant coronary artery disease (CAD) who do not respond to medical treatment and who are not suitable candidates for percutaneous coronary intervention. CABG does not address valve disorders, pericardial effusion, or cardiomyopathies.

The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as:

Berry aneurysm The description of the aneurysm describes a berry aneurysm usually found at the circle of Willis. A saccular aneurysm appears sac-like, while the fusiform aneurysm is characterized by a gradual, progressive dilatation of the vessel.

Cardiac output (CO) is used to measure the efficiency of the heart as a pump. What is the equation used to express CO?

CO = SV × HR The efficiency of the heart as a pump often is measured in terms of cardiac output (CO) or the amount of blood the heart pumps each minute. The CO is the product of the stroke volume (SV) and the heart rate (HR), and can be expressed by the equation: CO = SV × HR. AV stands for atrioventricular, and EF stands for ejection fraction. Neither is part of the equation for CO.

Which of the following blood vessels function without the benefit of having walls comprised of three muscular layers?

Capillaries The capillaries are small, thin-walled vessels that link the arterial and venous sides of the circulation and allow the exchange of oxygen and metabolites generated by the various tissues. The walls of all blood vessels, except the capillaries, are composed of three layers: tunica externa, tunica media, and tunica intima.

A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?

Cardiac tamponade Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart. It can be life-threatening and symptoms include tachycardia, elevated central venous pressure, jugular vein distention, fall in systolic blood pressure with narrowed pulse pressure. Pericarditis is inflammation of the pericardium. A myocardial infarction does not have these symptoms nor does a thrombus.

A nurse is assessing a client and becomes concerned that the client may be experiencing heart failure. Which of the following would be the best indicator to determine pressure being exerted on the right side of the heart?

Central venous pressure Blood from the systemic veins flows into the right atrium of the heart; therefore, the pressure in the right atrium is called the central venous pressure. Blood pressure is composed of the systolic blood pressure and the diastolic pressure. Cardiac output reflects the efficiency and work of the heart. Pulse pressure is the difference between systolic and diastolic pressure and reflects the volume of blood ejected from the left ventricle in a single beat.

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

Constrictive pericarditis In constrictive pericarditis, fibrous, calcified scar tissue develops between the visceral and parietal layers of the serous pericardium. Acute pericarditis is due to inflammation of the pericardium. Pleural effusion is caused by accumulation of fluid and can lead to cardiac tamponade.

A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?

Decreased level of consciousness Fibrinolytic therapy is most effective in treating STEMI when administered within 30 minutes after the onset of symptoms. It can still be beneficial up to 12 hours after the onset of ischemic pain. Patients who should not receive fibrinolytic therapy are those with a history of intracranial hemorrhage or significant trauma within the preceding 3 months. The primary complication of fibrinolytic treatment is intracranial bleeding that usually occurs within the first 24 hours following treatment. This would be evident with a change in mental status.

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the patient to be in atrial fibrillation. Which of the following tests will the practitioner order to find the source of the emboli?

Echocardiogram Most acute arterial occlusions are the result of an embolus or thrombus. Most emboli arise in the heart and are caused by conditions (such as atrial fib) that cause blood clots to develop on the wall of a heart chamber or valve surface. An echocardiogram looks at the structure of the heart. The other tests do not demonstrate blood clots in the heart.

A client has been diagnosed with diabetes mellitus. Which of the following lab results would the practitioner expect?

Elevation of triglycerides In diabetes mellitus and the metabolic syndrome, typical dyslipidemia is seen with elevation of triglycerides, low HDL and minimal or modest elevation of LDL. High calorie intake and diabetes mellitus increase the production of VLDL.

Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?

Emotional stress Angina pectoris usually is precipitated by situations that increase the work demands of the heart, such as physical exertion, exposure to cold, and emotional stress. The pain typically is described as a constricting, squeezing, or suffocating sensation. It usually is steady, increasing in intensity only at the onset and end of the attack. Changing positions abruptly does not cause an attack of angina pectoris.

In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis?

Endocarditis The endocardium is a thin, three-layered membrane that lines the heart and covers the valves; infection of this part of the heart is consequently referred to as endocarditis

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?

Exchange gases, nutrients and wastes The circulatory system consists of the heart which pumps blood, the arterial system which distributes oxygenated blood to the tissues, the venous system which collects deoxygenated blood from the tissues and returns it to the heart, and the capillaries where exchange of gases, nutrients and waste takes place.

The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as which of the following?

Fibrous atheromatous plaque The lesions associated with atherosclerosis are of three types - the fatty streak, the fibrous atheromatous plaque, and the complicated lesion. Fatty streaks are thin, flat, yellow intimal discolorations. The fibrous atheromatous plaque grows larger and proliferates into the smooth muscle. As they increase in size, they encroach on the lumen of the artery. More advanced complicated lesions contain hemorrhage, ulceration, and scar deposits and can cause thrombus formation which may occlude the vessel.

Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in which of the following?

Fingers Raynaud disease is a disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes.

The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?

Genetic Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young athletes. It actually occurs in one person out of every 500.

The nurse is teaching a class on reduction of cardiovascular disease. Which of the following demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?

Going for a brisk walk with a friend and talking to him about continuing to exercise regularly The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes. Therapeutic lifestyle changes include an increased emphasis on physical activities such as walking and exercise. Dietary measures to reduce LDL levels include decreasing the use of saturated fats and transfats. Testing for al hypercholesterolemia is not a modifiable risk factor

A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring?

HDL HDL is known as the "good" cholesterol because it transports cholesterol back to the liver for metabolism. LDL, VLDL, and IDL transport cholesterol to the tissues.

Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?

Have the client sit up and lean forward. With acute periocarditis, the pain typically is pleuritic (aggravated by inspiration and swallowing) and positional (decreases with sitting and leaning forward; increases with moving to the side) because of changes in venous return and cardiac filling.

A client who has just recently completed his second series of radiation therapy for lung cancer was admitted yesterday to an acute care facility with ascites. He begins to have jugular vein distention, pedal edema, and dyspnea upon exertion as well as fatigue. What should the nurse suspect?

He has developed constrictive pericarditis. Longstanding inflammation from mediastinal radiation, cardiac surgery and infection is usually the cause of constrictive pericarditis. Ascites is the early finding and can be followed by pedal edema, dyspnea upon exertion, fatigue and jugular vein distention.

What is the most important factor in myocardial oxygen demand?

Heart rate The heart rate is the most important factor in myocardial oxygen demand since as heart rate increases, myocardial oxygen demands increase. The degree of affect the other options have on myocardial oxygen demand is related to how much affect they have on heart rate.

The nursing instructor, while teaching the physiology of the heart, informs the students that there are 3 major determinants of myocardial oxygen demand, which include the heart rate, left ventricular contractility, and systolic pressure. Which does she tell them is the most important factor in myocardial oxygen demand?

Heart rate There are 3 major determinants of myocardial oxygen demand, with the heart rate being the most important factor. The other two are systolic pressure and left ventricular contractility.

A nurse teaching a patient about atherosclerosis identifies which of the following as major risk factors that can be affected by a change in health care behaviors? Select all that apply.

High blood cholesterol levels Cigarette smoking Obesity Hypertension The major risk factors for atherosclerosis that can be affected by a change in health care behaviors include high blood cholesterol levels (specifically high-density lipoprotein cholesterol levels), cigarette smoking, obesity and visceral fat, hypertension, and diabetes mellitus (traditional cardiovascular risk factors).

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which of the following disorders was the player's most likely cause of death?

Hypertrophic cardiomyopathy (HCM) The most frequent symptoms of HCM are dyspnea and chest pain in the absence of coronary artery disease. Syncope (fainting) is also common and is typically postexertional, when diastolic filling diminishes and outflow obstruction increases. Ventricular arrhythmias are also common, and sudden death may occur, often in athletes after extensive exertion. Risk factors for sudden cardiac death among clients with HCM include a family history of syncope or sudden cardiac death, certain mutations, and extreme hypertrophy of the left ventricle. HCM is characterized by a massively hypertrophied left ventricle with a reduced chamber size.

Because cholesterol is insoluble in plasma, it is mainly carried by which of the following lipoproteins?

Low-density lipoprotein (LDL) Although all of the lipoproteins contain cholesterol and triglycerides, LDL is the main carrier of cholesterol.

A patient comes to the clinic complaining of anorexia, weight loss, fever, fatigue along with paresthesias, pain, and weakness of the lower extremities. Assessment findings include reddish blue, mottled areas of discoloration to the skin of the lower extremities. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and abnormal liver function tests. A diagnosis of necrotizing vasculitis is confirmed through biopsy. The nurse anticipates treatment with which of the following medications?

High-dose corticosteroid therapy and cytotoxic immunosuppressant agents Clinical signs and symptoms may vary due to the widely varied vascular involvement. It usually begins complaints of anorexia, weight loss, fever, and fatigue often accompanied by signs of organ involvement. Myalgia, arthralgia, and arthritis are common, as are peripheral neuropathies such as paresthesias, pain, and weakness. Skin lesions may also occur and are highly variable. They include reddish blue, mottled areas of discoloration of the skin of the extremities called livedo reticularis, purpura (i.e., black- and-blue discoloration from bleeding into the skin), urticaria (i.e., hives), and ulcers. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and signs of organ involvement such as hematuria and abnormal liver function test results. Diagnosis is confirmed through biopsy specimens demonstrating necrotizing vasculitis of the small and large arteries. Treatment involves use of high-dose corticosteroid therapy and often-cytotoxic immunosuppressant agents (e.g., azathioprine, cyclophosphamide).

Release of which of the following humoral factors will result in vasodilation?

Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Norepinephrine, angiotensin II, and serotonin are all potent vasoconstrictors.

The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:

Hypertension The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors .The other options are nonmodifiable risk factors for atherosclerosis.

A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure?

Hypertrophic cardiomyopathy HCM is an autosomal dominant heart disease caused by mutations in the genes encoding proteins of the cardiac sarcomere. HCM is the most common cause of sudden cardiac death (SCD) in young athletes. Dilated cardiomyopathy, mitral valve prolapse, and atrial regurgitation all lead to heart failure but much later in life.

A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this?

Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the interventricular septum, abnormal diastolic filling, cardiac arrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac deat in young athletes.

A grandmother, a cook at a nearby school, was recently hospitalized when she lost an extensive amount of blood in a work-related accident. The grandmother tells the nurse that she heard that she would keep feeling faint until the brain made more blood. The nurse knows that when the blood pressure dropped, the pressure in the carotid arteries decreased. This was detected by baroreceptors in the carotid arteries. What did the baroreceptors do?

Increase sympathetic stimulation of the heart and blood vessels The baroreceptors in the carotid arteries increase sympathetic stimulation, not parasympathetic, of the heart and blood vessels. The baroreceptors do not stimulate the brain to form new red blood cells or inhibit renin release from the kidneys to promote fluid retention.

A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?

Increased heart rate and increased contractility The sympathetic nervous system has an excitatory influence on heart rate and contractility, and it serves as the final common pathway for controlling the smooth muscle tone of the blood vessels. With stimulation, both heart rate and contractility would increase.

A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process?

Infective endocarditis Infective endocarditis is a serious and potentially life-threatening infection of the inner surface of the heart. Pericarditis involves an inflammatory response of the pericardium. Myocardial infarction is a heart attack while cardiomyopathy is a heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorders.

Contractile properties of cardiac muscle are similar to those of skeletal muscle except that heart muscle has the ability to contract as a single unit due to which of the following unique anatomical features?

Intercalated disks The contractile properties of cardiac muscle are similar to those of skeletal muscle, except the contractions are involuntary and the duration of contraction is much longer. Unlike the orderly longitudinal arrangement of skeletal muscle fibers,cardiac muscle cells are arranged as an interconnecting latticework, with their fibers dividing, recombining, and then dividing again. Dense structures, - intercalated disks - separate the cardiac muscle fibers from neighboring cardiac muscle cells. The intercalated disks, which are unique to cardiac muscle, contain gap junctions that serve as low resistance pathways for passage of ions and electrical impulses from one cardiac cell to another. Thus, the myocardium behaves as a single unit, or syncytium, rather than as a group of isolated units, as does skeletal muscle. When one myocardial cell becomes excited, the impulse travels rapidly so the heart can beat as a unit. The heart muscle has two syncytia: atrial and ventricular.

Which of the following is true regarding pulmonary circulation?

It is a low-pressure system that allows for improved gas exchange. The pulmonary circulation consists of the right heart and the pulmonary artery, capillaries, and veins. It is the smaller of the systems and functions at a lower pressure to assist with gas exchange.

The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?

It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. Hyperlipidemia, particularly LDL, with its high cholesterol content, is also believed to play an active role in the pathogenesis of the atherosclerotic lesion. Dietary cholesterol tends to increase LDL cholesterol. HDL participates in the reverse transport of cholesterol by carrying cholesterol from the peripheral tissues back to the liver.

Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a:

Large lipid core Plaque disruption causes thrombus formation, with white platelet-containing thrombi being associated with unstable angina. The major determinants of plaque vulnerability to disruption include the size of its lipid-rich core, lack of stabilizing smooth muscle cells, presence of inflammation with plaque degradation, and stability and thickness of its fibrous cap. Plaques with a thin fibrous cap overlaying a large lipid core are at high risk for rupture. Plaque tends to be stable or fixed unevenly in any area of the coronary arteries. Calcified plaque tends to be stable and encased in a thrombus, until it begins to degrade.

The physician states that a client has adequate collateral circulation. The nurse interprets this as:

Long-term compensatory regulation of blood flow Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart and other vital structures, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. Lymph node removal requires establishment of compensatory lymphatic drainage. The aging process produces the development of increased collagen.

The nurse is teaching the client with chronic venous insufficiency. Which part of the body is particularly prone to development of stasis dermatitis?

Lower leg The lower part of the leg is particularly prone to development of stasis dermatitis and venous ulcers.

A client is concerned about his family history of atherosclerosis and asks the nurse if there is anything he can do to decrease his risk. The client has type 2 diabetes. Which response by the nurse is most accurate? Select all that apply.

Maintain normal weight Control hypertension Control blood glucose levels The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors. Cigarette smoking must be stopped not decreased.

A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have?

Mitral valve stenosis Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole, with left atrial distention and impaired filling of the left ventricle with associated symptoms. Mitral prolapse and aortic valve disorders will lead to the development of cardiomyopathies.

Antibodies directed against the M protein of certain strains of streptococcal bacteria seem to cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response resulting in rheumatic fever. This occurs through what phenomenon?

Molecular mimicry It is thought that antibodies directed against the M protein of certain strains of streptococci cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response through a phenomenon called molecular mimicry. None of the other answers are correct.

The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?

Morphine Although a number of analgesic agents have been used to treat pain of myocardial infarction, morphine is the drug of choice and is usually indicated if chest pain is unrelieved with oxygen and nitrates.

Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?

Nitric oxide The fact that nitric oxide is released into the vessel lumen (to inactivate platelets) and away from the lumen (to relax smooth muscle) suggests that it protects against both thrombosis and vasoconstriction. Nitroglycerin, which is used in treatment of angina, produces its effects by releasing nitric oxide in vascular smooth muscle of the target tissues. None of the other options are released by nitroglycerin.

Stimulation of the sympathetic nervous system during stress or exercise causes local constriction because of the release of which hormone?

Norepinephrine Stimulation of the sympathetic nervous system during stress or exercise causes local constriction of veins and arterioles because of the release of norepinephrine from sympathetic nerve endings, not epinephrine, angiotensin II or histamine.

A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:

Onset of STEMI The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin.

Which of the following are characteristic signs of acute arterial embolism?

Pallor, pulselessness, and pain The presentation of acute arterial embolism is often described as that of the seven Ps: pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.

Five hours after presenting to the emergency department with substernal chest pain, a patient's laboratory results demonstrate that troponin I is elevated and the creatine kinase-myoglobin (CK-MB) levels are within normal range. Which of the following is the nurse's interpretation of these results?

Patient is currently experiencing an MI. Troponin assays are highly specific for identifying myocardial infarction (MI). A rise in troponins can be seen as soon as 3 hours after MI and will remain elevated for 7-&10;days. Creatinin kinase is an intracellular enzyme found in muscle cells. The CK-MB isoenzyme is specific to myocardial muscle injury and can rise between 4 and 8 hours after injury. They will return to normal within 2-3 days. Thus, a client with an elevated troponin I 5 hours after the first symptoms is already showing signs of MI, but the CK-MB has another 3 hours before the elevation might develop.

The nurse is reviewing the lipid results of four clients. Select the client at greatest risk for cardiovascular disease.

Patient with LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL Diagnosis of hyperlipidemia depends on a person's complete lipid profile (total cholesterol, LDL, HDL, and triglyceride levels) after an overnight fast. One person may have a favorable lipid profile with a HDL of 110 mg/dL, a triglyceride level of 175 mg/dL, and an LDL of 130 mg/dL, whereas, another person with a HDL of 40 mg/dL, a triglyceride level of 150 mg/dL, and LDL cholesterol of 205 mg/dL would be at much greater risk for cardiovascular disease.

A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?

Pericardial effusion Pericardial effusion refers to the accumulation of fluid in the pericardial vacuity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200ml of fluid may raise intracardiac pressure to levels that will cause symptoms similar to right-sided heart failure. Pericarditis is inflammation of the pericardium while COPD is a respiratory disease.

A client is seen in the emergency room with complaints of sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?

Pericarditis This patient is demonstrating signs and symptoms of pericarditis, which includes a triad of chest pain, pericardial friction rub, and EKG changes. Other signs are that the pain is usually abrupt in onset, occurs in the pericardial area, and may radiate to the neck, back, abdomen or side. It is usually worse with deep breathing and swallowing, and the person often finds relief when sitting up and leaning forward.

The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?

Receives blood returning to the heart from the systemic circulation The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes?

Peripheral vascular resistance The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent which of the following?

Pulmonary embolism The most common site of a deep vein thrombosis (DVT) is in the venous sinuses in the soleus muscle and posterior tibial and peroneal veins. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT. The other options are caused by occlusions in the arterial system.

A female client tells the health care provider that she has recently been experiencing episodes of changes occuring in the color of her fingertips especially when she experiences cold temperatures. She further states that the tips become pale, turn a bluish color, and then become reddened. The client is most likely experiencing:

Raynaud phenomenon Raynaud phenomenon is seen in otherwise healthy young women, and it often is precipitated by exposure to cold or by strong emotions and usually is limited to the fingers. The ischemic phase of Raynaud phenomenon is manifested by changes in skin color that progress from pallor to cyanosis and progress to hyperemia. The other conditions do not manifest these changes.

A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?

Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. Rest and intake of nitroglycerin relieve chest pain with angina but not with an MI. Pain with angina and MI is an subjective symptom for each client. Pain with angina and MI can occur at a variety of times.

A teenager is seen in the emergency room with complaints of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen three weeks before in the clinic and treated with antibiotics for a strep throat. He was better for a few days but now he seems to have gotten worse in the last two days. What should the nurse suspect is wrong with this client?

Rheumatic fever Rheumatic fever is an immune-mediated inflammatory disease that occurs a few weeks after a group A strep (sore throat). It can manifest as an acute, recurrent or chronic disorder.

Which of the following is the correct sequence for blood flow through the heart?

Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta he correct pathway for blood flow through the heart is the right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta.

A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?

Right sided heart failure Right sided heart failure, not left sided heart failure, shock, or cerebral vascular accident, is seen with prominent jugular veins.

A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which of the following interventions?

Sclerotherapy or surgery Sclerotherapy, which often is used in the treatment of small residual varicosities, involves the injection of a sclerosing agent into the collapsed superficial veins to produce fibrosis of the vessel lumen. Surgical treatment consists of removing the varicosities and the incompetent perforating veins, but it is limited to persons with patent deep venous channels. Sclerotherapy produces fibrosis of the vessel lumen. There is no fibrotherapy for varicose veins. There is no Trendelenburg therapy for varicose veins. There is a Trendelenburg test that is diagnostic for primary or secondary varicose veins.

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?

See the doctor for evaluation immediately. Angina that occurs at rest, is of new onset, or is increasing in intensity or duration denotes an increased risk for myocardial infarction and should be seen immediately using the criteria for acute coronary syndrome (ACS).

Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture? (Select all that apply.)

Size of lipid-rich core Presence of inflammation Thickness of fibrous cap The major determinants of plaque vulnerability to disruption include the size of the lipid-rich core, the stability and thickness of its fibrous cap, the presence of inflammation, and lack of smooth muscle cells. A decrease in blood pressure and coronary blood flow are not determinants of plaque vulnerability to rupture.

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. Which responses is best for the nurse to educate this client about? Select all that apply.

Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes; when these are unsuccessful, pharmacologic treatment may be necessary. Therapeutic lifestyle changes include an increased emphasis on physical activity, dietary measures to reduce LDL levels, smoking cessation, and weight reduction for people who are overweight. Increased intake of fats and sodium would cause weight gain and hypertension and result in a negative consequence.

A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?

Smooth muscle relaxation of vessels Nitroglycerin produces its effects by releasing nitric oxide in vascular smooth muscle of the target tissues, resulting in relaxation of this muscle and increased blood flow. This drug does not decrease heart rate. Because it vasodilates, it decreases preload. Nitroglycerine does not affect cardiac refractory periods.

A nurse has worked for 25 years and has recently noticed the development of varicose veins. Which part of the nurse's job is likely most responsible for the development of the varicose veins?

Standing upright for long periods Prolonged standing and increased intra-abdominal pressure are important contributing factors in the development of primary varicose veins. Prolonged standing increases venous pressure and causes dilation and stretching of the vessel wall. Stress and sleep patterns have no effect on venous circulation. Lifting can also cause varicose veins, but standing upright is known to be a more significant risk factor.

A client is diagnosed with a deep vein thrombosis. The nurse anticipates the administration of which medication in an attempt to dissolve the clot?

Streptokinase Thrombolytic therapy (i.e., streptokinase, urokinase, or tissue plasminogen activator) may be used in an attempt to dissolve the clot.

The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:

Stroke volume × heart rate The cardiac output (CO) is a product of the stroke volume and the heart rate (HR) and can be expressed as CO = SV × HR.

The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes:

T-wave changes Unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) is a clinical syndrome of myocardial ischemia ranging from angina to myocardial infarction. The ECG pattern associated with in NSTEMI may display normal or ST-segment depression (or transient ST-segment elevation) and T-wave changes. The degree of ST-segment deviation from baseline is an important measure of ischemia and indicator of prognosis. Abnormal Q waves occur with ACS.

A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for

Tearing or ripping-type pain in the chest or back A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated.

Which of the following patients is at the greatest risk of developing rheumatic heart disease?

Teenager with untreated strep throat Rheumatic fever is caused by group A (beta-hemolytic) streptococcal throat infection. Although the same bacteria cause the skin infection called impetigo, it is not known to cause rheumatic heart disease. Viral infections such as meningitis and shingles (herpes zoster) do not cause rheumatic heart disease.

A client reporting a headache is diagnosed with giant cell arteritis. The nurse is aware that the vessels most commonly affected are the:

Temporal Giant cell (temporal) arteritis, the most common of the large vessel vasculitides, is an acute and chronic inflammation of large to small arteries. It mainly affects arteries of the head—especially the temporal arteries—but may include the vertebral and ophthalmic arteries. The most common clinical presentations are headache and tenderness over the superficial temporal artery.

The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.

The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues . The circulatory system consists of the heart which pumps blood, the arterial system which distributes oxygenated blood to the tissues, the venous system which collects deoxygenated blood from the tissues and returns it to the heart, and the capillaries where exchange of gases, nutrients and waste takes place.

The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?

The disabling effects that result from involvement of heart valves Rheumatic fever is a very important cause of heart disease and its most serious and disabling effects result from involvement of the heart valves.

A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response?

The most common cause is a staph infection. Staphylococcal infections have now emerged as the leading cause of infective endocarditis, with streptococci and enterococci as the other two most common causes. Informing the client's wife about the drug abuse connection infers that you think he is a drug addict and is not therapeutic. Parasites are never the cause and telling the patient to focus on her husband also is not appropriate as this is a genuine concern for her.

Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease?

The pulse decreases rather than increases in amplitude. With peripheral arterial disease, there is a delay in the transmission of the reflected wave so that the pulse decreases rather than increases in amplitude.

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:

The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. This increases the work and volume of the chamber emptying through the narrowed valve—the left atrium in the case of mitral stenosis and the left ventricle in aortic stenosis. An incompetent or regurgitant valve permits backward flow to occur when the valve should be closed—flowing back into the left ventricle during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased

Which serum biomarker is highly specific for myocardial tissue?

Troponin The troponin assays have high specificity for myocardial tissue and have become the primary biomarker tests for the diagnosis of myocardial infarction. Creatine kinase is specific for muscle injury but is not as focused as is troponin. White blood cells and C-reactive protein are associated with inflammation.

A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?

Troponin assays The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction. Creatine kinase is an intracellular enzyme found in muscle cells. The troponin level identifies necrosis in cardiac muscles earlier than creatine kinase. The others are not necessarily used when suspecting a myocardial infarction.

A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?

Troponin level The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction (MI). The troponin complex, which is part of the actin filament, consists of three subunits (i.e., TnC, TnT, and TnI) that regulate calcium-mediated actin-myosin contractile process in striated muscle (see Chapter 1, Fig. 1-19). TnI and TnT, which are present in cardiac muscle, begin to rise within 3 hours after the onset of MI and may remain elevated for 7 to 10 days after the event. This is especially adventitious in the late diagnosis of MI. The other blood work may be ordered, but not to confirm the diagnosis of MI.

Which of the following blood vessel layers is composed primarily of smooth muscle cells?

Tunica media The tunica media consists primarily of circumferentially arranged layers of smooth muscle cells. The tunica externa is composed of loose connective tissue and the tunica intima of endothelial cells. The endothelium is the lining of the vascular system and is composed of endothelial cells.

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?

Tunica media The tunica media, the middle layer, is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The tunica adventitia and tunica externa refer to the outermost layer of a vessel. The tunica intima refers to the innermost layer that prevents platelet adherence and blood clotting.

Although Raynaud's phenomenon and thromboangiitis are both characterized by ischemia, Raynaud's phenomenon and thromboangiitis obliterans are caused by which of the following?

Vasospasm; inflammation Raynaud's disease is caused by vasospasms of small distal arteries; thromboangiitis obliterans is caused by an inflammatory process that also affects veins and nerves.

Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by:

Vegetative valve destruction Murmurs are sounds produced by blood flow through incompetent valves. Both infective endocarditis and carditis of rheumatic heart disease are characterized by growth of vegetation on valve leaflets, causing destruction, regurgitation, and murmur. Atrial fibrillation is a conduction disorder that impairs atrial emptying rather than valve function. Myocardial inflammation is present but does not cause murmurs. Valve dysfunctions can chronically decrease emptying and lead to left ventricular hypertrophy.

Preload represents the volume work of the heart and is largely determined by:

Venous blood return Preload represents the amount of blood the heart must pump with each beat and represents the volume of blood stretching the ventricular muscle fibers at the end of diastole. Pressure (resistance), contraction, and ventricular emptying relate to afterload.

Which of the following is associated with stasis of blood, increased blood coagulability and vessel wall injury?

Venous thrombosis Venous thrombosis is associated with stasis of blood, increased blood coagulability, and vessel wall injury. Varicose veins are dilated, tortuous veins of the lower extremeties and lead to venous insufficiency. PAD is caused by atherosclerosis in arteries of the lower extremities.

The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?

Ventricles contract and blood is ejected from the heart. Systole occurs when the ventricles contract and blood is ejected from the heart. Diastole occurs when the ventricles are relaxed and blood fills the heart.

The 40-year-old nurse is concerned that her job requires her to stand most of the day. Which of the following therapies could be implemented to prevent tissue injury?

Wearing correctly fitted, elastic support stockings The incidence of varicose veins is more common in females between 30 and 50 years of age and among people who stand for the majority of their day due to an occupation (e.g., nurses). Treatment measures for varicose veins focus on improving venous flow and preventing tissue injury. Support stockings prevent vein distention. Sclerotherapy is used in the treatment of small varicosities. Warfarin therapy and heat application are used to treat deep vein thrombosis.

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

fills rapidly; compresses Rapid accumulation of effusion fluid or blood in the pericardial sac causes cardiac tamponade, resulting in compression of the heart. This leads to cardiac standstill or failure. Pericardial sac thickening due to inflammation can restrict the heart, rather than allow stretching. Rupture of the sac is pathologic, resulting in heart expansion. A friction rub sound (rubbing between the inflamed pericardial surfaces) is characteristic of acute pericarditis. Constrictive pericarditis causes scar tissue formation that contracts and interferes with filling.