Unit 8
Based on assessment, a nurse suspects the client may be experiencing heart failure. Which diagnostic test 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.
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 client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli? CT of the head Echocardiogram Ultrasound of the kidney Chest x-ray
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 fibrillation) 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 with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection. Aggregatibacter actinomycetemcomitans Staphylococcus aureus Eikenella corrodens Kingella kingae
Staphylococcus aureus While all of these bacteria can cause infective endocarditis, Staphylococcus aureus is the major offender in injection drug abusers, whereas prosthetic heart valve infective endocarditis tends to be caused by coagulase-negative staphylococci (e.g., Staphylococcus epidermidis).
The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia? Talking to a friend about using more saturated and less unsaturated fats when cooking Encouraging a friend to be tested for familial hypercholesterolemia Encouraging a friend to cook with trans fats, as they extend the shelf life of foods 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 trans fats. Testing for familial hypercholesterolemia is not a modifiable risk factor.
The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition? The pulse is unobtainable in one or both arms A pulsating mass in the abdomen Syncope Hemiplegia
A pulsating mass in the abdomen Most abdominal aortic aneurysms are asymptomatic. Because an aneurysm is of arterial origin, a pulsating mass in the abdomen may provide the first evidence of the disorder. The other options are signs and symptoms of aortic dissection.
Release of which humoral factors will result in vasodilation? Serotonin Norepinephrine Histamine Angiotensin II
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.
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another? Axially Laminar Turbulent Crosswise
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).
A client with persistent, primary hypertension remains apathetic about high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement? "You're right, but it's still worthwhile to monitor it in case you do develop problems." "That's true, but it's an indicator that you're not taking very good care of yourself." "Actually, high blood pressure makes you very susceptible to getting diabetes in the future." "You may not sense any problems, but hypertension increases your risk of heart disease and stroke."
"You may not sense any problems, but hypertension increases your risk of heart disease and stroke." Target-organ damage particularly affects organs that are highly vascular in structure or strongly dependent upon adequate blood supply for appropriate function, including the heart, brain, kidneys, and the retina of the eyes. Hypertension is a highly significant risk factor for heart disease and stroke. It would be inappropriate to promote monitoring without promoting lifestyle modifications or other interventions to lower the client's blood pressure, or teaching the client about the deleterious effects of hypertension. It is likely unproductive to simply characterize the client's hypertension as demonstrating that he does not "take care" of himself. Hypertension is not a risk factor for the development of diabetes mellitus.
Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply. Femoral Thoracic Abdominal Carotid
Abdominal Thoracic There are no valves in the abdominal or thoracic veins. Therefore, pressure in the abdominal and thoracic cavities heavily influence blood flow in these veins.
A client taking an antihypertensive drug for several months comes to the physician's office with a dry, persistent cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? Beta-blockers Calcium channel blockers Angiotensin II receptor blockers Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors inhibit bradykinin degradation in the lungs, which can cause a common side effect of a dry, nonproductive cough.
The nurse knows that which groups of drugs influence the renin-angiotensin-aldosterone system (RAAS) for the treatment of hypertension? Select all that apply. Diuretics Beta-adrenergic blockers (beta-blockers) ACE inhibitors Angiotensin-receptor blockers Calcium-channel blockers
Angiotensin-receptor blockers ACE inhibitors Beta-adrenergic blockers (beta-blockers) Angiotensin-converting enzyme (ACE) catalyzes the conversion of angiotensin I to angiotensin II, which is a powerful vasoconstrictor and also stimulates the release of aldosterone which enhances sodium and water retention. Both of these physiologic responses cause an increase in blood pressure. ACE inhibitors block the conversion to angiotensin II, thus decreasing vasoconstriction and sodium retention. Angiotensin receptor blockers decrease the actions of angiotensin by decreasing its ability to bind to angiotensin II receptors. Beta-adrenergic blockers inhibit the beta-receptor mediated release of renin. Diuretics and calcium-channel blockers do not interact directly with the RAAS.
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 Dilated cardiomyopathy Mitral valve prolapse Atrial regurgitation
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 client reports severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate: benign late repolarization. advanced hypokalemia. decreased intracranial pressure. myocardial infarction.
myocardial infarction. The ST-segment elevation with myocardial infarction could be caused by a decrease in blood supply to that area of cardiac muscle. Hypokalemia results in flattening or inversion of T waves.
A nurse is evaluating hypertension risk factors with a client. Of the risk factors in the client's history noted, which risk factor(s) for hypertension is nonmodifiable? Select all that apply. stress excessive alcohol consumption race obesity family history
race family history Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure, and race. Modifiable risk factors are lifestyle factors that can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.
A client awaiting a heart transplant is experiencing decompensation of the left ventricle that will not respond to medications. The health care provider (HCP) suggests placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. Which response most accurately describes the purpose of a VAD? "Has a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." "Measures the pressures inside your heart continuously to asses pumping ability of your left ventricle." "Pulls your blood from the right side of the heart and runs it through a machine to oxygenate it better, and then return it to your body." "Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
"Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure." Although the response is technical in nature, it is the most accurate. The nurse will use the most accurate terms and then follows up with an explanation of these terms based on the client's level of understanding of the terminology. Decompensated, refractory heart failure reflects deterioration in cardiac function that is unresponsive to medical or surgical interventions. Ventricular assist devices (VADs) are mechanical pumps used to support ventricular function. VADs are used to decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure. This decreases the workload on the ventricle and allows it to rest and recover. The rest of the distractors relate to the monitoring in an ICU of cardiac functioning. Invasive hemodynamic monitoring may be used for assessment in acute, life-threatening episodes of heart failure. With the balloon inflated, the catheter monitors pulmonary capillary pressures (i.e., pulmonary capillary wedge pressure or pulmonary artery occlusion pressure), which reflect pressures from the left ventricle. The pulmonary capillary pressures provide a means of assessing the pumping ability of the left ventricle. One type of pulmonary artery catheter is equipped with a thermistor probe to obtain thermodilution measurements of cardiac output.
In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which level indicates inadequate renal perfusion? 40—20 mL/hour 20 mL/hour 80—60 mL/hour 60—40 mL/hour
In hypovolemia, renal vasculature is constricted in a compensatory attempt to circulate blood to more vital organs. Urinary output at 20 mL/hour or below indicates that renal perfusion is too inadequate.
If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations? Increased heart rate and decreased contractility Decreased contractility and decreased heart rate Decreased rate and force of contraction Increased heart rate and increased contractility
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 of sympathetic nervous system, both heart rate and contractility would increase.
Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity? Inherent low-impulse conductivity Inherent discharge rate of 60-80 Inherent spontaneous action-potential Inherent discharge rate of 40-60
Inherent spontaneous action-potential The heart has four inherent properties essential in the development and conduction of cardiac rhythms. The property of automaticity is the ability of certain cells in the myocardium to automatically or spontaneously initiate an electrical impulse called an action potential. In a normally functioning heart the rate is controlled by the sinoatrial (SA) node.
An 80-year-old male client arrives for his yearly physical without any complaints, and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder, the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that: atrial fibrillation is a disorganized ventricular rhythm with recurrent circuits. many people live with atrial fibrillation without even knowing they have it. the client will be placed on anticoagulants immediately. the client will experience severe palpitations.
Many people live with atrial dysrhythmias, including atrial fibrillation, without knowing the dysrhythmia exists. Atrial dysrhythmias are typically less serious because they do not impact the ability of the ventricles to pump. This client is at high risk to develop atrial fibrillation due to his advanced age; the rates of atrial fibrillation begin to increase over the age of 60 and males have a greater prevalence. It is true that atrial fibrillation is a disorganized rhythm; however it is not ventricular. The client may or may not need anticoagulation; there are other considerations to be made before these medications would be considered.
A client is seen in the emergency room reporting 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? Abdominal aortic aneurysm Pneumonia Myocardial infarction Pericarditis
Pericarditis This client 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.
A client experiencing a sinus arrest would demonstrate which symptom or finding? Heart rate of greater than 100 beats/min P-wave that occurs more frequently than expected Prolonged periods of asystole demonstrated on an electrocardiogram Spontaneous persistent sinus bradycardia
Prolonged periods of asystole demonstrated on an electrocardiogram Sinus arrest refers to failure of the sinoatrial node to discharge and results in an irregular pulse, prolonged periods of asystole, and predisposition to other dysrhythmias. The other options do not demonstrate the symptoms demonstrated during a sinus arrest.
The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control? Promotes retention of water Produces prolonged increase in blood pressure Decreases blood volume Increases osmolality of body fluids
Promotes retention of water Vasopressin increases the permeability to water of the collecting ducts of the kidney, promoting renal reabsorption of water. Vasopressin is released in response to decreased blood volume or increased osmolality. Vasopressin also constricts some vascular beds. However, it cannot maintain an increase in blood pressure.
A client has had an acute myocardial infarction (MI). The brother of the client has a history of angina. The client asks how he will know if his brother's pain is angina or if the brother is actually having an MI. Which statement is correct? Chest pain with angina only occurs during the day; MI pain is more likely at night. Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. Chest pain with angina only occurs at rest; MI pain occurs during a stressful time. Pain is more severe and lasts longer with angina than with an MI.
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 a subjective symptom for each client. Pain with angina and MI can occur at a variety of times.
A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which common dysrhythmia is the nurse aware this client most likely has related to maintaining a large stroke volume? Atrial flutter Sinus tachycardia Atrial fibrillation Sinus bradycardia
Sinus bradycardia is a slow (<60 bpm) heart rate. In sinus bradycardia, a P wave precedes each QRS. A normal P wave and PR interval (0.12 to 0.20 sec) indicates that the impulse originates in the SA node rather than in another area of the conduction system that has a slower inherent rate. Vagal stimulation as well as some medications decrease the firing rate of the sinoatrial node and conduct through the atrioventricular node to cause a decrease in heart rate. This rhythm may be normal in trained athletes, who maintain a large stroke volume, and during sleep. In most cases, it is a benign rhythm unless the client has had a myocardial infarction or after resuscitation from cardiac arrest.
A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as: Infective endocarditis Valvular stenosis Valvular regurgitation Pericardial effusion
When cardiac valves such as the aortic or mitral fail to close properly, blood does not efficiently exit from the left ventricle. This condition is valvular regurgitation. Valvular stenosis is a narrowing of the lumen of the valve. Pericardial effusion, an accumulation of fluid in the pericardial sac, causes obstructive shock, as it impedes ventricular filling. Infective endocarditis could trigger septic shock.
A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the knowledge is understood when the client correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor? Decreases vascular volume by suppressing renal reabsorption of sodium Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction Inhibits the movement of calcium into cardiac and vascular smooth muscle Decreases the heart rate, which will cause a decrease in cardiac output
Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction.
A client is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which action is important for the nurse to tell the client to ensure accuracy in correlating dysrhythmias with symptoms? It is important to keep a diary of activities and symptoms. The client must limit activity while the Holter monitor is in place. If the monitor detects a lethal dysrhythmia, it will defibrillate to correct the dysrhythmia. The client may feel a pins and needles sensation while the monitor is connected.
It is important to keep a diary of activities and symptoms. Holter monitoring is one form of long-term monitoring during which a person wears a device that digitally records two or three electrocardiographic (ECG) leads for up to 48 hours. During this time, the person keeps a diary of his or her activities or symptoms, which are later correlated with the ECG recording. The client should have no sensation of pins and needles, and although the monitor will detect dysrhythmias, it will not defibrillate the client.
The nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking? Measure his blood pressure and show him how much higher it is when he is smoking. Measure his pulse and show him how much lower it is when he is smoking. Measure his temperature and show him how much higher it is when he is smoking. Have him listen to his heart for the obvious murmur that presents when smoking.
Measure his blood pressure and show him how much higher it is when he is smoking. Although a relationship between smoking and hypertension has not been established, vasoconstriction from nicotine in cigarette smoke will raise blood pressure. Elevated blood pressure and cigarette smoking are independent risk factors for heart disease.
Sick sinus syndrome is suspected in the case of a child who is postoperative following cardiac surgery. Which nursing action is most appropriate? Monitor the child's ECG for bradycardia. Reassure the child's family that the condition is usually self-limiting. Review the results of the child's echocardiogram. Facilitate an exercise stress test as ordered.
Monitor the child's ECG for bradycardia. The simple ECG would be enough to give a preliminary diagnosis of sick sinus syndrome, which typically reveals persistent sinus bradycardia. The stress test would be used to determine if the cause was neurologic or muscular in origin. The disease is not self-limiting and would not be revealed by echocardiogram.
What is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction? AV node - bundle of HIS - bundle branches - SA node - Purkinje fibers AV node - SA node - bundle of His - bundle branches - Purkinje fibers SA node - AV node - bundle of His - bundle branches - Purkinje fibers SA node - AV node - bundle branches - Purkinje fibers - bundle of His
SA node - AV node - bundle of His - bundle branches - Purkinje fibers The atrial conduction begins with the sinoatrial (SA) node, serving as the pacemaker of the heart. Impulses originating in the SA node travel through the atria to the atrioventricular (AV) node. There are three internodal pathways between the SA node and the AV node, including the anterior (Bachmann), middle (Wenckebach), and posterior (Thorel) internodal tracts. These three tracts anastomose with each other proximally to the AV node. The AV junction connects the two conduction systems and provides for one-way conduction between the atria and the ventricles. The impulse travels through the nodal region into the natriuretic hormone region, which connects with the bundle of His (also called the AV bundle). The fibers of the AV node proceed to form the bundle of His, which extends through the fibrous tissue between the valves of the heart and into the ventricular system. The bundle of His penetrates into the ventricles and almost immediately divides into right and left bundle branches that straddle the interventricular septum. The bundle branches move through the subendocardial tissues toward the papillary muscles and then subdivide into the Purkinje fibers, which branch out and supply the outer walls of the ventricles. The Purkinje system, which initiates ventricular conduction, has large fibers that allow for rapid conduction. Once the impulse enters the Purkinje system, it spreads almost immediately to the whole ventricle.
A client is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F (38.3°C) for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 second preceding each QRS complex. What does the nurse determine the rhythm to be?
Sinus tachycardia Sinus tachycardia is a heart rate >100 bpm that has its origin in the sinoatrial node. A normal P wave and PR interval should precede each QRS complex. The mechanism of sinus tachycardia is enhanced automaticity, related to sympathetic stimulation or withdrawal of vagal tone. Sinus tachycardia is a normal response during any increase in metabolic activity such as fever, stress, and anxiety.