Week 2 ICU Cardiac Study Test 12.1.20

Which ventricular dysrhythmia is more likely if the patient has a prolonged QTc internal? A. sinus tachycardia B. SVT C. Torsades de pointes D. Ventricular bigeminy

Answer C torsades de pointes

The nurse would assess for symptoms of a pneumothorax after placement of a central line into which vein? A. Internal jugular B. External jugular C. Femoral D. Subclavian

Answer D

While performing an admission assessment, the nurse identifies a high-pitched systolic murmur and suspects that the patient has which condition? A. Mitral regurgitation B. Mitral stenosis C. Aortic regurgitation D. Aortic stenosis

Answer A A murmur of mitral regurgitation produces a high-pitched systolic murmur. A murmur of mitral stenosis produces a low-pitched diastolic murmur. A murmur of aortic regurgitation produces a high-pitched diastolic murmur, and a murmur of aortic stenosis produces a low-pitched systolic murmur.

Which intracellular structure, essential for cardiac contraction, stores calcium ions for release and use after depolarization? A. Sarcoplasmic reticulum B. Sarcomere C. Sarcolemma D. Transverse tubules

Answer A An extremely important intracellular structure that is necessary for successful contraction is the sarcoplasmic reticulum. Calcium ions are stored in the sarcoplasmic reticulum and released for use after depolarization.

Which structure stores calcium ions for release and use after depolarization? A. Sarcoplasmic reticulum B. Sarcomere C. Sarcolemma D. Transverse tubules

Answer A An extremely important intracellular structure that is necessary for successful contraction is the sarcoplasmic reticulum. Calcium ions are stored in the sarcoplasmic reticulum and released for use after depolarization.

What part of the arterial system contains the greatest amount of elastin? A. Aorta B. Pulmonary artery C. Common carotids D. Arterioles

Answer A The aorta contains the greatest amount of elastic tissue. This is necessary because of the sudden shifts in pressure created by the left ventricle.

A patient has a diastolic murmur located at the fifth intercostal space (ICS) midclavicular line (MCL). The nurse knows this is indicative of what disorder? A. Mitral stenosis B. Tricuspid regurgitation C. Aortic regurgitation D. Pulmonic stenosis

Answer A mitral stenosis Mitral stenosis produces a diastolic murmur that is heard at the fifth intercostal space (ICS) midclavicular line (MCL). Tricuspid regurgitation and pulmonic stenosis are systolic murmurs. Aortic regurgitation is a diastolic murmur that is heard at the second ICS right sternal border.

The nurse is assessing a newly admitted patient. Which finding would indicate a chronic cardiac history? (Select all that apply.) A. The patient states he has a "beer belly." B. The patient's fingernails are thickened, yellow, brittle, and cracked. C. The patient has a visible pulse at the fifth intercostal space just lateral to the midclavicular line. D. The patient has a capillary refill time of 2 seconds. E. The patient has a large, firm bulge noted on the left upper chest.

Answer A, C, E Abdominal adipose is often related to cardiac problems (an "apple-shaped" body). A visible point of maximal impulse (PMI) is associated with a cardiac history. A large, firm bulge on the left upper chest is a sign of an implanted pacemaker. Thickened, yellow, brittle, and cracked fingernails are a sign of nail infection, and a capillary refill time of 2 seconds is normal.

1. A new graduate asks the preceptor why the hospital is not using heparin in the hemodynamic flush bags. What is the correct response? A. "It is a cost-saving measure." B. "There is a correlation between heparin infusions in cardiac patients and heparin-induced thrombocytopenia." C. "Heparin infusions increase the occurrence of clots, so we no longer use them." D. "The pressure on the bag breaks down the heparin, so heparin infusions are not effective."

Answer B A patient receiving heparin is at increased risk for heparin-induced thrombocytopenia. Although it may save money, this is not the reason many hospitals have stopped using heparin. Heparin decreases, not increases, the occurrence of clots. Pressure does not destabilize heparin.

A patient recovering from a myocardial infarction (MI) notifies the nurse that he is having chest pain. Upon listening to the patient's heart sounds, the nurse hears a grating sound that is present during both systole and diastole. The nurse suspects that the patient's chest pain is most likely caused by which condition? A. Another MI B. Inflammation of the pericardium C. Papillary muscle rupture D. Ventricular septal rupture

Answer B A pericardial friction rub is a sound that can occur within 2 to 7 days after a myocardial infarction (MI). The friction rub is from pericardial inflammation (pericarditis). Classically, a pericardial friction rub is a grating or scratching sound that is both systolic and diastolic, corresponding with cardiac motion within the pericardial sac. It is often associated with chest pain, which can be aggravated by deep inspiration, coughing, swallowing, and changing position.

The nurse is caring for a patient who underwent cardiac catheterization earlier in the day. The nurse will monitor the femoral site to identify which complication? A. Infection B. Bleeding C. Reocclusion of the coronary artery D. Nephropathy

Answer B After cardiac catheterization, removal of the arterial and venous catheters places the patient at risk for bleeding. Lying flat for 6 hours, using a clamp device, or deploying a collagen plug can decrease the incidence of bleeding. Bleeding usually occurs within the first few hours after the procedure but can occur at any time. Infection would not be apparent for several days. Reocclusion of the coronary artery presents with chest pain and electrocardiogram changes unrelated to the catheter site. Nephropathy occurs as a result of osmotic diuresis from the contrast dye and is prevented by encouraging the patient to drink or possibly with an infusion of a crystalloid solution such as 0.9% saline.

1. Which location of a myocardial infarction (MI) poses the greatest risk of heart failure and cardiogenic shock? A. Inferior B. Anterior C. Lateral Right ventricular

Answer B Although all myocardial infarctions (MIs), including those located in the inferior wall, lateral wall, and right ventricular wall, can cause heart failure and cardiogenic shock, an anterior wall MI is of most concern. In an anterior wall MI, the occlusion is located in the left descending coronary artery, which supplies blood to the left ventricle. When large areas of myocardium are destroyed, left ventricular pump failure and cardiogenic shock frequently are the consequences.

The nurse is choosing the appropriate lead to monitor the patient's electrocardiogram rhythm. For which patient would lead II be the most appropriate lead? A. A patient with a right bundle branch block B. A patient in atrial fibrillation C. A patient who is having supraventricular versus ventricular tachycardia D. A postintervention recovery patient after a stent placement for a lateral infarct

Answer B Atrial rhythms are best monitored in lead II. Lead II would not help with identification of a right bundle branch block. MCL1 is the best lead for differentiation of tachycardias. V6 is the best lead for monitoring a patient with a lateral infarct.

1. A nurse admits a patient from the emergency department with a diagnosis of acute coronary syndrome (ACS) and anterior wall myocardial infarction (MI). Per physician order, the nurse administers oxygen and nitroglycerin. This therapy should reduce or relieve chest pain by which mechanism? A. Increasing preload and decreasing afterload B. Increasing oxygen delivery and decreasing oxygen demand C. Minimizing plaque formation and preventing vasospasm D. Preventing dysrhythmias and decreasing cardiac contractility

Answer B In the acute period, if severe heart muscle damage has occurred, myocardial oxygen supply is increased by the administration of supplemental oxygen to prevent tissue hypoxia. Myocardial oxygen supply can be further enhanced by the use of coronary artery vasodilators. Nitroglycerin is recommended for the first 48 hours to increase vasodilatation and prevent myocardial ischemia.

Arterial blood pressure monitoring is used for the assessment of cardiac output, fluid status, and tissue perfusion. Which parameter is observed with arterial blood pressure monitoring? A. End-diastolic pulmonary pressure B. Mean arterial pressure C. Peripheral vascular resistance D. Mixed venous oxygenation

Answer B Intraarterial blood pressure monitoring is indicated for any major medical or surgical condition that compromises cardiac output, tissue perfusion, or fluid volume status. The system is designed for continuous measurement of three blood pressure parameters: systole, diastole, and mean arterial blood pressure. The direct arterial access is helpful in the management of patients with acute respiratory failure who require frequent arterial blood gas measurements.

The nurse is caring for a patient admitted with an anterior wall myocardial infarction (MI) who has developed a third-degree atrioventricular (AV) block as evidenced by which electrocardiogram (ECG) finding? A. An irregular QRS rhythm with a wavy baseline, no identifiable P waves, and a rapid rate B. A regular QRS rhythm with regular P waves, variable PR interval, and a slow rate C. A regular QRS rhythm with inverted P waves, PR interval less than 0.12 second, and a slow rate D. A regular QRS rhythm with wide QRS, no identifiable P waves, and a rapid rate

Answer B On the electrocardiogram (ECG), P waves are present and usually occur at regular intervals. If a junctional focus is pacing the heart, normal QRS complexes are present but occur at a rate and timing interval totally independent of the P waves. The PR intervals vary widely because the P wave and QRS are not related to each other. If a ventricular focus is pacing the heart, the QRS complex is wide and unrelated to the P waves.

On admission to the progressive care unit after a colon resection, the nurse assesses the patient's risk for venous thromboembolism (VTE). Prevention measures for VTE include which therapy? A. Bedrest B. Subcutaneous low-molecular-weight heparin (LMWH) C. Unfractionated heparin (UFH) infusion D. Inferior vena cava filter

Answer B Preventive measures include prophylactic anticoagulation with subcutaneous low-molecular-weight heparin (LMWH) or unfractionated heparin infusion (UFH), increasing mobility, and use of sequential compression devices placed on the lower extremities. Unfractioned heparin infusion and placement of an inferior vena cava filter are measures for management of a diagnosed VTE.

The nurse is caring for a patient with a venous stasis ulcer of the right lateral malleolus. On performing the assessment, which finding would the nurse expect to note of the right pedal pulse? A. Weak or absent and symmetric B. Normal, strong, and symmetric C. Weak or absent and asymmetric D. Normal, strong, and asymmetric

Answer B Pulses in the presence of venous disease are normal, strong, and symmetric because pulses are an assessment of arterial patency. Arterial disease presents with pulses that are weak or absent. "Weak or absent and asymmetric" and "normal, strong, and asymmetric" are not accurate descriptions of either arterial or venous disease.

Which statement is true regarding electrocardiogram (ECG) monitoring using lead V1? A. QRS complexes in V1 are normally a positive deflection. B. V1 is a useful lead to determine RBBB from LBBB patterns. C. Electrode placement is the fourth intercostal space, left sternal border. D. Lead V1 is useful to monitor for inferior lead ischemia.

Answer B The V1 electrode is placed at the fourth intercostal space to the right of the sternal border. The normal QRS complex in lead V1 is mostly negative. V1 provides information to facilitate differentiation between an RBBB versus an LBBB pattern, or distinguish between VT and SVT with aberrant conduction; determine whether PVCs originate in the right or left ventricle; and clarify when ST segment changes are caused by the RBBB and when they are the result of ischemia. Inferior wall leads are II, III, and aVF. V1 is considered a ventricular septal lead.

A patient who is in the cardiac intensive care unit with an acute myocardial infarction (AMI) suddenly becomes hypotensive, tachycardic, and short of breath. Upon further assessment, the nurse hears a high-pitched holosystolic blowing murmur. The nurse is concerned that the patient may have developed which complication? A. Cardiac tamponade B. Papillary muscle rupture C. Pericardial friction rub D. Ventricular septal rupture

Answer B The auscultation of a new, high-pitched, holosystolic, blowing murmur at the cardiac apex heralds mitral valve regurgitation resulting from papillary muscle dysfunction. Cardiac tamponade is associated with distant heart sounds and bulging neck veins. Ventricular septal rupture is also a serious complication of acute myocardial infarction (AMI) that causes sudden hemodynamic compromise, but it presents with a harsh holosystolic murmur that is loudest along the left sternal border.

Which statement is true regarding noninvasive blood pressure measurement? A. A difference of 20 mm Hg between arms is an expected finding. B. The arm should be at the level of the heart during measurement. C. The popliteal artery is the most common measurement location. D. Subclavian venous stenosis can be ruled out through measurement.

Answer B The most common peripheral locations for blood pressure monitoring are the bilateral brachial arteries. The pressure is measured in both arms to rule out subclavian arterial stenosis. Normally, the difference in pressure between the arms is less than 10 mm Hg. Correct positioning of the extremity being measured is essential; the arm or leg should be at the level of the heart.

Which myocardial structure is supplied by the left anterior descending artery? A. Sinus node B. Intraventricular septum C. Posterior wall D. Atrioventricular (AV) node

Answer B The right coronary artery (RCA) serves the right atrium and the right ventricle in most people. In 63% of the population, the sinus node artery arises from the RCA. The atrioventricular (AV) node is supplied via the RCA in 90% of the population. The term dominant coronary artery is used to describe the artery that supplies the posterior part of heart. In most of the population, the RCA is dominant, supplying the posterior cardiac wall. The left anterior descending (LAD) artery and the circumflex artery serve the left atrium and most of the left ventricle. The LAD provides blood supply to the intraventricular septum via septal perforator branches.

A patient is admitted with an acute myocardial infarction. Upon assessment, the patient is noted to be confused. The nurse suspects that the confusion is most likely attributable to which cause? A. Early onset of dementia B. Low cardiac output C. Anxiety over chest pain D. Poor oxygen exchange

Answer B When assessing a patient with an altered cardiac function, confusion is most likely because of a decrease in cardiac output, hypotension, or hypoxemia. There is no indication from the patient's history to support a consideration of dementia. Anxiety may cause distraction, but confusion is uncommon.

Aortic valve dysfunction pathologically alters the which structure of the heart? A. Left atrium B. Left ventricle C. Right ventricle Mitral valve

Answer B Aortic valve dysfunction from any cause not only affects the valve leaflets but also pathologically alters the shape of the left ventricle.

1. A patient woke up from a sound sleep in a cold sweat with nausea and light-headedness and now has chest pain (8 of 10 on the pain scale) that is unrelieved by nitroglycerin (NTG) after 5 minutes. The nurse suspects the patient is experiencing which problem? A. Stable angina B. Unstable angina C. Variant angina D. Silent ischemia

Answer B unstable angina The patient is showing signs of unstable angina. Stable angina occurs with predictable precipitating factors and improves with rest or nitroglycerin (NTG) within 5 minutes. Variant angina is caused by spasm of a coronary artery, usually occurs at the same time every day, and is relieved by NTG. Silent ischemia is painless.

A patient in the acute phase of systolic heart failure is admitted to the intensive care unit. Which interventions would the nurse anticipate? (Select all that apply.) A. Diuretics to lower systemic vascular resistance (SVR) B. Morphine for peripheral dilation and to decrease anxiety C. Nitroglycerin to decrease preload and afterload D. Dopamine to decrease contractility of the heart E. Nesiritide to decrease pulmonary artery occlusion pressure and dyspnea

Answer B, C, E Morphine, nitroglycerine, and nesiritide are all used to treat patients in systolic heart failure. Diuretics will decrease preload, not systemic vascular reistance (SVR). Dopamine will increase myocardial contractility.

Which question is appropriate for the nurse to ask to determine the quality of the patient's chest pain? A. "How long does it last?" B. "How severe is it?" C. "What is it like?" D. "When did it begin?"

Answer C "What is it like?" is an open-ended question that allows the patient to describe the quality of the chest pain. "How severe is it?" and "How long does it last?" are questions related to the quantity of the chest pain. "When did it begin?" will elicit a reply that refers to the chronology of the chest pain.

1. When a papillary muscle in the left ventricle ruptures, the mitral valve leaflets do not close completely, resulting in which condition? A. Acute myocardial infarction B. Aortic valve failure C. Cardiac murmur D. Systemic venous congestion

Answer C A dysfunction of the chordae tendineae or of a papillary muscle can cause incomplete closure of an atrioventricular valve, which results in backflow of blood into the atrium and produces a murmur. If a papillary muscle in the left ventricle ruptures, the mitral valve leaflets do not close completely. Clinically, this causes acute mitral regurgitation and an audible murmur that can be auscultated with a stethoscope.

A patient is admitted with fever, hematuria, and new onset of a cardiac murmur. The patient has a history of intravenous drug abuse and complains of tender spots on the pads of her fingers. She has a low-grade fever, and the nurse notes an enlarged spleen on physical examination. What is the priority nursing diagnosis? A. Risk for infection related to invasive procedures B. Risk for anxiety related to lack of availability of narcotics C. Decreased cardiac output related to alteration in contractility D. Knowledge deficit related to discharge plans

Answer C Because the patient is experiencing endocarditis, the most important nursing diagnosis is decreased cardiac output related to alteration in contractility. Infection and anxiety are only potential problems, and although knowledge deficit is important, it is not the priority on admission.

Which finding is a clinical manifestation of left-sided heart failure? A. Increased cardiac output B. Decreased systemic vascular resistance C. Cool, pale extremities D. Vasodilatation of the arterial bed

Answer C Failure of the left ventricle is defined as a disturbance of the contractile function of the left ventricle, resulting in a low cardiac output state. This leads to vasoconstriction of the arterial bed that raises systemic vascular resistance, a condition also described as "high afterload," and creates congestion and edema in the pulmonary circulation and alveoli. Patients presenting with left ventricular failure have one of the following: (1) decreased exercise tolerance, (2) fluid retention, or (3) discovery during examination of noncardiac problems. Clinical manifestations of left ventricular failure include decreased peripheral perfusion with weak or diminished pulses; cool, pale extremities; and in later stages, peripheral cyanosis.

Which finding is a clinical manifestation of left-sided heart failure? A. Increased cardiac output B. Decreased systemic vascular resistance C. Cool, pale extremities D. Vasodilatation of the arterial bed

Answer C Failure of the left ventricle is defined as a disturbance of the contractile function of the left ventricle, resulting in a low cardiac output state. This leads to vasoconstriction of the arterial bed that raises systemic vascular resistance, a condition also described as "high afterload," and creates congestion and edema in the pulmonary circulation and alveoli. Patients presenting with left ventricular failure have one of the following: (1) decreased exercise tolerance, (2) fluid retention, or (3) discovery during examination of noncardiac problems. Clinical manifestations of left ventricular failure include decreased peripheral perfusion with weak or diminished pulses; cool, pale extremities; and in later stages, peripheral cyanosis.

A pericardial friction rub is best heard in which area? A. Pulmonic area B. Mitral area C. Erb point D. Tricuspid area

Answer C Pericardial friction rubs are best heard at the third intercostal space (ICS) on the left sternal border, known as Erb point.

A patient is complaining of a 6 of 10 chest pain that radiates to the left arm. The nurse obtains a 12-lead electrocardiogram (ECG) and notes that the patient has ST segment depression in leads V3 and V4. What does the ECG reveal? A. Ischemia in the anterior leads B. Injury in the inferior leads C. Infarction in the ventricular septum leads D. Ischemia in the lateral leads

Answer C ST segment depression indicates ischemia; V3 and V4 are anterior leads. Injury would be indicated by ST segment elevation; leads II, III, and aVF are inferior leads. Infarction is indicated by the presence of pathologic Q waves; ventricular septum is leads V1-V2, and lateral leads are I, aVL, V5, and V6.

Which structure of the microcirculation allows for solute diffusion across the endothelium? A. Arteriole B. Venule C. Capillary D. Precapillary sphincter

Answer C The capillary consists of a single cell layer of endothelium and is devoid of muscle and elastin. This arrangement allows solutes to diffuse in and out of the capillaries unimpeded by mechanical barriers. Capillaries normally retain large structures, such as red blood cells, but are highly permeable to smaller solutes, such as electrolytes.

A patient admitted for elective aortic aneurysm repair, scheduled for the next day, suddenly complains of severe back pain. Vital signs are blood pressure, 180/110 mm Hg; heart rate, 127 beats/min; and respiratory rate, 23 breaths/min. The nurse suspects that the patient has developed which problem? A. Pulmonary embolism B. Papillary muscle rupture C. Aortic dissection D. Duodenal ulcer perforation

Answer C The classic clinical presentation an aortic dissection is the sudden onset of intense, severe, tearing pain, which may be localized initially in the chest, abdomen, or back. As the aortic tear (dissection) extends, pain radiates to the back or distally toward the lower extremities. Many patients have hypertension on initial presentation.

1. What action should be performed prior to insertion of an arterial line? A. Check the patient's platelets for indication of heparin-induced thrombocytopenia. B. Obtain a 100-mL bag of 0.9% saline for the flush system. C. Perform an Allen test to confirm adequate arterial blood flow. D. Set up a double transducer tubing system.

Answer C The major advantage of the radial artery is the supply of collateral circulation to the hand provided by the ulnar artery through the palmar arch in most people. Before radial artery cannulation, collateral circulation must be assessed by using Doppler flow or by the modified Allen test according to institutional protocol. In the Allen test, the radial and ulnar arteries are compressed simultaneously. The patient is asked to clench and unclench the hand until it blanches. One of the arteries is then released, and the hand should immediately flush from that side. The same procedure is repeated for the remaining artery.

1. Which part of the heart is damage during a heart attack? a. Pericardium b. Epicardium c. Myocardium Endocardium

Answer C Myocardium

A physiologic cardiac shunt occurs when there is mixing of deoxygenated blood (usually venous blood with reduced oxygen content) with arterial oxygenated blood. In the heart, this is demonstrated by which mechanism? A. Atrial septal defect B. Patent foramen ovale C. Thebesian veins D. Ventricular septal defect

Answer C Thebesian veins The thebesian veins are small vessels that connect capillary beds directly with the cardiac chambers via irregular endothelium-lined sinuses within the myocardium. The thebesian veins add a small quantity of deoxygenated blood to the oxygenated blood in the left ventricle.

A patient with an arterial line has a systolic blood pressure of 110 mm Hg on inspiration but 128 mm Hg on expiration. This is known as: A. pulsus alternans. B. narrowed pulse pressure. C. pulsus paradoxus. D. vascular bruit.

Answer C pulsus paradoxus The patient is experiencing pulsus paradoxus, which is a drop in systolic blood pressure owing to increased intrathoracic pressure during inspiration. This is often the result of volume depletion or cardiac tamponade. Pulsus alternans is a pattern of amplitude change noted in end-stage left ventricular failure. Narrowed pulse pressure is a compensatory mechanism noted with vasoconstriction, and vascular bruit is a sound noted when there is vascular turbulence, especially with increased plaque buildup.

The nurse is assessing a patient on complete bed rest. Which site should be checked for dependent edema? A. The arms B. The ankles C. The sacrum D. The lower legs

Answer C sacrum The sacrum is the best place to assess the patient on bed rest for dependent edema. In the ambulatory patient, the ankles and the lower legs would not be appropriate. Edema may be present in the arms, but it would not be dependent edema.

An elderly female patient is complaining of "heartburn." While considering further assessment, the nurse understands which statement to be true? A. Heartburn has little to no correlation to cardiac disease and is typically gastric in nature. B. Patients are very consistent and objective when describing their physical complaints. C. There is a high correlation between the severity of discomfort and the gravity of its cause. D. The assumption should be made that chest discomfort is caused by myocardial ischemia until proven otherwise.

Answer D If there is any evidence of coronary artery disease (CAD) or risk of heart disease, assume that the chest pain is caused by myocardial ischemia until proven otherwise. There may be little correlation between the severity of chest discomfort and the gravity of its cause. This is a result of the subjective nature of pain and the unique presentation of ischemic disease in women, elderly patients, and individuals with diabetes. Subjective descriptors vary greatly among individuals. There is not always a correlation between the location of chest discomfort and its source.

A patient with a history of aortic stenosis is admitted for surgery to repair the valve. During cardiac assessment, the nurse would expect to hear which murmur? A. A high-pitched diastolic murmur B. A high-pitched systolic murmur C. A low-pitched diastolic murmur D. A low-pitched systolic murmur

Answer D The murmur of aortic stenosis occurs during systole. It is auscultated at the aortic area (second intercostal space, right sternal border). Aortic stenosis produces a low-pitched murmur that does not radiate.

A patient has been feeling weak for 4 days with a rapid, irregular heart rate. The monitor shows atrial fibrillation with a rapid ventricular response. What is the priority nursing intervention? A. Preparing for elective cardioversion B. Administering adenosine IV C. Performing carotid massage D. Initiating an ordered amiodarone drip

Answer D The patient is in atrial fibrillation, which has probably been going on for more than 48 hours. The American Heart Association does not recommend cardioversion until the patient has been anticoagulated. The appropriate intervention is to control the rate with a medication such as amiodarone while initiating anticoagulation. Elective cardioversion and adenosine IV would not be appropriate because cardioversion (electrical or chemical) would increase the risk of stroke. Carotid massage is not a nursing function and could cause an embolism.

A patient is admitted with acute exacerbation of his heart failure. When auscultating for heart sounds, the nurse would anticipate the presence of which finding? A. Systolic murmur B. Diastolic murmur C. Pericardial friction rub D. S3 heart sound

Answer D The presence of S3 may be normal in children, young adults, and pregnant women because of rapid filling of the ventricle in a young, healthy heart. An S3 in the presence of cardiac symptoms is an indicator of heart failure in a noncompliant ventricle with fluid overload.

In regard to cardiac action potential, which statement best describes phase 3? A. It consists of rapid depolarization, opening of the fast Na+ channels and causing a rapid influx of Na+ ions. B. It consists of resting membrane potential; excess Na+ that entered the cell is removed from the cell in exchange for K+ by means of the Na+/K+ pump. C. It consists of partial repolarization, as the action potential returns toward zero, when the rapid influx of Na+ is terminated. D. It consists of repolarization, preventing further influx of Ca2+/Na+ while promoting efflux of K+ out of the cell.

Answer D The repolarization phase is described as phase 3, and it depends on two processes. The first is the inactivation of the slow channels, which prevents further influx of Ca2+ and Na+. The other is the continued efflux of K+ out of the cell.

The time from the beginning of the cardiac action potential (AP) until the time when the fiber can accept another AP is known as which period? A. Excitability B. Depolarization C. Relative refractory D. Absolute refractory

Answer D The time from the beginning of the action potential (AP) until the fiber can accept another AP is called the effective or absolute refractory period. During this period, the cell cannot be depolarized regardless of the amount or intensity of the stimulus.

What is the time from the beginning of the cardiac action potential (AP) until the time when the fiber can accept another AP called? A. Excitability period B. Depolarization period C. Relative refractory period D. Absolute refractory period

Answer D The time from the beginning of the action potential (AP) until the fiber can accept another AP is called the effective or absolute refractory period. During this period, the cell cannot be depolarized regardless of the amount or intensity of the stimulus.

A patient is reported to have an ejection fraction of 30%. What is this finding most likely a sign of? A. Coronary artery disease B. Ventricular dysrhythmia C. Pulmonic valve regurgitation D. Poor ventricular function

Answer D The ejection fraction (EF) is the ratio of the stroke volume ejected from the left ventricle per beat to the volume of blood remaining in the left ventricle at the end of diastole. EF is expressed as a percentage, and a normal value is 50% or greater. An EF of less than 35% indicates poor ventricular function (as in cardiomyopathy), poor ventricular filling, obstruction to outflow (as in some valve stenosis conditions), or a combination of these conditions.

The nurse is assessing a patient's lower extremities. Which condition is consistent with arterial disease? A. Painless, pink fluid drains from an ulceration just above the right ankle. B. The feet become cyanotic when the patient sits in a chair. C. The nail beds are normal with a capillary refill time of 2 seconds. D. Varicose veins are noted on both legs. E. Skin on the leg is thin and shiny with a painful ulceration surrounded by eschar.

Answer E Skin on the leg that is thin and shiny with a painful ulceration surrounded by eschar is characteristic of an arterial disease of the lower extremity. Painless, pink fluid draining from an ulceration just above the right ankle, the feet becoming cyanotic when the patient sits in a chair, and varicose veins noted on both legs are consistent with a venous disease. Nail beds with a capillary refill time of 2 seconds is a normal finding.

Education for a patient with chronic heart failure would include which information? A. The need for accurate daily weights B. Appropriate diet choices C. Signs of negative changes in cardiac symptoms and when to notify the physician D. All of the above

Answer: All of the above Education for a patient with acute or chronic heart failure caused by valvular dysfunction includes (1) information related to diet, (2) fluid restrictions, (3) the actions and side effects of heart failure medications, (4) the need for prophylactic antibiotics before undergoing any invasive procedures, and (5) when to call a health care provider to report a negative change in cardiac symptoms.

Which hemodynamic changes are associated with mitral stenosis? A. Elevated left atrial pressure, pulmonary artery occlusive pressure, and pulmonary artery diastolic pressure; normal left ventricular end-diastolic pressure B. Elevated left atrial pressure, pulmonary artery occlusive pressure, and left ventricular end-diastolic pressure; normal pulmonary artery diastolic pressure C. Elevated pulmonary artery occlusive pressure, pulmonary artery diastolic pressure, and left ventricular end-diastolic pressure; normal left atrial pressure D. Elevated left atrial pressure, pulmonary artery diastolic pressure, and left ventricular end-diastolic pressure; normal pulmonary artery occlusive pressure

Answer: A In mitral valve stenosis, left atrial pressure and pulmonary artery occlusive pressure are increased and cause pulmonary congestion; however, these elevated values do not reflect the left ventricular end-diastolic pressure (LVEDP) because a stenotic mitral valve decreases normal blood flow from the left atrium to the left ventricle, decreasing left ventricular preload and consequently lowering LVEDP. The other options do not accurately describe the hemodynamic effects of mitral stenosis.

An inferior myocardial infarction (MI) occurs with an occlusion to the right coronary artery. In which leads would the electrocardiograph (ECG) changes be evident? A. II, III, and aVF B. I, aVL, V5, and V6 C. V1 to V4 D. V1 to V2

Answer: A Inferior wall infarction occurs with occlusion of the right coronary artery. This infarction manifests by electrocardiographic (ECG) changes in leads II, III, and aVF. Left lateral wall infarction occurs as a result of occlusion of the circumflex coronary artery. On a 12-lead ECG, new Q waves and ST segment T-wave changes are seen in leads I, aVL, V5, and V6. Anterior wall infarction results from occlusion of the proximal left anterior descending artery, ST segment elevation is expected in leads V1 through V4 on the 12-lead ECG. A posterior wall MI is difficult to detect but may be identified by specific leads placed in the left scapular area or by very tall R waves in leads V1 and V2.

A patient admitted with sepsis has a pulmonary artery catheter placed that also measures SvO2. During a routine assessment, the nurse notes that the patient's SvO2 is 56%. What does this finding indicate? A. Oxygen supply is not equal to demand. B. Oxygen supply is equal to demand. C. Oxygen saturation is not accurate. D. Oxygen is not being extracted by the tissues.

Answer: A SvO2 measures venous oxygen saturation, which is the oxygen reserve after tissues have extracted the oxygen they need. Normal SvO2 is 60% to 80%; therefore, an SvO2 of 56% is low, indicating that supply is not equal to demand. There is nothing in the scenario to suggest that the oxygen saturation is not accurate; however, the nurse would evaluate the functioning of the catheter as part of the assessment, particularly if the patient's appearance does not correlate with the recorded SvO2. If oxygen was not being extracted by the tissues, the SvO2 would be elevated.

When caring for the patient in atrial fibrillation (AF), the nurse understands which statement is true? A. Pulmonary veins frequently serve as a trigger site to initiate and maintain AF. B. AF maintains some regularity due to the consistent blockage of atrial impulses by the atrioventricular (AV) node. C. A label of persistent AF is claimed when the dysrhythmia has persisted for 3 days without interruption. D. Rate control and therapeutic anticoagulation are optional management strategies for patients in permanent AF.

Answer: A The four pulmonary veins that drain into the left atrium are a trigger site for early atrial foci to initiate and propagate re-entry circuits to maintain atrial fibrillation (AF). The atrioventricular (AV) node acts as a filter to protect the ventricles from the hundreds of atrial impulses that occur each minute. When the atrial muscle tissue immediately surrounding the AV node is in a refractory state, impulses generated in other areas of the atria cannot reach the AV node, which helps to explain the wide variation in R-R intervals during AF. AF sustained beyond 7 days or with multiple bouts of paroxysmal AF is labeled persistent. For long-term management of permanent AF, rate control is the recommended approach, and therapeutic anticoagulation to prevent embolic stroke is mandatory.

A patient is admitted for worsening heart failure (HF). While administering medications per practitioner order, the nurse assesses the patient's response. What is the goal of therapy for this patient? A. Managing fluid overload and improving cardiac output B. Increasing preload while decreasing afterload C. Enhancing the renin-angiotensin-aldosterone system (RAAS) D. Maximizing systemic vascular resistance

Answer: A The goal of therapy is management of the fluid overload and improvement of cardiac output to promote adequate tissue perfusion. Although decreasing afterload is desired, increasing preload would worsen the heart failure (HF). Inhibiting, rather than enhancing, the renin-angiotensin-aldosterone system (RAAS) using medications such as angiotensin-converting-enzyme inhibitors will improve HF. In the same manner, decreasing, not maximizing, systemic vascular resistance (SVR) improves HF. SVR, which measures afterload, should be decreased in HF to lessen myocardial workload and improve cardiac output.

A patient is admitted with syncope, exertional dyspnea, and a systolic murmur. Cardiac catheterization reveals significantly increased left ventricular end-diastolic pressure (LVEDP). The nurse suspects the patient may be experiencing which problem? A. Aortic stenosis B. Mitral stenosis C. Tricuspid stenosis D. Pulmonary regurgitation

Answer: A aortic stenosis Symptoms of aortic stenosis include syncope, exertional dyspnea, increased left ventricular end-diastolic pressure (LVEDP), and systolic murmur. Mitral and tricuspid stenoses are associated with a diastolic murmur as is pulmonary regurgitation

The nurse is leveling and rezeroing the patient's hemodynamic line upon returning from the radiology department. The patient asks the nurse, "Why are you doing that?" What is an appropriate response? (Select all that apply.) A. "Leveling the transducer above or below the reference point on your body can result in erroneous readings." B. "Zeroing removes the effects of atmospheric pressure on the readings." C. "If we use the same reference point, we will obtain consistent measurements." D. "It is important to line up the reference point to the left side of the top of your heart." E. "This is something we do periodically."

Answer: A, B, C, D Leveling the transducer above or below the reference point on your body can result in erroneous readings; zeroing removes the effects of atmospheric pressure on the readings; if we use the same reference point, we will obtain consistent measurements; and it is important to line up the reference point to the left side of the top of your heart are all correct and appropriate statements to share with a patient. This is something we do periodically is an incomplete and inappropriate response to a patient's question.

A patient with a family history of coronary artery disease (CAD) has the following laboratory results: total cholesterol, 250 mg/dL; high-density lipoprotein, 35 mg/dL; low-density lipoprotein, 160 mg/dL; and triglycerides, 240 mg/dL. Which interventions should the nurse anticipate? (Select all that apply.) A. Document the normal findings. B. Instruct the patient to increase exercise to 30 minutes a day, 5 days a week. C. Educate on increasing saturated fat and decreasing fiber in the diet. D. Monitor and control blood pressure. E. Enroll in smoking cessation classes.

Answer: B, D, E The patient with elevated lipids and a history of coronary artery disease (CAD) should be instructed to increase exercise, monitor blood pressure, and stop smoking. Documenting the findings as normal would be inappropriate because the laboratory test results are not normal. The patient should be educated to decrease saturated fats and increase fiber.

To perfuse the coronary arteries, a patient needs a mean arterial pressure (MAP) of at least 60 mm Hg. Which blood pressure reading will not provide an adequate MAP? A. 120/70 mm Hg B. 110/50 mm Hg C. 90/40 mm Hg D. 120/90 mm Hg

Answer: C 90/40 mm Hg equals a mean arterial pressure (MAP) of 90 + 80/3 = 57, which is inadequate for this patient. The other options are adequate as follows: 110/50 mm Hg = MAP of 110 + 100/3 = 70; 120/70 mm Hg = MAP of 120 + 140/3 = 87; and 120/60 mm Hg = MAP of 120 + 120/3 = 80.

In the early stages of pulmonary edema, which arterial blood gas pH would the nurse expect to find? A. pH of 7.38 B. pH of 7.34 C. pH of 7.50 D. pH of 7.26

Answer: C In the early stage of pulmonary edema, respiratory alkalosis (pH > 7.45) may be present because of hyperventilation, which eliminates carbon dioxide. As the pulmonary edema progresses and gas exchange becomes impaired, acidosis (pH

A patient with a history of chronic obstructive pulmonary disease (COPD) and heart failure presents with severe shortness of breath (SOB). Which laboratory test will assist with differentiation of the SOB? A. Troponin B. Calcium C. NT-pro-BNP D. Creatinine kinase

Answer: C NT-pro-BNP is one of several tests measuring brain natriuretic peptide, which is secreted from cells in the ventricle in response to the ventricular stretch that occurs in heart failure. NT-pro-BNP has a longer half-life than BNP. Troponin and creatinine kinase are biomarkers for damaged cardiac cells. Calcium is measured for many reasons, including its effect on cardiac contractility.

What is the volume of blood in the left ventricle at the end of diastole called? A. Afterload B. Stroke volume C. Preload D. Contractility

Answer: C Preload is the volume of blood in the left ventricle at the end of diastole. Contractility refers to the heart's contractile force. Afterload can be defined as the ventricular wall tension or stress during systolic ejection.

1. Which central venous catheter site has the lowest incidence of catheter-related blood infection? A. Internal jugular vein B. External jugular vein C. Subclavian vein D. Femoral vein

Answer: C Studies have shown that the subclavian vein has the lowest infection rate. Internal and external jugular vein catheters may be contaminated by oral or tracheal secretions. Femoral vein catheters may be contaminated because of their proximity to urine and stool in an incontinent patient.

1. What is the only artery in the body that caries deoxygenated blood? a. Left main coronary artery b. Posterior descending artery c. Pulmonary artery d. Right coronary artery

Answer: C pulmonary artery

1. When a papillary muscle in the left ventricle ruptures, the mitral valve leaflets do not close completely. This results in which condition? A. Acute myocardial infarction B. Aortic valve failure C. Systemic venous congestion D. Cardiac murmur

Answer: D A dysfunction of the chordae tendineae or of a papillary muscle can cause incomplete closure of an atrioventricular (AV) valve, which results in backflow of blood into the atrium and produces a murmur. If a papillary muscle in the left ventricle ruptures, the mitral valve leaflets do not close completely. Clinically, this causes acute mitral regurgitation and an audible murmur that can be auscultated with a stethoscope.

1. What is the pulse pressure of a patient with a blood pressure of 120/84 mm Hg? A. 204 mm Hg B. 96 mm Hg C. 84 mm Hg D. 36 mm Hg

Answer: D Pulse pressure describes the difference between the systolic and diastolic values. In this example the pulse pressure is 36 mm Hg. The normal pulse pressure is 40 mm Hg.

Aortic valve dysfunction pathologically alters the shape of the which structure in the heart? A. Right ventricle B. Mitral valve C. Left atrium D. Left ventricle Correct

Answer: D left ventricle