CARDIAC- CH 25 - Assess. of Cardiac F(x)
A nurse is preparing a client for an exercise stress test the following morning. Which client statement indicates a need for additional teaching? "I won't eat or drink anything after midnight tonight." "I'll likely be able to take my regular medications before the test." "I won't smoke for 2 to 3 hours before the test." "I'll have to sign a consent form before the test."
"I won't eat or drink anything after midnight tonight." Explanation: The client requires additional teaching if he states that he'll fast from midnight until the test. Clients need to abstain from eating and drinking for only 4 hours before the test. The client should refrain from smoking for several hours before the test. Although the physician may direct the client to avoid certain medications, it's more likely that the physician will direct the client to take all his normal medications. The client must sign a consent form before the test.
afterload
(THINK HOW CLAMPED DOWN THE VESSEL IS) the amount of resistance to ejection of blood from the ventricle
preload
(THINK VOLUME) degree of stretch of the cardiac muscle fibers at the end of diastole
Normal pulse pressure
30-40 mm/Hg
Resting normal cardiac output for an adult
4-6 L/min
The avg. resting stroke volume
60-130 ml
The following clients are in need of exercise electrocardiography. Which client would the nurse indicate as most appropriate for a drug-induced stress test? A 48-year-old policemen with history of knee replacement 4 years ago A 68-year-old housewife with history of osteoporosis A 72-year-old retired janitor obtaining a cardiac baseline A 55-year-old recovering from a fall and broken femur
A 55-year-old recovering from a fall and broken femur Explanation: An exercise electrocardiography or stress test monitors the electrical activity of the heart while the client walks on a treadmill. If a client has a sedentary lifestyle or physical disability, cardiac medications may be administered to stress the heart similar to activity. Even though the client is middle aged at 55 years old, the client is recovering from a broken femur thus would be unable to have vigorous exercise. None of the other clients have a history which precludes them from exercise electrocardiography.
The nurse is assessing a patient who reports feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding? A heart rate of more than 20 bpm above the resting rate An unchanged systolic pressure An increase of 10 mm Hg blood pressure reading An increase of 5 mm Hg in diastolic pressure
A heart rate of more than 20 bpm above the resting rate Explanation: Normal postural responses that occur when a person moves from a lying to a standing position include (1) a heart rate increase of 5 to 20 bpm above the resting rate; (2) an unchanged systolic pressure, or a slight decrease of up to 10 mm Hg; and (3) a slight increase of 5 mm Hg in diastolic pressure. Postural (orthostatic) hypotension is a sustained decrease of at least 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP within 3 minutes of moving from a lying or sitting to a standing position (Freeman et al., 2011). It is usually accompanied by dizziness, lightheadedness, or syncope.
What is TEE?
A transesophageal echocardiogram (TEE) is a special type of echocardiogram. It is usually done when your doctor wants to look more closely at your heart to see if it could be producing blood clots
The nurse observes that a patient has 2+ pitting edema in the lower extremities. What does the nurse know that the presence of pitting edema indicates regarding fluid retention? A weight gain of 4 lbs A weight gain of 6 lbs A weight gain of 8 lbs A weight gain of 10 lbs
A weight gain of 10 lbs Explanation: Pitting edema, in which indentations in the skin remain after even slight compression with the fingertips (Fig. 29-2), is generally obvious after retention of at least 4.5 kg (10 lb) of fluid (4.5 L).
The client states, "My doctor says that because I am now taking this water pill, I need to eat more foods that contain potassium. Can you give me some ideas about what foods would be good for this?" What is the appropriate response by the nurse? Apricots, dried peas and beans, dates Asparagus, blueberries, green beans Cranberries, apples, popcorn Bok choy, cooked leeks, alfalfa sprouts
Apricots, dried peas and beans, dates Explanation: Apricots, dried peas and beans, dates, and kiwi contain high amounts of potassium. The other foods listed contain minimal amounts.
A client is experiencing an irregular heartbeat. The client asks the nurse how a heartbeat occurs. The nurse explains the conduction system of the heart beginning with the sinoatrial node (SA node). Place the conduction sequence of the heart in order beginning with the SA node. Use all options. AV node Atrial cell stimulation Purkinje fibers Bundle branches Bundle of His
Atrial cell stimulation AV node Bundle of His Bundle branches Purkinje fibers
A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal? Potassium B-type natriuretic peptide (BNP) C-reactive protein (CRP) Platelet count
B-type natriuretic peptide (BNP) Explanation: The client's symptoms suggest heart failure. BNP is a neurohormone that's released from the ventricles when the ventricles experience increased pressure and stretch, such as in heart failure. A BNP level greater than 51 pg/ml is commonly associated with mild heart failure. As the BNP level increases, the severity of heart failure increases. Potassium levels aren't affected by heart failure. CRP is an indicator of inflammation. It's used to help predict the risk of coronary artery disease. There is no indication that the client has an increased CRP. There is no indication that the client is experiencing bleeding abnormalities, such as those seen with an abnormal platelet count.
The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure? Chemoreceptors Sympathetic nerve fibers Baroreceptors Vagus nerve
Baroreceptors Explanation: Baroreceptor sense pressure in nerve endings in the walls of the atria and major blood vessels. The baroreceptors respond accordingly to raise or lower the pressure. Chemoreceptors are sensitive to pH, CO2, and O2 in the blood. Sympathetic nerve fibers increase the heart rate. The vagus nerve slows the heart rate.
The nurse is performing a skin assessment for a client and observes a blue tinge in the buccal mucosa and tongue. What condition does the nurse correlate this finding with? Congenital heart disease. Blood leaking outside the blood vessels. Intermittent arteriolar vasoconstriction. Peripheral vasoconstriction.
Congenital heart disease. Explanation: Cyanosis is due to serious cardiac disorders. A bluish tinge in the tongue and buccal mucosa are signs of central cyanosis caused by venous blood passing through the pulmonary circulation without being oxygenated. In the absence of pulmonary edema and cardiogenic shock, this sign is indicative of congenital heart disease. Refer to Table 12-3 in the text.
A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? Call the health care provider and obtain an order for a fluid bolus. Re-zero the equipment and take another reading. Call the physician and obtain an order for a diuretic. Continue to monitor the client as ordered.
Continue to monitor the client as ordered. Explanation: Normal CVP ranges from 3 to 7 mm Hg. The nurse doesn't need to take any action other than to monitor the client. It isn't necessary to re-zero the equipment. Calling a health care provider and obtaining an order for a fluid bolus would be an appropriate intervention if the client has a CVP less than 3 mm Hg. Administering a diuretic would be appropriate if the client had excess fluid, as demonstrated by a CVP greater than 7 mm Hg.
A cardiac patient with a magnesium lab result of 2.5 mEq/L would most likely evidence which of the following? Atrial tachycardia Ventricular arrhythmias Depressed myocardial contractility Increased cardiac excitability.
Depressed myocardial contractility Explanation: The normal magnesium level is 1.3 to 2.2 mEq/L. An elevated magnesium level can depress myocardial contractility and excitability, which can lead to heart block or asystole.
A patient has been diagnosed with congestive heart failure (CHF). The health care provider has ordered a medication to enhance contractility. The nurse would expect which medication to be prescribed for the patient? Digoxin Clopidogrel Enoxaparin Heparin
Digoxin Explanation: Contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, and certain medications, such as Lanoxin. Increased contractility results in increased stroke volume. The other medications are classified as platelet-inhibiting medications.
A client is being scheduled for a stress test. The client is unable to exercise during the test. The nurse would include information about which medication used for pharmacologic stress testing? Dipyridamole Lanoxin Thallium 201 Cardiolite
Dipyridamole Explanation: If the patient is unable to exercise, a pharmacologic stress test is performed by injecting a vasodilating agent, dipyridamole or adenosine, to mimic the physiologic effects of exercise. The stress test may be combined with an echocardiogram or radionuclide imaging techniques to examine myocardial function during exercise and rest. Digoxin would not be used for stress testing. Thallium 201 and Cardiolite are radioisotopes used in myocardial perfusion scanning.
The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries? Thallium Ativan Diazepam Dobutamine
Dobutamine Explanation: Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. The other options would not dilate the coronary arteries.
x When caring for a client with dysfunction in the conduction system, at which period would the nurse note that cells are resistant to stimulation? During polarization During depolarization During repolarization During the refractory period
During the refractory period Explanation: The refractory period is the time when cells are resistant to electrical stimulation. Repolarization is when the ions realign themselves to wait for an electrical signal. Depolarization occurs during muscle contraction when positive ions move inside the myocardial cell membrane and negative ions move outside. Before an impulse is generated, the cells are in a polarized state.
The nurse instructor is teaching a group of nursing students about adventitious heart sounds. The instructor explains that auscultation of the heart requires familiarization with normal and abnormal heart sounds. What would the instructor tell these students a ventricular gallop indicates in an adult? Heart failure Hypertensive heart disease Normal functioning Pericarditis
Heart failure Explanation: A sound that follows S1 and S2 is called an S3 heart sound or a ventricular gallop. An S3, normal in children, often is an indication of heart failure in an adult. An extra sound before S1 is an S4 heart sound, or atrial gallop. An S4 sound often is associated with hypertensive heart disease. A friction rub may cause a rough, grating, or scratchy sound that is an indication of pericarditis or inflammation of the pericardium.
A client is admitted to the hospital with weakness. What nursing assessment indicates postural hypotension? Heart rate increased from 85 to 110 bpm. Systolic pressure did not change with the change in position. Diastolic pressure went from 80 to 110 mm Hg. Heart rate decreased from 85 to 75 bpm at the same time that the systolic pressure increased from 120 to 135 mm Hg.
Heart rate increased from 85 to 110 bpm. Explanation: A sign of postural hypotension is the increase in the heart rate from 5 to 20 bpm with the change in position from lying, sitting and standing. Therefore, an increase of 25 bpm is indicative of hypotension. With postural hypotension, the systolic and diastolic blood pressure will decrease with standing and heart rate will increase.
The nurse reviews a client's lab results and notes a serum calcium level of 7.9 mg/dL. It is most appropriate for the nurse to monitor the client for what condition? Impaired myocardial contractility Enhanced sensitivity to digitalis Increased risk of heart block Inclination to ventricular fibrillation
Impaired myocardial contractility Explanation: Normal serum calcium is 8.9 to 10.3 mg/dL. A reading of 7.9 is below normal. Hypocalcemia is associated with slow nodal functioning and impaired myocardial contractility, which can increase the risk of heart failure.
The nurse is caring for a client who is diagnosed with an infarction of the posterior wall of the right atrium. Which assessment finding would the nurse anticipate relating to the infarction location? Respiratory compromise Chronic chest pain Irregular heart rate Cyanosis
Irregular heart rate Explanation: The posterior wall of the right atrium is the location of the sinoatrial node (SA node), which is the pacemaker of the heart. Damage to this location may result in an irregular heart rate due to a disturbance of electrical pulse initiation. Depending on muscle damage, the client may have respiratory compromise, chest pain, and/or cyanosis.
While the nurse is preparing a client for a cardiac catheterization, the client states that they have allergies to seafood. Which of the following medications may the nurse give prior to the procedure? Methylprednisolone Furosemide Lorazepam Phenytoin
Methylprednisolone Explanation: Prior to cardiac catheterization, the patient is assessed for previous reactions to contrast agents or allergies to iodine-containing substances, as some contrast agents contain iodine. If allergic reactions are of concern, antihistamines or methylprednisolone (Solu-Medrol) may be administered to the patient before angiography is performed. Furosemide, Lorazepam, and Phenytoin do not counteract allergic reactions.
The nurse is caring for a client in the cardiac intensive care unit (CICU) after a myocardial infarction (MI). Which drug will the nurse administer that will decrease contractility? Digoxin Dopamine Dobutamine Metoprolol
Metoprolol Explanation: Contractility is depressed by beta-adrenergic blocking medications. The other choices all enhance contractility. Beta-blockers decrease contractility
The client's heart rate is observed to be 140 bpm on the monitor. The nurse knows to monitor the client for what condition? Myocardial ischemia A pulmonary embolism Right-sided heart failure A stroke
Myocardial ischemia Explanation: As heart rate increases, diastolic time is shortened, which may not allow adequate time for myocardial perfusion. As a result, clients are at risk for myocardial ischemia (inadequate oxygen supply) during tachycardias (heart rate greater than 100 bpm), especially clients with coronary artery disease.
You are working on a telemetry unit. Your client was admitted with a cardiac event and is now on a cardiac monitor. You know a cardiac monitor reveals the heart's electrical but not its mechanical activity. How would you assess the mechanical activity of the client's heart? Take the blood pressure in both arms. Palpate a peripheral pulse. Auscultate the carotid artery. Percuss the perimeter of the heart.
Palpate a peripheral pulse. Explanation: A cardiac monitor reveals the heart's electrical but not its mechanical activity. The healthcare provider must palpate a peripheral pulse or auscultate the apical heart rate to obtain this information. You cannot obtain information on the mechanical activity of the heart by taking the client's blood pressure, auscultating the carotid artery, or attempting to percuss the perimeter of the heart.
Preload/afterload/stroke volume
Preload, filling a bottle of water afterload is squeezing the bottle of water into someone's face Stroke volume, the amount
The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure? Pulse pressure Auscultatory gap Pulse deficit Korotkoff sound
Pulse pressure Explanation: The difference between the systolic and the diastolic pressures is called the pulse pressure.
The nurse screens a client prior to a magnetic resonance angiogram (MRA) of the heart. Which action should the nurse complete prior to the client undergoing the procedure? Select all that apply. Remove the client's Transderm Nitro patch. Sedate the client prior to the procedure. Position the client on the stomach for the procedure. Remove the client's jewelry. Offer the client a headset to listen to music during the procedure.
Remove the client's Transderm Nitro patch. Remove the client's jewelry. Offer the client a headset to listen to music during the procedure. Explanation: Transdermal patches that contain a heat-conducting aluminized layer (e.g., NicoDerm, Androderm, Transderm Nitro, Transderm Scop, Catapres-TTS) must be removed before MRA to prevent burning of the skin. A client who is claustrophobic may need to receive a mild sedative before undergoing an MRA. During an MRA, the client is positioned supine on a table that is placed into an enclosed imager or tube containing the magnetic field. Clients are instructed to remove any jewelry, watches, or other metal items (e.g., ECG leads). An intermittent clanking or thumping that can be annoying is generated by the magnetic coils, so the client may be offered a headset to listen to music.
The nurse is caring for a client with nursing diagnosis of ineffective tissue perfusion. Which area of the heart would the nurse anticipate being compromised? Right atrium Pulmonary artery Right ventricle Aorta
Right ventricle Explanation: There are four chambers to the heart. The right and left ventricles is the heart's major pumping chamber. The right ventricle pumps to the lungs to oxygenate the blood. The left ventricle pumps blood to the tissues and cells. The pulmonary artery and aorta are not of the heart. If the blood is not being properly oxygenated, it will lead to ineffective tissue perfusion.
A client in the ICU has a central venous pressure (CVP) line placed. The CVP reading is 10 mm Hg. To what condition does the nurse correlate the CVP reading? Right-sided heart failure Hypovolemia Left-sided heart failure Reduction in preload
Right-sided heart failure Explanation: Normal CVP is 2 to 8 mm Hg. A CVP greater that 8 mm Hg indicates hypervolemia or right-sided heart failure. A CVP less than 2 mm Hg indicates a reduction in preload or hypovolemia.
S1 S2 S3 S4
S1: the first heart sound produced by closure of the atrioventricular (mitral and tricuspid) valves S2: the second heart sound produced by closure of the semilunar (aortic and pulmonic) valves S3: an abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure S4: an abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertrophy of the ventricle
The nurse is assessing heart sounds in a patient with heart failure. An abnormal heart sound is detected early in diastole. How would the nurse document this? S1 S2 S3 S4
S3 Explanation: An S3 ("DUB") is heard early in diastole during the period of rapid ventricular filling as blood flows from the atrium into a noncompliant ventricle. It is heard immediately after S2. "Lub-dub-DUB" is used to imitate the abnormal sound of a beating heart when an S3 is present.
The nurse is most correct to state the proper circulation as which? Place the pattern of circulation in the correct order beginning in the right atrium. Use all options. Left ventricle Pulmonary artery Pulmonary vein Right ventricle Left atrium Aorta
Start: Right Atrium Right ventricle Pulmonary artery Pulmonary vein left atrium Left ventricle Aorta RA RV PA PV LA LV A
Stroke volume depends on....
Stroke volume is the amount of blood pumped out of the ventricle with each contraction and depends on three factors: preload, afterload, and contractility.
The nurse is discussing the cardiac system with a client admitted with heart failure. The client asks "What determines the heart rate?" What is the nurse's best response? The autonomic nervous system controls the heart rate. Preload controls the heart rate. Stroke volume controls the heart rate. Force of contractility controls the heart rate.
The autonomic nervous system controls the heart rate. Explanation: The autonomic nervous system primarily controls the heart rate. When the sympathetic branch is stimulated, heart rate increases. When the parasympathetic branch is stimulated, heart rate decreases. Stroke volume is the amount of blood pumped out of the ventricle with each contraction and depends on three factors: preload, afterload, and contractility.
Endocardium Myocardiuum Epicardium Pericardium
The inner layer, the endocardium, is composed of a thin, smooth layer of endothelial cells. Folds of endocardium form the heart valves. The middle layer, the myocardium, consists of muscle tissue and is the force behind the heart's pumping action. The pericardium is a saclike structure that surrounds and supports the heart. The outer layer, the epicardium, is composed of fibrous and loose connective tissue.
Normal Central Venous Pressure (CVP)
The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right-ventricular preload, which is most often from hypovolemia.
A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate? Bounding pulse Weak pulse Thready pulse A pulse deficit
Thready pulse Explanation: The nurse is most correct to anticipate a thready (barely palpable) pulse quality. A bounding pulse indicates a strong cardiac output. A weak pulse indicates a lower pulse quality. A pulse deficit occurs when the pulses between the apex of the heart differs from the radial pulse.
Total cholesterol: HDL: LDL: Trigylcerides:
Total cholesterol: less than 200 HDL: 35+ LDL: less than 160 Trigylcerides: 100-200
The nurse is auscultating a client's heart sounds and notes a murmur at the left fourth intercostal space and lateral to the sternum. At which cardiac valve would the nurse document this murmur? Mitral valve Tricuspid valve Aortic valve Pulmonic valve
Tricuspid valve Explanation: The tricuspid valve is at the left fourth intercostal space and lateral to the sternum. The mitral valve is heard at the left fifth intercostal space and midclavicular line. The aortic valve is heard at the right second intercostal space, lateral to the sternum. The pulmonic valve is left second intercostal space, lateral to the sternum.
acute coronary syndrome
a constellation of signs and symptoms due to the rupture of atherosclerotic plaque and resultant partial or complete thrombosis within a diseased coronary artery; leads to unstable angina or acute myocardial infarction
hypotension
a decrease in blood pressure to less than 100/60 mm Hg that compromises systemic perfusion
postural (orthostatic) hypotension
a significant drop in blood pressure (20 mm Hg systolic or more or 10 mm Hg diastolic or more) after an upright posture is assumed
cardiac stress test
a test used to evaluate the functioning of the heart during a period of increased oxygen demand; test may be initiated by exercise or medications
contractility
ability of the cardiac muscle to shorten in response to an electrical impulse
opening snaps
abnormal diastolic sound generated during opening of a rigid atrioventricular valve leaflet
summation gallop
abnormal sounds created by the presence of an S3 and S4 during periods of tachycardia
systolic click
abnormal systolic sound created by the opening of a calcified aortic or pulmonic valve during ventricular contraction
stroke volume
amount of blood ejected from one of the ventricles per heartbeat
cardiac output
amount of blood pumped by each ventricle in liters per minute
cardiac catheterization
an invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries
Which term describes the ability of the heart to initiate an electrical impulse? automaticity contractility conductivity excitability
automaticity Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an electrical impulse. Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse. Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another. Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to respond to an electrical impulse.
hypertension
blood pressure that is persistently greater than 140/90 mm Hg
myocardial ischemia
condition in which heart muscle cells receive less oxygen than needed
The nurse is preparing discharge instructions for an elderly client with cardiovascular health changes. What is an age-related change in the cardiovascular system that may affect the sympathetic nervous system? tachycardia increased contractility response to exercise decreased response to beta-blockers decreased time for the heart rate to return to baseline
decreased response to beta-blockers Explanation: The sympathetic nervous system exhibits structural and functional changes that are age-related. Heart rate will decrease, and it will take longer for the heart rate to return to baseline. The ability to sustain increased contractility with a high level of exercise for a prolonged period of time decreases with age, even with healthy aging. Elderly clients will have a decreased response to beta blockers.
The nurse cares for a client in the ICU diagnosed with coronary artery disease (CAD). Which assessment data indicates the client is experiencing a decrease in cardiac output? BP 108/60 mm Hg, ascites, and crackles disorientation, 20 mL of urine over the last 2 hours reduced pulse pressure and heart murmur elevated jugular venous distention and postural changes in BP
disorientation, 20 mL of urine over the last 2 hours Explanation: Assessment findings associated with reduced cardiac output include reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, or disorientation.
depolarization
electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell
Age-related changes associated with the cardiac system include decreased size of the left atrium. endocardial fibrosis. increase in the number of SA node cells. myocardial thinning.
endocardial fibrosis. Explanation: Age-related changes associated with the cardiac system include: endocardial fibrosis, increased size of the left atrium, a decreasing number of SA node cells, and myocardial thickening.
Which symptom is an early warning sign of acute coronary syndrome (ACS) and heart failure (HF)? hypotension fatigue change in level of consciousness weight gain
fatigue Explanation: Fatigue is an early warning symptom of ACS, heart failure, and valvular disease. Other signs and symptoms of cardiovascular disease are hypotension, change in level of consciousness, and weight gain.
The nurse is performing an assessment for an older adult client and auscultates an S3 heart sound. What condition does the nurse determine may correlate with this finding? congenital heart disease heart failure aortic stenosis coronary artery disease
heart failure Explanation: The S3 heart sound is heard immediately after the S2 sound, early in diastole, as blood flows from the atrium into a noncompliant ventricle. The S3 heart sound is normal in children and young adults, but it is a significant finding suggestive of heart failure in older adults. A client with aortic stenosis commonly may have a murmur. A client with congenital heart disease may have more that one abnormal heart sound. Clients with coronary artery disease do not have S3 heart sounds.
The nurse cares for a client in the emergency department who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition? heart failure ventricular hypertrophy pulmonary edema myocardial infarction
heart failure Explanation: A BNP level greater than 100 pg/mL is suggestive of heart failure. Because this serum laboratory test can be quickly obtained, BNP levels are useful for prompt diagnosis of heart failure in settings such as the emergency department. Elevations in BNP can occur from a number of other conditions such as pulmonary embolus, myocardial infarction (MI), and ventricular hypertrophy. Therefore, the healthcare provider correlates BNP levels with abnormal physical assessment findings and other diagnostic tests before making a definitive diagnosis of heart failure.
The nurse is explaining vasovagal syncope to a client. What does the nurse associate the temporary loss of consciousness with for the client? vertigo increase fluid intake blood pressure 190/50 standing heart rate 48
heart rate 48 Explanation: Parasympathetic hyperactivity leading to sudden hypotension secondary to bradyarrhythmia causes vasovagal syncope; bradyarrhythmia leads to cerebral ischemia, which in turn leads to syncope. Vasovagal syncope isn't caused by vestibular dysfunction such as vertigo, hypertension, or vascular fluid shifting.
During the auscultation of a client's heart sounds, the nurse notes an S4. The nurse recognizes that an S4 is associated with which condition? heart failure hypertensive heart disease turbulent blood flow diseased heart valves
hypertensive heart disease Explanation: Auscultation of the heart requires familiarization with normal and abnormal heart sounds. An extra sound just before S1 is an S4 heart sound or atrial gallop. An S4 sound often is associated with hypertensive heart disease. A sound that follows S1 and S2 is called an S3 heart sound or a ventricular gallop. An S3 heart sound is often an indication of heart failure in an adult. In addition to heart sounds, auscultation may reveal other abnormal sounds, such as murmurs and clicks, caused by turbulent blood flow through diseased heart valves. S3= HEART FAILURE S4= HYPERTENSIVE HEART DISEASE
apical impulse
impulse normally palpated at the fifth intercostal space, left midclavicular line; caused by contraction of the left ventricle; also called the point of maximal impulse
Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for receiving oxygenated blood from the lungs? left atrium left ventricle right atrium right ventricle
left atrium Explanation: The left atrium receives oxygenated blood from the lungs. The left ventricle pumps that blood to all the cells and tissues of the body. The right atrium receives deoxygenated blood from the venous system. The right ventricle pumps that blood to the lungs to be oxygenated.
R ventricle pumps blood to... L ventricle pumps blood to...
lungs the rest of the body The right ventricle pumps the oxygen-poor blood to the lungs through the pulmonary valve. The right atrium receives oxygen-poor blood from the body and pumps it to the right ventricle through the tricuspid valve The left atrium receives oxygen-rich blood from the lungs and pumps it to the left ventricle through the mitral valve. The left ventricle pumps the oxygen-rich blood through the aortic valve out to the rest of the body.
myocardium
muscle layer of the heart responsible for the pumping action of the heartmuscle layer of the heart responsible for the pumping action of the heart
baroreceptors
nerve fibers located in the aortic arch and carotid arteries that are responsible for control of the blood pressure
ejection fraction
percentage of the end-diastolic blood volume ejected from the ventricle with each heartbeat
A client describes chest pain as sharp, substernal, of intermittent duration, and radiating to the arms and back. The client says the pain increases with inspiration and swallowing and is alleviated when sitting upright. What does the nurse suspect the client may be experiencing? pericarditis angina pectoris panic attack dissecting aorta
pericarditis Explanation: Chest pain described as a sharp, substernal, of intermittent duration, and radiating to the arms and back that increases with inspiration and swallowing and is alleviated when sitting upright is pericarditis. Angina pectoris pain is often described as a squeezing, pressure, heaviness, tightness, or pain in the chest. Panic attack pain is not always relieved with sitting upright. A client with dissecting aorta experiences back and abdominal pain not relieved with sitting upright.
systole
period of ventricular contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta
diastole
period of ventricular relaxation resulting in ventricular filling
sinoatrial (SA) node
primary pacemaker of the heart, located in the right atrium
The nurse assesses a client with increasing shortness of breath and peripheral edema. The healthcare provider inserts a triple lumen catheter and orders a transduced central venous pressure (CVP). What CVP reading does the nurse suspect will correlate with the client's symptoms? 0 mmHg 2 mmHg 6 mmHg 8 mmHg
pt will have a high CVP because they have peripheral edema, which is indicative of HYPERVOLEMIA. 2-6 is normal CVP <2 is hypovolemia or decreased preload >8 is hypervolemia / R-sided HF The normal CVP reading is 2-6 mmHg. A reading of 0 mmHg indicates hypovolemia. A reading of 8 mmHg, which is high, correlates with hypervolemia and the client's symptoms of fluid overload with increasing shortness of breath and edema.
systemic vascular resistance
resistance to blood flow out of the left ventricle created by the systemic circulatory system
pulmonary vascular resistance
resistance to blood flow out of the right ventricle created by the pulmonary circulatory system
repolarization
return of the cell to resting state, caused by reentry of potassium into the cell while sodium exits the cell
Central venous pressure is measured in which heart chamber? right atrium left atrium left ventricle right ventricle
right atrium Explanation: The pressure in the right atrium is used to assess right ventricular function and venous blood return to the heart. The left atrium receives oxygenated blood from the pulmonary circulation. The left ventricle receives oxygenated blood from the left atrium. The right ventricle is not the central collecting chamber of venous circulation.
atrioventricular (AV) node
secondary pacemaker of the heart, located in the right atrial wall near the tricuspid valve
The nurse is reviewing the laboratory results for a client with heart failure. Which laboratory value will the nurse report to the healthcare provider? sodium 148 mEq/L potassium 3.9 mEq/L calcium 9.8 mg/dL magnesium 2.5 mg/dL
sodium 148 mEq/L Explanation: Normal sodium levels are between 135 and 145 mEq/L, so the sodium value is abnormal. The remaining values are normal. Normal potassium levels range from 3.5 to 5.0 mEq/L. The normal range for calcium level is 8.5 to 10.5 mg/dL. Normal magnesium levels range from 1.8 to 3.0 mg/dL.
murmurs
sounds created by abnormal, turbulent flow of blood in the heart
normal heart sounds
sounds produced when the valves close; normal heart sounds are S1 (atrioventricular valves) and S2 (semilunar valves)
cardiac conduction system
specialized heart cells strategically located throughout the heart that are responsible for methodically generating and coordinating the transmission of electrical impulses to the myocardial cells
Pulse pressure
the difference between systolic and the diastolic pressures, it reflects stroke volume, ejection velocity, and systemic vascular resistance Decreased pulse pressure reflects reduced stroke volume and ejection velocity and (shock, HF, hypovolemia, mitral regurgitation)A pulse pressure less than 30mm/Hg signifies a serious reduction in cardiac output
pulse deficit
the difference between the apical and radial pulse rates
telemetry
the process of continuous electrocardiographic monitoring by the transmission of radio waves from a battery-operated transmitter worn by the patient
hemodynamic monitoring
the use of pressure monitoring devices to directly measure cardiovascular function
An obese client describes symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm the suspected diagnosis. What diagnostic procedure would the nurse expect to be prescribed? transesophageal echocardiography chest radiograph radionuclide angiography electrocardiography
transesophageal echocardiography (TEE) Explanation: TEE involves passing a tube with a small transducer internally from the mouth to the esophagus to obtain images of the posterior heart and its internal structures from the esophagus, which lies behind the heart. TEE provides superior views that are not possible using standard transthoracic echocardiography. Clients whose chests are rotund or who are obese are candidates for TEE. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. The radionuclide technetium-99m is used to detect areas of myocardial damage. The radionuclide thallium-201 is used to diagnose ischemic heart disease during a stress test. Electrocardiography (ECG) is the graphic recording of the electrical currents generated by the heart muscle.
Which test used to diagnose heart disease is least invasive? transthoracic echocardiography magnetic resonance imaging cardiac catheterization coronary arteriography
transthoracic echocardiography Explanation: Transthoracic echocardiography uses high-frequency sound waves that pass through the chest wall (transthoracic) and are displayed on an oscilloscope. MRI uses magnetism to identify disorders that affect many different structures in the body without performing surgery. While an MRI does not expose clients to radiation, it does require intravenous infusion to instill medication and contrast medium. Cardiac catheterization requires the insertion of a long, flexible catheter from a peripheral blood vessel in the groin, arm, or neck into one of the great vessels and then into the heart. Coronary arteriography requires the installation of a contrast medium into each coronary artery.
radioisotopes
unstable atoms that give off small amounts of energy in the form of gamma rays as they decay; used in cardiac nuclear medicine studiesunstable atoms that give off small amounts of energy in the form of gamma rays as they decay; used in cardiac nuclear medicine studies
A nurse is conducting procedures to determine the extent of a client's left-sided heart failure. What adventitious lung sounds would the nurse expect to hear during auscultation of the lungs to support the diagnosis? Select all that apply. wheezes wet lung sounds stridor labor
wheezes wet lung sounds Explanation: With left-sided heart failure, auscultation reveals a crackling sound and possibly wheezes and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe.
