CH.22 Intro to the Cardiovascular System**

A patient has been placed on telemetry following treatment for a non-ST wave elevation myocardial infarction (NSTEMI). Which of the patient's following statements indicates that the nurse should perform further patient teaching?

- "If I get chest pain or shortness of breath, it will show up on my telemetry monitor." Explanation: Telemetry provides a real-time recording of the electrical activity of the heart. Patients on telemetry may mobilize, but they need to be aware that symptoms such as chest pain and dyspnea are not detected by telemetry and that these need to be reported by the patient himself or herself.

The nurse is conducting client teaching about cholesterol levels. When discussing the client's elevated LDL and lowered HDL levels, the client shows an understanding of the significance of these levels by making what statement?

- "Increased LDL and decreased HDL increase my risk of coronary artery disease." Explanation: Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.

A 71-year-old woman has complained of chest pain that appears when she is doing housework or climbing stairs. The woman claims that the pain dissipates when she stops exerting herself and rests for a few minutes. The woman's history, combined with these complaints, prompted her primary care provider to order cardiac catheterization. What instructions should the nurse provide this patient in anticipation of her procedure?

- "Make sure that you don't eat or drink before the procedure." Explanation: - Fasting is required for cardiac catheterization. - Activity is resumed slowly after the procedure, which is not performed under general anesthetic. - Bleeding from the puncture site requires prompt intervention.

The nurse is calculating a cardiac client's pulse pressure. If the client's blood pressure is 122/76 mm Hg, what is the client's pulse pressure?

- 46 mm Hg Explanation: Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg.

The nurse is caring for a client who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output?

- A heart rate of 54 bpm Explanation: Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.

A lipid profile has been ordered for a client who has been experiencing cardiac symptoms. When should a lipid profile be drawn in order to maximize the accuracy of results?

- After a 12-hour fast Explanation: Although cholesterol levels remain relatively constant over 24 hours, the blood specimen for the lipid profile should be obtained after a 12-hour fast

What Regulates Heart Rate?

- Autonomic N.S - Sympathetic N.S - Parasympathetic N.S - Baroreceptors: pressure-sensitive nerve endings (BP compensation) - Chemoreceptors: sensitive to pH and CO2 (alters heart rate) - Cardiac output: 4 to 8 L/minute; stroke volume

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. The client's temperature is 99.8° F (37.7° C). The client's blood pressure is 104/68 mm Hg. The client's pulse rate is 76 beats/minute. The nurse detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?

- Contact the health care provider and report the findings. Explanation: The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the health care provider immediately to preserve the blood flow in the client's leg.

Compare Diastole vs Systole

- Diastole: filled atria contract - Systole: contracted ventricles

The student nurse is preparing a teaching plan for a client being discharged status post MI. What should the nurse include in the teaching plan? Select all that apply

- Dietary modifications, exercise, weight loss, and careful monitoring are important strategies for managing three major cardiovascular risk factors: - hyperlipidemia - hypertension - diabetes. There is no need to increase fluid intake and activity should be slowly and deliberately increased.

A patient's gradual decline in activity tolerance and increased shortness of breath have prompted her health care provider to assess the structure and size of her heart. Which of the following diagnostic tests is most likely to yield these assessment data?

- Echocardiography Explanation: An echocardiogram yields a two-dimensional rendering of the heart's structure and mechanical function. An ECG indicates the heart's electrical activity Angiography and cardiac catheterization are used to assess the patency of the coronary arteries.

Following the morning assessment of an older adult patient, the nurse has documented, "Edema 3+ present to ankles and feet; dorsalis pedis and posterior tibial pulses palpable bilaterally." The nurse should recognize that this patient may be exhibiting symptoms of:

- Heart failure Explanation: Peripheral edema is associated with heart failure and peripheral vascular diseases, such as deep vein thrombosis or chronic venous insufficiency. Angina and hypertension do not directly cause peripheral edema. Intermittent claudication is a symptom that represents arterial insufficiency.

A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult client who has been experiencing vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis?

- Heart failure Explanation: The level of BNP in the blood increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF. It is not specific to cardiomyopathy, pleurisy, or valve dysfunction.

The health care provider has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a client. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis?

- Inflammation Explanation: High-sensitivity CRP is a protein produced by the liver in response to systemic inflammation. Inflammation is thought to play a role in the development and progression of atherosclerosis.

The nurse is performing an assessment of the patient's heart. Where would the nurse locate the apical pulse if the heart is in a normal position?

- Left 5th intercostal space at the midclavicular line Explanation: As a result of this close proximity to the chest wall, the pulsation created during normal ventricular contraction, called the apical impulse (also called the point of maximal impulse [PMI]), is easily detected. In the normal heart, the PMI is located at the intersection of the midclavicular line of the left chest wall and the fifth intercostal space

The physical therapist notifies the nurse that a client with coronary artery disease (CAD) experienced a significant increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a client with CAD may result in which outcome?

- Myocardial ischemia Explanation: Unlike other arteries, the coronary arteries are perfused during diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Clients, particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not usually result in a pulmonary embolism or create electrolyte imbalances. Atrial-septal defects are congenital.

A client has had a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. This client experienced damage to which area of the heart?

- Myocardium Explanation: The middle layer of the heart, or myocardium, is made up of muscle fibers and is responsible for the pumping action. The inner layer, or endocardium, consists of endothelial tissue and lines the inside of the heart and valves. The heart is encased in a thin, fibrous sac called the pericardium, which is composed of two layers. Adhering to the epicardium is the visceral pericardium. Enveloping the visceral pericardium is the parietal pericardium, a tough fibrous tissue that attaches to the great vessels, diaphragm, sternum, and vertebral column and supports the heart in the mediastinum.

The nurse measures the pulmonary artery wedge pressure in a client with left ventricular dysfunction. Which action will the nurse take after deflating the balloon tip following pressure measurement?

- Observe for return of the pulmonary artery systolic and diastolic waveforms. Explanation: Pulmonary artery pressure monitoring is used in critical care for: - assessing left ventricular function - diagnosing the etiology of shock - evaluating the client's response to medical interventions. After measuring the pulmonary artery wedge pressure, the nurse ensures that the balloon is deflated and that the catheter has returned to its normal position. This intervention is verified by evaluating the return of the pulmonary artery systolic and diastolic waveform displayed on the bedside monitor. The head of the bed does not need to be lowered nor does the blood pressure need to be measured on both arms after measuring the pulmonary artery wedge pressure. The transducer must be positioned at the phlebostatic axis before the measurement is taken to ensure an accurate reading.

A critically ill client is admitted to the ICU. The health care provider decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize?

- Perfusion distal to the insertion site Explanation: The radial artery is the usual site selected. However, placement of a catheter into the radial artery can further impede perfusion to an area that has poor circulation. As a result, the tissue distal to the cannulated artery can become ischemic or necrotic. Vigilant assessment is thus necessary. Alterations in temperature and the development of esophageal varices or compartment syndrome are not high risks.

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 Explanation: The difference between the systolic and the diastolic pressures is called the pulse pressure

A student nurse is caring for a client with suspected cardiovascular disease. The nursing instructor asks the student what side effects a client may experience when undergoing a cardiac magnetic resonance imaging (MRI) test. What should the student respond?

- Rapid heart rate Explanation: Side effects that a client may experience when undergoing a cardiac MRI test include: - chest pressure - rapid heart rate - hypotension, side effects from the cardiac medications given via intravenous route for the test.

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?

- 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 critical care nurse is caring for a client who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located?

- SA node Explanation: The heart rate is determined by the myocardial cells with the fastest inherent firing rate. Under normal circumstances, the SA node has the highest inherent rate (60 to 100 impulses per minute).

A nurse is aware that the patient's heart rate is influenced by many factors. The nurse understands that the heart rate can be decreased by:

- Stimulation of the vagus nerve. Explanation: Parasympathetic impulses, which travel to the heart through the vagus nerve, can slow the cardiac rate. The other choices cause an increase in heart rate. - An excess level of thyroid hormone. - An increased level of catecholamines. - Sympathetic nervous system stimulation.

A patient tells the nurse, "I was straining to have a bowel movement and felt like I was going to faint. I took my pulse and it was so slow." What does the nurse understand occurred with this patient?

- The patient had a vagal response. Explanation: When straining during defecation, the patient bears down (the Valsalva maneuver), which momentarily increases pressure on the baroreceptors. This triggers a vagal response, causing the heart rate to slow and resulting in syncope in some patients. Straining during urination can produce the same response. Myocardial infarction is damage to the heart and clients will experience pain or shortness of breath. Anxiety causes the heart rate to increase. The client with an abdominal aortic aneurysm will experience back or abdominal pain, not a decrease in heart rate.

The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from?

- The sinoatrial node Explanation: The sinoatrial node, the primary pacemaker of the heart, in a normal resting adult heart has an inherent firing rate of 60 to 100 impulses per minute; however, the rate changes in response to the metabolic demands of the body

The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is located?

- The thin fibrous sac encasing the heart Explanation: The heart is encased in a thin, fibrous sac called the pericardium, which is composed of two layers. Inflammation of this sac is known as pericarditis.

The nurse is caring for a client admitted with angina who is scheduled for cardiac catheterization. The client is anxious and asks the reason for this test. The nurse should explain that cardiac catheterization is most commonly done for which purpose?

- To assess how blocked or open a client's coronary arteries are Explanation: Cardiac catheterization is usually used to assess coronary artery patency to determine whether revascularization procedures are necessary. A thallium stress test shows myocardial ischemia after stress. An ECG shows the electrical activity of the heart.

The nurse is performing an intake assessment on a client with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?

- Whether the client and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately Explanation: During the health history, the nurse needs to determine if the client and involved family members are able to recognize symptoms of an acute cardiac problem, such as acute coronary syndrome (ACS) or HF, and seek timely treatment for these symptoms. Each of the other listed topics is valid, but the timely and appropriate response to a cardiac emergency is paramount.

The cardiologist has scheduled a client for drug-induced stress testing. What instructions should the nurse provide to prepare the client for this test?

- You will receive medication via IV administration. Explanation: Drugs such as: - adenosine (Adenocard) - dipyridamole (Persantine) - dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. Drugs may be used to stress the heart for clients with sedentary lifestyles or those with a physical disability, such as severe arthritis, that interferes with exercise testing. Drug-induced stress testing does not require the client to exercise. Instead, drugs are used to stress the heart. Clients performing exercise electrocardiography should report: - chest pain - dizziness - leg cramps, or weakness

During an initial assessment, the nurse measures the client's apical pulse and compares it to the peripheral pulse. The difference between the two is known as pulse:

- deficit. Explanation: To determine the pulse deficit, one nurse counts the heart rate through auscultation at the apex while a second nurse simultaneously palpates and counts the radial pulse for a full minute. The difference, if any, is the pulse deficit. Pulse rhythm is the pattern of the pulsations and the pauses between them. Pulse volume is described as feeling full, weak, or thready, meaning barely palpable. The pulse quality refers to its palpated volume.

Pulmonary artery function?

- delivers venous blood to the lungs

Inferior and superior vena cava function?

- deoxygenated blood into the right atrium

Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue?

- endocardium Explanation: 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.

Which area of the heart is located at the third intercostal (IC) space to the left of the sternum?

- erb point Explanation: Erb point is located at the 3rd IC space to the left of the sternum. The aortic area is located at the 2nd IC space to the right of the sternum. The pulmonic area is at the 2nd IC space to the left of the sternum. The epigastric area is located below the xiphoid process.

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 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.

During the auscultation of heart, what is revealed by an atrial gallop?

- 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.

he critical care nurse is caring for a client with a central venous pressure (CVP) monitoring system. The nurse notes that the client's CVP is increasing. This may indicate:

- hypervolemia. Explanation: CVP is a useful hemodynamic parameter to observe when managing an unstable client's fluid volume status. An increasing pressure may be caused by hypervolemia or by a condition, such as heart failure, that results in decreased myocardial contractility. Stress, dislodgment of the catheter, and low magnesium levels would not typically result in increased CVP.

The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate?

- international normalized ratio (INR) Explanation: The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis.

Coronary arteries (Coronary ostia) function?

- myocardium Oxygen-rich blood

Pulmonary veins function?

- oxygenated blood to left atrium - Transportation of blood to left ventricle

A nurse hears bilateral crackles in a client's lungs. What could be a cause of crackles in the bases of the client's lungs?

- pulmonary congestion Explanation: Crackles heard in the bases of the lungs are a sign of pulmonary congestion.

An older client acknowledges being "out of shape" and not exercising as they used to do. The client has no prior history of cardiac problems. The nurse is aware that the client's sedentary lifestyle is a risk factor for:

- sarcopenia. Explanation: Sarcopenia refers to changes in composition of muscle tissue that can occur in aging as the result of deconditioning. Muscle fiber reduction and replacement with fatty tissue decreases the strength of muscle contraction and thus can decrease cardiac output. Coronary ostia are the openings at the base of the aorta. Edema occurs when blood is not pumped efficiently or plasma protein levels are inadequate to maintain osmotic pressure. When blood has nowhere else to go, the extra fluid enters the tissues. Many clients with cardiac disorders exhibit changes in skin color, such as cyanosis. If this client develops cardiac problems in the future, they may present with skin color changes.

"Conduction System" Function?

- sustains electrical system of heart

During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure?

- wheezes with wet lung sounds Explanation: If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound, wheezes, and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does not reveal a high pitched sound.

Name and describe the 6 valves of the heart

1. Atrioventricular (AV) valves - Separate the atria from ventricles; cusped, leaflike 2. Tricuspid valve: - right atrium and ventricle 3. Bicuspid valve (mitral): - left atrium and ventricle - Chordae tendineae, papillary muscles 4. Semilunar valves: - prevent blood from flowing back into the ventricles 5. Pulmonic valve (pulmonary): - right ventricle and pulmonary artery 6. Aortic valve: - left ventricle and aorta - Function from contraction and relaxation of the ventricles

List the 4 Cardiac Tissue Layers

1. Epicardium: - outer layer - fibrous and loose connective tissue 2. Myocardium: - middle layer - muscle tissue 3. Endocardium: - inner layer - thin, smooth layer of endothelial cells 4. Pericardium: - saclike structure - 2 layers: parietal + visceral - Serous fluid between layers: reduces friction

Describe a Focused Assessment of the Cardiovascular System

1. History: - past medical history - family history - Familial and genetic predisposition - Prescription and nonprescription drug use 2. Physical Exam: - General appearance: ischemia; chest pain or leg pain 3. Vital signs: - temperature - fever - pulse rate - rhythm - pulse volume - pulse deficit - respiratory rate - accessory muscles - blood pressure 4. Cardiac Rhythm - Heart's electrical, not mechanical, activity; palpate peripheral pulse or auscultate apical heart rate - Telemetry 5. Normal Heart Sounds - S1/S2; "lub-dub"; apex of heart 6. Abnormal heart sounds: * S3—ventricular gallop * S4—atrial gallop, murmurs and clicks, friction rub 7. Peripheral pulses: - Radial pulses - Leg pulses bilaterally - Presence/absence and strength 8. Skin: - assess for cyanosis and pallor - Color changes to mucous membranes, lips, earlobes, skin, and nail beds; sparse hair growth; thick toe nails, varicosities 9. Peripheral edema: - pitting edema; scale +1 to +4 10. Weight: - indicates edema; daily 11. Jugular veins: - distention; increased pressure on the right side of the heart 12. Lung sounds: - crackles - wheezes - gurgles 13. Sputum: - frequency - amount - appearance - Pulmonary complications, heart failure 14. Mental status - cerebral ischemia - confusion/disorientation

List Cardiac labs and diagnostics

1. Laboratory Tests: - Serum enzymes and isoenzymes - serum cholesterol - lipid analysis 2. Radiography and Radionuclide Studies: - Determines size and position of heart - Nuclear cardiology= myocardial damage 3. Echocardiography - Functioning of left ventricle - tumors - congenital defects - changes in tissue layers of heart - TEE 4. Magnetic resonance imaging (MRI): - cardiac anatomy, function, blood flow, metabolism, circulatory perfusion - Preparation: screen kidney function, flushed feeling, earplugs during test, anxiety 5. Electrocardiography: resting, exercise - Ambulatory ECG: Holter monitoring - Diary of activities and associated symptoms - Exercise ECG: stress test; increase heart's workload 6. Drug-Induced Stress Testing - Compromised blood flow, coronary artery disease; adenosine (Adenocard), dipyridamole (Persantine) 7. Cardiac Catheterization - Preparation: medication omission, NPO, allergies identified, IV fluids, sedative - Postprocedure: pressure dressing; BP; client instructions: avoid movement, report pain and bleeding, drink large volume of fluids 8. Coronary Arteriography - Determines degree of blockage of coronary arteries - Postprocedure: assess for bleeding, infection, vascular assessments 9. Angiocardiography: - size and shape of heart chambers and great vessels - congenital abnormalities 10. Aortography: - aortic aneurysms 11. Peripheral arteriography: - occlusive arterial disease

List the 5 structures that make up the Conduction Sysem

1. Sinoartial node (SA) - Pacemaker of the heart; 60 to 100 impulses per minute 2. Atrioventricular node (AV) 3. Bundle of His 4. Bundle branches 5. Purkinje fibers - Ventricular contraction

The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the sinoartrial (SA) node and then proceeds in which sequence?

AV node to bundle of His to Purkinje fibers Explanation: - The normal electrophysiological conduction route is SA node to AV node to bundle of His to Purkinje fibers.

Which assessments should a nurse perform when caring for a client following a cardiac catheterization? Select all that apply.

After a cardiac catheterization: - the nurse monitors BP and pulse frequently to detect complications - checks the dressing over the insertion site frequently for signs of bleeding - palpates the pulse in various locations - checks the color and temperature in the affected extremity to confirm that blood is circulating well.

A client is being discharged after having a cardiac catheterization through the femoral artery. Which teaching will the nurse provide for the client to perform self-care at home? Select all that apply.

After discharge from the hospital for cardiac catheterization, the client should follow specific instructions for self-care. These instructions include: - avoiding tub baths since the puncture site should not be submerged in water - Bending at the waist should be avoided for 24 hours - The health care provider should be notified if any bruising occurs at the puncture site since this could indicate bleeding or hematoma formation - The client should call 911 if there is a large amount of bleeding from the access site and apply pressure to the site for 10 minutes if bleeding occurs.

Define the functions of Arteries and Arterioles

Arteries: - carry oxygenated blood from the heart Arterioles: - dilate or constrict

Describe the Heart Chambers

Atria (upper) Ventricles (lower) Septum (middle) - Right side: pulmonary circulation - Left side: systemic circulation

The function of the tricuspid valve is: A) Allows blood to flow out of the left ventricle into aorta B) Allows blood to flow from right atrium into right ventricle C) Allows blood to flow out of right ventricle into the pulmonary artery D) Allows blood to flow from left atrium to left ventricle

B) Allows blood to flow from right atrium into right ventricle Rationale: The function of the tricuspid valves is to prevent blood from returning to the atria when the ventricles contract. The tricuspid valve is between the right atrium and right ventricle.

Define the function of the capillaries

Capillaries: - direct contact with cells - Deliver oxygen and metabolic substances to cells

Coronary veins function?

Carry CO2 away—inferior and superior venae cavae

A nurse is examining a client with a history of cardiac disease. An assessment finding that indicates cardiac dysfunction includes which of the following? A) Presence of pedal edema B) Irregular heart rhythm C) Clubbing of fingers D) All of the above

D) All of the above Rationale: Abnormal vital signs including heart rate; abnormal heart sounds; and general appearance changes including skin temperature, distended neck veins, clubbing of fingers, and presence of edema are all assessment findings associated with cardiovascular disease.

The major functions of the cardiovascular system are to perform all of the following, except: A) Supply of oxygen-rich blood to tissues B) Elimination of carbon dioxide C) Transportation of nutrients D) Exchange of oxygen and carbon dioxide

D) Exchange of oxygen and carbon dioxide Rationale: The exchange of oxygen and carbon dioxide between the body and the outside environment is a function of the lungs known as ventilation and is not a primary function of the heart.

A client has been admitted to the intensive care unit (ICU) after an ischemic stroke, and a central venous pressure (CVP) monitoring line was placed. The nurse notes a low CVP. Which condition is the most likely reason for a low CVP?

Hypovolemia Explanation: CVP is a measurement of the pressure in the vena cava or right atrium. A low CVP indicates a reduced right ventricular preload, most often from hypovolemia. An MI is an unlikely cause of low CVP. CVP measures the right side of the heart, so left-sided failure is unlikely to affect CVP. Aortic valve regurgitation is a less likely cause of low CVP.

Define thee following from the conduction System: - Polarization - Depolarization - Repolarization - Refractory period

Polarization: - diastole - myocardial cells at rest Depolarization: - cardiac muscle contraction Repolarization: - polarized alignment - another electrical impulse Refractory period: - cells resist electrical stimulation - Electrocardiograph (ECG): detection of electrical activity

Define the functions of Veins & Venules

Veins: - return deoxygenated blood to the heart Venules: - larger diameters - lower venous pressure