Ch.33 EAQ

While caring for a patient with cardiovascular disease (CVD), the nurse recognizes the patient is at risk for decreased cardiac output (CO). Which finding supports the nurse's observation? Cardiac output (CO) of 3 L/min Cardiac output (CO) of 5 L/min Cardiac output (CO) of 6 L/min Cardiac output (CO) of 8 L/min

Ans: A Cardiac output (CO) of 3 L/min Rationale:A cardiac output (CO) of 3 L/min indicates a low CO state. The normal range of CO is 4 to 7 L/min. Therefore, the CO of 5 L/min, 6 L/min, and 8 L/min indicate normal values.

Indicate the correct sequence of events that occur during a cardiac cycle.

1. Release of large number of calcium ions from sarcoplasmic reticulum 2. Interaction of the actin and myosin filaments 3. Sliding of the protein filaments and formation of linkages 4. Pumping of calcium ions back into sarcoplasmic reticulum 5. Disengagement of the protein filaments

A patient has a cardiac output (CO) of 6.1 L/min and a body surface area of 2.3 m2. What is the cardiac index of this patient? Record your answer using two decimal places. ____________ L/min/m2

Ans: 2.65 Rationale: Cardiac index (CI) can be determined by dividing the cardiac output (CO) by the body surface area. Therefore 6.1 L/min divided by 2.3 m 2 is equal to 2.65 L/min/m 2. This patient's cardiac index is 2.65 L/min/m 2.

The nurse finds that a patient's stroke volume (SV) is approximately 80 mL at rest and heart rate (HR) is 70 beats/min. What is the patient's cardiac output (CO)?____________ L/min

Ans: 5.6 L/min Rationale: Cardiac output (CO) is defined as heart rate (HR) x stroke volume (SV). Therefore, 80 mL/beat x 70 beats/min = 5600 mL/min. This patient's CO is 5.6 L/min.

Which statement about blood pressure (BP) is correct? Kidneys help to regulate cardiovascular activity. Blood pressure rises when body temperature decreases. Sodium and water is retained when renal blood flow increases. Anger causes the sympathetic nervous system to decrease BP and heart rate.

Ans: A Kidneys help to regulate cardiovascular activity. Rationale: The kidneys help to regulate cardiovascular activity. When renal blood flow or pressure decreases, the kidneys retain sodium and water. BP tends to rise because of fluid retention and activation of the renin-angiotensin-aldosterone mechanism. Blood pressure falls when the body temperature decreases as the tissues require fewer nutrients. Emotional behaviors such as anger stimulate the sympathetic nervous system to increase BP and heart rate.

The nurse is assessing a patient with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential? Validate that the patient has remained NPO. Reassure the patient that the test is painless. Teach the patient about the reason for the TEE. Auscultate the patient's precordium for murmurs.

Ans: A Validate that the patient has remained NPO Rationale: Owing to the risk for aspiration, the patient must be NPO before the procedure. It is anticipated that the patient with mitral stenosis may have an audible murmur; this action is not essential at this time. Although teaching is important, the patient could undergo the procedure without understanding the reason for the test. The patient will have sedation during the test because it is uncomfortable.

A patient who is to undergo cardiac catheterization should be taught which essential information by the nurse? "Keep your affected leg straight for 2 to 6 hours." "Monitor the pulses in your feet when you get home." "Do not take your blood pressure medications on the day of the procedure." "Take your oral hypoglycemic with a sip of water on the morning of the procedure."

Ans: A "Keep your affected leg straight for 2 to 6 hours." Rationale: The patient will remain in bed and the affected leg must remain straight for 2 to 6 hours after the procedure, depending on the type of vascular closure device used to allow the arterial puncture to heal well and prevent bleeding. The nurse monitors the pulses in the affected extremity until discharge, and then teaches the patient to contact the health care provider immediately if pallor, pain, paresthesia, or coolness of the extremity develops. The patient may take regular medications except oral hypoglycemics. Blood pressure may be elevated due to anxiety before the procedure; therefore, antihypertensive medications are taken. Oral hypoglycemics are taken with or before meals based on an anticipated rise in glucose after eating; they are not taken when the patient is NPO for procedures or surgery.

What is the average pressure of blood in the right atrium (RA)? 0 to 5 mm Hg 20 to 50 mm Hg 60 to 70 mm Hg 100 to 120 mm Hg

Ans: A 0 to 5 mm Hg Rationale: The average pressure of blood in the right atrium (RA) is 0 to 5 mm Hg. The average pressure of blood in the RA is not equal to 20 to 50 mm Hg. A mean arterial pressure (MAP) of 60 to 70 mm Hg is necessary to maintain perfusion of major body organs, such as the kidneys and the brain. The pressure of blood in the aorta of a young adult is 100 to 120 mm Hg.

During a diagnostic test for a patient suspected of having a cardiac tumor, the nurse elevates the patient's head to 20 degrees and places a small transducer on the patient's chest at the level of fourth intercostal space near the left sternal border. Which diagnostic test is the patient undergoing? Echocardiography Electrocardiography Magnetic resonance imaging Myocardial nuclear perfusion imaging

Ans: A Echocardiography Rationale: Echocardiography helps to assess and diagnose cardiac tumors. The nurse prepares the patient by instructing him or her to lie on the left side with the head elevated 15 to 20 degrees. During an echocardiogram, a small transducer lubricated with gel to facilitate transducer movement and conduction is placed on the patient's chest at the level of the third or fourth intercostal space near the left sternal border. During electrocardiography, the technician places electrodes on the patient's chest and attaches them to a multilead monitoring system. During magnetic resonance imaging, the nurse ensures that the patient has removed all metallic objects. Myocardial nuclear perfusion imaging test involves injection of different types of radioactive isotopes into the antecubital vein to view, record, and evaluate cardiovascular abnormalities.

A patient who is suffering dyspnea on exertion and congestive heart failure will likely report which symptom during the health history? Fatigue Slow heart rate Swelling of one leg Brown discoloration of lower extremities

Ans: A Fatigue Rationale: Although fatigue in itself is not diagnostic of heart disease, many people with heart failure are limited by leg fatigue during exercise. Fatigue that occurs after mild activity and exertion usually indicates inadequate cardiac output (due to low stroke volume) and anaerobic metabolism in skeletal muscle. Unilateral swelling is more typical with a local finding such as DVT, not a systemic problem such as heart failure. Tachycardia, rather than bradycardia, develops with heart failure and decreased cardiac output. Brown discoloration of the lower extremities is indicative of long-standing venous stasis, such as occurs with varicose veins.

While performing a cardiovascular assessment of a patient, the nurse detects a very loud heart murmur accompanied by a palpable thrill. This is audible even if the stethoscope is partially off the patient's chest. What grade of heart murmur does this describe? Grade V Grade III Grade IV Grade VI

Ans: A Grade V Rationale: A very loud heart murmur that is audible with the stethoscope partially off the patient's chest and accompanied by a palpable thrill can be categorized as grade V. A heart murmur that is loud but with moderate intensity can be categorized as grade III. A heart murmur that is loud and accompanied by a palpable thrill can be categorized as grade IV. A grade VI heart murmur has two characteristics: the first being extremely loud and may be heard with the stethoscope slightly above the patient's chest, the second that it is accompanied by a palpable thrill.

Cardiac output is represented by which formula? Heart rate × stroke volume Systolic - diastolic blood pressure Systolic pressure ÷ diastolic pressure Pulmonary artery diastolic = pulmonary artery wedge pressure

Ans: A Heart rate × stroke volume Rationale: Cardiac output = heart rate × stroke volume. Systolic - diastolic blood pressure = pulse pressure. Under normal conditions, the pulmonary artery diastolic pressure theoretically is equivalent to the pulmonary capillary wedge pressure, but that does not answer the question. Systolic pressure ÷ diastolic pressure is an oversimplified equation for the mean arterial blood pressure.

The nurse is caring for an older patient diagnosed with cardiovascular disease (CVD). After teaching the patient to change positions slowly, the nurse assesses the patient's blood pressure (BP) and finds a drop in BP by 20 mm Hg when changing from a sitting to standing position. What cardiovascular changes related to aging does the nurse suspect the patient has? Ineffective baroreceptors Enlarged left ventricle (LV) Calcification in mitral and aortic valves Thick, stiff, and less distensible arteries

Ans: A Ineffective baroreceptors Rationale: The drop in the patient's blood pressure (BP) with position change could be due to cardiovascular changes such as baroreceptors that are less sensitive to hypotension. An enlarged left ventricle (LV), calcification in mitral and aortic valves, and thick, stiff and less distensible arteries may not cause a drop in BP. However, an enlarged LV results in widening of the QRS complex and prolonged QT interval, as well as a decreased stroke volume (SV) and ejection fraction. Calcification in mitral and aortic valves results in changes in heart rate (HR) and rhythm, and may manifest in a heart murmur. Thick, stiff, and less distensible arteries cause hypertension.

The nurse assesses peripheral pulses and auscultates the patient's heart and lungs before a cardiac catheterization test for a patient suspected to have valvular dysfunction. Which other intervention should the nurse implement before the procedure? Instruct the patient to withhold any medication for diuretics therapy. Administer steroids if the patient has contrast-induced renal toxicity. Administer acetylcysteine if the patient has an allergy to iodine-based contrast agents. Instruct the patient to withhold medication if the patient is on calcium channel blockers.

Ans: A Instruct the patient to withhold any medication for diuretics therapy. Rationale: The nurse should instruct the patient to withhold any diuretic or digitalis medications before the procedure to minimize the effect on catheterization. If the patient has an allergy to iodine-based contrast agents, the nurse should administer steroids. The nurse should administer acetylcysteine if the patient has contrast-induced renal toxicity. The nurse should instruct the patient to withhold medication if the patient is on calcium channel blockers therapy.

Which description is characteristic of peripheral cyanosis? Presence of rubor (dusky redness) in a dependent foot Presence of bluish discoloration of the nail beds and earlobes Presence of warmth and pink coloration in the palm and nail beds Presence of moisture, coolness, and pale coloration in the palms and nail beds

Ans: A Presence of rubor (dusky redness) in a dependent foot Rationale: The presence of rubor (dusky redness) in a dependent foot suggests peripheral cyanosis due to arterial insufficiency. Warmth and pink coloration in the palm and nail beds indicate normal blood flow. The patient with anemia has decreased perfusion manifested as moist, cool, pale coloration in the palms and nail beds. The presence of bluish discoloration of the nail beds and earlobes is referred to as cyanosis.

A patient has been admitted to the hospital with chest pain radiating down the left arm. The pain has been unrelieved by rest and antacids. Which test result best confirms that the patient sustained a myocardial infarction? Troponin of 5.2 ng/mL C-reactive protein of 1 mg/dL Homocysteine level 13 mmol/L Creatine kinase (CK) of 125 mg/dL

Ans: A Troponin of 5.2 ng/mL Rationale: The presence of elevated troponin indicates myocardial damage; normal troponin should be less than 0.03 ng/mL. A C-reactive protein level lower than 1 mg/dL is optimal for identifying inflammation and risk for heart disease. A homocysteine level lower than 12 mmol/dL is optimal, but elevation indicates risk, not myocardial damage. CK totals must be broken down into isoenzyme MB to evaluate for heart damage. Elevations in the CK total may be caused by stroke or skeletal muscle damage.

Which term is used to refer to the degree of myocardial fiber stretch at the end of diastole and just before contraction? Preload Afterload Impedance Stroke volume (SV)

Ans: A preload Rationale: Preload is the term used to refer to the degree of myocardial fiber stretch at the end of diastole and just before contraction. Afterload is the pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels. Impedance, the peripheral component of afterload, is the pressure that the heart must overcome to open the aortic valve. Stroke volume (SV) is the amount of blood ejected by the left ventricle (LV) during each contraction.

Which noncardiac factors may precipitate palpitations? Select all that apply. Fatigue Insomnia Hyperthyroidism Sinus tachycardia Paroxysmal supraventricular tachycardia

Ans: A,B,C Fatigue, Insomnia, Hyperthyroidism Rationale: Fatigue, insomnia, and hyperthyroidism are noncardiac factors that may precipitate palpitations. Sinus tachycardia and paroxysmal supraventricular tachycardia are cardiac rhythm disturbances that may cause palpitations.

The nurse is assessing a patient's smoking history. What does the nurse ask the patient who reports being a nonsmoker? Select all that apply. "Have you ever smoked?" "Does anybody in your home smoke?" "Do you smoke when you are stressed?" "Do you have smokers among your friends?" "Do you wake up from sleep with an urge to smoke?"

Ans: A,B,D "Have you ever smoked?" "Does anybody in your home smoke?" "Do you have smokers among your friends?" Rationale: To identify a patient's smoking history, the nurse should ask if the patient has ever smoked. The risk for cardiovascular disease (CVD) appears to be similar to that of a nonsmoker, 3 to 4 years after a person quits smoking. The nurse identifies if the patient is exposed to secondary smoke by asking if any family member or friend smokes. Passive smoke significantly reduces blood flow in a healthy young adult's coronary arteries, and the risk for dying increases among those who are exposed to secondhand smoke. When assessing a patient who does smoke, the nurse asks if the patient smokes when stressed and if the patient has the tendency to wake up from sleep with an urge to smoke.

The left circumflex branch (LCX) of left main artery sometimes supplies blood to the portions of the interventricular septum. Which other portions of the heart receive blood from this branch? Select all that apply. Sinoatrial node Left atrium (LA) Right atrium (RA) Right ventricle (RV) Atrioventricular (AV) node

Ans: A,B,E Sinoatrial node. Left atrium (LA).Atrioventricular (AV) node Rationale: The left circumflex branch (LCX) descends towards the lateral wall of the left ventricle (LV) and apex. It sometimes supplies blood to portions of interventricular septum. The other portions of the heart that receive blood from this branch include the sinoatrial node in about half of people, the left atrium (LA), the atrioventricular (AV) node, and lateral and posterior surface of the LV in a very small section of people. The right coronary artery (RCA) supplies blood to the right atrium (RA) and the right ventricle (RV).

Which laboratory findings are consistent with acute coronary syndrome (ACS)? Select all that apply. Troponin 3.2 ng/mL Triglycerides 400 mg/dL Myoglobin of 234 mcg/L C-reactive protein 13 mg/dL Lipoprotein-a (Lp[a]) 18 mg/dL

Ans: A,C Troponin 3.2 ng/mL,Myoglobin of 234 mcg/L Rationale: Normal troponin should be less than 0.03 ng/mL. Normal myoglobin should be less than 90 mcg/L. Normal C-reactive protein should be less than 1 mg/dL; however, this tests for risk for coronary artery disease (CAD), not ACS. Normal triglycerides should be less than 150 mg/dL; however, this tests for risk for CAD, not ACS. Normal lipoprotein-a (Lp[a]) is 18 mg/dL; however, this tests for risk for CAD, not ACS.

Which statement by the patient with a recent cardiovascular diagnosis indicates maladaptive denial? "I don't think it is as bad as the doctors say." "I don't need to change. It hasn't killed me yet." "I will have to change my diet and exercise more." "I don't know how I am going to change my lifestyle."

Ans: B "I don't need to change. It hasn't killed me yet." Rationale: A common and normal response is denial, which is a defense mechanism that enables the patient to cope with threatening circumstances. He or she may deny the current cardiovascular condition, may state that it was present but is now absent, or may be excessively cheerful. Denial becomes maladaptive when the patient is noncompliant or does not adhere to the interdisciplinary plan of care. The statement about not changing because "it hasn't killed me yet" indicates maladaptive denial. Not knowing how to change indicates that the patient is overwhelmed, not in denial. Not thinking it is that bad indicates denial, but not maladaptive denial. Changing diet and exercising more indicates a willingness to change.

The nurse is closely monitoring her patient's vital signs and knows that which mean arterial pressure (MAP) is necessary to maintain adequate blood flow through the coronary arteries? 55 mm Hg 60 mm Hg 65 mm Hg 70 mm Hg

Ans: B 60 mm Hg Rationale: To maintain adequate blood flow through the coronary arteries, the mean arterial pressure (MAP) must be at least 60 mm Hg, therefore a MAP of 55 mm Hg is insufficient. A MAP of between 60 and 70 mm Hg is necessary to maintain perfusion of major body organs, such as the kidneys and the brain. Therefore, the MAP values 62 mm Hg, 65 mm Hg, and 70 mm Hg are necessary to maintain perfusion of major body organs, such as the kidneys and the brain.

According to the New York Heart Association Functional Classification of Cardiovascular Disability, which class includes patients with symptoms of fatigue, palpitations, dyspnea, and angina even after ordinary physical activities? Class I Class II Class III Class IV

Ans: B Class II Rationale: According to the New York Heart Association Functional Classification of Cardiovascular Disability, class II includes patients with symptoms of fatigue, palpitation, dyspnea, or angina even after ordinary physical activities. Class I includes patients who do not face fatigue, palpitation, dyspnea, or angina after ordinary physical activities. Class III includes patients who complain of palpitation, dyspnea, or angina after less than ordinary physical activity. Class IV includes patients who complain of increased discomfort after conducting any form of physical activity.

A patient reports fatigue, palpitations, and dyspnea after performing an ordinary task. According to the New York Heart Association's functional classification of cardiovascular disability, in which class does the patient belong? Class I Class II Class III Class IV

Ans: B Class II Rationale: According to the New York Heart Association's functional classification of cardiovascular disability, a patient having fatigue, palpitations, and dyspnea upon doing an ordinary task can be categorized under class II. A patient having cardiac insufficiency and angina syndrome can be categorized under class IV. A patient who does not have fatigue, palpitation, and dyspnea upon doing an ordinary task can be categorized under class I. These patients report having increased discomfort during any physical activity. A patient having fatigue, palpitations, and dyspnea upon minimal exertion can be categorized under class III.

A patient is admitted for chest pain. The nurse questions the patient about the use of which substance associated with heart disease? Opiates Cocaine Marijuana Barbiturates

Ans: B Cocaine Rationale: Cocaine is a stimulant which raises blood pressure, a risk factor for heart disease. Marijuana, barbiturates, and opiates do not contribute directly to cardiovascular disease; they have sedating effects.

A 72-year-old patient admitted with fatigue and dyspnea has elevated white blood cell count, low-density lipoproteins, serum troponin I level, and C-reactive protein. Which finding is consistent with acute coronary syndrome (ACS) and should be communicated immediately to the health care provider? C-reactive protein Serum troponin I level Low-density lipoproteins White blood cell (WBC) count

Ans: B Serum troponin I level Rationale: Elevation in serum troponin levels is associated with acute myocardial injury and indicates a need for immediate interventions such as angioplasty, anticoagulant administration, or administration of fibrinolytic medications. The white blood cell count does not reflect acute coronary syndrome; a mild leukocytosis may occur secondary to inflammation, but this does not constitute an emergency. Although elevated lipoproteins may have contributed to development of atherosclerosis, which is the cause of acute coronary syndrome, the results are not emergent. C-reactive protein indicates inflammation and is increased in people at risk for atherosclerosis and ACS, but it does not indicate an acute problem.

The nurse is caring for a patient admitted with pericarditis. Which symptom does the nurse anticipate the patient will report? Viselike substernal chest pain in response to exertion Substernal chest pain described as sharp and stabbing Dizziness requiring the patient to stop activities and rest Abrupt awakening with dyspnea which worsens after sitting on the edge of the bed

Ans: B Substernal chest pain described as sharp and stabbing Rationale: Pericarditis, an inflammation of the outer lining of the heart, is characterized by sudden onset of sharp, stabbing chest pain, which may be relieved by sitting upright. Abrupt awakening with dyspnea after lying down for several hours is referred to as paroxysmal nocturnal dyspnea (PND), the result of increased venous return to the heart that is typical of heart failure. Viselike substernal chest pain in response to exertion describes a typical angina episode. Dizziness or syncope results from decreased tissue perfusion to the brain, which may occur with decreased cardiac output.

The nurse anticipates finding a bounding or hyperkinetic pulse in the patient with which disorder or condition? Heart failure Thyrotoxicosis Carotid stenosis Syncope and dehydration

Ans: B Thyrotoxicosis Rationale: Thyrotoxicosis causes increased metabolism and heart rate. Syncope and dehydration will result in a rapid, weak pulse. Carotid stenosis may not affect the pulse. Heart failure may cause tachycardia with a weak pulse.

An older patient may be at risk for developing left ventricular hypertrophy as a result of arterial changes related to aging. Which interventions should the nurse implement while caring for this patient? Select all that apply. Assess the heart sounds for murmurs. Assess for activity intolerance and shortness of breath. Note increase in systolic, diastolic, and pulse pressures. Assess for dizziness when the patient changes positions. Assess electrocardiogram (ECG) for widening QRS complex and a longer QT interval.

Ans: B,C Assess for activity intolerance and shortness of breath. Note increase in systolic, diastolic, and pulse pressures. Rationale: Changes that occur in the older patient's heart include systemic vascular resistance that increases as a result of the less distensible arteries; therefore, the left ventricle (LV) pumps against greater resistance, contributing left ventricular hypertrophy. The nurse should assess for activity intolerance and shortness of breath, and note any increase in systolic, diastolic, and pulse pressures and while caring for the patient. Heart sounds for murmurs should be assessed if the patient has changes in cardiac valves. Dizziness, when the patient changes positions, should be possessed when baroreceptors become insensitive. Assessment of electrocardiogram (ECG) for widening QRS complex and a longer QT interval should be carried out when the patient has increase in size of the LV.

Which factors influence the activity of the cardiovascular (CV) system? Select all that apply. Blood viscosity Physical activity Body temperature Aortic compliance Emotional behaviors

Ans: B,C,E Rationale: The factors that influence the CV system include increased physical activity such as exercise, changes in body temperature such as hypothermia or hyperthermia, and emotional behaviors. In hyperthermia, the blood pressure (BP) falls, and in hypothermia the BP rises. Emotional behaviors such as excitement, pain, and anger stimulate the sympathetic nervous system to increase the BP and heart rate. Blood viscosity and aortic compliance are the factors on which the amount of impedance depends.

What are modifiable risk factors for cardiovascular disease (CVD)? Select all that apply. Male, age 35 years A patient's limited physical activity Family history of cardiovascular disease Body mass index (BMI) greater than 30 A patient's five pack-year smoking history

Ans: B,D,E A patient's limited physical activity. Body mass index (BMI) greater than 30. A patient's five pack-year smoking history. Rationale: A BMI greater than 30, a five pack-year smoking history, and limited physical activity are modifiable risk factors for CVD. Modifiable risk factors are personal lifestyle habits that can be changed. The patient can reverse the tendency for CVD by maintaining good body weight, avoiding smoking, and exercising. Family history of cardiovascular disease, gender, and age are nonmodifiable risk factors.

The head nurse is teaching a group of student nurses about cardiac valves. Which statement by the student nurse requires correction? "The aortic valve separates the left ventricle (LV) from the aorta." "The tricuspid valve separates the right atria (RA) from the right ventricle (RV)." "The pulmonic valve separates the right ventricle (RV) from the pulmonary vein." "The mitral (bicuspid) valve separates the left atria (LA) from the left ventricle (LV)."

Ans: C "The pulmonic valve separates the right ventricle (RV) from the pulmonary vein." Rationale: The pulmonic valve separates the right ventricle (RV) from the pulmonary artery, not the pulmonary vein. Therefore, this statement of the student nurse requires correction. The aortic valve separates the left ventricle (LV) from the aorta. The tricuspid valve separates the right atria (RA) from the RV. The mitral or bicuspid valve separates the left atria (LA) from the LV.

The nurse is preparing the patient for an echocardiogram. Which point reflects correct patient teaching before the procedure? "You must not eat or drink anything for 8 hours before the test." "You will need to drink a contrast dye 1 hour before the procedure." "The technician will put lubricant on a transducer and rub this on your chest." "After the technician injects you with a radioisotope, you will be asked to exercise a few additional minutes."

Ans: C "The technician will put lubricant on a transducer and rub this on your chest." Rationale: An echocardiogram is a noninvasive ultrasound procedure to view the cardiac structures; a transducer lubricated with gel is rubbed over the chest. This test does not require anesthesia or sedation; therefore, the timing of a meal is not essential for patient safety. A myocardial nuclear perfusion imaging test involves walking on a treadmill or injecting a chemical which simulates exercise, followed by the injection of a radioisotope to assess myocardial perfusion. Contrast media, via IV or oral route, is not used for an echocardiogram.

Which factor is least related to impedance? Blood viscosity Aortic compliance Coronary vascular resistance Total systemic vascular resistance

Ans: C Coronary vascular resistance Rationale: Impedance, the peripheral component of afterload, is the pressure that the heart must overcome to open the aortic valve. Coronary vascular resistance is not a factor that involves impedance. The amount of impedance depends on blood viscosity, aortic compliance, and total systemic vascular resistance.

The nurse is caring for patient diagnosed with a myocardial infarction. The nurse knows which artery, if blocked, would lead to death of tissue in the anterior wall of the heart? Circumflex artery Right coronary artery Left anterior descending artery Posterior descending coronary artery

Ans: C Left anterior descending artery Rationale: The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The circumflex artery supplies the lateral wall of the left ventricle (LV) and possibly portions of the posterior wall or the sinoatrial (SA) node and atrioventricular (AV) nodes. The right coronary artery supplies most of the SA and AV nodes, as well as the right ventricle (RV) and inferior or diaphragmatic portion of the LV. The posterior descending coronary artery supplies the inferior wall, ventricular septum, and the papillary muscles.

Which structure of the heart is responsible for receiving deoxygenated venous blood as well as the blood from the heart muscle? Septum Pericardium Right atrium Right ventricle

Ans: C Right Atrium Rationale: The right atrium (RA) receives deoxygenated venous blood, which is returned from the body through the superior and inferior vena cava. The RA also receives blood from the heart muscle through the coronary sinus. The pericardium is a covering that protects the heart. The septum is a muscular wall that separates the heart into two halves. The right ventricle is a muscular pump located behind the sternum that generates enough pressure to close the tricuspid valve, open the pulmonic valve, and propel blood into the pulmonary artery and lungs.

Which statement is true regarding the anatomy of the heart? Left ventricle (LV) collects oxygenated blood from the pulmonary veins. Left atrium (LA) receives deoxygenated blood from the superior and inferior vena cavae and coronary sinus. Right ventricle (RV) receives blood from the right atrium (RA) and propels it through the pulmonary artery and lungs. Right atrium (RA) receives blood from the left atrium (LA) through the aorta to circulate systemically through the body.

Ans: C Right ventricle (RV) receives blood from the right atrium (RA) and propels it through the pulmonary artery and lungs Rationale: The right ventricle (RV) is a muscular pump located behind the sternum. It receives blood from the right atrium (RA) and propels it through the pulmonary artery and the lungs. The LA collects reoxygenated blood from the pulmonary veins. The RA receives deoxygenated venous blood which is returned from the body through the superior and inferior venae cavae. It also receives blood from the heart muscle through the coronary sinus. The left ventricle (LV) receives blood from the left atrium (LA) and pumps it through the aorta to circulate systemically through the body.

Which receptors are stimulated by hypoxemia? Baroreceptors Stretch receptors Central chemoreceptors Peripheral chemoreceptors

Ans: D Peripheral chemoreceptors Rationale: Peripheral chemoreceptors are sensitive to a decrease in partial pressure of arterial oxygen (hypoxemia). Therefore, hypoxemia results in stimulation of peripheral chemoreceptors. Baroreceptors are stimulated when the arterial walls are stretched by an increase in the blood pressure (BP). Stretch receptors are stimulated by hypovolemia. Increase in partial pressure of carbon dioxide (hypercapnia) may lead to stimulation of central chemoreceptors.

The nurse assesses the electrocardiogram (ECG) and heart rhythm of an older patient that shows atrial dysrhythmias. The nurse understands that aging may cause a decrease in the number of pacemaker cells, leading to cardiovascular abnormalities. Which physiological consequence of a decreased number of pacemaker cells may cause dysrhythmias in this patient? Ventricular changes Valvular abnormalities Orthostatic and postprandial changes Premature ventricular contractions (PVCs)

Ans: D Premature ventricular contractions (PVCs) Rationale: Aging may result in a decreased number of pacemaker cells which may cause premature ventricular contractions, resulting in atrial dysrhythmias. Ventricular changes, valvular abnormalities, and orthostatic and postprandial changes are not associated with the presence of dysrhythmias in the older patient. Ventricular changes result in the decreased ability of the heart to meet increased oxygen demands. Valvular abnormalities may result in inadequate perfusion. Orthostatic and postprandial changes occur because of ineffective baroreceptors.

The nurse is assessing the cardiac health of a patient with a body mass index (BMI) of 30. What does the nurse tell the patient about maintaining a healthy weight? "Include high calorie, nutrient-rich foods." "Take a 30-minute brisk walk twice a week." "Include vegetables and dairy products in your diet." "Avoid eating more calories than you can burn every day."

Ans: D "Avoid eating more calories than you can burn every day." Rationale: The nurse should tell the patient to avoid eating more calories than what can be burned every day. This helps to avoid excessive intake and maintain balance in calories. The patient must perform light to moderate exercise for 30 minutes daily. The patient should be encouraged to include vegetables, fat-free dairy products, whole grains, and nutrient-rich foods that are not high in calories in the diet.

The nurse is caring for a patient with mitral valve prolapse who asks about the purpose of the mitral valve. How should the nurse respond? "It prevents blood from flowing from the right atrium into the right ventricle during systole." "Located between the left ventricle and the aorta, it promotes the flow of blood to the entire body." "Located between the right atrium and right ventricle, it prevents the flow of blood between these chambers." "Located between the left atrium and left ventricle, it prevents blood from flowing back into the atrium during systole."

Ans: D "Located between the left atrium and left ventricle, it prevents blood from flowing back into the atrium during systole." Rationale: The mitral valve separates the left atrium from the left ventricle. During ventricular diastole, these valves allow the flow of blood from the atria to the ventricles. During systole, the valves close to prevent the backflow or regurgitation of blood into the atria. The aortic valve separates the left ventricle from the aorta and prevents backflow of blood into the left ventricle during systole. The pulmonic valve prevents blood from flowing back into the right ventricles during systole and opens during diastole. An atrial septal defect allows blood to flow from the left atrium to the right in an adult; it is an abnormal defect.

An RN and an LPN/LVN, both of whom have several years of experience in the intensive care unit, are caring for a group of patients. Which patient is appropriate for the RN to assign to the LPN/LVN? A patient with pulmonary edema who requires hourly monitoring of pulmonary artery wedge pressures A patient with acute coronary syndrome who has just been admitted and needs an admission assessment A patient who has intermittent chest pain and requires teaching about myocardial nuclear perfusion imaging A patient who was admitted with peripheral vascular disease and needs assessment of the ankle-brachial index

Ans: D A patient who was admitted with peripheral vascular disease and needs assessment of the ankle-brachial index Rationale: The scope of practice of the LPN/LVN includes assessment of blood pressure in the arm and lower extremity. The scope of practice for the LPN/LVN does not include interpretation of hemodynamic monitoring results. The scope of practice of the RN includes providing patient education; the LPN/LVN may reinforce that teaching. The role of the professional nurse is to perform assessment and develop the plan of care; the LPN/LVN may implement the plan.

A nurse assesses the heart rate (HR) and rhythm of an older patient who is suspected of having age-related cardiac valve dysfunction. Which is the most appropriate nursing intervention that would help in confirming this in the patient? Asking about the patient's drug history Asking about the patient's medical history Assessing if the patient has an abnormal gait Assessing if the patient has difficulty breathing

Ans: D Assessing if the patient has difficulty breathing Rationale: The changes in heart rate (HR), rhythm, and the presence of heart sounds for murmurs indicate that the patient's condition is likely to be associated with changes in cardiac valves related to aging. Questioning the patient about dyspnea or breathing difficulties helps the nurse to confirm the changes in the cardiac valves. This is because dyspnea on exertion is a cause of abnormalities in the cardiac valves. Questioning the patient about drug history is not useful in confirming the suspicion of cardiac valve dysfunction. Asking the patient's medical history would not be useful in confirming cardiac valve dysfunction. Assessing the patient for gait disorders would not reveal cardiac valve impairment; it may be used in the assessment of neurological abnormalities.

The nurse is reviewing the results of cardiac output (CO) as well as the resistance in the arterioles to determine a cardiac component. Which component would the nurse determine? Cardiac index Heart rate (HR) Stroke volume (SV) Blood pressure (BP)

Ans: D Blood pressure (BP) Rationale: Blood pressure (BP) is determined by the quantity of the blood flow or cardiac output (CO) as wells as the resistance in the arterioles. Therefore, the nurse determines BP by this intervention. Cardiac index is determined by dividing the CO by the body surface area. Heart rate (HR) is the number of times the ventricles contract each minute. Stroke volume (SV) is the amount of blood ejected by the left ventricle (LV) during each contraction.

The nurse in a coronary care unit interprets information from hemodynamic monitoring. The patient has a cardiac output of 2.4 L/min. Which action would be taken by the nurse? Administer a stat dose of metoprolol. Ask the patient to perform the Valsalva maneuver. No intervention is needed; this is a normal level. Collaborate with the health care provider to administer a positive inotropic agent.

Ans: D Collaborate with the health care provider to administer a positive inotropic agent. Rationale: A positive inotropic agent will increase the force of contraction (SV), thus increasing cardiac output. Recall that SV × heart rate (HR) = cardiac output (CO). The beta blocker metoprolol has side effects of bradycardia and decreased contractility; cardiac output would be further reduced. The Valsalva maneuver or bearing down will decrease the heart rate and thus cardiac output. Normal cardiac output is 4 to 7 L/min. 2.4 L/min is below normal, so an intervention addressing the level would be needed.

The imaging studies of an older patient reveal an increase in the fibrous tissue and fat in the sinoatrial (SA) node. The nurse also finds that the patient's heart rate (HR) is 50 beats/min. Which component of the changes in the cardiovascular system (CV) is associated with bradycardia and includes the SA node related to such complications? Baroreceptors Cardiac valves Left ventricle (LV) Conduction system

Ans: D Conduction system Rationale: Increase in fibrous tissue and fat in the sinoatrial (SA) node and heart rate (HR) less than 60 beats/min are the complications associated with changes in the conduction system. Calcification and mucoid degeneration in mitral and aortic valves and murmurs are the complications associated with changes in cardiac valves. Orthostatic and postprandial changes are the complications associated with insensitive baroreceptors. Increase in the size of the left ventricle (LV), widening of the QRS complex, and prolonged QT interval in the electrocardiogram (ECG) are the complications associated with changes in the LV.

Which statement reflects correct education for a patient with a blood pressure (BP) of 136/86 mm Hg? It is a normal reading, so no action is needed. The patient has hypertension or high BP. The BP is low and the patient should be further assessed for orthostatic hypotension. Lifestyle modification is needed to decrease the workload on the heart.

Ans: D Lifestyle modification is needed to decrease the workload on the heart. Rationale: Although not considered hypertension because the BP is not greater than 140/90 mm Hg, a BP of 136/86 mm Hg is consistent with an increased risk for heart disease caused by placing an increased workload on the heart. The patient requires further education. Hypertension is defined as BP greater than 140/90, but a BP that exceeds 135/85 mm Hg increases the workload of the left ventricle and oxygen consumption of the myocardium. Orthostatic hypotension is defined as BP less than 90/60.

The nursing instructor is teaching a group of student nurses about the structure of the heart. Which statement does the nursing student know to be true? The heart is protected by a covering called the epicardium. The heart is separated into three halves by a muscular wall or septum. The heart pumps about 120 mL blood or 10 L/min in each beat during strenuous activity. The heart is a fist-sized muscular organ located in the mediastinum between the lungs.

Ans: D The heart is a fist-sized muscular organ located in the mediastinum between the lungs. Rationale: The human heart is a fist-sized, muscular organ located in the mediastinum between the lungs. The heart is protected by a covering called the pericardium. The heart is separated into two halves by a muscular wall or septum. The heart pumps about 120 mL blood with each beat or 10 L of blood/min. However, during strenuous physical activity the heart pumps about double the amount of blood.

Which statement describes a thallium imaging scan? This test helps to differentiate normal from diseased myocardium. This test helps to evaluate cardiac motion and calculate ejection fraction. This test helps to detect the location and size of acute myocardial infarctions. This test helps to detect the location and extent of acute or chronic myocardial infarctions.

Ans: D This test helps to detect the location and extent of acute or chronic myocardial infarctions. Rationale: Thallium imaging is used to assess myocardial scarring and perfusion to detect the location and extent of acute or chronic myocardial infarctions. Positron emission tomography (PET) scans are used to compare cardiac perfusion and metabolic function and differentiate normal from diseased myocardium. Cardiac blood pool imaging is a noninvasive test that helps to evaluate cardiac motion and calculate ejection fraction. The technetium scan test helps to detect the location and size of acute myocardial infarctions.

A patient has a magnesium level of 1.0 mEq/L. Which complication of this electrolyte imbalance does the nurse anticipate? Diabetes Heart failure Myocardial infarction Ventricular dysrhythmia

Ans: D Ventricular dysrhythmia Rationale: Torsade de pointes, a ventricular dysrhythmia, is a complication of hypomagnesemia caused by a widened QRS duration. Coronary atherosclerosis, caused by a multitude of metabolic conditions, causes MI. Diabetes may be caused by autoimmunity, obesity, or a variety of complex phenomena. Heart failure results from coronary atherosclerosis or valve disease.

A student nurse is discussing the characteristics of cardiac muscle cells with other students. Which characteristic of cardiac cell muscles is least likely to be important to the discussion? Elasticity Contractility Automaticity Refractoriness

Ans:A Elasticity Rationale: Elasticity is not a characteristic of cardiac muscle cells; it is a characteristic of skeletal muscle cells. The characteristics of cardiac muscle cells include contractility, automaticity, and refractoriness.

What quality and severity of pain is associated with angina? Squeezing, vise-like Intense stabbing, vise-like Sharp stabbing, moderate to severe Moderate ache, worse on inspiration

Ans:A Squeezing, vise-like Rationale: Angina is often described as a squeezing vise-like pain. Intense stabbing pain that is vise-like is associated with myocardial infarction. A moderate ache that is worse on inspiration is associated with pleuropulmonary pain. Sharp stabbing pain that is moderate to severe is associated with pericarditis.

Which portion of the heart is supplied by the right coronary artery (RCA)? Papillary muscle Ventricular septum Chordae tendineae Inferior portion of left ventricle (LV)

Ans:D Inferior portion of left ventricle (LV) Rationale: The right coronary artery (RCA) originates from the right sinus of Valsalva, encircling the heart and descending towards the apex of the right ventricle (RV). It supplies blood to the inferior portion of the left ventricle (LV), right atrium (RA), and RV. In half of people, the RCA supplies the sinoatrial (SA) node and in almost everyone it supplies the atrioventricular (AV) node. The left main coronary artery is divided into the left anterior descending branch (LAD) which descends towards the anterior wall and the apex of the LV. It supplies blood to the portions of papillary muscle, ventricular septum, and chordae tendineae as well as a lesser extent to the RV.

The head nurse is teaching the newly recruited nurses regarding the properties of the heart. Which term would she use that best describes the amount of blood ejected by the LV with each cardiac contraction? Preload Cardiac index Heart rate (HR) Stroke volume (SV)

Ans:D Stroke volume (SV) Rationale: Stroke volume (SV) is the amount of blood ejected by the left ventricle (LV) during each contraction. Preload refers to the degree of myocardial fiber stretch at the end of diastole and just before contraction. Cardiac index is determined by dividing the cardiac output (CO) by the body surface area. Heart rate (HR) refers to the number of times the ventricles contract each time.