Chapter 25-28

What is Turbulent flow?

disordered flow; blood moves crosswise and lengthwise in blood vessels

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse questions the prescription of an ACE inhibitor for a client with which condition?

renal artery stenosis

The nurse caring for a young pregnant client is educating about which cardiovascular changes are expected during a normal pregnancy? Select all that apply.

-Blood pressure rises during the third trimester. -Levels of angiotensin-II contribute to elevated blood pressure. -Blood pressure falls during the first trimester.

In caring for clients with acute coronary syndromes (ACS), the nurse knows that without accurate assessments, including ECGs, these clients are at a much higher risk of developing which complications? Select all that apply.

-Continuing myocardial ischemia -Increased area of infarction -Life-threatening dysrhythmias

When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart?

Left ventricle

The physician states that a client has adequate collateral circulation. The nurse interprets this as:

Long-term compensatory regulation of blood flow

When the electrocardiogram (ECG) of a client in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta-adrenergic blocker. Which factors in the client's history will cause the nurse to withhold medication pending discussion with physician? Select all that apply.

-Myocardial infarction caused by cocaine use -Third-degree heart block -Shock

The nurse obtains a blood pressure reading of 150/96 mm Hg from a client at the clinic. What instructions for follow-up does the nurse anticipate giving to this client?

Confirm within 2 months

What should the nurse teach the pregnant woman about congenital heart defects?

Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant.

The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.

Tricuspid Mitral

Which client is at the greatest risk of developing rheumatic heart disease?

Teenager with untreated strep throat

The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states:

"Capillaries permit the exchange of material between the blood and interstitial fluid."

The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition?

"I should report episodes of dizziness or fainting."

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which statement demonstrates an accurate understanding of his new diagnosis?

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

What should the nurse teach the client prior to ergometry?

"This test evaluates cardiac function."

An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate?

"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."

A client is lying in a recumbent position. In this client, approximately how much total blood volume is in the central circulation?

25% - 30%

Which ECG patterns would the nurse observe in a client admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply.

-T-wave inversion in the right precordial leads -Ventricular tachycardia with left bundle branch block pattern

While studying the physiology of the heart, the nursing students have learned that which of the following influence the blood flow in the coronary vessels that supply the myocardium? Select all that apply.

-The aortic pressure -Autoregulatory mechanisms -Compression of the intramyocardial vessels

What are some Contributing factors of Blood flow?

-pressure -Vessel Compliance -Volume -Contraction of the heart -Distensibility of the heart

Which client will likely experience difficulty maintaining lipoprotein synthesis, resulting in elevated LDL levels?

35-year-old client with history of hepatitis C and B with end-stage liver disease.

A client with a history of heart failure has the following echocardiogram results: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction (EF)?

50%

Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?

51-year-old man who has been diagnosed with glomerulonephritis

A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography?

55% - 75%

The nurse knows that mean arterial pressure is:

60% of diastolic pressure and 40% of systolic pressure

The nurse is teaching a group about cardiovascular risk factors and complications. Which clients are at risk for developing an aortic dissection? Select all that apply.

A 59-year-old male with a blood pressure of 180/100 A 30-year-old female with Marfan syndrome A client who is 36 weeks' pregnant A client who has recently had coronary artery bypass grafting.

When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which statements are accurate? Select all that apply.

A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. When there is an AV block, impulses from the atria and ventricles beat independently of each other, so the heart rhythm is usually chaotic and irregular.

In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up.

A client with high blood pressure has swollen ankles. Which physiologic factor could relieve this condition?

A decrease in the hydrostatic pressure that drives fluid into the tissue

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hypercyanotic attack brought on by periods of stress

A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the client about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium?

A membranous sac that encloses the heart

Because of its location, the presence of an abdominal aortic aneurysm may first be identified by which clinical manifestation?

A pulsating mass

Which statement describes phase 4 of the action potential of cells in the sinoatrial (SA) node?

A slow depolarization occurs because of the particular permeability of the cellular membranes.

A client is admitted to the hospital with severe bradycardia, heart rate in low to upper 40s, after contracting Lyme disease. She asks the nurse why the heart rate is so slow. The most accurate response would be a possible disassociation between the atria and ventricles due to:

AV nodal block

Which neurotransmitter is associated with the parasympathetic nervous system?

Acetylcholine

A client admitted with septic shock has a blood pressure of 70/46 mm Hg, pulse 125 bpm, respirations 30 breaths/min, temperature 103°F (39.4°C), and blood glucose 266 mg/dL (14.76 mmol/L). Which intervention prescribed by the health care provider should the nurse implement first?

Administer a fluid bolus of normal saline IV at 500 mL/hr.

The nurse knows that there are many different groups of antihypertensive drugs having varied mechanisms of action. Which medication decreases the exit of adrenergic (sympathetic) stimulation from the central nervous system, thereby decreasing sympathetic outflow?

An alpha-2 adrenergic agonist

When a client experiences the Cushing reflex, what occurs with the body?

An increase in arterial pressure to levels above the intracranial pressure

The client is diagnosed with a respiratory sinus dysrhythmia. Which electrocardiogram pattern correlates to this finding?

An increase in heart rate with inspiration and slowing with expiration

The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as:

Berry aneurysm

A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:

Bicuspid valve

A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child?

Antibiotics and anti-inflammatory drugs

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which has lead to a diagnosis of deep vein thrombosis (DVT). What treatment option will be of greatest benefit to prevent further thrombus formation?

Anticoagulation therapy and elevation of the leg

The nurse knows that acute regulation of blood pressure involves which physiologic processes? Select all that apply.

Arterial chemoreceptors Vagal nerve impulses Adrenergic (sympathetic) stimulation Carotid baroreceptors

A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to "watch" for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which physiologic principle?

As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture.

Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?

Atherosclerosis and unstable angina

Which Valves are one way?

Atrioventricular valves and semilunar valves are pressure valves that ensure one way flow.

A nurse is teaching a client newly prescribed with an angiotensin-converting (ACE) inhibitor. Which information is very important to include in the teaching plan?

Avoid salt substitutes and foods high in potassium.

Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences?

Backflow from the left ventricle to left atrium

A client is admitted to the intensive care unit suspected of having infective endocarditis. Which test is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client?

Blood culture

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy

The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?

C-reactive protein

What is Compliance?

C= V/P — A change in (V)olume causes less of an increase in tranmural pressure (p)

Cardiac output (CO) is used to measure the efficiency of the heart as a pump. What is the equation used to express CO?

CO = SV × HR

A client has been diagnosed with heart failure. The client's cardiac contractility will be primarily affected by which factor?

Ca2+ levels in the myocardium

Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. Due to ischemia, which initial peripheral symptom is associated with this disease?

Calf pain

A client's initial blood pressure on admission to the outpatient clinic is 190/120 mm Hg. Which action by the clinic staff is most appropriate at this time?

Calling an ambulance to take the client to the emergency department

Which blood vessels function without the benefit of having walls comprised of three muscular layers?

Capillaries

A nurse is planning a community education program on hypertension. Which parameter should be included to explain the regulation of arterial blood pressure?

Cardiac output and systemic vascular resistance

A critical care nurse is carefully monitoring a client's mean arterial pressure. Which combination of factors is responsible for mean arterial blood pressure?

Cardiac output multiplied by systemic vascular resistance

How many types of Circulation are there?

Central Circulation and Peripheral Circulation

Based on assessment, a nurse suspects the client may be experiencing heart failure. Which diagnostic test would be the best indicator to determine pressure being exerted on the right side of the heart?

Central venous pressure

A client is receiving home care for the treatment of a wound on the inside of the lower leg described as 3 cm in diameter with a yellow wound bed draining clear exudate. Assessment of the client's legs reveals edema and a irregularly darkened pigmentation on the ankles and shins of both legs. How would the home care nurse document these findings?

Chronic venous insufficiency

The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?

Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation

A client with a history of angina has presented to the emergency department with uncharacteristic chest pain. The electrocardiogram (ECG) reveals ST segment depression. Which test is most effective for identifying transient ongoing myocardial ischemia?

Continuous ECG monitoring

In heart failure, what causes the increase in renal secretion of renin?

Decreased cardiac output

A client has just experienced stimulation of the vagus nerve. Which sign would the nurse anticipate the client to manifest?

Decreased heart rate

The nurse knows that administration of insulin to a client in septic shock will provide which beneficial effects? Select all that apply.

Decreased risk of infection Better wound healing

A client is experiencing a sudden increase in heart rate resulting in less time in diastole. This can result in which potential complication?

Decreased stroke volume

What is Laplace law?

Describes the relation between wall tension, transmural pressure and radius.

Which children may be considered high risk for developing hypertension? Select all that apply

Diagnosed with coarctation of the aorta as an infant Recent scan showing a pheochromocytoma Takes cyclosporine daily since a kidney transplant

Which function is performed by arteries such as the coronary and renal arteries?

Distribution of blood to organs that are controlled by contraction and relaxation of these vessels

Brugada syndrome, an autosomal dominant disorder, manifests in adulthood as ST-segment elevation, right bundle branch block, and susceptibility to ventricular tachycardia. In Brugada syndrome, the timing of cardiac events is significant. When do these cardiac events typically occur?

During sleep or rest

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?

Echocardiogram

A client has been diagnosed with runs of intermittent ventricular tachycardia where the client loses consciousness and needs to be stimulated to recovery. Knowing this history, the nurse will educate the client about which treatment intervention/procedure that will depolarize the heart to allow the sinoatrial node to regain control of the heart?

Education involving automatic implantable cardioverter-defibrillators implantation

What is the primary physiologic result of obstructive shock?

Elevated right heart pressure

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?

Exchange gases, nutrients, and wastes

A client with heart failure has just had an automatic defibrillator implanted. When the nurse is performing follow-up assessment the next month, which finding is most likely the result of a complication?

Fever and diaphoresis

The nursing instructor when teaching about disorders of cardiac function informs the students that all people presenting with ST-segment elevation myocardial infarction (STEMI) should be assessed for reperfusion therapy as quickly as possible. Reperfusion therapy includes which of the following? Select all that apply.

Fibrinolytic therapy Percutaneous coronary intervention (PCI) Coronary artery bypass grafting (CABG)

The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as:

Fibrous atheromatous plaque

What is the pericardium?

Fibrous sac around the heart holding it in a fixed position and providing physical protection and a barrier to infection.

A nurse is assessing a client's apical pulse. The nurse is palpating the point of maximum impulse between which ribs?

Fifth and sixth

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

Fixed coronary obstruction

A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which reason? Select all that apply.

For its vasodilation effect To relieve coronary pain

A client who has just recently completed his second series of radiation therapy for lung cancer was admitted yesterday to an acute care facility with ascites. He begins to have jugular vein distention, pedal edema, and dyspnea upon exertion as well as fatigue. What should the nurse suspect?

He has developed constrictive pericarditis.

A client has systolic hypertension. The nurse knows that systolic pressure is influenced by which factors? Select all that apply.

Heart rate Compliance of arteries Stroke volume Contractile force

What is Arterial Blood pressure?

Higher pressure: 90-100mm gg Propel blood to all the other tissues in the body(i.e. Systemic circulation)

Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability.

Histamine

Release of which humoral factors will result in vasodilation?

Histamine

A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting ECG reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?

Holter monitoring

Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?

Hypercholesterolemia

During assessment of a 66-year-old woman, the nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. Which aspects of the pathophysiology of aneurysms would the health care provider explain to this client?

Hypertension is a frequent modifiable contributor to aneurysms.

A client with a history of heart failure has been assessed and the care team has determined that a reduction in myocardial workload would benefit his prognosis. Which intervention is most likely to meet this client's needs?

Implantation of a ventricular assist device (VAD)

A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man?

Infusion of normal saline or Ringer's lactate to maintain the vascular space.

A grandmother who works as a cook at a nearby school was recently hospitalized when she lost an extensive amount of blood in a work-related accident. The grandmother tells the nurse that she heard that she would keep feeling faint until the brain made more blood. The nurse knows that when the blood pressure dropped, the pressure in the carotid arteries decreased. This was detected by baroreceptors in the carotid arteries. What did the baroreceptors do?

Increase sympathetic stimulation of the heart and blood vessels

Which phenomenon would be most likely to accompany increased myocardial oxygen demand (MVO2)?

Increased aortic pressure

A client took a weight loss drug that activated the alpha-adrenergic receptors in the sympathetic nervous system. Which manifestations would the nurse expect to occur? Select all that apply.

Increased blood pressure of cardiac contraction Increased cardiac cycle speed

An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure?

Increased vascular stiffness

Which intervention will the nurse anticipate being prescribed to treat an adult admitted to the ICU with acute respiratory distress syndrome (ARDS)?

Increasing oxygen concentration in the inspired air

A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process?

Infective endocarditis

The nurse is reviewing a client's history and recognizes that the client smokes cigarettes. The nurse is concerned because smoking does which of the following?

Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development

A nurse is monitoring a client with sick sinus syndrome who is experiencing lightheadedness, dizziness, and syncope. Which treatment will the nurse anticipate for this client?

Insertion of a pacemaker

When a client has a recurrent, life-threatening arrhythmia originating either supraventricularly or ventricularly, ablation therapy is an option for treatment. What does ablation therapy do?

Isolates and destroys arrhythmogenic cardiac tissue

During ventricular systole, closure of the atrioventricular (AV) valves coincides with which physiologic event?

Isovolumetric contraction

Which of the following is true regarding pulmonary circulation?

It is a low-pressure system that allows for improved gas exchange.

The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state:

It is the most common cardiovascular disorder. The incidence increases with age. The systolic pressure is ≥140 mm Hg.

The pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following?

Kawasaki disease

The nurse practitioner's examination of a client reveals xanthomas along the client's tendons. Which test will the practitioner order?

LDL level

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?

Laminar

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often follows the vascular response in anaphylaxis?

Laryngeal edema

What is Laminar Blood flow?

Layering of blood components in the center of bloodstream. Reduces the frictional forces and prevents clotting factors from coming into contact with the vessel wall

A 30-year-old client arrives with these vital signs: Blood pressure 50/30 mm Hg, pulse 100 beats/min, respiratory rate 12 breaths/min, temperature 101°F (38.3°C). The nurse interprets these results as the client being in shock based on which reading?

Low blood pressure

Increased secretion of renin in heart failure is caused by which event?

Low cardiac output

A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy 1 year ago. What does the nurse suspect is the problem?

Lymphedema

Which related circulatory complication can result from surgical treatment for metastatic breast cancer?

Lymphedema in the affected arm

What is Pulmonary Circulation?

Moves blood through the lungs and creates a link with the gas exchange function of the respiratory system

The nurse is caring for a 75-year-old client with end-stage emphysema who is having severe dyspnea. The nurse is evaluating the client's cardiac rhythms and notes a very irregular rhythm with P waves before most if not all the QRS complexes with a rate of 140. With closer inspection of the cardiac rhythm, the nurse notes the P waves all look different. Which term most accurately describes this rhythm?

Multifocal atrial tachycardia

What is the myocardium?

Muscular portion; forms the wall of the atria and ventricles

A client has developed cardiogenic shock. The most frequent cause of this type of shock is:

Myocardial infarction

In distributive shock, there are abnormalities in vascular resistance. Which types of shock display the same distributive pattern? Select all that apply.

Neurogenic Septic Anaphylactic

Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?

Nitric oxide

Suddenly a client in the surgical intensive care unit develops ventricular fibrillation following open heart surgery. What does the nurse immediately prepare for?

Nonsynchronized defibrillation

Is the Circulatory System an opened or closed system?

Opened.

A nurse is assessing a client diagnosed with severe mitral valve stenosis. The nurse anticipates which classic assessment finding?

Orthopnea

The pericardium is a tri-layer sac. Which layer prevents acute dilation of the heart chambers and exerts a restraining effect on the left ventricle?

Outer fibrous layer

A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering?

Pericardial effusion

A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?

Pericarditis

Which factor represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?

Preload

The nurse is teaching a client diagnosed with heart failure about preload. Which principle would be most appropriate to provide to the client?

Preload represents the volume work of the heart.

The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control?

Promotes retention of water

What does the Fibrous Skeleton do?

Provides structural support and isolating force for electrical impulse.

A 75-year-old man presents at the clinic for a routine physical checkup. He is found to be hypertensive. While taking his blood pressure in the sitting, standing, lying positions, the nurse notes that the brachial artery is pulseless at a high cuff pressure, but she can still feel it. What condition would the nurse suspect?

Pseudohypertension

Colloidal osmotic pressure acts differently than the osmotic effects of the plasma proteins. What is its action?

Pulls fluid back into the capillary

The heart consists of four valves. Which are the semilunar valves? Select all that apply.

Pulmonary Aortic

A nurse is caring for a client with right heart failure caused by pulmonary hypertension. Which hemodynamic parameter is most appropriate for the nurse to monitor?

Pulmonary arterial pressure (PAP)

The heart is a four-chambered pump. What is the function of the right ventricle?

Pumps blood to the lungs

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?

Raising the head of the bed to a high Fowler's position

The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?

Receives blood returning to the heart from the systemic circulation

The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?

Repolarization of the ventricles

A client in the intensive care unit died shortly after developing multiple organ dysfunction syndrome (MODS). Which health problem most likely preceded the client's MODS?

Sepsis

A client has had an acute myocardial infarction (MI). The brother of the client has a history of angina. The client asks how he will know if his brother's pain is angina or if the brother is actually having an MI. Which statement is correct?

Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.

A teenager is seen in the emergency room with reports of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen 3 weeks before in the clinic and treated with antibiotics for strep throat. He was better for a few days but now he seems to have gotten worse in the last 2 days. What should the nurse suspect is wrong with this client?

Rheumatic fever

A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?

Right-sided heart failure

Aortic aneurysms take varied forms and can occur anywhere along the aorta. What are the types of aneurysm termed abdominal aortic aneurysms? Select all that apply.

Saccular aneurysms Fusiform aneurysms

An emergency room nurse is caring for a client with cardiomyopathy who has chest pain and shortness of breath. Vital signs include heart rate 100, blood pressure 84/62, RR 30 and temperature 37.0°C. Cardiac monitor reveals an irregular rhythm with frequent premature ventricular complexes. The nurse understands that this client is at risk for:

Serious dysrhythmias

The diagnosis of chronic stable angina is based on a detailed pain history, the presence of risk factors, invasive and noninvasive studies, and laboratory studies. Which diagnostic test is usually not prescribed since the results are normal for clients with the diagnosis of chronic stable angina?

Serum biochemical markers

Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture? Select all that apply.

Size of lipid-rich core Presence of inflammation Thickness of fibrous cap

If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern?

Slowing of heart rate to below 60 beats/minute

A client with supraventricular tachycardia has received a dose of verapamil to slow the heart rate. Which explanation describes the effect of this drug on the heart?

Slows the sinoatrial (SA) node pacemaker and inhibits conduction in the atrioventricular (AV) node

Which of the following is the site of chylomicron synthesis?

Small intestine

Which one of the following organs are the two primary sites of lipoprotein synthesis?

Small intestine and liver

Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include:

Stasis of blood, hypercoagulability, vessel wall injury

A nurse is administering medication to treat familial hypercholesterolemia. Which medication lowers blood levels of low-density lipoproteins (LDL)?

Statins

The difference between the end-diastolic and end-systolic volumes is called what?

Stroke volume

The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:

Stroke volume × heart rate

What is Systemic circulation?

Supplies all the other tissues of the body

How can the health care provider determine if the client has "aerobic fitness"?

Tests help to determine aerobic fitness by measuring heart rate while under the stress of exercise.

Torsade de pointes is a specific type of polymorphic ventricular tachycardia in which the polarity of the QRS complex swings between positive and negative, often on a beat-to-beat basis. It is the result of the long QT syndrome and can cause sudden cardiac death. Which medication is not linked to torsade de pointes as a causative agent?

Tetracycline

The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?

The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?

During an assessment of a client with ankle swelling, the nurse observes jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. What is the correct interpretation of this finding?

The client has increased pressure related to right-sided heart failure.

The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:

The condition is getting progressively worse.

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The client's physician would anticipate that which phenomenon is most likely occurring?

The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

The circulatory system is a closed system that is divided into two parts. Which statement is correct about the closed system?

The low pressure pulmonary circulation links circulation and gas exchange in the lungs.

A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response?

The most common cause is a staph infection.

What is systole of the cardiac cycle?

The period during which the ventricles are contracting.

Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease?

The pulse decreases, rather than increases, in amplitude.

What is the main function of the Cirulatory system?

Transport, Carries waste from the kidneys,circulates electrolytes and hormones

The nurse is caring for a client who develops atrial fibrillation. What concern is the highest priority for this client?

The risk of emboli

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:

The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.

In infective endocarditis, vegetative lesions grow on the valves of the heart. These vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin strands of clotted blood. What are the possible systemic effects of these vegetative lesions?

They can fragment and cause cerebral emboli.

Heart failure and circulatory shock are both conditions of circulatory system failure. Which statement regarding these conditions is correct?

They have the same compensatory mechanisms.

What is the Endocardium?

Thin, three-layered membrane lining the heart

Which degree of "heart block" results in decreased cardiac output and fainting?

Third-degree

Which most important complication of atherosclerosis can result in occlusion of small heart vessels?

Thrombosis

When a physician suspects a client has suffered an acute myocardial infarction, which serum biomarkers should he order? Select all that apply.

Troponin 1 Creatine kinase Troponin T

The troponin complex is one of a number of important proteins that regulate actin-myosin binding. Troponin works in striated muscle to help regulate calcium-mediated contraction of the muscle. Which of the troponin complexes is diagnostic of a myocardial infarction?

Troponin T and troponin I

A client comes to the emergency room with all the symptoms of a myocardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order?

Troponin assays

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as:

Tunica media

Which blood vessel layer is made primarily of muscle?

Tunica media

What Function does the cardiac cycle have?

Used to describe rhythmic pumping action of the heart.

An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased:

Vascular stiffness

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Vasoconstriction

In circulatory shock, the adrenergic (or sympathetic) nervous system is activated. The nurse knows that stimulation of beta-2 adrenergic receptors will result in which responses? Select all that apply.

Vasodilation of the skeletal muscle vascular bed Dilation of the bronchioles

Which pathogenesis is primarily responsible for Raynaud phenomenon?

Vasospasm causing excessive vasoconstriction

A client has a blood pressure of 68/38 mm Hg and fainted after donating a unit of blood. The client is experiencing low preload from loss of blood volume. What is preload?

Venous return to the heart

What is preload?

Volume of blood it pumps out

What affects Wall tension?

Wall thickness; it increases as a the wall becomes thinner and Decreases as the wall becomes thicker.

A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?

When the client experiences chest pain

A nurse is assessing a client who lost consciousness during a wrestling match when his opponent applied a neck hold. The client likely lost consciousness because:

a baroreceptor was stimulated.

An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:

blocking the conversion of angiotensin I to angiotensin II.

What is Peripheral Circulation?

blood outside the central circulation

What is Central Circulation?

blood that is in the heart and pulmonary circulation

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.

compensatory mechanisms

A nursing student is studying the properties of cardiac rhythm to better understand what causes dysrhythmias to occur. The student begins to understand that there is a programmed ability for certain cells to conduct impulses. Interruption in this ability can result in abnormalities of cardiac rate and rhythm; this property would be:

conductivity.

A nurse is teaching a client with newly diagnosed dilated cardiomyopathy (DCM) about associated treatments. The nurse determines that the knowledge is understood when the client correctly matches which drug category to the primary action of decreasing preload by suppressing renal reabsorption of sodium and increasing salt and water excretion?

diuretics

A nurse is evaluating hypertension risk factors with a client. Of the risk factors in the client's history noted, which risk factor(s) for hypertension is nonmodifiable? Select all that apply.

family history race

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

fills rapidly; compresses

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

hypovolemic shock due to acute intravascular volume loss.

A client with hypercholesterolemia is being treated with diet and exercise. Which assessment finding is a positive outcome of this treatment regimen?

increased high-density lipoproteins

A client reports severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate:

myocardial infarction.

At 4 AM the hemodynamic monitoring for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure (MAP) is at the low end of the normal range; at 5 AM the client's MAP has fallen definitively below normal. The nurses should prioritize assessments for:

organ damage and hypovolemic shock.

What Are Components of Pulmonary Circulation?

right heart, pulmonary artery, capillaries, and veins

A college student is in pre-op area prior to knee surgery. The nurse attaches the cardiac monitor and notes a gradual lengthening and shortening between the R waves. The nurse realizes that this rhythm is most often found in people with healthy hearts. This rhythm is a respiratory:

sinus dysrhythmia.

What are the two parts of the Cardiac Cycle?

systole and diastole

A nurse working with a client in heart failure is explaining why the symptoms of the heart failure were not evident for a long period of time. When describing the Frank-Starling mechanism, the nurse will explain:

the relationship between venous return and stroke volume.

In an ICU setting, one assessment that would lead the nurse to suspect that shock has led to decreased blood flow to vital organs is:

urine output less than 20 mL/hour.

A 55-year-old client has been diagnosed with atherosclerosis. The client understands that his or her lifestyle includes many of the risk factors for developing the disease, but the client asks the nurse, "What actually caused my disease?" What is the nurse's best scientific answer?

"LDL and VLDLs stimulate endothelial cell dysfunction."

A client asks the purpose of an exercise stress test. What is the nurse's best response?

"The test is used to measure functional status during stress."

Which statement regarding heart failure is true?

Compensated congestive heart failure may be clinically asymptomatic.

For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve?

Compensatory mechanisms

The nurse is caring for a client who has been admitted to the hospital with a diagnosis of unstable angina and the client wants to know why daily ECGs are necessary. The nurse explains that the ECGs can pick up early indications of cardiac ischemia and the nurse knows that according to the American Heart Association practice standards, the client falls into which ECG monitoring category?

Class I

Which client with cardiomyopathy does the nurse identify as having the greatest risk for a complication?

Client with an ejection fraction of 25% and atrial fibrillation

A nurse is providing care for a client with a history of severe atherosclerosis. Which clinical manifestations should the nurse anticipate and assess in the client? Select all that apply

Cognitive deficits due to ischemia or thrombosis. Aneurysm formation due to weakening of blood vessel walls.

When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?

Conversion from aerobic to anaerobic metabolism

The client's ultrasound shows a true aneurysm that involves the entire circumference of the vessel and has a gradual and progressive dilation of the vessel. The provider tells the client the aneurysm is which of the following forms?

Fusiform

The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?

Genetic

Which lab result strongly suggests an immunologic response in the client with possible rheumatic heart disease?

Group A (β-hemolytic) streptococcal antibodies

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

History of cigarette smoking and elevated blood pressure

A nurse is monitoring the electrocardiogram (ECG) of a client with a recent right ventricular infarction. The ECG reveals a first-degree atrioventricular (AV) block, which is characterized by:

PR interval >0.20 seconds

A 35-year-old client arrives for an appointment with his primary care physician because he has been experiencing "this funny fluttering in my chest" and is concerned that there is something seriously wrong. The physician evaluates the client and discovers that the client has many stressors along with suspected alcohol and tobacco abuse. The physician notes on the cardiac monitor that the client has a heart rate of 90 with a slightly irregular rhythm with P waves before the QRS, although not all the P waves are the same shape. Which rhythm fits this description?

Premature atrial contractions

What is afterload?

Pressure it must generate to pump the blood out of the heart

Which is the most common site for an aortic aneurysm?

abdominal aorta

Which intervention will the nurse prioritize for the medical management of a client with a dissecting aortic aneurysm?

administration of vasodilators and beta-adrenergic blocking medications (beta-blockers)

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?

beta-adrenergic blocking drugs (beta-blockers)

A group of nursing students is discussing ventricular dysrhythmias and one student is unsure why a client with frequent premature ventricular complexes (PVCs) has an irregular radial pulse. One of the other students explains that premature ventricular complexes often do not produce a palpable pulse due to:

decreased ventricular filling time.

A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. The nurse teaches the client that this medication lowers blood pressure through what effect?

decreasing vascular volume

What are the two types of Blood flow?

laminar and turbulent

A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo:

percutaneous transluminal angioplasty and stent placement.

The nurse is assessing a client involved in a motor vehicle collision who has bruising across the sternum from seat belt pressure. The nurse notes muffled heart sounds, and the client's blood pressure is 100/85 mm Hg. The nurse notifies the health care provider to present these findings as evidence of which condition?

pericardial effusion

A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. The results suggest that the client's end-diastolic volume is insufficient. Which parameter of cardiac performance will directly decrease as a result of this finding?

preload

What is Venous Blood pressure?

pressure within the venous system, lower 12 mmg, Propel blood through the lungs ( i.e. Pulmonary Circulation)

What are the two parts of the Circulatory system?

pulmonary circulation and systemic circulation

A nurse educator is explaining normal cardiac conduction and action potentials to a nursing cohort. How can the nurse best describe the term "slow response" (calcium current) to the students?

"It facilitates the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction."

An older adult client's blood pressure (BP) is 120/80 mm Hg when in a lying position. When the nurse retakes the client's BP in a sitting position, the BP is 92/60 mm Hg. Which intervention is appropriate for the nurse to implement?

Encouraging the client to maintain hydration throughout the day

Hypertension is a risk factor for atherosclerosis. The nurse knows that which of the following is the initial lesion in the pathogenesis of atherosclerosis?

Endothelial damage

Which statements regarding hypertension are correct? Select all that apply.

Hypertension is more frequent among younger men than in younger women. Hypertension is a major risk factor for cardiovascular disease. Hypertension is one of the most common health problems for adults.

A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure?

Hypertrophic cardiomyopathy

What are the components of systemic circulatory?

Left Heart, aorta and it's branches, capillaries supplying the brain and peripheral tissues Systemic venous system and the vena cava.

The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?

Left ventricle

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?

Peripheral vascular resistance

A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment, the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?

Cardiac tamponade

The heart controls the direction of blood flow. What is the role of the aortic valve?

Controls the direction of blood flow from the left side of the heart to the systemic circulation

A 37-year-old woman is admitted to the unit with a differential diagnosis of rule out pheochromocytoma. What are the most common symptoms the nurse would expect this client to exhibit?

Periodic severe headache and marked variability in blood pressure

A nurse preparing education on managing the risk factors for coronary artery disease (CAD) will stress which information? Select all that apply.

-Smoking cessation techniques -Identification of high cholesterol foods -Importance of exercise on managing hypertension -Signs and symptoms of type 2 diabetes mellitus

A cardiac nurse is describing to a colleague the relationship between the law of Laplace and a client's peripheral vascular disease. To express the law of Laplace in an equation, the nurses need to know which values? Select all that apply.

-The tension that exists in the walls of a blood vessel -The radius of a particular blood vessel -The pressure that exists in the lumen of a vessel

The nurse caring for a client 12 hours after a coronary bypass graft notes a sudden decrease in the amount of chest tube drainage, a rapidly narrowing pulse pressure, paradoxical pulse, and shortened amplitude of the QRS complex on the electrocardiogram monitor. Which action should the nurse take next?

Prepare for pericardiocentesis

Blood flow in the circulatory system depends on a blood volume that is sufficient to fill the blood vessels and a pressure difference across the system that provides the force to move blood forward. What is the total blood volume in an adult?

70 to 75 mL/kg

Acute pulmonary edema often occurs with heart failure. Which signs of acute pulmonary edema should the nurse monitor their clients for? Select all that apply.

Frothy, blood-tinged sputum Respiratory crackles Confusion Rapid pulse

If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations?

Increased heart rate and increased contractility

A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?

Vasodilating effects reducing preload and afterload

Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

constrictive pericarditis

Select the correct sequence of blood return to the heart.

Capillaries, venules, veins, right atrium

A client in circulatory shock may experience which damaging effect(s) at the cellular level caused by lack of oxygen supply? Select all that apply.

-pyruvate converted to lactic acid -cellular edema -deranged sodium/potassium balance -impaired cellular production of adenosine triphosphate (ATP)

The semilunar valves of the heart open at the onset of the ejection period. Approximately what percentage of the stroke volume is ejected during the first quarter of systole?

60%

The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:

64 mm Hg

A nurse witnesses an older adult woman sitting outside who suddenly faints and is helped to the ground by family. She is awake, although confused, heart rate 130, RR 28. The woman states that all of a sudden she felt dizzy, but denies other symptoms. She says that her husband died last week and she has been very upset. The nurse determines that which of the following is the most likely reason for the syncopal episode?

Severe anxiety

The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?

Ventricles contract and blood is ejected from the heart.

Which of the following facilitates the clearance of cholesterol from the periphery (including atheromatous plaques) and transports it to the liver where it may be excreted?

HDL

Pregnancy-induced hypertension is a serious condition affecting between 5% and 10% of pregnant women. The most serious classification of hypertension in pregnancy is preeclampsia-eclampsia. It is a pregnancy-specific syndrome that can have both maternal and fetal manifestations. What is a life-threatening manifestation of the preeclampsia-eclampsia classification of pregnancy-induced hypertension?

HELLP syndrome

The nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that which activity is most likely the cause of the varicosities?

Heavy lifting

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?

Hypertrophic cardiomyopathy (HCM)

Which of the following is associated with stasis of blood, increased blood coagulability, and vessel wall injury?

Venous thrombosis

What is Diastole of the Cardiac cycle?

Ventricles are relaxed and filling with blood.