Chapter 29 Pathophysiology Rutgers Dr. Lawrence

Question 2 of 20 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 Aortic valve Pulmonic valve Tricuspid valve SUBMIT ANSWER

Bicuspid valve

Question 15 of 20 A client has suffered chest injuries following a automobile accident. The chest injury has resulted in an increase in intrathoracic pressure. There can be a transient shift from the pulmonary to the systemic circulation of how much blood? 250 mL 200 mL 150 mL 300 mL

250 mL An increase in intrathoracic pressure, which impedes venous return to the right heart, can produce a transient shift from the pulmonary to the systemic circulation of as much as 250 mL of blood.

Question 20 of 20 In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities? A client reclines from a sitting to supine position A client undergoes a stress test on a treadmill A client is helped out of bed and stands up A client does isotonic exercises in a wheelchair SUBMIT ANSWER

A client is helped out of bed and stands up During a change in body position, blood is rapidly relocated from the central circulation (when the client is recumbent) to the lower extremities (when the client stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.

Question 16 of 20 A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the patient 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? The innermost lining of the heart chambers The outer muscular layer of the heart A membranous sac that encloses the heart The electrical conduction system of the heart SUBMIT ANSWER

A membranous sac that encloses the heart

Question 10 of 20 A client with a diagnosis of secondary hypertension has begun to experience signs and symptoms that are consistent with decreased cardiac output. Which of the following determinants of cardiac output is hypertension most likely to affect directly? Afterload Preload Contractility Heart rate SUBMIT ANSWER

Afterload The afterload is the pressure or tension work of the heart. It is the pressure that the heart must generate to move blood into the aorta. The systemic arterial blood pressure is the main source of afterload work on the left heart. As blood pressure increases, the left ventricle must overcome greater resistance in order to pump blood into the circulatory system. Preload represents the volume work of the heart. It is the amount of blood that the heart must pump with each beat and represents the volume of blood stretching the ventricular muscle fibers at the end of diastole. Heart rate and cardiac contractility are strictly cardiac factors, meaning they originate in the heart, although they are controlled by various neural and humoral mechanisms.

Question 15 of 20 The efficiency of the heart as a pump often is measured in the amount of blood the heart pumps per minute. Which is the correct formula to figure out the cardiac output? SV = HR x CO CO = SV x HR HR = CO + SV HR = SV x CO SUBMIT ANSWER

CO = SV x HR

Question 3 of 20 Select the correct sequence of blood return to the heart. Capillaries, venules, veins, left atrium Capillaries, arterioles, arteries, right atrium Capillaries, venules, veins, right atrium Capillaries, arterioles, veins, left atrium

Capillaries, venules, veins, right atrium

Question 19 of 20 As the needs of the body change, the heart's ability to increase output needs to change too. This ability in the heart depends on what factors? (Select all that apply.) Afterload Preload Heart rate Cardiac reserve Cardiac contractility

Cardiac contractility Heart rate Preload Afterload The heart's ability to increase its output according to body needs mainly depends on four factors: the preload, or ventricular filling; the afterload, or resistance to ejection of blood from the heart; cardiac contractility; and the heart rate. Cardiac reserve does not add to the heart's ability to increase its output

Question 8 of 20 Which of the following mediates long-term autoregulation of local blood flow in circulation? Autonomic nervous system Arteriovenous shunting Metabolic needs of the tissues Collateral circulation SUBMIT ANSWER

Collateral circulation Long-term autoregulation is established by the formation of collateral circulation. Short-term (increase/decrease) autoregulation is mediated by mechanisms that include arteriovenous shunting of blood, the metabolic needs of the tissues, and autonomic nervous system controls

Question 13 of 20 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 lungs Controls the direction of blood flow from the left side of the heart to the systemic circulation Controls the direction of blood flow from the ventricles to the artia Controls the direction of blood flow from the atria to the ventricles

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

Question 9 of 20 In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis? Myocarditis Pericarditis Vasculitis Endocarditis SUBMIT ANSWER

Endocarditis The endocardium is a thin, three-layered membrane that lines the heart and covers the valves; infection of this part of the heart is consequently referred to as endocarditis.

Question 9 of 20 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? Pump blood Distribute oxygenated blood to the tissues Collect deoxygenated blood from the tissues Exchange gases, nutrients and wastes

Exchange gases, nutrients and wastes

Question 5 of 20 Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability? Arachidonic acid Serotonin Prostaglandins Histamine SUBMIT ANSWER

Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.

Question 5 of 20 A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following? Increased heart rate and decreased contractility Increased heart rate and increased contractility Decreased rate and force of contraction Decreased contractility and decreased heart rate

Increased heart rate and increased contractility The sympathetic nervous system has an excitatory influence on heart rate and contractility, and it serves as the final common pathway for controlling the smooth muscle tone of the blood vessels. With stimulation, both heart rate and contractility would increase

Question 1 of 20 Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another? Laminar Crosswise Turbulent Axially

Laminar Laminar blood flow reduces friction by allowing the blood layers to slide smoothly over one another, with the axial layer having the most rapid rate of flow. Axially, crosswise, and turbulent blood flow would result in increased friction. In turbulent flow, the laminar stream is disrupted and the flow becomes mixed, moving radially (crosswise) and axially (lengthwise

Question 12 of 20 The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation? Right atrium Left atrium Right ventricle Left ventricle

Left ventricle

Question 4 of 20 The nurse determines that the capillary pore exchange of a client's gases, nutrients, and/or waste products would be best facilitated by which of the following? Brain Bone Kidney Liver SUBMIT ANSWER

Liver The liver capillaries have large pores so that substances can pass easily through the capillary wall; the kidney has glomerular capillaries with fenestrations that assist with filtration. The brain and the endothelial cells are joined by tight junctions that form the blood-brain barrier. This prevents substances that would alter neural excitability from leaving the capillary. Bone has no involvement with the exchange of waste products.

Question 2 of 20 Which of the following factors 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 Afterload Cardiac contractility Heart rate SUBMIT ANSWER

Preload

Question 20 of 20 Colloidal osmotic pressure acts differently than the osmotic effects of the plasma proteins. What is its action? Pulls fluid back into the capillary Pulls fluid into the interstitial spaces Controls the direction of the fluid flow in the large arteries Pushes fluid into the extracellular spaces

Pulls fluid back into the capillary The osmotic pressure caused by the plasma proteins in the blood tends to pull fluid from the interstitial spaces back into the capillary. This pressure is termed colloidal osmotic pressure to differentiate the osmotic effects of the plasma proteins, which are suspended colloids, from the osmotic effects of substances such as sodium and glucose, which are dissolved crystalloids

Question 14 of 20 The heart consists of four valves. Which are the semilunar values? Select all that apply. Mitral Pulmonary Tricuspid Aortic SUBMIT ANSWER

Pulmonary Aortic

Question 12 of 20 The heart is a four-chambered pump. What is the function of the right ventricle? Receives oxygenated blood from the lungs Receives blood returning to the heart from the systemic circulation Pumps blood into the systemic circulation Pumps blood to the lungs SUBMIT ANSWER

Pumps blood to the lungs

Question 11 of 20 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 Receives oxygenated blood from the lungs Pumps blood to the lungs Pumps blood into the systemic circulation

Receives blood returning to the heart from the systemic circulation

Question 8 of 20 A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the 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. Chest pain with angina only occurs at rest; MI pain occurs during a stressful time. Chest pain with angina only occurs during the day; MI pain is more likely at night. Pain is more severe and lasts longer with angina than with an MI.

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

Question 6 of 20 Which of the following is the difference between the end-diastolic and end-systolic volumes? Stroke volume Ejection fraction Cardiac output Cardiac reserve SUBMIT ANSWER

Stroke volume Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Ejection fraction is the volume ejected from the left ventricle. Cardiac reserve is determined by cardiac output

Question 18 of 20 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 Stroke volume × respiratory rate Blood pressure × stroke volume Blood pressure × heart rate SUBMIT ANSWER

Stroke volume × heart rate

Question 16 of 20 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. Which of the following is the correct interpretation of this finding? The client has stenosis of the jugular veins. The client has decreased fluid volume. The client has an increased cardiac output. The client has increased pressure related to right heart failure. SUBMIT ANSWER

The client has increased pressure related to right heart failure The jugular veins are normally flat or collapsed. Since there are no valves at the atrial sites (i.e., venae cavae and pulmonary veins) where blood enters the heart they can become prominent in severe right-sided heart failure. This means that excess blood is pushed back into the veins when the atria become distended

Question 11 of 20 The circulatory system is a closed system that is divided into two parts. Which statement is correct about the closed system? The high pressure systemic circulation system links circulation and gas exchange in the lungs The low pressure systemic circulation system provides oxygen and nutrients to the tissues. The high pressure pulmonary circulation provides oxygen and nutrients to the tissues. The low pressure pulmonary circulation links circulation and gas exchange in the lungs. SUBMIT ANSWER

The low pressure pulmonary circulation links circulation and gas exchange in the lungs. The low pressure pulmonary circulation links circulation and gas exchange in the lungs, and the high pressure systemic circulation provides oxygen and nutrients to the tissues

Question 18 of 20 A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client: "You need to increase the amount of exercise you do to get your heart muscle back in shape." "This means your heart is not pumping as much blood out of the heart with each beat." "Your ventricular muscle is getting too stiff to beat normally." "This means you have a lot of pressure built-up inside your heart

This means your heart is not pumping as much blood out of the heart with each beat." Ejection fraction is the percentage of diastolic volume ejected from the heart [left ventricle] during systole. Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level

Question 13 of 20 The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply. Pulmonary Tricuspid Mitral Aortic SUBMIT ANSWER

Tricuspid Mitral

Question 17 of 20 The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following? Tunica adventitia Tunica externa Tunica media Tunica intima SUBMIT ANSWER

Tunica media

Which of the following vessel layers is made primarily of muscle? Tunica media Tunica intima Tunica externa Tunica adventitia

Tunica media The outermost layer of a vessel is called the tunica externa or tunica adventitia. The middle layer is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The innermost layer is the tunica intima.

Question 19 of 20 A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is: "You are just a lucky person since most people would have had a massive heart attack by now." "With this amount of blockage, your red blood cells get through the vessel one-by-one and supply oxygen to the muscle." "You must have been taking a blood thinner for a long time." "You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." SUBMIT ANSWER

You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked

Question 17 of 20 A nurse is caring for a client following surgery. The central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take? Document the CVP and continue to monitor. Administer oxygen 2L per nasal cannula. Increase the IV fluid infusion per protocol. Elevate the head of the patient's bed to 45 degrees

Increase the IV fluid infusion per protocol Systemic veins flow into the right atrium of the heart; the pressure in the right atrium is called the central venous pressure (CVP). Right atrial pressure is regulated by the ability of the right ventricle to pump blood into the lungs and the tendency of blood to flow from the peripheral veins into the right atrium. The normal right atrial pressure is about 0 mm Hg, which is equal to atmospheric pressure. A low CVP indicates hypovolemia and a need for an increase in the IV infusion rate.

Question 7 of 20 Which of the following statements are true regarding the parasympathetic nervous system and its effect on the cardiac system? Select all that apply. It innervates the heart. Heart contractility is controlled by this system. Bradycardia is a result of this system. It controls blood vessel tone. Its effects are facilitated by the vagus nerve. SUBMIT ANSWER

It innervates the heart. Its effects are facilitated by the vagus nerve. Bradycardia is a result of this system.

Question 1 of 20 Which of the following is true regarding pulmonary circulation? It consists of the left side of the heart, the aorta, and its branches. It is a low-pressure system that allows for improved gas exchange. It is the larger of the two circulatory systems. The system functions with an increased arterial pressure to circulate through the distal parts of the body. SUBMIT ANSWER

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

Question 4 of 20 Which of the following vessel layers is made primarily of muscle? Tunica adventitia Tunica intima Tunica externa Tunica media SUBMIT ANSWER

Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta

Question 10 of 20 The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. The heart exchanges gases, nutrients and wastes. The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues . The capillaries pump blood

The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues

Preload represents the volume work of the heart and is largely determined by: Venous blood return Vascular resistance Force of contraction Ventricular emptying

Venous blood return Preload represents the amount of blood the heart must pump with each beat and represents the volume of blood stretching the ventricular muscle fibers at the end of diastole. Pressure (resistance), contraction, and ventricular emptying relate to afterload.

Question 14 of 20 The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole? Atria contract and blood is ejected from the heart. Ventricles relax and blood fills the heart. Atria relax and blood fills the heart. Ventricles contract and blood is ejected from the heart

Ventricles contract and blood is ejected from the heart.

Question 6 of 20 In the arterial-venous circulatory system, pressure is inversely related to which of the following? Tension Volume Velocity Viscosity SUBMIT ANSWER

Volume In the circulatory system, pressure is inversely related to volume. Arterial circulation contains a lower percentage of total blood volume and has higher pressure than the venous circulation, which contains the majority of circulating blood. Flow is related to viscosity and radius is related to wall tension. Velocity is inversely proportional to the cross-sectional area of the vessel.