Evolve: Chapter 30 Exam 4
Which education will the nurse provide to a patient with mitral valve prolapse when describing the purpose of the mitral valve? (30) "It prevents blood from flowing from the right atrium into the right ventricle during systole." "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."
"Located between the left atrium and left ventricle, it prevents blood from flowing back into the atrium during systole." 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.
Which is the average blood pressure in the right atrium (RA)? (30) 0 to 5 mm Hg 20 to 50 mm Hg 60 to 70 mm Hg 100 to 120 mm Hg
0 to 5 mm Hg The average blood pressure in the RA is 0 to 5 mm Hg; all other options listed are too high. 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 blood pressure in the aorta of a young adult is 100 to 120 mm Hg.
Which modifiable risk factor for cardiovascular disease (CVD) will the nurse address in patient education? Select all that apply. One, some, or all responses may be correct. (30) Man, age 35 years A patient's limited physical activity Family history of CVD Body mass index (BMI) greater than 30 A patient's 5-pack-year smoking history
A patient's limited physical activity Body mass index (BMI) greater than 30 A patient's 5-pack-year smoking history Modifiable risk factors are personal lifestyle habits that can be changed. Limited physical activity, a BMI greater than 30, and a 5-pack-year smoking history are modifiable risk factors for CVD. The patient can reverse the tendency for CVD by maintaining good body weight, avoiding smoking, and exercising. Sex, family, history of CVD, and age are nonmodifiable risk factors.
Which education regarding diagnostic cardiovascular testing is correct? (30) The left side of the heart is catheterized first and may be the only side examined. Holter monitoring allows periodic recording of cardiac activity during an extended period of time. An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. Complications of coronary arteriography include stroke, nonlethal dysrhythmias, arterial bleeding, and thromboembolism.
An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. Intravascular ultrasonography is an alternative to the medium injection method of diagnostic cardiovascular testing. Several parts of the heart are examined during diagnostic cardiovascular testing. Holter monitoring allows periodic recording of cardiac activity during short periods of time. Lethal, not nonlethal, dysrhythmias are a complication of diagnostic cardiovascular testing.
Which action by the nurse is essential before the patient undergoes cardiac catheterization? (30) Obtaining informed consent Administering a prescribed diuretic Providing patient education about sensations during the procedure Assessing for allergies to iodine-containing substances and contrast media
Assessing for allergies to iodine-containing substances and contrast media Essential interventions before heart catheterization include assessing for allergies to iodinated contrast, obtaining vital signs, and performing a cardiovascular assessment, including distal pulses. The health care provider who is performing the procedure obtains the consent. Diuretics are typically held on the day of the procedure. Providing patient education is an important component of patient preparation, but omitting it is not life-threatening.
Which action performed by the nurse during a physical assessment demonstrates an understanding of the cardiovascular system? (30) Assesses for carotid bruit by auscultating over the anterior neck Palpates the apical pulse over the third intercostal space in the mid-clavicular line Auscultates the aortic valve in the second intercostal space at the right sternal border Evaluates for orthostatic hypotension by moving the patient from a standing to a reclining position
Auscultates the aortic valve in the second intercostal space at the right sternal border The aortic valve is auscultated at the second intercostal space at the right sternal border. A bruit is assessed by auscultating the carotid artery in the neck. The apical pulse is palpated over the fifth intercostal space in the mid-clavicular line. Orthostatic hypotension is measured when a person moves from a reclining to a standing position.
Which cardiac valve maintains forward flow of blood through the heart by separating the left atrium (LA) from the left ventricle (LV)? (30) Aortic Tricuspid Pulmonic Bicuspid (mitral)
Bicuspid (mitral) The bicuspid or mitral valve maintains forward flow of blood by separating the LA from the LV. The aortic valve separates the LV from the aorta. The tricuspid valve separates the right atrium from the right ventricle (RV). The pulmonic valve separates the RV from the pulmonary artery.
Which component will the nurse document upon reviewing the results of cardiac output (CO) and the resistance in the arterioles? (30) Cardiac index Heart rate (HR) Stroke volume (SV) Blood pressure (BP)
Blood pressure (BP) BP is determined by the quantity of the blood flow or CO, as well 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. HR is the number of times the ventricles contract each minute. SV is the amount of blood ejected by the left ventricle (LV) during each contraction.
8.Which will the nurse include as the leading cause of death in adults when educating a group of patients about lifestyle changes? (30) Cancers Accidents Cardiovascular disease Chronic lung disease
Cardiovascular disease Almost every year since 1900, cardiovascular disease (CVD) has been the number one cause of death in the United States. Nearly 2300 Americans die of CVD each day. The disease kills more people than the next four causes of death combined, including cancer, chronic lung diseases, accidents, and diabetes.
Which clinical manifestation will the nurse expect in a patient with suspected pericarditis? Select all that apply. One, some, or all responses may be correct. (30) Squeezing, viselike chest pain Chest pain relieved by sitting upright Sudden-onset chest pain relieved by NSAIDs Chest and abdominal pain relieved by antacids Pain in the chest described as sharp or stabbing
Chest pain relieved by sitting upright Sudden-onset chest pain relieved by NSAIDs Pain in the chest described as sharp or stabbing The pain of pericarditis is relieved when sitting upright or forward, may appear abruptly, and is relieved by NSAIDs. The inflammatory pain of pericarditis tends to be sharp, stabbing, and related to breathing; squeezing, viselike chest pain is characteristic of myocardial infarction (MI). Chest and abdominal pain relieved by antacids is characteristic of a peptic ulcer.
Which finding will the nurse document when a patient reports a cramping sensation in the legs and buttocks after a walk that ceases after rest? (30) Syncope Palpitation Claudication Near-syncope
Claudication These symptoms describe claudication. Intermittent claudication occurs while walking and is caused by decreased arterial tissue perfusion. Syncope is the brief loss of consciousness caused by decreased perfusion to the brain. Near-syncope refers to dizziness with an inability to maintain an upright position. Palpitation is an uneasy feeling or a fluttering feeling in the chest caused by an irregular heartbeat. This may result from a change in heart rate or rhythm or from an increase in the force of heart contractions.
Which finding on a cardiovascular physical assessment indicates chronic hypoxemia? (30) Peripheral pitting edema Clubbing of the fingers and toes Decreased skin turgor over the chest Petechiae on the arms and inner thigh
Clubbing of the fingers and toes Clubbing of the fingers and toes is caused by chronic oxygen deprivation to body tissues such as in chronic pulmonary disease, cor pulmonale, and congenital heart defects. Pitting edema is present in fluid excess and heart failure. Petechiae are indicative of a low platelet count. Decreased skin turgor indicates fluid volume deficit or dehydration.
Which substance use will the nurse assess for when a patient is admitted for chest pain? (30) Opiates Cocaine Marijuana Barbiturates
Cocaine Cocaine is a stimulant that raises blood pressure, a risk factor for heart disease. Opiates, marijuana, and barbiturates do not contribute directly to cardiovascular disease; they have sedating effects.
Which statement regarding heart contractility describes Starling's law of the heart? (30) Contraction is more forceful when the heart is filled more during diastole. Emptying during systole results in more forceful contraction. Minimal coronary vascular resistance increases contractility. The heart contracts more forcefully when total systemic vascular resistance is minimized.
Contraction is more forceful when the heart is filled more during diastole According to Starling's law of the heart, the heart contracts more forcefully when it is filled more during diastole. The following statements are not consistent with Starling's law: The heart contracts more forcefully when it is emptied more during systole; the heart contracts more forcefully when coronary vascular resistance is minimized; the heart contracts more forcefully when total systemic vascular resistance is minimized.
Which factor is not related to impedance? (30) Blood viscosity Aortic compliance Coronary vascular resistance Total systemic vascular resistance
Coronary vascular resistance 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.
Which is a physiologic change of the cardiovascular system associated with aging? (30) Increase in the sensitivity of baroreceptors Decrease in the number of pacemaker cells Thinning of the aorta and other larger arteries Reduction in size and efficacy of the left ventricle
Decrease in the number of pacemaker cells In older-adult patients, the number of pacemaker cells is decreased as a result of loss of tissue integrity and inability of the cells to divide. Baroreceptor sensitivity is lost in older adults, as aging results in the degeneration of impulse transmission. The aorta and other large arteries become thicker with age as a result of the deposition of fat on their walls. The size of the left ventricle increases with age as a result of the dilation of heart muscles.
Which side effect of amlodipine will the nurse include when providing patient education? (30) Paradoxical blood pressure Central and peripheral cyanosis Postural orthostatic hypotension Dependent foot and ankle edema
Dependent foot and ankle edema Dependent foot and ankle edema is a common side effect of most antihypertensive drugs like amlodipine. It is caused by venous obstruction or lymphatic blockage of the extremity. Paradoxical blood pressure, central and peripheral cyanosis, and postural orthostatic hypotension are not side effects of amlodipine.
Which phrase describes the purpose of a thallium imaging scan? (30) Differentiates normal from diseased myocardium Determines cardiac motion and calculates ejection fraction Evaluates enzyme levels that indicate heart muscle breakdown Detects the location and extent of acute or chronic myocardial infarctions
Detects the location and extent of acute or chronic myocardial infarctions 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 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 evaluate cardiac motion and calculate ejection fraction. Cardiac enzyme markers such as troponin can be measured through serum blood levels. These increase with myocardial muscle injury and may be indicative of an acute myocardial infarction.
Which medication allergy is essential for a nurse to report before cardiovascular assessment when a patient is unable to perform an exercise-tolerance test on a treadmill? (30) Propranolol Dipyridamole Thallous chloride Fluoro-18-deoxyglucose
Dipyridamole Dipyridamole is administered to the patient who is unable to exercise on a treadmill. It is administered to simulate the effect of exercise in the patient because it causes vasodilation. Propranolol is a beta-blocker used for managing blood pressure in hypertensive patients. Thallous chloride is used in thallium imaging to identify perfusion deficits that cannot be identified during rest. Fluoro-18-deoxyglucose is used in positron emission tomography to compare cardiac perfusion and metabolic function and differentiate normal and myocardial tissue.
Which diagnostic test consists of elevating the patient's head to 20 degrees and placing a small transducer on the patient's chest at the level of the fourth intercostal space near the left sternal border? (30) Echocardiography ECG MRI Myocardial nuclear perfusion imaging
Echocardiography Echocardiography helps assess and diagnose cardiac tumors. The nurse prepares the patient by instructing the patient 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 ECG, the technician places electrodes on the patient's chest and attaches them to a multilead monitoring system. During MRI, the nurse ensures that the patient has removed all metallic objects. A myocardial nuclear perfusion imaging test involves injection of different types of radioactive isotopes into the antecubital vein to view, record, and evaluate cardiovascular abnormalities.
Which characteristic would not be included in an educational session for a patient with a disorder affecting cardiac muscle cells? (30) Elasticity Contractility Automaticity Refractoriness
Elasticity 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.
Which symptom will the patient suffering from dyspnea on exertion and congestive heart failure likely report during the health history? (30) Fatigue Slow heart rate Swelling of one leg Brown discoloration of lower extremities
Fatigue Although fatigue 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 (caused by low stroke volume) and anaerobic metabolism in skeletal muscle. Tachycardia, rather than bradycardia, develops with heart failure and decreased cardiac output. Unilateral swelling is more typical with a local finding such as deep vein thrombosis (DVT), not a systemic problem such as heart failure. Brown discoloration of the lower extremities is indicative of long-standing venous stasis, such as occurs with varicose veins.
Which noncardiac factor will the nurse assess for in a patient complaining of palpitations? Select all that apply. One, some, or all responses may be correct. (30) Fatigue Insomnia Hyperthyroidism Sinus tachycardia Paroxysmal supraventricular tachycardia
Fatigue Insomnia Hyperthyroidism 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.
Which formula is used to calculate cardiac output? (30) Heart rate × stroke volume Systolic - diastolic blood pressure Systolic pressure ÷ diastolic pressure Pulmonary artery diastolic = pulmonary artery wedge pressure
Heart rate × stroke volume -Cardiac output = heart rate × stroke volume. -Systolic - diastolic blood pressure = pulse pressure. -Systolic pressure ÷ diastolic pressure is an oversimplified equation for the mean arterial blood pressure. Under normal conditions, the pulmonary artery diastolic pressure is theoretically equivalent to the pulmonary capillary wedge pressure, but that does not answer the question.
Which physical assessment datum will the nurse document when calculating a patient's cardiac index? Select all that apply. One, some, or all responses may be correct. (30) Age Height Weight Sex Waist size
Height Weight Cardiac index is the cardiac output (CO) adjusted for a patient's body size or body surface area. Body surface area is calculated using height and weight measurements. Therefore the nurse requires height and weight physical assessment data to calculate a patient's cardiac index. Age, sex, and waist size are not required to calculate a patient's cardiac index.
Which will the nurse identify in patient education as a modifiable risk factor for coronary heart disease? (30) Age Sex Hypertension Family history
Hypertension Hypertension is modifiable with proper diet, smoking cessation, stress management, and/or medication. Age, sex, and family history cannot be changed.
Which class per the New York Heart Association's functional classification system will the nurse document when a patient with cardiovascular disease reports fatigue and palpitations with ordinary physical activity? (30) I II III IV
II As per the New York Heart Association's functional classification system, the patient with cardiac disease resulting in fatigue and palpitation with ordinary physical activity is classified as class II. Class I patients do not experience limitations with physical activity. Class III patients have marked limitation of physical activity; less-than-ordinary physical activity causes fatigue, palpitation, dyspnea, or angina pain. Class IV patients are unable to carry out any physical activity without discomfort, and symptoms of cardiac insufficiency or anginal syndrome may be present at rest.
Which class will the nurse document for a patient with symptoms of cardiac insufficiency at rest when charting according to the New York Heart Association's functional classification of cardiovascular disability? (30) I II III IV
IV According to the New York Heart Association's functional classification of cardiovascular disability, class IV consists of patients with symptoms of cardiac insufficiency, even at rest. Classes I, II, and III consist of patients who remain comfortable at rest.
Which change in the cardiovascular (CV) system secondary to aging results in decreased stroke volume (SV), ejection fraction, and cardiac output (CO) during exercise? (30) Decrease in pacemaker cells Calcification in aortic and mitral valves Increase in the size of the left ventricle (LV) Thickening of the aorta and other large arteries
Increase in the size of the left ventricle (LV) Changes to the cardiovascular system during aging include an increase in the size of the LV, resulting in decreased SV, ejection fraction, and CO during exercise. A decrease in pacemaker cells is associated with the sinoatrial (SA) node losing its inherent rhythm. Calcification in aortic and mitral valves is associated with valvular abnormalities. Thickening of the aorta and other large ventricles may result in hypertension.
Which change in heart function will the nurse anticipate when a patient presents to the emergency department after a motor vehicle accident and is extremely anxious with no apparent injuries? Select all that apply. One, some, or all responses may be correct. (30) Increased heart rate (HR) Decreased stroke volume (SV) Decreased cardiac output (CO) Decreased blood pressure (BP) Increased myocardial contractility
Increased heart rate (HR) Increased myocardial contractility After a motor vehicle accident, even with no injuries, the patient's sympathetic nervous system (fight or flight response) is on overdrive. The stimulation of the sympathetic nervous system causes increased HR and increased myocardial contractility. Decreased SV, CO, and BP are related to the parasympathetic nervous system responsible for slowing the HR.
Which portion of the heart receives blood supply by the right coronary artery (RCA)? (30) Papillary muscle Ventricular septum Chordae tendineae Inferior portion of left ventricle (LV)
Inferior portion of left ventricle (LV) The RCA originates from the right sinus of Valsalva, encircling the heart and descending toward the apex of the right ventricle (RV). It supplies blood to the inferior portion of the LV, right atrium, and RV. In half of people, the RCA supplies the sinoatrial node, and in almost everyone it supplies the atrioventricular node. The left main coronary artery is divided into the left anterior descending branch, 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, to a lesser extent, to the RV.
Which artery, if blocked, would lead to death of tissue in the anterior wall of the heart after a myocardial infarction? (30) Circumflex artery Right coronary artery Left anterior descending artery Posterior descending coronary artery
Left anterior descending artery 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 and inferior or diaphragmatic portion of the LV. The posterior descending coronary artery supplies the inferior wall, ventricular septum, and the papillary muscles.
Which action will the nurse delegate to trained and experienced assistive personnel (AP) working in the cardiac catheterization laboratory? (30) Assess any preprocedure medications the patient took that day. Obtain patient vital signs and a 12-lead ECG. Ask the patient to sign the consent form before the procedure is performed. Educate the patient about the need to remain on bedrest after the procedure.
Obtain patient vital signs and a 12-lead ECG. Obtaining vital signs and a 12-lead ECG are both tasks that can be delegated to trained and experienced AP in a cardiac catheterization laboratory. The AP is performing specific tasks for which they have been specially trained in that setting, and the data produced will be assessed and analyzed by the registered nurse (RN) and health care provider. Assessments and patient teaching should be performed by the RN. The health care provider will explain the catheterization procedure and ask the patient to sign the consent form before the procedure is performed.
Which clinical manifestation will be documented by the nurse when the patient reports an inability to sleep well at night because of difficulty breathing and the need for two or three pillows at night to promote sleep? (30) Fatigue Orthopnea Dyspnea on exertion (DOE) Paroxysmal nocturnal dyspnea (PND)
Orthopnea These signs and symptoms describe orthopnea. The patient is experiencing dyspnea upon lying flat, and several pillows are used to elevate the head and chest. The severity of orthopnea is measured by the number of pillows or amount of head elevation needed for restful sleep. This symptom is relieved by sitting or standing. Fatigue is described as a feeling of tiredness resulting from activity; fatigue that occurs after mild activity or exertion indicates inadequate cardiac output. Dyspnea associated with activity such as climbing stairs is referred to as DOE. PND develops after the patient has been lying down for several hours and then awakens abruptly, often with a feeling of suffocation and panic. This is relieved by sitting up and dangling the legs over the side of the bed.
Which condition will the nurse suspect when the patient reports an intermittent, sharp, stabbing pain that usually spreads to the left side or back and is relieved when sitting upright? (30) Angina Pericarditis Valvular dysfunction Myocardial infarction
Pericarditis The presence of intermittent sharp, stabbing pain that usually spreads to the left side or the back and is relieved when sitting upright indicates symptoms of pericarditis. Angina is indicated by a squeezing, viselike pain, usually on the left side of the chest without radiation, which lasts for less than 15 minutes and is relieved by rest. The presence of fluttering, racing, or irregular heartbeat, and symptoms of dizziness and fainting, indicates valvular dysfunction. Myocardial infarction is indicated by a continuous, intense stabbing or viselike pain that spreads throughout the anterior chest to the arms, jaw, back, or neck, which is relieved with morphine and cardiac drugs.
Which receptors are stimulated by hypoxemia? (30) Baroreceptors Stretch receptors Central chemoreceptors Peripheral chemoreceptors
Peripheral chemoreceptors 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 blood pressure. Stretch receptors are stimulated by hypovolemia. Increase in partial pressure of carbon dioxide (hypercapnia) may lead to stimulation of central chemoreceptors.
Which patient is appropriate for the registered nurse (RN) to assign the licensed practical nurse/licensed vocational nurse (LPN/LVN) with several years of experience in the ICU? (30) Diagnosis of pulmonary edema who requires hourly monitoring of pulmonary artery wedge pressures Acute coronary syndrome who has just been admitted and needs an admission assessment Complaints of intermittent chest pain and requires teaching about myocardial nuclear perfusion imaging Peripheral vascular disease and needs assessment of the ankle-brachial index
Peripheral vascular disease and needs assessment of the ankle-brachial index 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 role of the professional nurse is to perform assessment and develop the plan of care; the LPN/LVN may implement the plan. The scope of practice of the RN includes providing patient education; the LPN/LVN may reinforce that teaching.
Which factor influences the activity of the cardiovascular (CV) system? Select all that apply. One, some, or all responses may be correct. (30) Blood viscosity Physical activity Body temperature Aortic compliance Emotional behaviors
Physical activity Body temperature Emotional behaviors 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. Increased physical activity increases oxygen demand, resulting in increased blood pressure (BP) and heart rate. In hyperthermia the 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.
Which condition does the patient on a telemetry unit scheduled for an electrophysiologic study (EPS) likely have? (30) Pericarditis Post-sudden cardiac arrest Allergy to IV contrast An episode of acute coronary syndrome (ACS)
Post-sudden cardiac arrest EPS is performed for patients who experience sudden cardiac arrest or ventricular dysrhythmia. Pericarditis may be diagnosed with white blood cell count, erythrocyte sedimentation rate, and ECG. Allergies are reported by the patient or a member of the health care team after observing the allergic reaction. ACS is diagnosed with enzyme and cardiac markers and ECG.
Which laboratory result in a patient admitted with heart failure will the nurse report to the health care provider? (30) Calcium 8.5 mEq/L Potassium 3.0 mEq/L Magnesium 2.1 mEq/L International Normalized Ratio (INR) of 1.0
Potassium 3.0 mEq/L Normal potassium is 3.5 to 5.0 mEq/L; hypokalemia may predispose a patient to dysrhythmia, especially if the patient is taking digitalis preparations. A normal calcium level is 8.5 to 10.5 mEq/L A normal magnesium level is 1.7 to 2.4 mEq/L INR of 1.0 reflects a normal value
Which cardiac parameter will the nurse document as the degree of myocardial fiber stretch at the end of diastole, as determined by the amount of blood returning from the venous system to the right side of the heart and the pulmonary system to the left side of the heart? (30) Preload Afterload Impedance Stroke volume
Preload
Which does the nurse recognize as being the function of the semilunar valves? (30) Maintaining the forward flow of blood Separating the atria from the ventricles Dividing the left ventricle from the aorta Preventing blood from flowing back into the ventricles
Preventing blood from flowing back into the ventricles Semilunar valves prevent blood from flowing back into the ventricles. They are made up of the pulmonic valve and the aortic valve. The cardiac valves maintain the forward flow of blood through the chambers of the heart. The atrioventricular valves separate the atria from the ventricles. The aortic valve separates the left ventricle from the aorta.
Which body system will the nurse suspect is impaired when changes in oxygenation and tissue perfusion are noted, leading to alterations in the cardiovascular (CV) system? (30) Renal Neurologic Respiratory Integumentary
Respiratory The respiratory system is one of the systems that the CV system works in conjunction with to meet the human needs for oxygenation and tissue perfusion. Problems in this system require the CV system to work harder to meet oxygenation and tissue perfusion needs. The CV system does not work in conjunction with the renal, neurologic, or integumentary systems to meet the human needs for oxygenation and tissue perfusion; it works to serve the organs of these systems with life-sustaining oxygen and nutrients to meet the metabolic needs of the body.
Which structure of the heart receives deoxygenated venous blood and blood from the heart muscle? (30) Septum Pericardium Right atrium (RA) Left ventricle
Right atrium (RA) The RA receives deoxygenated venous blood, which is returned from the body through the superior and inferior vena cava. The septum is a muscular wall that separates the heart into two halves. The RA also receives blood from the heart muscle through the coronary sinus. The pericardium is a covering that protects the heart. The left ventricle receives reoxygenated blood.
Which characteristic clinical manifestation will the nurse document in the patient with peripheral cyanosis? (30) Rubor (dusky redness) in a dependent foot Bluish discoloration of the nail beds and earlobes Warmth and pink coloration in the palm and nail beds Moisture, coolness, and pale coloration in the palms and nail beds
Rubor (dusky redness) in a dependent foot The presence of rubor (dusky redness) in a dependent foot suggests peripheral cyanosis caused by arterial insufficiency. The presence of bluish discoloration of the nail beds and earlobes is referred to as cyanosis. 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.
Which will the nurse document as a risk factor related to cardiovascular disease? Select all that apply. One, some, or all responses may be correct. (30) Smoking Low blood pressure Consuming a diet rich in fiber Elevated C-reactive protein levels Elevated high-density lipoprotein (HDL) cholesterol level
Smoking Elevated C-reactive protein levels Smoking cessation should be emphasized; smoking is a major modifiable risk factor for cardiovascular disease. Elevation in C-reactive protein, suggestive of inflammation, is a risk factor for atherosclerosis and cardiac disease. Hypertension, not low blood pressure, is a risk for cardiovascular disease. A diet rich in fiber is not a risk factor for cardiovascular disease; rather, it is a desirable behavior. Elevated low-density lipoprotein (LDL) cholesterol is a risk for atherosclerosis; elevated HDL cholesterol is desirable and may be cardioprotective
Which description of the quality and severity of chest pain will lead the nurse to suspect angina? (30) Squeezing, viselike Intense stabbing, viselike Sharp stabbing, moderate to severe Moderate ache, worse on inspiration
Squeezing, viselike Angina is often described as a squeezing, viselike pain. Intense, stabbing pain that is viselike is associated with myocardial infarction. Sharp stabbing pain that is moderate to severe is associated with pericarditis. A moderate ache that is worse on inspiration is associated with pleuropulmonary pain.
Which receptors in the right atrium stimulate the sympathetic nervous system to cause peripheral blood vessel constriction when patients are dehydrated, leading to difficulty in gaining peripheral IV access? (30) Baroreceptors Stretch receptors Central chemoreceptors Peripheral chemoreceptors
Stretch receptors Stretch receptors are present in the vena cavae and the right atrium. When a patient is hypovolemic, stretch receptors in the blood vessels sense a reduced volume or pressure and send fewer impulses to the central nervous system (CNS). This reaction stimulates the sympathetic nervous system to increase the heart rate (HR) and constrict the peripheral blood vessels. Baroreceptors are present in the arch of the aorta and at the origin of the internal carotid arteries. These are stimulated when the arterial walls are stretched by an increased blood pressure (BP). Central chemoreceptors present in the respiratory center of the brain are stimulated by hypercapnia. Peripheral chemoreceptors are present in the carotid arteries and along the aortic arch. They send impulses along the vagus nerve to activate a vasoconstrictor response and raise the BP.
Which finding will the nurse document as a bruit during cardiac assessment? (30) A weak, thready pulse Pulse sounds upon auscultation with a stethoscope A bounding pulse The presence of swishing sounds
The presence of swishing sounds Bruits are swishing sounds that occur from turbulent blood flow in narrowed or atherosclerotic arteries. Hypokinetic pulse is a weak pulse indicative of a narrow pulse pressure and is seen patients with hypovolemia, aortic stenosis, and decreased cardiac output. There are no pulse sounds if the artery has uninterrupted blood flow or if the artery has 90% or greater blockage. A hyperkinetic pulse is a large "bounding pulse" caused by an increased ejection of blood and occurs in patients with a high cardiac output and in those with increased sympathetic system activity.
Which description would the nurse document as fatigue in a patient with cardiovascular disease? (30) Difficult or labored breathing A brief loss of consciousness Tiredness or weariness resulting from activity Feelings of fluttering or an unpleasant feeling in the chest caused by an irregular heartbeat.
Tiredness or weariness resulting from activity Fatigue is a feeling of tiredness or weariness resulting from activity. Dyspnea refers to difficult or labored breathing. A brief loss of consciousness is referred to as syncope. Palpitation is a feeling of fluttering or unpleasant feeling in the chest caused by an irregular heartbeat.
