patho 17
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?
Tunica media
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
As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function?
"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."
A local athlete is getting prepared for the upcoming national track and field championships. Since this athlete is performing extreme exercise, what would be the most probable cardiac output?
16 to 36 L/minute
The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body?
1800
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%
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
In which of the following situations would blood be 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 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?
A membranous sac that encloses the heart
Which of the following is true regarding pulmonary circulation?
It is a low-pressure system that allows for improved gas exchange.
The nurse is assessing a client said to be in sinus rhythm. What does the nurse expect to find when evaluating the electrocardiogram? Select all that apply.
A p before every QRS wave A rate between 60 and 100 beats per minute Constant R to R intervals
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 which of the following?
AV nodal block
When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?
An ejection fraction of 40%
Select the correct sequence of blood return to the heart.
Capillaries, venules, veins, right atrium
The heart valves control the direction of blood flow. What is the function of the pulmonic valve?
Controls the direction of blood flow from the right side of the heart to the lungs
While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?
Decreased heart rate as a result of parasympathetic innervation of the heart
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
Respiratory sinus arrhythmia is considered a more optimal rhythm than a rhythm where all RR intervals are equal. In respiratory sinus arrhythmia, what is the variation in cardiac cycles related to?
Intrathoracic pressure changes that occur with respiration
The lymph system correlates with the vascular system without actually being a part of the vascular system. Among other things, the lymph system is the main route for the absorption of fats from the gastrointestinal system. The lymph system empties into the right and left thoracic ducts, which are the points of juncture with the vascular system. What are these points of juncture?
Junctions of the subclavian and internal jugular veins
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
Which organs has larger capillary pores to allow the exchange of gases, nutrients, and/or waste products?
Liver
The physician states that a client has adequate collateral circulation. The nurse interprets this as
Long-term compensatory regulation of blood flow
Resistance to flow is determined by the diameter of the blood vessels and the blood vessel itself. An equation has been developed for understanding the relationship between the diameter of the blood vessel, the viscosity of the blood, and resistance. What is the equation called?
Poiseuille law
Which of the following occurs during repolarization?
Positively charged K+ moves outward across the cell membrane
A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart?
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
The nurse is teaching a client diagnosed with heart failure about preload. Which of the following would be the most appropriate information to provide?
Preload represents the volume work of the heart.
The nurse is evaluating a client with cardiac problems and notes that the client's peripheral pulse is different than the apical pulse. To which physiologic response would the nurse attribute the difference in rates?
Premature beats not following normal conduction pathways
The heart consists of four valves. Which are the semilunar values? Select all that apply.
Pulmonary Aortic
The circulatory system is divided into two parts. What does the pulmonary circulation include? Select all that apply.
Pulmonary artery Pulmonary veins Right heart
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
Following angioplasty for a blocked coronary artery following a myocardial infarction, a client is prescribed serial 12-lead ECGs for three days. On the second day the nurse notices a distinct difference in the QRS morphology from the previous ECG. Which is the best action for the nurse to take?
Repeat ECG with proper lead placement.
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
Right sided heart failure
Which of the following is called the pacemaker of the heart?
SA node
When trying to explain to a new dialysis patient the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:
Small openings that allow large amounts of smaller molecular substances to filter through the glomeruli.
A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?
Sympathetic nervous system
A nurse is evaluating a client to determine the effectiveness of medications given to reduce left ventricular afterload. Which hemodynamic parameter is most appropriate for the nurse to monitor?
Systemic vascular resistance (SVR)
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 increased pressure related to right heart failure.
Select the client who may be at risk for developing an increase in resistance to blood flow.
The client in hypovolemic shock experiencing extreme dehydration
A nurse educator is teaching a group of nurses at a long term care facility about atrial fibrillation in light of its prevalence in older adults. Which of the following statements by the nurses would the educator most want to correct?
The contraction of the ventricles and the atria can range from 400-600 beats per minute
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.
A client is visiting the primary physician and appears extremely nervous. The intake nurse does his vital signs and notes an increase in both his heart rate and blood pressure. In an effort to better understand the client's presenting signs and symptoms the nurse asks the client about his concerns and the client states that the person who performed his pre-visit told him that he had an arrhythmia. Which is the most therapeutic response about cardiac arrhythmias that the nurse can make?
They can occur in diseased or healthy hearts.
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
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.
A client with a history of angina presents with uncharacteristic chest pain. The subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which aspects of the cardiac cycle?
Ventricular repolarization
Which of the following neurotransmitters is associated with the parasympathetic nervous system?
acetylcholine
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
Which of the following blood vessels function without the benefit of having walls comprised of three muscular layers?
capillaries
Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability?
histamine
If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations?
increased heart rate and increased contractility
Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?
it documents only current cardiac function.
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?
laminar
An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:
many people live with atrial fibrillation without even knowing they have it.
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.
tricuspid mitral
A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The man's nurse has been educating him around his diagnosis and treatment and answering the numerous questions he has about his health problem. Which of the following teaching points should the nurse include in this patient teaching?
"The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently."
Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in resulting in resting membrane potential.
A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which of the following assessments should the nurse complete?
Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves
When explaining to a patient why they only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to:
Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually.
A nurse is monitoring the electrocardiogram (ECG) of a patient with a recent right ventricular infarction. The ECG reveals a first-degree arterioventricular (AV) block, which is characterized by which of the following?
PR interval >0.20 seconds
A 72 year old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds:
Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.
A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?
High afterload because of backpressure against the left ventricle.
The nurse is assisting a patient who had a myocardial infarction 2 days ago during a bath. The patient suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the patient was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. Which of the following is a priority intervention at this time?
Immediate defibrillation
The nurse assesses the electrocardiogram for depolarization of the atria. What portion of the ECG will the nurse be assessing?
P wave above the baseline
ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?
Most ECG-detected ischemic events are clinically silent.
A client has had an acute myocardial infarction (MI). 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.
Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:
ST times HR
A group of nursing students is discussing ventricular arrhythmias 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.
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?
left ventricle
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 one year ago. Which of the following does the nurse suspect is the problem?
lymphedema
A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?
notify the physician
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
Which sequence is the correct pathway for blood flow through the heart?
right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?
nitric oxide
A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention?
A 69-year-old woman who has entered ventricular fibrillation.
A grandmother, 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
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
Which blood vessel layer is made primarily of muscle?
tunica media
During an automobile accident where the patient is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need?
veins
Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?
ventricular fibrillation
The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?
ventricular repolarization
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues .
