Quiz 3
A patient is reading a brochure on atherosclerosis while in the waiting room of a medical clinic. Which excerpts from the educational brochure warrants correction?
"Because smoking causes a permanent increase in your risk of heart disease, it's best not to start." - Cessation of smoking is associated with a decrease in the risk of CHD. Males have an increased risk of atherosclerosis. Atherosclerosis is often associated with hypertension. Lowering cholesterol levels brings a commensurate reduction in risk of CHD.
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." - While atrial contraction can range from 400-600bpm, ventricular contraction is normally in the range of 80-180bpm during atrial fibrillation. The electrical impulses do go in chaotic, inappropriate directions and the ECG can appear random. Measurement can be challenging because of the lack of pulses corresponding to all ventricular contractions.
When a 55-year old patients routine blood work returns, the nurse notes that their C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds:
"This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease." - CRP is a serum marker for systemic inflammation. Elevated levels are associated with vascular disease. The normal metabolism of homocysteine requires adequate levels of folate, vitamin B6, vitamin B12, and riboflavin. CRP is not associated with red meat consumption. LDL is an independent risk factor for development of premature coronary heart disease.
In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels?
A 51-year old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness - Hemorrhagic stroke is not a pathology noted to be associated with secondary hypercholesterolemia. Diabetes, thyroid medications, estrogen therapy, obesity, and beta-blocker medications are all correlated with hypercholesterolemia.
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. - Ventricular fibrillation, or ventricular flutter, is a life-threatening emergency that would necessitate immediate intervention. Ventricular tachycardia is also a serious condition, but less so than ventricular fibrillation. PVCs and a first-degree AV block would not normally require emergency intervention.
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. - During a changed in body position, blood is rapidly relocated from the central circulation (when the patient is recumbent) to the lower extremities (when the patient stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.
A patient arrives at the ED complaining of numbness in left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses non-palpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on that fact that:
Acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow. - The presentation of acute arterial embolism is often described as that of the seven "P's". Pallor, polar, pulselessness, pain, paresthesia, and paralysis ... Treatment is aimed at restoring blood flow. Embolectomy, thrombolytic therapy, anticoagulant (heparin) usually given. Application of cold should be avoided.
An 81-year old female client of a long term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indictor for the assessment of the client's condition?
Blood backs up into the jugular vein because there are no valves at the point of entry into the heart - Because there are no valves at the entry points to the atria, congestion can result in engorgement of the jugular veins which are proximal to the heart. Increased cardiac demand is not associated with engorgement of vessels or peripheral dilation.
In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of:
Decreasing cardiac output due to less ventricular filling time - One of the dangers of ventricular tachycardia is a reduction in cardiac output because the heart does not have time to fill adequately
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?
Left ventricle - The right atrium receives blood returning to the heart from the systemic circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.
During a routine physical exam for patient diagnosed with hypertension, the nurse practitioner will be most concerned if which of the following assessments are found?
Noted hemorrhages and microaneurysms during evaluation of internal eye - Hypertension affects the eye in sometimes devastating ways. If there are acute increases in BP, hemorrhages, microaneurysms, and hard exudates can manifest. Vibrations relate to hearing loss. The kidneys should not be palpable to touch. Varicose veins are not associated with hypertension.
A group of novice nursing students are learning how to manually measure a client's blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct?
Undercuffing yields a blood pressure reading that is overestimated. The cuff should be inflated to 30 mmHg above palpated systolic pressure, and is both dependent on clear auscultation of the Karotkoff sounds. The properly performed manual method is more accurate than automated measurement.
The nurse is caring for a client with small veins. The nurse can improve the chance of successfully drawing a blood sample by applying the principled of critical closing pressure and:
Using minimal negative pressure when drawing the sample into the syringe. - The critical closing pressure refers to the point at which blood vessels collapse so that blood can no longer flow through them. The nurse should not withdraw the blood quickly as this can cause the vein to contain too little blood to keep the walls patent. Raising the limb would cause less blood to be present due to the effects of gravity. Flushing the vein prior to drawing the sample would dilute the sample and make the results inaccurate.
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 - Compliance refers to the total quantity of blood that can be restored in a given portion of the circulation for each mm Hg rise in pressure. The most distensible of all vessels are the veins, which can increase their volume with only slight changes in pressure. This allows the veins to function as a reservoir for storing large quantities of blood that can be returned to the circulation when it is needed. Liver, pancreas, and kidneys are not vascular components.
Which of the following statements most accurately captures a principle of blood flow?
With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow. - Doubling the radius of a vessel is associated with a fourth-power increase in flow, provided pressure remains constant. Blood flow is primarily a function of blood pressure, resistance and viscosity. The small size of capillaries is associated with quite slow velocity, given their total combined cross-sectional area. Smaller cross-sectional area is associated with greater velocity.