Unit 3: Cardiovascular (Ch. 25)

Myocardium

muscle layer of the heart responsible for the pumping action of the heart

During the refractory period

When caring for a client with dysfunction in the conduction system, at which period would the nurse note that cells are resistant to stimulation?

Pulmonary artery wedge pressure

When the balloon on the distal tip of a pulmonary artery catheter is inflated and a pressure is measured, the measurement obtained is referred to as which of the following?

Initiates the parasympathetic response

Which of the following is a true statement regarding the role of baroreceptors?

Fatigue

Which of the following is an early warning symptom of acute coronary syndrome (ACS) and heart failure (HF)?

Transesophageal echocardiography

A 24-year-old obese woman describes her symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm his suspected diagnosis. What diagnostic would you expect him to prescribe?

• Wet lung sounds • Wheezes

A client in the cardiac unit is undergoing procedures to determine the extent of his left-sided heart failure. As his nurse, what adventitious lung sounds would you expect to hear during your auscultation of his lungs to support his diagnosis?

Continue to monitor the client as ordered

A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate?

Thready pulse

A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate?

Fingers, hands

A nurse is completing a head to toe assessment on a patient diagnosed with right-sided heart failure. To assess peripheral edema, which of the following areas should be examined?

Irregularly irregular heart rate

A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation?

Decreases myocardial contractility

A patient has a high magnesium level. Identify how hypermagnesemia affects cardiac function.

Right sided heart failure

A patient in the ICU has a central venous pressure (CVP) line placed. The CVP reading is 10 mm Hg. The nurse would interpret this reading as being related to which of the following?

Dipyridamole (Persantine)

A patient is being scheduled for a stress test. The patient is unable to exercise during the test. The nurse would include information about which medication used for pharmacologic stress testing?

"The aortic arch causes the closure of the aortic valve to be heard best on the right side of the sternum."

A student nurse is to perform a cardiac assessment for a client and asks the instructor why the aortic valve closure is best heard on the right side of the sternum. The best response of the nurse is which of the following?

Automaticity

Ability to initiate an electrical impulse

Excitability

Ability to respond to an electrical impulse

Conductivity

Ability to transmit an electrical impulse from one cell to another

Endocardial fibrosis

Age-related changes associated with the cardiac system include

Determination of atrial thrombi

Which of the following would be an indication for a transesophageal echocardiography (TEE)?

electrocardiogram (ECG)

Following a myocardial infarction, a client develops an arrhythmia and requires a continuous infusion of lidocaine. To monitor the effectiveness of the intervention, the nurse should focus primarily on the client's:

Heart block

Identify which of the following as an age-related change associated with conduction system of the heart?

Hemorrhage, sepsis, and anaphylaxis

In presenting a workshop on parameters of cardiac function, which conditions should a nurse list as those most likely to lead to a decrease in preload?

Right-sided heart failure

One of your students asks what the consequences of uncorrected, left-sided heart failure would be. What would be your best response?

You will receive medication via IV administration

The cardiologist has scheduled a 57-year-old male client for drug-induced stress testing. To prepare the client for this test, the nurse should instruct him about which of the following?

In pediatric clients

The critical care nurse is caring for clients in an emergency department. When caring for a variety of clients, when is the presence of a third heart sound normal?

Cardiac catheterization

The nurse accompanies a client to an exercise stress test. The client can achieve the "target heart rate," but the ECG leads show an ST-segment elevation. The nurse recognizes this as a "positive" stress test, and will begin to prepare the client for which of the following procedures?

• Jugular vein distention • Increased dyspnea • Increased palpitations • Increased weakness on ambulation

The nurse is caring for a client on the cardiac unit. Which change of condition may indicate potential increasing of right-side heart failure?

Irregular heart rate

The nurse is caring for a client who is diagnosed with an infarction of the posterior wall of the right atrium. Which assessment finding would the nurse anticipate relating to the infarction location?

Right ventricle

The nurse is caring for a client with nursing diagnosis of ineffective tissue perfusion. Which area of the heart would the nurse anticipate being compromised?

Disorientation, 20 mL of urine over the last 2 hours

The nurse is caring for a patient in the ICU diagnosed with coronary artery disease (CAD). Which of the following assessment data indicates the patient is experiencing a decrease in cardiac output?

Hypervolemia

The nurse is caring for a patient in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the patient's CVP as 8 mm Hg. The nurse understands that this finding indicates the patient is experiencing which of the following?

"Are you allergic to shellfish?"

The nurse is caring for a patient with diabetes who is scheduled for a cardiac catheterization. Prior to the procedure, it is most important for the nurse to ask which of the following questions?

• How would you describe your symptoms? • Are you allergic to any medications or foods? • How did your mother die?

The nurse is interviewing a client who is complaining of chest pain. Which of the following questions related to the client's history are most important to ask?

ST-segment changes on the ECG

The nurse is observing a patient during an exercise stress test (bicycle). Which of the following findings indicates a positive test and the need for further diagnostic testing?

"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours."

The nurse is reviewing discharge instructions with a patient who underwent a left groin cardiac catheterization 8 hours ago. Which of the following instructions should the nurse include?

• Remove the patient's Transderm Nitro patch. • Remove the patient's jewelry. • Offer the patient a headset to listen to music during the procedure.

The nurse is screening a patient prior to a magnetic resonance angiogram (MRA) of the heart. Which of the following actions should the nurse complete prior to the patient undergoing the procedure?

Heart failure

You are teaching a group of nursing students about adventitious heart sounds. You explain that auscultation of the heart requires familiarization with normal and abnormal heart sounds. What would you tell these students a ventricular gallop indicates in an adult?

Palpate a peripheral pulse

You are working on a telemetry unit. Your client was admitted with a cardiac event and is now on a cardiac monitor. You know a cardiac monitor reveals the heart's electrical but not its mechanical activity. How would you assess the mechanical activity of the client's heart?

"Echocardiography is a way of determining the functioning of the left ventricle of your heart."

Your client is being prepared for echocardiography when he asks you why he needs to have this test. What would be your best response?

Hypotension

a decrease in blood pressure to less than 100/60 mm Hg that compromises systemic perfusion

Postural (Orthostatic) Hypotension

a significant drop in blood pressure (20 mm Hg systolic or more) after an upright posture is assumed

Cardiac Stress Test

a test used to evaluate the functioning of the heart during a period of increased oxygen demand; test may be initiated by exercise of medications

Contractility

ability of the cardiac muscle to shorten in response to an electrical impulse

Opening Snaps

abnormal diastolic sound generated during opening of a rigid AV valve leaflet

Summation Gallop

abnormal sounds created by the presence of an S3 and S4 during periods of tachycardia

Systolic Click

abnormal systolic sound created by the opening of a calcified aortic or pulmonic valve during ventricular contraction

Stroke Volume

amount of blood ejected from one of the ventricles per heartbeat

Cardiac Output

amount of blood pumped by each ventricle in liters per minute

S3

an abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure

S4

an abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertrophy of the ventricle

Cardiac Catheterization

an invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries

HTN

blood pressure that is persistently greater than 140/90 mm Hg

Myocardial Ischemia

condition in which heart muscle cells receive less oxygen than needed

Preload

degree of stretch of the cardiac muscle fibers at the end of diastole

Depolarization

electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell

Apical Impulse

impulse normally palpated at the fifth intercostal space, left midclavicular line; caused by contraction of the left ventricle; also call the PMI

Baroreceptors

nerve fibers located in the aortic arch and carotid arteries that are responsible for control of the blood pressure

Ejection Fraction

percentage of the end-diastolic blood volume ejected from the ventricle with each heartbeat

Systole

period of ventricular contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta

Diastole

period of ventricular relaxation resulting in ventricular filling

SA Node

primary pacemaker of teh heart, located in teh right atrium

Acute Coronary Syndrome

refers to rupture of an atheromatous plaque in a diseased coronary artery, which rapidly form an obstructive thrombus

Systemic Vascular Resistance

resistance to blood flow out of the left ventricle created by the systemic circulatory system

Pulmonary Vascular Resistance

resistance to blood flow out of the right ventricle created by the pulmonary circulatory system

Repolarization

return of the cell to resting state, caused by reentry of potassium into the cell while sodium exits the cell

AV Node

secondary pacemaker of the heart, located in the right atrial wall near the tricuspid valve

Murmurs

sounds created by abnormal, turbulent flow of blood in the heart

Normal Heart Sounds

sounds produced when the valves close

Cardiac Conduction System

specialized heart cells strategically located throughout the heart that are responsible for methodically generating and coordinating the transmission of electrical impulses to the myocardial cells

Afterload

the amount of resistance to ejection of blood from the ventricle

Pulse Deficit

the difference between the apical and radial pulse rates

S1

the first heart sound produced by closure of teh AV valves

Telemetry

the process of continuous electrocardiographic monitoring by the transmission of radio waves from a battery-operated transmitter worn by the patient

S2

the second heart sound produced by closure of the semilunar valves

Hemodynamic Monitoring

the use of pressure monitoring devices to directly measure CV function

Radioisotopes

unstable atoms that give off small amounts of energy in the form of gamma rays as they decay; used in cardiac nuclear medicine studies