Cardiovascular System
QRS interval
- <0.12 sec - Depolarization from the AV node throughout ventricles
Number in sequence the path of the action potential along the conduction system of the heart.
1. Sinoatrial node 2. Right & Left Atrial cells 3. Internodal pathways 4. Atrioventricular (AV) node 5. Bundle of His 6. Right &Left Bundle branches 7. Purkinje fibers 8. Ventricular cells
During a physical examination of a patient, the nurse performs a capillary refill test. What test finding should the nurse consider as normal?
Capillary refill time of one second The capillary refill test assesses arterial flow to the extremities. The fingernail is pressed and the time required for refilling of blood is noted. This refill is appreciated by the change in the color of the nail bed. This should occur in less than 2 seconds with normal tissue perfusion and cardiac output. Capillary refill times of four seconds, six seconds, and eight seconds indicate an underlying defect in circulation.
The nurse is completing a physical assessment on a clinic pt who has been complaining of fatigue and intermittent chest pain over the last several weeks. Upon auscultation of the chest, the nurse hears an S1, S2, and S3. Bc of these findings, the nurses priority will be to assess for which other finding?
Lung sounds for crackles. S1 and S2 heart sounds are normal. An S3 indicates excess fluid, and the nurse would want to assess for crackles in the lungs. The nurse might also check for JVD, peripheral edema, ascites, and other signs of fluid overload.
The nurse notes JVD when the pt is lying flat in bed. Which nursing action is indicated??
Place pt in a supine position & raise HOB 30 degrees for reassessment.
The nurse is reviewing basic electrocardiogram (ECG) interpretation. The T wave represents which action?
Repolarization of the ventricles
While completing the health history of a pt with a suspected cardiac disorder, the nurse would ask about which childhood illnesses?
Rheumatic fever & Strep throat infections. Rheumatic fever & Streptococcal throat infections are caused by beta-hemolytic streptococci, which have a propensity to form growths and calcium deposits on the leaflets of heart valves.
A nurse is caring for a patient who is a smoker with a two-year history of using oral contraceptives. Based on the findings, the patient should be assessed for which condition?
Venous thromboembolism Long-term use of oral contraceptives can lead to serious side effects. In addition, smoking enhances the risk of developing complications such as venous thromboembolism. Hypotension is not an effect of oral contraceptives. Similarly, contraceptives do not affect the muscles of the heart and do not cause cardiomyopathy. Dependent edema is not a common side effect of oral contraceptives.
Heart murmur grade I/VI
murmur very soft, barley audible.
While assessing a patient for orthopnea, what is an appropriate question for the nurse to ask?
"How many pillows do you use for sleeping at night?" Patients with heart failure often experience orthopnea. This refers to a condition in which patients may feel the need to sleep with their head elevated and use several pillows to sleep upright. When assessing a patient for nocturia, the nurse asks how frequently the patient gets up at night to urinate. When assessing the patient for paroxysmal nocturnal dyspnea, the nurse asks if the patient wakes up at night due to shortness of breath at night. When checking for shortness of breath during daily activities, the nurse asks the patient whether the patient is comfortable while walking and talking at the same time.
The nurse provides education to a patient that is scheduled for a transesophageal echocardiogram (TEE). Which statement made by the patient indicates the need for more instruction?
"I will be able to have lunch as soon as the test is finished" Patient instructions for a transesophageal echocardiogram (TEE) include remaining nothing by mouth (NPO) for at least six hours before the test, removing dentures, and having a designated driver if the patient has the test as an outpatient. The patient may not eat or drink until the gag reflex has returned.
A patient with a myocardial infarction is preparing for discharge, following successful treatment. What is important for the nurse to include in the discharge teaching related to elimination?
"It is important to avoid straining during bowel movements." It is extremely important that the patient doesn't strain during bowel movement. Straining during bowel movement puts pressure on the heart for circulation of blood. This can aggravate heart troubles. Passing stools after food and passing stools more than once a day are absolutely fine and do not affect the patient. Advising the patient to take unsupervised over-the-counter (OTC) drugs is not advisable, because they can be detrimental to the patient's health.
Which instruction should the nurse give to a patient that is scheduled for Holter monitoring?
"Keep a diary of all activities and symptoms." A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor. Normal patient activity is encouraged to stimulate conditions that produce symptoms. Event monitoring involves the starting of a recording as soon as symptoms begin or as soon thereafter as possible.
Which instruction should the nurse give to a patient that is scheduled for Holter monitoring?
"Remove the monitor only to shower or bathe." A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor. Normal patient activity is encouraged to stimulate conditions that produce symptoms. Event monitoring involves the starting of a recording as soon as symptoms begin or as soon thereafter as possible.
A pt has mild pitting edema over the legs. A -inch indentation remains in the tissue after the nurse depresses it with a finger. The nurse would document this finding as +______ pitting edema.
+1 +1 edema is mild edema in which finger pressure leaves a -inch indentation. +2 edema is moderate, a - to -inch indentation.
The nurse assesses full and bounding pulses in a pt being assessed for cardiac risk factors. The nurse would document this finding as +_____ pulses.
+3 Full and bounding pulses should be documented as +3 pulses.
A review of the medical record reveals that a pt has been diagnosed with paroxysmal nocturnal dyspnea (PND). Which questions would the nurse ask to assess the status of this condition? Select all that apply.
- "Are you still waking up at night b/c you are SOB?" - "How long after you go to bed do you start having trouble breathing?" PND is dyspnea that occurs an hour or so after retiring. It is caused by the redistribution of body fluids. PND generally occurs 1-2HRS after pt goes to bed.
PR interval
- Measured from beginning of P wave to beginning of QRS complex - 0.12-0.20
While palpating the arteries of a patient with cardiovascular disease, the nurse rates the force of the pulse as weak. How should the nurse document the assessment finding?
1+ A weak pulse in a patient with cardiovascular disease is indicated by 1+. Absence of a pulse is indicated by 0. A normal pulse rate is indicated by 2+, and 3+ indicates an increased, full, bounding pulse.
When measuring the blood pressure of a patient, the nurse should perform the steps of the procedure in what order?
1. Place the appropriate size cuff on the upper arm. 2. Inflate the cuff to 20 to 30 mm Hg above the estimated systolic blood pressure (SBP). 3. Lower the cuff pressure and auscultate the artery. 4. Note the tapping sound as the systolic blood pressure (SBP). 5. Note the diastolic pressure when the sound disappears. The nurse should first place the appropriate size of cuff on the upper arm. This is because the brachial artery is the recommended site for measuring blood pressure, and the wrong cuff size can give an inaccurate reading. The cuff is then inflated to a pressure 20 to 30 mm Hg above the most recently recorded SBP. This causes the blood flow in the artery to cease. The nurse should then lower the pressure in the cuff while auscultating the artery and also note the first phase of the Korotkoff sound. It is a tapping sound caused by the spurt of blood into the constricted artery. This is the SBP. Finally, when the sound disappears, the nurse notes the diastolic pressure.
During a physical examination of a patient, where should a nurse auscultate for the aortic area?
2nd intercostal space to the right of the sternum The surface anatomy for the aortic area is in the second intercostal space to the right of the sternum. The pulmonic area is in the second aortic area to the left of the sternum. The tricuspid area is in the fifth left intercostal space. No auscultation is performed in the fifth right intercostal space.
The blood pressure of a patient is 90/60 mm Hg. What should the nurse document as the patient's pulse pressure? Record the answer using a whole number. ________ mm Hg
30 The difference between the systolic blood pressure (SBP) and diastolic blood pressure (DBP) is the pulse pressure. The patient's systolic blood pressure is 90, and the diastolic blood pressure is 60; therefore the pulse pressure is 90 - 60 = 30 mm Hg.
Studies show that 0.070 L of blood is ejected from the ventricle with every heartbeat. A patient's heart rate is 72 beats/min. What cardiac output value should the nurse document in the patient's medical record? Record the answer using a whole number. ___________ L/min
5.0 The amount of blood ejected from the ventricle with each heartbeat is known as the stroke volume. Therefore, this patient's stroke volume is 0.070 L. Cardiac output (CO) is calculated by multiplying the stroke volume (SV) by the heart rate (HR), or CO = SV × HR. Therefore, CO = 0.070 × 72 = 5.0 L/min.
Immediately after completing an exercise class, a patient's blood pressure is 140/85 mm Hg. The nurse calculates the pulse pressure and should document what number? Fill in the blank using a whole number. ____
55 Pulse pressure is the difference between the systolic blood pressure and the diastolic blood pressure. 140 - 85 = 55.
A pt is being evaluated for intermittent chest pain. The nurses concern about a cardiac origin for this pain would be increased if the pt reports his mother had an MI at the age of ______ y/o or younger.
55. The pts risk for cardiac dysfunction increases if a blood relative had CAD at or under age 55.
A wheelchair-bound patient is scheduled for a multigated acquisition (MUGA) scan to aid in the diagnosis of coronary artery disease (CAD). The nurse most expects which revisions in the test procedure will be made?
Adenosine will be administered intravenously (IV). A multigated acquisition (MUGA) scan is a common nuclear imaging test for heart wall motion during systole and diastole. Because the patient is unable to exercise, IV adenosine (Adenocard) will be given to dilate the coronary arteries and simulate the effect of exercise. The nurse will monitor vital signs, but this is not the priority action at this time. A 12-lead ECG will not be performed at this time. The patient will not be prepared for the treadmill, because he or she is unable to exercise.
The S1 heart sound corresponds to which physiological event?
Closure of the AV valves.
The S2 heart sound corresponds to which physiological event?
Closure of the Semilunar valves.
What does the QRS complex represent in an electrocardiogram?
Depolarization of both ventricles An electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the cause of chest pains. Time taken for depolarization of both the ventricles is represented by the QRS interval. Depolarization of the atria is represented by the P wave. The T wave in the electrocardiogram should be upright, and it represents time for ventricular repolarization. If present, the U wave indicates the repolarization of the Purkinje fibers.
The nurse is assessing a pts heart & believes a pericardial friction rub is present, but it is very faint. Which technique might help the nurse hear this sound more clearly?
Have the pt lean on the overbed table. This maneuver causes the heart to be closer to the chest wall.
When auscultating the chest of a 75 y/o pt who recently experienced a MI, the nurse hears an S3 heart sound immediately following S2. B/c of these findings, the nurse would assess for which other condition?
Heart failure. S3 immediately following S2 is called a ventricular gallop and is an indication of heart failure. Renal failure is a late complication of heart failure & is not manifested with an S3.
The nurse provides information to a group of nursing students about cardiac output. What information should be included in the teaching?
It is calculated by multiplying the patient's stroke volume by the heart rate. Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a one-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.
The nurse is conducting a physical examination of a pt's heart. Where will the nurse place the stethoscope to best assess the S1 heart sound?
Left midclavicular line at the 5th intercostal space. S1 is the sound produced by the atrioventricular (AV) valves closing. The apex of the heart is located lower on the left chest wall than the base of the heart. The loudest sounds can be heard over the apex of the heart.
The nurse reviews an elderly patient's electrocardiogram and recognizes that what finding indicates cellular aging and fibrosis of the conduction system?
Lengthened QT intervals Lengthened QT intervals in an elderly patient's electrocardiogram indicate cellular aging and fibrosis of the conduction system. The patient with cellular aging and fibrosis of the conduction system is characterized by irregular cardiac rhythms, lengthened PR, QRS complex, and a decreased amplitude of QRS complex.
The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. The nurse identifies that what age-related change contributes to this finding?
Loss of elasticity in arterial vessels An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel and hypertension results. Valvular rigidity of aging causes murmurs and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate.
A patient's laboratory report reveals increased creatine kinase (CK-MB) enzymes. The nurse suspects what diagnosis?
Myocardial infarction (MI) Creatine kinase (CK-BB) enzymes are present in the cardiac muscle and are released into the blood due to cell injury. An increase in creatine kinase (CK-MB) enzymes indicates the onset of symptoms of myocardial infarction (MI). Homocysteine is an amino acid produced during protein catabolism; elevated levels of this amino acid are an indication of stroke, coronary artery disease (CAD), and peripheral vascular disease (PVD).
While assessing the cardiovascular status of a patient, what technique should the nurse use to assess for the presence of a pulse deficit?
Palpate the radial pulse while auscultating the apical pulse To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation. The diaphragm is more appropriate than the bell when auscultating S1 and S2.
A pt presents to the med-surg unit confused and with a BP of 90/50. Which assessment findings would support the nurses concern that the pt has low cardiac output?
Prolonged capillary refill & diminished peripheral pulses. The pt with low cardiac output will have signs of poor circulation, such as prolonged capillary refill and diminished peripheral pulses.
A nurse is performing a cardiac assessment. How should the nurse assess for jugular venous distention in the patient?
Raise the patient to approximately 45 degrees. Jugular venous distention can be seen in right-sided heart failure. In this condition the large veins in the neck are distended due to the back-pressure exerted by the blood. It is best appreciated when the patient is raised to approximately 45 degrees or slightly less. This exerts pressure and helps in visualization of jugular veins. Placing the patient in other positions like supine, sitting, leaning, or standing does not help in clear visualization of jugular venous distention.
While palpating a thrill on the precordium, the nurse recognizes that this sign is associated with which cardiac condition?
Severe valve stenosis A palpable thrill over the precordium is indicative of valvular disorders such as stenosis.
The nurse assesses a patient with anxiety and expects which type of pulse?
Tachycardia Tachycardia is associated with anxiety due to increased adrenaline. A thready pulse is associated with peripheral arterial disease, aortic valve disease, and decreased cardiac output. The pulse is irregular in patients with cardiac dysrhythmias. Pulsus alternans is observed in patients with heart failure and cardiac tamponade.
A pt presents with complaints of intermittent chest pain. The nurse assesses that the pt holds a high-stress job and is a Type A personality. How can the nurse best explain the importance of reducing cardiac risk factors?
The exposure to chronic stress increases the workload for the heart. Managing stress in a healthy manner will help decrease the risk factors for cardiovascular disease. Current and previous job stresses can contribute to an increased risk for cardiovascular disease by increasing the workload on the heart. Stress is unavoidable, so the pt should find healthy ways to manage stress.
A nurse is reviewing a patient's laboratory results: blood cholesterol level of 350 mg/dL; homocysteine level of 14 µmol/L; b-Type natriuretic peptide (BNP) of 90 pg/mL; Troponin I (cTnI) level of 0.3 ng/mL; myoglobin level of 16 mcg/L, and C-reactive protein of 4 mg/L. What should the nurse interpret from the lab reports?
The patient has a high risk of cardiovascular disease. The patient has a high risk of developing cardiovascular disease as evident by the high cholesterol levels, the homocysteine levels, and the C-reactive protein level. High cholesterol levels directly impact the heart and the blood vessels. A high homocysteine level indicates amino acid production during protein catabolism. It can harm the endothelium. C-reactive protein is a marker of inflammation, and a level of >3 mg/L indicates high risk of cardiac disease. The patient has normal levels of troponin and myoglobin, which are indicators of myocardial injury; therefore the patient has not had a myocardial infarction. The b-Type natriuretic peptide (BNP) level is normal, thus ruling out heart failure. A normal level of BNP also rules out pulmonary complications.
A pt being assessed for cardiac illness states, My previous Dr told me that I had a Type D personality. How would the nurse interpret this information?
The pt probably avoids social contact and focuses on negative emotions. Type D personalities are distressed and tend to focus on negative emotions. They avoid social contact.
QT interval
Time of depolarization and repolarization of ventricles.
A patient presents to the emergency department reporting chest pain. The nurse recalls that what component of the patient's blood work is most clearly indicative of an acute myocardial infarction (MI)?
Troponin Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of other markers. CK enzymes are found in a variety of organs and tissues. Myoglobin elevation is a sensitive indicator of very early myocardial injury but lacks specificity for MI. CRP levels are not used to diagnose acute MI; rather, an increased level has been linked with the presence of atherosclerosis.
Auscultation of a patient's heart reveals the presence of a murmur. The nurse recalls that the finding is the result of what abnormality?
Turbulent blood flow across a heart valve Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.
The nurse observes a bluish tinge around the ears of a patient with cardiovascular disease. What does the nurse suspect is the likely reason behind the assessment finding?
Vasoconstriction A bluish tinge around the ears or in the ears indicates peripheral cyanosis, which is characterized by vasoconstriction. Vasoconstriction is the narrowing of blood vessels due to the contraction of muscular walls of the vessels, resulting in reduced blood flow. This reduced blood flow will result in insufficient oxygen supply by the heart to other parts of the body, causing a bluish tinge in the extremities of ears. Diabetes causes ulcers in patients with cardiovascular disease. Endocarditis causes clubbing of nail beds. Venous thromboembolism results in asymmetry in limb circumference.
A woman diagnosed with CAD says, I would have come to the doctor sooner, but I don't think women get heart disease. Which information should the nurse provide?
Women are more likely than men to die suddenly from cardiac disease.
Heart murmur grade V/VI
murmur can be heard with the stethoscope barley touching the chest wall.
Heart murmur grade III/VI
murmurs loud, with no vibration or thrill.
A pt is admitted to the telemetry unit. Which nursing assessment has the highest priority for further investigation?
The pt complains of intermittent chest pain. A Hx of intermittent chest pain during mild exercise signals the highest need for further investigation into the pts cardiovascular system.
A patient's blood pressure is 180/100 mm Hg. To assess cardiovascular status, which question related to nutrition is appropriate for the nurse to ask?
"How much salt do you consume in an average day?" A person's food habits impact the cardiovascular system greatly. A patient with hypertension needs to limit consumption of salt, because salt is known to increase blood pressure. Hence asking the patient about approximate consumption of salt in a day is important when assessing cardiovascular status. Consuming salads is good for overall health, but is not a definitive query for a patient with hypertension. Chili can cause gastrointestinal issues, but it is not an important factor in cardiovascular health. Meat is not an important factor for hypertension.
The patient reports being confused about how there can be a blockage in the left anterior descending artery (LAD) although there is damage to the right ventricle. What explanation should the nurse give?
"The LAD supplies blood to the left side of the heart and part of the right ventricle." The best response is explaining that the lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole.
A patient with a history of angina is being treated with nitrates and beta blockers. What important information should the nurse give to the patient regarding sexuality?
"You cannot take medicines like sildenafil." The nurse should advise the patient to avoid taking erectile dysfunction (ED) drugs such as sildenafil. This is because the combination of ED drugs and nitrates can cause significant hypotension. The patient should not be asked to avoid sex. Beta blockers may cause erectile dysfunction; however, the drug should not be stopped without consulting the primary healthcare provider. Discontinuing nitrates can worsen the angina.
A pt has a split S1 heart sound. How would the nurse explain this finding to the pt?
"Your mitral & tricuspid valves are not closing at exactly the same time." the S1 hrt sound is caused by closure of the mitral & tricuspid valves. If they do not close at exactly the same time a splitting of the sound occurs.
The nurse obtains subjective data while assessing a patient that presents with suspected cardiac failure. What questions should the nurse ask related to the patient's sleep-rest pattern? Select all that apply.
- "Do you need to sleep upright in a chair?" - "How many pillows do you need to sleep at night?" Many patient with heart failure need to sleep with several pillows or upright in a chair. The nurse should note the number of pillows needed to sleep or the need to sleep upright (orthopnea) and whether this has changed recently. Indications of insomnia and sleeping habits (e.g., how long it takes to fall asleep, exercising before going to bed, falling asleep with the television on) are not part of the assessment for cardiovascular problems.
A pt being assessed for cardiovascular illness reports smoking cigarettes. Which nursing questions are indicated? Select all that apply.
- "How many years have you been smoking?" - "Have you ever tried to quit smoking?" - "How do you feel about smoking?"
A patient is admitted to a hospital with chest pain and is scheduled for a stress test. What instructions should the nurse give to the patient regarding the test? Select all that apply.
- "Wear comfortable clothes and shoes for the test." - "Refrain from smoking for three hours before the test." - "Do not engage in strenuous exercise for three hours before the test." - "Report any uncomfortable symptoms that you experience during the test." The patient scheduled for a stress test should not smoke for three hours before the test. Smoking may alter the oxygen-carrying capacity of the blood and result in an increased workload of the heart. This can interfere with accurate test results. Engaging in strenuous exercise also increases the activity of the heart and interferes with the stress test. The patient should wear comfortable clothes and shoes for walking and running during the test. The patient should immediately report any discomfort experienced during the test, which can indicate undue stress on the heart. In such a case, the test would need to be discontinued. Caffeine-containing foods and fluids should be avoided for 24 hours before the test, because they can interfere with the test results.
During admission assessment for evaluation of chest pain, the pt reports an allergy to sulfa drugs. Which nursing statements are indicated? Select all that apply.
- "what happens when you take sulfa drugs?" - "when did you first find out about this allergy?" These questions aid in determining what effects are noted when the drug is taken and provide additional information about the drugs effects.
T wave
- 0.16 sec - Repolarization of the ventricles
While obtaining objective data during the assessment of the cardiovascular system of a patient, the nurse identifies that which findings will require further evaluation? Select all that apply.
- A thready pulse is present. - Hands and feet are cold to touch. - Capillary refill takes longer than two seconds. Hands and feet that are cold to the touch may indicate intermittent claudication, peripheral arterial disease, low cardiac output, or severe anemia. Capillary refill taking longer than two seconds indicates the possibility of reduced arterial capillary perfusion or anemia. Blood loss, decreased cardiac output, aortic valve disease, or peripheral arterial disease can result in a thready pulse. Absence of edema in the extremities and lack of distention of the veins in the neck are not causes for concern.
The nurse assesses a patient and finds that the patient is experiencing prolonged oxygen deficiency. Which findings support this conclusion? Select all that apply.
- Bluish or purplish tinge in the central areas of the tongue - Obliteration of the normal angle between the base of the nail and the skin Prolonged oxygen deficiency is characterized by cyanosis and clubbing of the nails. Therefore the presence of a bluish or purplish tinge in the central areas of the tongue and an obliteration of the normal angle between the base of the nail and the skin indicates that the patient has an oxygen deficiency. Presence of erythematous rashes on the extremities indicates that the patient has a skin infection but not an oxygen deficiency. A pulse rate of 70 beats/minute and blood pressure of 120/80 mm Hg are normal findings and do not indicate that the patient has an oxygen deficiency. Deficiency of oxygen results in hypothermia and may make the patient's hands and feet cooler than normal. A respiratory rate of 20 breaths/minute is a normal finding.
The nurse is reviewing the mechanism of blood pressure (BP). What are the main factors that influence blood pressure? Select all that apply.
- Cardiac output - Systemic vascular resistance The two main factors influencing BP are cardiac output and systemic vascular resistance. Capillary refill, oxygen saturation, and pulmonary pressure do not influence blood pressure.
The nurse provides information to a patient that is scheduled for a transesophageal echocardiography (TEE) related to potential complications. What should the nurse include in the education? Select all that apply.
- Hemorrhage - Dysrhythmias - Transient hypoxemia Transesophageal echocardiography (TEE) evaluates mitral valve disease and endocarditis vegetation in the patient. Complications of this procedure include tearing of the esophagus, hemorrhage, dysrhythmias, and transient hypoxemia. Some contrast media cause nephrotoxicity in patients; however, transesophageal echocardiography does not involve the injection of contrast medium into the patient's heart. Increased levels of lactate dehydrogenase is not a complication of the procedure.
The nurse obtains laboratory results for a patient that presents to an emergency department with angina. Which parameters in the laboratory report indicate myocardial infarction? Select all that apply.
- High troponin level - Increased creatinine kinase (CK-MB) level Many chemical parameters may indicate and confirm the presence of a myocardial infarction. Cardiac-specific troponin levels are specific to heart muscles. Their levels are usually very low, and any increase indicates myocardial injury. Creatinine kinase (CK) is a protein found skeletal muscle, brain and nervous tissue, and the heart. CK-MB is heart specific and high levels of this protein are indicative of myocardial infarction. A high cholesterol level indicates an increased risk of cardiovascular diseases but is not suggestive of myocardial infarction. C-reactive protein is elevated during inflammation. Homocysteine levels may be elevated in people having a high risk of coronary artery disease.
Which arteries are the major providers of coronary circulation? Select all that apply.
- Left circumflex artery - Right coronary artery - Left anterior descending artery The left circumflex and left anterior descending arteries branch from the left coronary artery. The left coronary artery and right coronary artery arise from the aorta to supply the atria, ventricles, and interventricular septum.
What techniques should the nurse use while assessing the heart sounds of a patient? Select all that apply.
- Listen for friction rubs with the patient upright and leaning forward. - Use the diaphragm of the stethoscope to listen to S1 and S2 sounds. - Listen to S3 and S4 sounds (if present) with the bell of the stethoscope. The nurse listens to the S1 and S2 sounds with the diaphragm of the stethoscope because they are high pitched. S3 and S4 are extra heart sounds. If these sounds are present, then they can be detected with the bell of the stethoscope. The nurse instructs the patient to lean forward while sitting. This helps her to listen to the enhanced sounds from the second intercostal space. The nurse listens to friction rubs when the patient sits in an upright position and leans forward following expiration. The patient is positioned in a left side-lying position to enhance the sounds at the mitral area.
The nurse assesses a patient with cardiac problems. The nurse measures the circumference of the calves and finds that they are asymmetrical. What might this finding imply? Select all that apply
- Lymphedema - Varicose veins - Venous thromboembolism There may be asymmetries in the circumference of two limbs in disorders like lymphedema, varicose veins, and thromboembolism. In these disorders, the affected limb is generally increased in circumference. Hypertension doesn't cause swelling of the limbs. Similarly, angina pectoris refers to pain in the chest and doesn't cause changes in the circumference of lower extremities.
Which factors affect the stroke volume of the blood? Select all that apply.
- Preload - Afterload - Contractility Increased or decreased preload, afterload, and contractility alter the stroke volume of the blood. Cardiac index and cardiac output are affected by stroke volume but do not affect the stroke volume of the blood.
When assessing the cardiovascular system of an 83-year-old patient, what symptoms should the nurse expect to find? Select all that apply.
- Systolic murmur - Diminished pedal pulses - Increased systolic blood pressure - Difficulty in isolating the apical pulse Gerontologic differences in the assessment of the cardiovascular system include the presence of a systolic murmur, diminished pedal pulses, increased systolic blood pressure, and difficulty in isolating the apical pulse. The pulse pressure may be widened, not narrowed.
A review of the EMR reveals that a pt has a grade IV/VI cardiac murmur. The nurse would expect which findings upon assessment? Select all that apply.
- loud murmur - a softly palpable thrill
P wave
0.06 - 0.12
The nurse recalls that it takes how long for the ventricular conduction system to deliver an electrical impulse? Use a leading zero, if applicable. Record the answer to the second decimal place. __ second(s)
0.12 The action potential is generated from the sinoatrial node. It travels through the conduction system including the AV node, bundle of His, and the left and right bundle branches. The action potential moves through the walls of both ventricles by means of Purkinje fibers. The ventricular conduction system delivers the impulse within 0.12 second.
The nurse assesses a patient for cardiovascular abnormalities. The nurse recalls that the blood flows through the heart in what order?
1. Right atrium 2. Right ventricle 3. Lungs 4. Left atrium 5. Mitral valve 6. Left ventricle Blood flows (from the body via the superior and inferior vena cava) into the right atrium. Blood passes from the right atrium (through the tricuspid valve) into the right ventricle, then (via the pulmonic valve into the pulmonic artery) the lungs. Blood flows back from the lungs (via the pulmonary veins) into the left atrium. Blood flows from the left atrium through the mitral valve into the left ventricle and then (via the aortic valve) to the aorta and the body.
A pt has a split S2 heart sound. Where would the RN auscultate to best hear this sound?
2nd intercostal space left of the sternum.
A patient's systolic blood pressure (SBP) is 100 mm Hg and diastolic blood pressure (DBP) is 70 mm Hg. What should the nurse document as the patient's mean arterial pressure? Record the answer using a whole number. ________ mm Hg
80 The mean arterial pressure (MAP) is calculated by using the formula MAP = (SBP + 2DBP)/3. Therefore, MAP = (100 + 2(70))/3 = (100 + 140)/3 = 240/3 = 80 mm Hg.
The pt presents to the ED complaining of chest pain, fatigue, and dyspnea. What is the RNs priority assessment?
Airway & Oxygenation status The priority is to assess the pts airway & oxygen status, with the GOAL of maintaining an open airway and adequate oxygen lvls.
A nurse examines a patient with cardiovascular problems and assesses for the presence of pitting edema. What is the best location to assess for edema?
Ankle Edema is a common and early symptom of cardiovascular conditions. The nurse should look for edema by depressing the skin over the tibia or medial malleolus for 5 seconds. This edema is commonly seen in dependent areas, such as on the feet and the ankle, due to gravity. Edema on the face, wrist, or chest may be due to other, noncardiac conditions.
During the physical assessment of a pt on admission, the nurse auscultates a grade II midsystolic heart murmur. The nurse would conduct additional assessment for which condition?
Aortic stenosis The murmur associated with aortic stenosis is a midsystolic, crescendo-decrescendo murmur.
A patient with pericarditis is admitted to the hospital. The nurse recognizes that what is the best method of auscultation in this patient?
Ask the patient to sit and lean forward. In a patient with pericarditis, a high-pitched sound can be auscultated. This sound can be heard during heart sound S1 or S2 at the apex. The best position for hearing this sound is when the patient is in a sitting position and leaning forward. The sound is not well heard in other positions such as supine or standing.
A patient is scheduled for cardiac catheterization. What does the nurse provide to the patient as the primary rationale for the procedure?
Assessing the presence of arterial blockages Cardiac catheterization is performed to assess the extent and severity of coronary artery blockage. The results of a cardiac catheterization will facilitate decisions regarding the need for medical management, angioplasty, or coronary artery bypass surgery.
A patient with cardiovascular disease is diagnosed with venous thromboembolism. What assessment finding does the nurse expect?
Asymmetry in limb circumference Venous thrombosis is the formation of clots and most commonly occurs in the pelvis or lower extremity—that is, in the deep veins of the legs. This condition results in asymmetry in limb circumference. Possible reduced arterial capillary perfusion and anemia cause abnormal capillary refill. Thyrotoxicosis results in unusually warm extremities. Interruption of venous return to the heart and right-sided heart failure are associated with pitting edema of the lower extremities.
The nurse assesses the vital signs of a patient and should use which artery to check the blood pressure?
Brachial Blood pressure is recorded using a device known as a sphygmomanometer and a stethoscope. The ideal and correct site for checking blood pressure is the brachial artery. This artery is on the arm near the elbow. The radial artery is on the wrist. The carotid artery is in the neck region, and the femoral artery is around the groin. Any other site other than the brachial artery is not suitable for checking blood pressure with a sphygmomanometer.
The nurse is reviewing the function of the vascular system. What portion of the vascular system exchanges cellular nutrients and metabolic end products?
Capillary vessels The exchange of cellular nutrients and metabolic end products takes place through the thin-walled capillaries, which connect the arterioles and the venules. Exchange of cellular nutrients and metabolic end products does not occur in the arteriole, arteries, or veins.
The nurse is caring for a patient with ventricular hypertrophy and expects what assessment finding?
Cardiac output of 4 L/min/m2 The patient with ventricular hypertrophy has an enlargement of the heart muscle without an increase in cardiac output (CO) or the size of the chambers. If the arterial blood pressure (BP) is elevated, the ventricles meet increased resistance to ejection of blood, thus increasing the work demand of the heart, causing the muscles of the heart to enlarge. The enlargement occurs without increase in the size of the chambers. The patient experiences elevated blood pressure. The normal CO is 2.8 to 4.2 L/min/m2.
While auscultating a patient's heart, the nurse hears turbulent sounds between normal heart sounds. Which complication does the nurse suspect?
Cardiac valve disorder Turbulent sounds heard between normal heart sounds are known as murmurs. Murmurs are found in patients with cardiac valve disorder. An aneurysm is associated with a turbulent flow sound in the peripheral artery. Cardiac dysrhythmias are characterized by an apical heart rate exceeding the peripheral pulse rate. Left ventricular failure is associated with an extra, low-pitched heart sound in early diastole.
A nurse is auscultating a patient's heart sounds and hears an S4 heart sound. Which condition may be present?
Cardiomyopathy S4 is an extra heart sound caused by atrial contraction. It can be normal in older adults. The common pathologies that cause this sound are cardiomyopathy, left ventricular hypertrophy, atrial stenosis, or coronary artery disease (CAD). Hypertension is increased blood pressure and postural hypotension is a fall in blood pressure after standing, and these conditions do not cause S4. Angina pectoris is pain in the chest region and is not accompanied by S4.
The nurse, assessing a pt for cardiac failure, has elected to test for abdominojugular reflux. Which action is indicated?
Compress the right upper abdomen for 30 seconds. Compression of the right upper abdomen will cause the blood volume in the abdomen to be displaced back to the right atrium. This influx of blood will be reflected in the jugular veins if the heart is failing.
A pt comes to the health clinic asking for advice on lowering her risk of heart disease. What is the nurses best response to this request?
Conduct a health history & physical exam to determine the areas of risk and use these findings to educate the pt. A thorough health history & physical exam should disclose a pt's risk factors. Modifiable risk factors should be evaluated and discussed with the pt.
A nurse provides education to a patient that is scheduled for exercise testing to evaluate the patient's cardiovascular function. What should the nurse include in the instructions?
Do not take β-blockers 24 hours before the test. β-blockers may be held 24 hours before the test because they blunt the HR and limit the patient's ability to achieve maximal HR. . The nurse informs the patient not to consume caffeine-containing foods (and caffeine-containing fluids) for 24 hours before the test. The nurse also instructs the patient to avoid strenuous exercise and smoking for three hours before the test.
The nurse reviews a patient's medication profile and recognizes that which medication is a potential cause of the patient's cardiomyopathy?
Doxorubicin Doxorubicin is an anticancer medication that results in cardiomyopathy. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that results in hypertension, myocardial infarction, and stroke. Prednisone is a corticosteroid that causes hypotension, edema, and potassium depletion. Chlorpromazine is an antipsychotic medication that results in dysrhythmias and orthostatic hypotension.
An elderly patient presents to a clinic for a routine physical examination. The nurse reviews the patient's medical record and notes a progressive increase in systolic blood pressure (SBP). What action should the nurse take?
Explain to the patient that this is a normal age-related change. As adults age, arterial stiffening from loss of elastin in arterial walls can cause thickening of arteries and progressive fibrosis which may have the downstream effect of causing increased systolic BP and a decrease or no change in diastolic BP. Thus an increase in pulse pressure is found. The nurse may explain to the patient that this is a normal age-related change. There is no need to alert the healthcare provider immediately, as this is not a life-threatening emergency. It may be prudent to assess for dizziness during cardiac evaluation, as orthostatic hypotension is common in the older adult. There is insufficient data to determine if an antihypertensive medication is needed.
While reviewing the laboratory reports of a patient, the nurse notes that the homocysteine level is 17 μmol/L. The nurse anticipates that which treatment will be prescribed?
Folic acid and vitamin B12 supplements When a patient's homocysteine levels are greater than 10.4 μmol/L, it indicates that the patient has hyperhomocysteinemia. Hyperhomocysteinemia is caused by a deficiency in folic acid, vitamin B12, and vitamin B6; therefore administering folic acid and vitamin B12 supplements will be beneficial for the patient. Nesiritide helps to increase b-Type natriuretic peptide (BNP), but it does not treat deficiencies of folic acid, vitamin B12, and vitamin B6. Estrogen + progestin helps to increase estrogen levels in the blood, but does not reduce homocysteine levels. Homocysteine levels increase because of folic acid and vitamin B deficiencies, but are unrelated to vitamins C and K.
The nurse identifies a U wave on a patient's electrocardiogram. Which dietary instruction will be beneficial to the patient?
Increase consumption of bananas. The presence of a U wave in the patient's electrocardiogram may indicate hypokalemia or repolarization of the Purkinje fibers. Hypokalemia can be caused by excessive sweating, diarrhea, or excessive laxative use. Bananas are a rich source of potassium. Therefore increasing the consumption of bananas will be beneficial for the patient. Coconut oil increases digestion and bowel function. Raw and virgin coconut oil have a laxative effect and should not be recommended. Milk and milk products like cheese are rich in sodium but not in potassium. Omega-3 oils help flush toxins out of the body. Therefore increasing the consumption of omega-3 oils would produce a laxative effect in the patient and potentiate hypokalemia.
The registered nurse observes another healthcare provider performing a cardiac assessment on a patient. Which activity should the nurse question?
Inspects the large veins in the neck while swiftly moving the patient from a supine position to a 40-degree position To assess for jugular vein distention, the healthcare provider should inspect the large veins in the neck while the patient is gradually moved from a supine position to an upright (30- to 45-degree position). The patient should not be repositioned too quickly. When a normal peripheral pulse is a normal force, it should be documented as 2+. A capillary refill should occur in less than 2 seconds with normal tissue perfusion and cardiac output (CO). S1 and S2 are heard best with the diaphragm of the stethoscope because they are high pitched.
The nurse assesses a patient's heart sounds and auscultates the left midclavicular line at the fifth intercostal space (ICS). This is the best location for hearing sounds from which heart valve?
Mitral The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth intercostal space (ICS). The aortic area is best heard at the right second intercostal space. Tricuspid area is assessed best at the midleft sternal border. Pulmonic is heard best at the left second intercostal space.
The nurse teaches a caregiver about the plan of care for an elderly patient with orthostatic hypotension. Which action by the caregiver will be most beneficial to the patient?
Monitoring for the risk of falls Orthostatic hypotension, or postural hypotension, is low blood pressure that occurs in patients when they stand up from sitting or lying down. Patients with orthostatic hypotension are at an increased risk of falls. Therefore the caregiver should monitor for falls in the patient. The caregiver can encourage laughter therapy and treadmill exercises, but these measures are not as beneficial as monitoring the patient for falls. The caregiver can take the patient out for recreation, but it is not as beneficial as monitoring the patient's risk of falls.
The nurse is caring for a patient with a psychosis who is prescribed amitriptyline therapy. The nurse should monitor the patient for which complication?
Orthostatic hypotension Amitriptyline is a tricyclic antidepressant that alleviates the symptoms of depression by decreasing the levels of serotonin and epinephrine in the brain. Due to the decrease in epinephrine, the patient may have low blood pressure, resulting in orthostatic hypotension. Therefore the nurse monitors for orthostatic hypotension in the patient. Hypokalemia occurs in patients receiving corticosteroids, not tricyclic antidepressants. Thromboembolism may occur in patients receiving hormone therapy, but this is not a risk for patients on amitriptyline. Patients taking hormone therapy and nonsteroidal antiinflammatory medications are at risk for developing myocardial infarctions, but amitriptyline does not increase the risk for myocardial infarctions.
A 78-year-old patient experiences cardiac sinus dysrhythmias. The nurse recalls that a reduction in which type of cells leads to this condition?
Pacemaker cells in the sinoatrial (SA) node A reduction in the number of pacemaker cells in the SA node may account for sinus dysrhythmias in the older adult patient. Reductions in the number of conduction cells in the internodal tracts, bundle of His, and bundle branches contribute to the development of atrial dysrhythmias and heart blocks.
The patient is admitted to the hospital with reports of awakening during the night with sudden shortness of breath. How should the nurse document this assessment finding?
Paroxysmal nocturnal dyspnea Paroxysmal nocturnal dyspnea is defined as "attacks of shortness of breath, especially at night," which awaken the patient. Orthopnea is the need to sleep in an upright position. Atrial fibrillation is a conduction abnormality of the heart. Intermittent claudication affects the muscles of the leg during exercise related to decreased oxygen delivery to the muscle.
A nurse reviews the medical records of four patients with cardiovascular disease and identifies which patient at an increased risk for pressure ulcers?
Patient 1 Arteriosclerosis is the hardening of arteries, which reduces the blood flow and leads to tissue damage that causes ulcers. Therefore patient 1 is at increased risk for pressure ulcers. Patient 2 has right-sided heart failure, which is associated with jugular vein distention. Patient 3 has venous thromboembolism, which results in asymmetry in limb circumference. Patient 4 has arterial obstruction, which is associated with arterial bruit.
The nurse is reviewing the laboratory reports of four patients. Which patient's cardiac index is abnormal?
Patient D Cardiac index is calculated by dividing the cardiac output by the body surface area. The normal values of cardiac index are in the range of 2.8 to 4.2 L/min/m2. The cardiac output and body surface area of patient D are 4 L/min and 1.9 m2 respectively. Therefore cardiac index = 4 / 1.9 = 2.1 L/min/m2, which is abnormal. The cardiac output and body surface area of patient A are 6 L/min and 1.6 m2 respectively. Therefore cardiac index = 6 / 1.6 = 3.75 L/min/m2, which is normal. The cardiac output and body surface area of patient B are 5 L/min and 1.5 m2 respectively. Therefore cardiac index = 5 / 1.5 = 3.33 L/min/m2, which is normal. The cardiac output and body surface area of patient C are 7 L/min and 1.8 m2respectively. Therefore cardiac index = 7 / 1.8 = 3.88 L/min/m2, which is normal.
Which blood vessel carries oxygenated blood toward the heart from the lungs?
Pulmonary vein The pulmonary vein, in contrast to all other veins, carries oxygenated blood toward the heart from the lungs. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs. The inferior vena cava carries deoxygenated blood from the legs and abdomen to the right atrium of the heart. The superior vena cava carries deoxygenated blood from the arms and head to the right atrium of the heart.
The nurse observes blanching of a patient's nail beds for two seconds after release of pressure. Which does the nurse recognize as the potential cause of the assessment finding?
Reduced arterial capillary perfusion Reduced arterial capillary perfusion results in a decreased amount of oxygen supply to body parts, which results in blanching of nail beds for two seconds after release of pressure. Hands and feet that are warmer than normal indicate thyrotoxicosis. When the hands and feet are cold to the touch, it indicates intermittent claudication. Visible finger pitting on application of firm pressure indicates interruption of venous return to the heart.
A nurse is preparing a patient for a transesophageal echocardiogram (TEE). What intervention does the nurse perform for this patient?
Remove dentures and place a bite block in the mouth. While preparing a patient for a TEE, the nurse asks the patient to remove the dentures and places a bite block in the mouth. This is done because an ultrasound transducer will need to be swallowed and passed through the esophagus. When preparing the patient for a chest x-ray, the nurse provides lead shielding to areas that are exposed to radiation. If the patient is undergoing ambulatory ECG, then the nurse asks him to carefully observe possible symptoms of skin irritation. The patient will receive IV sedation; general anesthesia is not used for the procedure.
The RN assesses changes in the pts fingers. The fingertips look swollen, and the nails seem to angle downward. How should the nurse proceed?
Review the pts Hx for pulmonary disorders. This assessment describes clubbing which indicates chronic oxygen deficiency.
When assessing the adult heart, the nurse expects to hear which heart sounds?
S1, then S2
During a physical examination of a patient with cardiovascular disease, the nurse auscultates murmurs. How should the nurse interpret the finding?
The cardiac valves are affected. Murmurs are heard when the blood flow is turbulent due to dysfunctional valves. The valves may get affected due to accumulation of lipids, degeneration of collagen, and fibrosis. A decreased compliance of ventricles during filling would result in the S4 heart sound. A pericardial friction rub is usually heard as a high-pitched, scratchy sound. High blood pressure does not cause murmurs.
What is cardiac reserve?
The cardiovascular system's ability to respond to health and illness demands by altering cardiac output The ability of the cardiovascular system to alter cardiac output in response to numerous situations in health and illness, such as stress, hypervolemia, and exercise, is known as cardiac reserve. The amount of blood pumped by each ventricle in one minute is called cardiac output. Afterload is the peripheral resistance against which the left ventricle must pump. Preload is the amount of blood in the ventricles at the end of diastole, before the next contraction.
A review of family history reveals that a significant number of pts ancestors died very early from cardiac diseases. What is the best use of this information for the pt and nurse?
The pt and nurse should work together to identify other risk factors and establish a plan for healthy living. The pt cannot change genetic risk factors but can modify many other risk factors ones they are identified. The nurse should assist the pt in developing a healthy lifestyle.
After reviewing a patient's laboratory reports, the nurse concludes that the patient is at a high risk for myocardial injury. Which finding in the patient's lab reports supports the nurse's conclusion?
Troponin I value of 3.5 ng/mL Troponin is a contractile protein released after a myocardial infarction. If the value of troponin I is greater than 2.3 ng/mL, it indicates that the patient is at high risk for myocardial injury. A CK-MB value greater than 4% to 6% indicates myocardial infarction. A cholesterol value of 250 mg/dL indicates cardiovascular heart disease. A b-type natriuretic peptide (BNP) value of 140 pg/mL indicates heart failure.
While auscultating the pt's heart sounds, the nurse hears an additional sound immediately following S2. The nurse would conduct further assessment for which condition?
Ventricular volume overload. S3 is an abnormal (pathologic) heart sound heart immediately following S2 in adults. It is often called a ventricular gallop and results from conditions such as congestive heart failure (CHF) and mitral or tricuspid valve regurgitation.
While assessing an elderly patient with arterial stiffening, the nurse finds the presence of inflamed, painful, cordlike varicosities. Which other finding is the nurse likely to observe?
Widened pulse pressure Arterial stiffening in the elderly patient results in loss of arterial compliance and increases pulse wave velocity, resulting in widened pulse pressure. Arterial stiffening is due to loss of elastin in arterial walls and subsequent thickening of the intima of the arteries. The presence of inflamed, painful, or cordlike varicosities indicates increased venous tortuosity. Arterial stiffening can result in increased systolic blood pressure.