** Cardiovascular System, perfusion prep u
After explaining an electrocardiogram to a patient, which statement indicates that the patient understands this test? "It will show the chambers of my heart in different views." "It will measure the amount of blood being pumped." "It will show how impulses are moving through my heart." "It will help to identify how my heart is working mechanically."
"It will show how impulses are moving through my heart." An electrocardiogram is a recording of the patterns of electrical impulses as they move through the heart. It is a measure of electrical activity and provides no information about the mechanical function of the heart.
After explaining an electrocardiogram to a patient, which statement indicates that the patient understands this test? "It will measure the amount of blood being pumped." "It will show how impulses are moving through my heart." "It will show the chambers of my heart in different views." "It will help to identify how my heart is working mechanically."
"It will show how impulses are moving through my heart." Explanation: An electrocardiogram is a recording of the patterns of electrical impulses as they move through the heart. It is a measure of electrical activity and provides no information about the mechanical function of the heart.
A client with chronic obstructive pulmonary disease (COPD) reports severe shortness of breath when it is raining. The nurse says to the client: "You should use your inhaler as often as necessary during this time to help your breathing." "Have you had a stress test to determine if your airway is obstructed?" "The airway becomes occluded during periods of rain." "The air is thicker or more viscous with humidity, thus it is harder for you to breathe."
"The air is thicker or more viscous with humidity, thus it is harder for you to breathe." Explanation: People with chronic respiratory diseases often find breathing more difficult when the weather is hot and humid because humidity contributes to air viscosity.
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 teaching point best captures a component of cardiac function? "Efficient heart function requires that the ventricles not retain any blood at the end of the cardiac cycle. "Recall that the heart sounds that we listen to as part of our assessments are the sounds of myocardium contracting." "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." "Aortic pressure will exceed ventricular pressure during systole."
"The diastolic phase is characterized by relaxation of ventricles and their filling with blood." Diastole is associated with ventricular filling and relaxation. Cardiac output is not 100% or near to it with each cardiac cycle, and heart sounds are associated with valve closing. Ventricular pressure exceeds that of the aorta during systole.
The nurse is caring for a client with a nonhealing wound who has been prescribed hyperbaric oxygen therapy (HBOT). When the client asks, "How will this help me?" what is the appropriate nursing response? "HBOT treats aerobic infections." "Wounds heal because HBOT helps to regenerate new tissue quickly." "It will help you breathe much easier, and feel better." "You will be treated for decompression sickness."
"Wounds heal because HBOT helps to regenerate new tissue quickly." Explanation: Although HBOT treats a multitude of conditions, the reason for using HBOT for a nonhealing wound is to help regenerate new tissue quickly. HBOT is used to treat anaerobic infections. The other responses are inappropriate.
A client who uses portable home oxygen states, "I still like to smoke cigarettes every now and then." What is the appropriate nursing response? "You should never smoke when oxygen is in use." "Oxygen is a flammable gas." "An occasional cigarette will not hurt you." "I understand; I used to be a smoker also."
"You should never smoke when oxygen is in use." Explanation: The nurse will educate the client about the dangers of smoking when oxygen is in use. Oxygen is not flammable, but it oxidizes other materials. Other answers are inappropriate.
In which situation would blood be most likely to be rapidly relocated from central circulation to the lower extremities? A client undergoes a stress test on a treadmill A client does isotonic exercises in a wheelchair A client is helped out of bed and stands up A client reclines from a sitting to supine position
A client is helped out of bed and stands up During a change 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.
When describing circulation, which would a nurse include? Low to high pressure system One course of blood flow A closed system Primarily a resistance system
A closed system Circulation is a closed, high- to low-pressure system that can follow two courses (systemic and pulmonary) and involves a resistance system (arterial) and a capacitance (venous) system.
The nurse is caring for a client admitted for a mild exacerbation of asthma who has been prescribed portable oxygen at 2 L/min. What delivery device will the nurse select to apply oxygen to the client? simple mask nasal cannula
A nasal cannula is ideal for administering low concentrations of oxygen to clients who are not extremely hypoxic or have chronic lung disease. The client does not have a tracheostomy. A simple mask is used to administer higher levels of oxygen than 2 L/min. A face tent is used without a mask.
After teaching a group of students about the events that occur when blood flow to the kidneys is reduced, the students demonstrate understanding when they identify that what occurs last? Aldosterone release Renin release Production of angiotensin I Conversion to angiotensin II
Aldosterone release When blood flow to the kidneys is reduced, the cells in the kidney release renin, which then converts angiotensinogen to angiotensin I. This is converted by angiotensin converting enzyme (ACE) to angiotensin II, which reacts with specific receptor sites on blood vessels to cause vasoconstriction. Angiotensin II also causes the release of aldosterone.
A nurse is explaining to a client the physiology of the heart with reference to the cardiac valves. Which statement by the client about the function of the cardiac valves demonstrates the correct understanding of the nurse's explanation? Contract with sufficient force to pump blood Act as receiving centers for blood Divide the heart into right and left sides Allow blood to flow in one direction only
Allow blood to flow in one direction only The cardiac valves are one-way flaps of tissue that open and close in response to pressure changes within the chambers. These unidirectional valves allow blood to flow in one direction only, preventing backflow. The cardiac valves do not contract with sufficient force to pump blood; that is the function of the left ventricle. The atria heart chambers are receiving centers for blood. A complete muscular wall called the septum divides the heart into right and left sides.
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? You Selected: 5 Correct response: 7
Aspirin should be stopped at least 7 to 10 days before surgery. The other time frames are incorrect.
A cardiovascular clinical nurse specialist describes the dysfunctional endothelium in relation to cardiovascular disease. What is the major factor in the development of the dysfunctional endothelium? Inflammation Septicemia Tumor Atherosclerosis
Atherosclerosis Dysfunctional endothelium is considered a major factor in atherosclerosis, acute coronary syndromes, hypertension, and thromboembolic disorders. Dysfunctional endothelium is not related to inflammation, septicemia, or tumor.
Which heart valve controls the flow of blood between the left atria and the left ventricle? Tricuspid valve Pulmonic valve Bicuspid valve Aortic valve
Bicuspid valve The bicuspid valve controls the flow of blood between the left atria and left ventricle. The tricuspid controls the flow between the right atria and ventricle. The pulmonic valve controls flow between the right ventricle and pulmonary artery, while the aortic valve controls flow between the left ventricle and aorta.
gerontologic nurse practitioner has a large patient population with heart disease problems. This nurse practitioner is aware that heart disease is the leading cause of death in the aging adult. What is the cause of this trend? Blood vessels lose their elasticity with age. Systolic blood pressure decreases with age. The cardiac output is increased with age. Resting heart rate decreases with age.
Blood vessels lose their elasticity with age. Explanation: In the aging adult, the blood vessels become less elastic. Because the blood vessels become more rigid, increase in blood pressure can result. The body is less able to increase heart rate and cardiac output with activity.
Place the components of the circulatory system in the correct sequence for returning blood back to the heart? 1 Capillaries 2 Venules 3 Veins 4 Right atrium
Capillaries Venules Veins Right atrium The correct pathway for blood returning back to the heart is the capillaries, venules, veins and right atrium.
Which property is related to the ability of the heart cells to transmit an action potential of electrical impulse? Contractility Automaticity Afterload Conductivity
Conductivity Conductivity is the property of heart cells to rapidly conduct an action potential of electrical impulse.
Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot? Contrast phlebography Lymphangiography Air plethysmography Lymphoscintigraphy
Contrast phlebography Explanation: When a thrombus exists, an X-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.
A nurse is caring for a client with Raynaud's phenomenon secondary to systemic lupus erythematosus (SLE). Which of the client statements demonstrates an understanding of the nurse's teaching about this disorder? Select all that apply. "I don't need to report any other skin problems with my fingers or hands to my practitioner." "I can't continue to wash dishes and do my cleaning because of this problem." "Medication might help treat this problem." "This problem is caused by a temporary lack of circulation in my hands." "I probably got this disorder because I have lupus." "My hands get pale, bluish, and feel numb and painful when I'm really stressed."
Correct response: "My hands get pale, bluish, and feel numb and painful when I'm really stressed." "I probably got this disorder because I have lupus." "This problem is caused by a temporary lack of circulation in my hands." "Medication might help treat this problem." Explanation: Raynaud's phenomenon causes blanching, cyanosis, coldness, numbness, and throbbing pain in the hands when the client is exposed to cold or stress. It is caused by episodic vasospasm in the small peripheral arteries and arterioles and can affect the feet as well as the hands. The phenomenon is commonly associated with connective tissue diseases such as lupus and may be alleviated by calcium channel blockers or adrenergic blockers. It does not limit the client's ability to function, although the symptoms are bothersome. Keeping the hands warm and learning to manage stressful situations effectively reduces the frequency of episodes. The disorder can progress to skin ulcerations and even gangrene in some clients, so all skin changes should be reported to the practitioner promptly.
A nurse is calculating the cardiac output of an adult with a stroke volume of 75 mL (75 × 109/L) and a pulse of 78 beats/min. What number would the nurse document for this assessment?
Correct response: 5,850 mL (5,850 × 109/L) Explanation: Cardiac output is determined by multiplying the stroke volume by the heart rate/min, which equals 5,850 mL (5,850 × 109/L). Cardiac output and peripheral resistance determine both systolic and diastolic pressures.
Four hours after a cast has been applied for a fractured ulna, the nurse assesses that the client's fingers are pale and cool and capillary refill is delayed for 4 seconds. How should the nurse interpret these findings? The finding is normal for this recovery period. Venous stasis is occurring in the fingers. Arterial blood supply to the fingers is decreased. Nerve impairment is developing in the fingers.
Correct response: Arterial blood supply to the fingers is decreased. Explanation: The pallor and cool temperature of the fingers and the decreased return time for capillary refill indicate decreased arterial blood supply to the fingers. These findings are not normal for any time in the recovery process. Nerve impairment includes numbness, tingling, and impaired movement of the fingers. Signs of venous stasis include edema and reddening of the fingers, not pallor and cool temperature.
A nurse is caring for a client who breathes very shallowly and has been reporting severe back pain. What suggestion could the nurse make to help the client breathe efficiently? Inform the client about nasal strips. Instruct the client in the use of pursed-lip breathing technique. Encourage the client to take deep breaths. Teach the client diaphragmatic breathing.
Correct response: Encourage the client to take deep breaths. Explanation: To help the client breathe efficiently, the nurse could encourage the client to take deep breaths. Deep breathing maximizes the ventilation and fills the alveoli to a greater capacity, thus improving gas exchange. Pursed-lip breathing and diaphragmatic breathing help to eliminate the extra carbon dioxide from the lungs. A nasal strip reduces airflow resistance by widening the nasal-breathing passageways, thus promoting easier breathing. It is used for reducing or eliminating snoring.
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? Tension pneumothorax Heart failure Cardiac tamponade Pulmonary embolism
Correct response: Heart failure Explanation: A client with heart failure has decreased cardiac output caused by the heart's decreased pumping ability. A buildup of fluid occurs, causing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. A client with pulmonary embolism experiences acute shortness of breath, pleuritic chest pain, hemoptysis, and fever. A client with cardiac tamponade experiences muffled heart sounds, hypotension, and elevated central venous pressure. A client with tension pneumothorax has a deviated trachea and absent breath sounds on the affected side as well as dyspnea and jugular vein distention.
A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime?
Correct response: Improve venous return Explanation: The major goal in management of venous insufficiency is to promote venous circulation. Arterial flow improvement is not the goal of treatment for this disorder. Venous valves that are incompetent cannot be strengthened. Venous congestion is a complication of venous insufficiency.
The nurse is auscultating the lungs of a client and detects normal vesicular breath sounds. What is a characteristic of vesicular breath sounds? They are loud, high-pitched sounds heard primarily over the trachea and larynx. They are soft, high-pitched discontinuous (intermittent) popping lung sounds. They are low-pitched, soft sounds heard over peripheral lung fields. They are medium-pitched blowing sounds heard over the major bronchi.
Correct response: They are low-pitched, soft sounds heard over peripheral lung fields. Explanation: Normal breath sounds include vesicular (low-pitched, soft sounds heard over peripheral lung fields), bronchial (loud, high-pitched sounds heard primarily over the trachea and larynx), and bronchovesicular (medium-pitched blowing sounds heard over the major bronchi) sounds. Crackles are soft, high-pitched discontinuous (intermittent) popping sounds.
Captopril, furosemide, and metoprolol are prescribed for a client with systolic heart failure. The client's blood pressure is 136/82 mm Hg and the heart rate is 65 bpm. Prior to medication administration at 0900, the nurse reviews the lab tests (see chart). What should the nurse do first? Administer the medications. Withhold the captopril.
Correct response: Withhold the captopril. Explanation: The nurse should withhold the dose of captopril; captopril is an ACE-inhibitor and a side effect of the medication is hyperkalemia. The BUN and creatinine, which are normal, should be viewed prior to administration since renal insufficiency is another potential side effect of an ACE-I. The heart rate is within normal limits. The nurse should question the dose of metoprolol if the client's heart rate is bradycardic. The hemoglobin and hematocrit are normal for a female. The nurse should report the high potassium level and that the captopril was withheld.
A nurse is volunteering at a day camp. A child is stung by a bee and develops wheezing in the upper airways. The child is experiencing: a bronchospasm. bronchitis. bronchiectasis. bronchiolitis.
Correct response: a bronchospasm. Explanation: When allergic responses take place in the lungs, breathing difficulties are far more severe. Small airways become edematous, mucus production increases, and inflammatory chemical mediators cause bronchospasm.
Which intervention is the greatest priority for the therapeutic management of a child with congestive heart failure (CHF) resulting from pulmonary stenosis? administering enoxparin to improve left ventricular contractility administering furosemide to decrease systemic venous congestion
Correct response: administering furosemide to decrease systemic venous congestion Explanation: Pulmonary stenosis can cause right-sided CHF, resulting in venous congestion. Removing accumulated fluid is a primary goal of treatment in right-sided CHF. Furosemide is used to reduce venous congestion. It is important to educate the family about signs and symptoms of CHF, but treating the client's CHF is the priority. Enoxaparin is an anticoagulant and will not help improve left ventricular contractility. It is important to assess vital signs frequently in the child with CHF, but assessments do not treat the problem.
**Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress
Correct response: decreases the production of neurotransmitters that constrict peripheral arterioles. Explanation: Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.
**Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to:
Correct response: revascularize the blocked coronary artery. Explanation: The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after onset of MI. The drug does not reduce coronary artery vasospasm; nitrates are used to promote vasodilation. Arrhythmias are managed by antiarrhythmic drugs. Surgical approaches are used to open the coronary artery and re-establish a blood supply to the area.
According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed essential. primary. secondary. isolated systolic.
Correct response: secondary. Explanation: Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).
The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected? Rhonchi Wheezes Coarseness Crackles
Crackles Explanation: When the heart is pumping inefficiently, blood backs up into the pulmonary veins and lung tissue. Auscultation reveals a crackling sound. Possible wheezes and gurgles are also possibilities.
While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe? Decreased vascular perfusion due to parasympathetic stimulation Decreased heart rate, contractility and after load Decreased heart rate as a result of parasympathetic innervation of the heart Decreased heart rate as a result of impaired acetylcholine reuptake
Decreased heart rate as a result of parasympathetic innervation of the heart Vagal stimulation results in lowered heart rate as a result of parasympathetic stimulation. Vascular perfusion, contractility and afterload would not be under direct effect. Acetylcholine reuptake would not be influenced.
The nurse assists and educates clients about blood pressure regulation. Based on this information, the nurse asks the client what the number 80 in the blood pressure 120/80 represents. Which response by the client demonstrates correct understanding of the basic concepts of blood pressure? Cardiac output Pulse pressure Systolic pressure Diastolic pressure
Diastolic pressure Cardiac output is the amount of blood the ventricles pump out in 1 minute; normally, 4 to 6 L/minute. Blood pressure is the force exerted by the blood against the walls of the blood vessels. Systolic blood pressure, in this example 120, is the force during ventricular contraction. Diastolic blood pressure, in this example is 80, is the force during ventricular relaxation. The difference between systolic and diastolic pressure is called pulse pressure.
A client with chronic obstructive pulmonary disease (COPD) develops signs of cor pulmonale. What assessment data would alert the nurse to this condition? Edema of the extremities and distended neck veins Difficulty breathing and crackles in the lungs Decreased urine output because of decreased arterial blood flow Irregular radial pulse and decreased pulse rate
Edema of the extremities and distended neck veins Explanation: Cor pulmonale is right-sided heart failure caused by lung problems, so the symptoms outlined indicate edema and venous congestion, which are backup signs from right-sided failure. The other choices are incorrect.
During oxygen administration to the client, which pieces of equipment would enable the nurse to regulate the amount of oxygen delivered? Flow meter Oxygen analyzer Nasal cannula Humidifier
Flow meter Explanation: In order to regulate the amount of oxygen delivered to the client, the nurse should use a flow meter. A flow meter is attached to the source of oxygen. An oxygen analyzer is a device that measures the percentage of delivered oxygen to determine if the client is receiving the amount prescribed by the physician. A humidifier is a device that produces small water droplets and may be used during oxygen administration, since oxygen dries the mucous membranes. A nasal cannula is a hollow tube with half-inch prongs placed into the client's nostrils. It provides a means for administering a low concentration of oxygen.
The nurse assists and educates clients about blood pressure regulation. Which information is important to include in the review with clients about blood pressure? Force exerted by the blood against the walls of the blood vessels Diastolic blood pressure is the force of blood pressure during ventricular contraction Systolic blood pressure is the force during ventricular relaxation Amount of blood the ventricles pumps out in 1 minute
Force exerted by the blood against the walls of the blood vessels Blood pressure is the force exerted by the blood against the walls of the blood vessels. Cardiac output is the amount of blood the ventricles pump out in 1 minute, normally, 4 to 6 L/minute. Systolic blood pressure is the force during ventricular contraction. Diastolic blood pressure is the force during ventricular relaxation.
Fluid moves into the arterial end of a capillary due to: Hydrostatic pressure Fluid needs of the cells Oncotic pressure Loose endothelial cells
Hydrostatic pressure Hydrostatic pressure regulates the movement of fluids at the arterial end of the capillary; entotic pressure regulates this movement at the venous end of the capillary. It is the pressure that directs flow through the loosely connected endothelial cells of the capillary.
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? Polyuria Hypotension Warm moist skin Bradycardia
Hypotension Explanation: Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased blood pressure; and decreased urine output.
The nurse assesses a client and detects the following findings: difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis. What condition would the nurse suspect as causing these respiratory alterations? Perfusion Atelectasis Hyperventilation Hypoxia
Hypoxia Explanation: Hypoxia is a condition in which an inadequate amount of oxygen is available to cells. Difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis are all signs of hypoxia. Hyperventilation is an increased rate and depth of ventilation, above the body's normal metabolic requirements. Perfusion refers to the process by which oxygenated capillary blood passes through body tissues. Atelectasis refers to collapsed alveoli.
With an understanding of how hydrostatic forces effect the capillaries, which would increase the capillary hydrostatic pressure? Decrease in the arteriole pressure Decrease in gravity when standing increase in small artery pressure Increase in venous pressure
Increase in venous pressure Changes in venous pressure have a greater effect on the capillary hydrostatic pressure than does the same change in arterial pressure. An increase in small artery and arterial pressure elevates capillary hydrostatic pressure.
Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? Intermittent claudication Vertigo Dizziness Acute limb ischemia
Intermittent claudication Explanation: The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease.
A nursing student is giving to a client with heart failure a medication with a positive inotropic effect on the heart. The student asks what a "positive inotropic" effect is. The correct response would be which of the following? It increases the force of the myocardial contraction. It increases the respiratory rate. It causes the kidneys to retain fluid and increase intravascular volume. It increases the heart rate.
It increases the force of the myocardial contraction. Explanation: A positive inotropic effect increases the force of myocardial contraction. A positive chronotropic effect increases the heart rate. A positive inotropic effect will usually help slow respiratory rate and will increase blood flow through the kidneys, so fluid output will increase.
Which is true regarding the pulmonary circulation? The system functions with an increased arterial pressure to circulate through the distal body parts It is a low pressure system that allows for improved gas exchange It is the larger of the two circulatory systems It consists of the left side of the heart, the aorta and its branches
It is a low pressure system that allows for improved gas exchange The pulmonary circulation consists of the right heart, and the pulmonary artery, capillaries and veins. It is the smaller of the systems at functions at a lower pressure to assist with gas exchange.
Which teaching about a flowmeter is important for the nurse to provide to a client using oxygen?
It regulates the amount of oxygen received. Explanation: The flowmeter is a gauge used to regulate the amount of oxygen that a client receives. The provider prescribes concentration. The oxygen analyzer measures the percentage of delivered oxygen. The humidifier produces small water droplets that are delivered during oxygen administration to decrease dry mucous membranes.
Which teaching about a flowmeter is important for the nurse to provide to a client using oxygen? It prescribes oxygen concentration. It determines whether the client is getting enough oxygen. It decreases dry mucous membranes via delivering small water droplets. It regulates the amount of oxygen received.
It regulates the amount of oxygen received. Explanation: The flowmeter is a gauge used to regulate the amount of oxygen that a client receives. The provider prescribes concentration. The oxygen analyzer measures the percentage of delivered oxygen. The humidifier produces small water droplets that are delivered during oxygen administration to decrease dry mucous membranes.
The triage nurse in the emergency department assesses a 66-year-old male patient who has presented to the emergency department with complaints of midsternal chest pain that has lasted for the last 5 hours. The care team suspects a myocardial infarction (MI). The nurse is aware that, because of the length of time the patient has been experiencing symptoms, the following may have happened to the myocardium: Will probably not have more damage than if he came in immediately Can have restoration of the area of dead cells with proper treatment Has been damaged already, so immediate treatment is no longer necessary May have developed an increased area of infarction
May have developed an increased area of infarction Explanation: When the patient experiences lack of oxygen to myocardium cells during an MI, the sooner treatment is initiated the more likely the treatment will prevent or minimize myocardial tissue necrosis. Despite the length of time the symptoms have been present, treatment needs to be initiated immediately to minimize further damage.
Proper function of the cardiovascular system relies on blood following the correct pathway through the heart. Valves within the heart separate the organ's chambers and prevent blood from flowing in the wrong direction. What valve separates the left atrium and left ventricle? Mitral Pulmonic Aortic Tricuspid
Mitral The mitral valve separates the left atrium and left ventricle.
A backflow of blood is noted in the left ventricle from the left atrium. The patient is suffering from a defect in which valve? Mitral valve Tricuspid valve Pulmonic valve Aortic valve
Mitral valve The mitral valve separates the left atrium and left ventricle. This malfunction allows the backflow of blood due to a defect in the mitral valve. The tricuspid valve separates the right atrium and right ventricle. The pulmonic valve separates the right ventricle and pulmonary artery. The aortic valve separates the left ventricle and aorta.
A nurse needs to measure the blood pressure of a client who has just undergone a bilateral mastectomy. How should the nurse measure the blood pressure? Over the lower arm Over the client's thigh Radial artery Brachial artery
Over the client's thigh Explanation: The nurse should measure the blood pressure over the client's thigh or the popliteal artery behind the knee. It is inadvisable following a mastectomy to assess blood pressure at the normal site, which is over the brachial artery at the inner aspect of the elbow. In normal cases, the blood pressure may also be assessed at the lower arm and radial artery.
A nurse is caring for a client following an arterial vascular bypass graft in the leg. What should the nurse plan to assess over the next 24 hours? Color of the leg every 4 hours Ankle-arm indices every 12 hours Peripheral pulses every 15 minutes after surgery Blood pressure every 2 hours
Peripheral pulses every 15 minutes after surgery Explanation: The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the client's status remains stable.
During which phase of the action potential does calcium slowly enter the cell and potassium begin to leave? Phase 2 Phase 0 Phase 1 Phase 3
Phase 2 During phase 2, the cell membrane becomes less permeable to sodium and calcium slowly enters the cell and potassium begins to leave (repolarization). During phase 0, the cell reaches a point of stimulation with sodium rushing into the cell (depolarization). During phase 1, sodium ion concentrations are equal inside and outside the cell. During phase 3, rapid repolarization occurs, as the gates close and potassium rapidly moves out of the cell.
Of the following factors, which increases the heart's output, and is dependent on the actions of the heart and the vasculature before contraction? Preload Afterload Cardiac contractility Heart rate
Preload Preload represents the amount of blood that the heart must pump with each beat and is determined by the venous return to the heart and the accompanying stretch of the cardiac muscle fibers.
A nurse is measuring the BP of a client. The client asks what the BP measures. What is the best response by the nurse about the measurement of BP? Pressure of blood within the veins Pressure of blood within the arteries Pressure of blood within the heart Pressure of blood within the lungs
Pressure of blood within the arteries When measuring BP, the systolic (contraction) pressure and the diastolic (relaxation) pressure of the blood within the arteries are recorded. The pressure of blood within the veins, within the heart, or within the lungs is not recorded for measuring BP.
What complication is the nurse aware of that is associated with deep venous thrombosis? Swelling of the entire leg owing to edema Marked tenderness over the anteromedial surface of the thigh Pulmonary embolism Immobility because of calf pain
Pulmonary embolism Explanation: Serious potential venous thromboembolism complications of surgery include deep vein thrombosis and pulmonary embolism (Rothrock, 2010).
Which is responsible for transmitting the nerve impulse to the ventricular cells? AV node Bundle of His Bundle branches Purkinje fibers
Purkinje fibers The Purkinje fibers deliver the impulse to the ventricular cells. The AV node receives the impulse from the atrial bundles and moves it to the bundle of His and then into the bundle branches.
A patient is brought to the emergency department with complaints of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? Reduce the blood pressure to about 140/80 mm Hg. Rapidly reduce the blood pressure so the patient will not suffer a stroke. Reduce the blood pressure by 20% to 25% within the first hour of treatment. Reduce the blood pressure by 50% within the first hour of treatment.
Reduce the blood pressure by 20% to 25% within the first hour of treatment. Explanation: A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.
Which is released initially when blood flow to the kidneys is decreased? Renin Angiotensin I Angiotensin II Aldosterone
Renin When blood flow to the kidneys is reduced, the cells in the kidney release renin, which then converts angiotensinogen to angiotensin I. This is converted by angiotensin-converting enzyme to angiotensin II, which reacts with specific receptor sites on blood vessels to cause vasoconstriction. Angiotensin II also causes the release of aldosterone.
Which enzyme is produced in the kidney? Lipase Renin Creatinine kinase Gastrin
Renin Cells in the kidney release renin, which is transported to the liver to convert angiotensinogen to angiotensin I.
The pathway for blood flow through the heart is: Right atria to left ventricle to pulmonary veins through lungs to pulmonary artery to left atria and then to left ventricle. Right atria to right ventricle to pulmonary artery through lungs to pulmonary veins to left atria and then to left ventricle. Left atria to right ventricle to pulmonary artery through lungs to pulmonary veins to left atria and then to left ventricle. Right atria to right ventricle to pulmonary veins through lungs to pulmonary artery to left atria and then to left ventricle.
Right atria to right ventricle to pulmonary artery through lungs to pulmonary veins to left atria and then to left ventricle. The heart has four chambers: two atria and two ventricles. The right atrium receives deoxygenated blood from the body by way of the vena cava; the right ventricle sends deoxygenated blood through the pulmonary circulation. The left atrium receives oxygenated blood from the lungs through the pulmonary veins. The left ventricle pumps oxygenated blood through the systemic circuit.
Which area of the heart is supplied by the right coronary artery? Left ventricle Right side of the heart Cardiac septum Conduction system
Right side of the heart The right coronary artery supplies most of the right side of the heart, including the SA node. The left circumflex artery supplies most of the left ventricle. The left anterior descending artery feeds the septum and anterior areas, including much of the conduction system.
Special bundles of unique tissue in the heart transmit and coordinate electrical impulses to stimulate the heart to beat. Place the path of an electrical impulse through the conduction system of the heart into the correct sequence of steps. 1 SA (sinoatrial) node 2 AV (atrioventricular) node 3 Bundle of His (AV bundle) 4 Right and left bundle branches 5 Purkinje fibers to muscles of ventricles
SA (sinoatrial) node AV (atrioventricular) node Bundle of His (AV bundle) Right and left bundle branches Purkinje fibers to muscles of ventricles Conduction System of the Heart: SA (sinoatrial) node (pacemaker); AV (atrioventricular) node; bundle of His (AV bundle); right and left bundle branches; Purkinje fibers to muscles of ventricles.
After teaching a group of students about the conduction system of the heart, the instructor determines that the teaching was successful when the students identify what as the origination of the impulse? SA node AV node Bundle of His Purkinje fibers
SA node The SA node acts as the pacemaker of the heart, initiating the impulse. The AV node, bundle of His, and Purkinje fibers are part of the conduction system.
The nurse is reviewing a patient's ECG and notes that the ECG is normal, but the rate is 110 beats/minute. The nurse would identify this as: Sinus tachycardia Atrial flutter Atrial fibrillation Paroxysmal atrial tachycardia
Sinus tachycardia Sinus tachycardia would be characterized by a normal appearing ECG, but a rate usually less than 100 beats per minute. Atrial flutter is characterized by sawtoothed shaped P waves, often with 2 or 3 P waves occurring for every QRS complex. Atrial fibrillation would be characterized by many irregular P waves, depicting bombardment of the AV node in an unpredictable number causing the ventricles to beat in a fast, irregular, and often inefficient heart manner. Paroxysmal atrial tachycardia would be characterized by sporadically occurring runs of rapid heart rate.
These are activities involved in the action potential of cardiac muscle. Place them in the proper sequence beginning with activities in phase 0 through phase 4. 1 Sodium rushes into the cell. 2 Sodium ion concentration equalizes. 3 Calcium slowly enters and potassium begins to leave the cell. 4 Potassium rapidly moves out of the cell. 5 Sodium is outside the cell and potassium is inside the cell
Sodium rushes into the cell. Sodium ion concentration equalizes. Calcium slowly enters and potassium begins to leave the cell. Potassium rapidly moves out of the cell. Sodium is outside the cell and potassium is inside the cell. The action potential of the cardiac muscle cell consists of five phases: Phase 0 occurs when the cell reaches a point of stimulation. The sodium gates open along the cell membrane, and sodium rushes into the cell, resulting in a positive flow of electrons into the cell, or an electrical potential. This is called depolarization. The membrane no longer has a positive side or pole and a negative side; it is depolarized, or electrically the same on both sides. Phase 1 is the very short period when the sodium ion concentrations are equal inside and outside the cell. Phase 2, or the plateau stage, occurs as the cell membrane becomes less permeable to sodium. Calcium slowly enters the cell, and potassium begins to leave the cell. The cell membrane is trying to return to its resting state, a process called repolarization, the return of the polarity on either side of the membrane. Phase 3 is a period of rapid repolarization as the gates are closed and potassium rapidly moves out of the cell. Phase 4 occurs when the cell comes to rest as the sodium-potassium pump returns the membrane to its previous state, with more sodium outside and more potassium inside the cell. Spontaneous depolarization begins again.
A client who has been diagnosed with blood pressure problems is eager to know more about the condition. What should the nurse explain is one of the internal processes that attempt to maintain blood pressure within normal limits? Special sensory receptors in blood vessel walls called baroreceptors are stimulated. The arteries that supply the heart muscle with blood will increase in size. The right and left coronary arteries divide into smaller branches over the surface. Blood moves on through the heart valve during contraction to enter lungs.
Special sensory receptors in blood vessel walls called baroreceptors are stimulated. Special sensory receptors in blood vessel walls, called baroreceptors, are stimulated by a change in blood pressure (BP). They send signals, which cause various body reactions to help maintain normal BP. The left anterior descending (LAD) artery descends along the anterior intraventricular groove to provide blood to most of the ventricular septum and the anterior portion of the left ventricle. The right and left coronary arteries extend over the heart's surface and divide into smaller branches to supply heart tissue with oxygen and nourishment. Blood moves on through the pulmonic valve during ventricular contraction to enter the pulmonary artery and lungs to receive oxygen.
An instructor is describing an action of the heart, likening it to that of stretching a rubber band. The instructor is describing: Starling's law of the heart Automaticity Capacitance system Conductivity
Starling's law of the heart Starling's law of the heart is often compared to the stretching of a rubber band, such that the heart returns to its normal size after it is stretched and the further it is stretched, the stronger the spring back to normal. Automaticity refers to the heart cells being able to generate an action potential without an external stimulus. Capacitance system refers to the venous system that is distensible and flexible. Conductivity refers to the heart cells being able to rapidly conduct an action potential of electrical impulse.
The newly hired nurse is caring for a client who had a tracheostomy four hours ago. Which action by the nurse, if noted by the charge nurse, would cause the charge nurse to intervene? The newly hired nurse assesses the client's pain and administers pain medication. The newly hired nurse explains what she is doing and the reason to the client, even though the client does not appear to be alert. The newly hired nurse adjusts the bed to a comfortable working position. The newly hired nurse delegates care of the tracheostomy to a licensed practical/vocational nurse (LPN/LVN).
The newly hired nurse delegates care of the tracheostomy to a licensed practical/vocational nurse (LPN/LVN). Explanation: Care of a tracheostomy tube in a stable situation, such as long-term care and other community-based care settings, may be delegated to licensed practical/vocational nurses (LPN/LVN); not in an acute instance. Adjusting the bed to a comfortable working position prevents back and muscle strain. Explanation alleviates fears; even if the client appears unconscious, the nurse should explain what is happening. When tracheostomy is new, pain medication may be needed before performing tracheostomy care.
A nurse is educating a group of nursing students about the heart's chambers and the muscular septum wall. What information by a nursing student demonstrates a correct understanding about the four chambers into which the heart is divided? (Select all that apply.) The interior of the heart is divided into two chambers. The thin-walled, low-pressure chambers are the receiving centers for blood. Ventricles are high-pressure chambers because they pump blood out of the heart. The left ventricle is the thickest chamber and it pumps blood to the rest of the body.
The thin-walled, low-pressure chambers are the receiving centers for blood. Ventricles are high-pressure chambers because they pump blood out of the heart. The left ventricle is the thickest chamber and it pumps blood to the rest of the body.
The nurse is reviewing with the client the three major layers of the heart wall and how they relate to the pericardium. What is the best description by the nurse to the client about the myocardium layer of the heart? Thick, strong muscles making up the middle layer Thin outer layer of the cardiac wall A membrane lining the heart's interior wall Outermost layer anchoring the heart
Thick, strong muscles making up the middle layer Thick, strong muscles making up the middle layer is known as the myocardium. The thin outer layer of the cardiac wall is known as the epicardium. The endocardium is a membrane lining the heart's interior wall. The pericardium is the outermost layer anchoring the heart.
A nurse is assessing the vital signs of a client. The client inquires about the functions of the arteries. What should the nurse include in the client education about the function of arteries? To serve as a capacitance vessels for blood To exchange oxygen and nutrients with body cells To take the blood back into the heart's chambers To carry oxygenated blood to the body cells
To carry oxygenated blood to the body cells Arteries are elastic and smooth muscular tubes that, with the exception of the pulmonary artery, carry oxygenated blood to body cells. To exchange oxygen and nutrients with cells is the function of the capillaries. Veins flow the blood back into the heart. Systemic veins and venules serve as capacitance vessels.
Which substance is responsible for keeping the proteins in the cardiac muscle apart? Troponin Actin Myosin Calcium
Troponin Troponin keeps the proteins, actin and myosin, apart. Actin is one of the proteins in the cardiac muscle cell. Myosin is one of the proteins of the cardiac muscle cell. Calcium is involved in the action potential and allows actomyosin bridges to form.
After teaching a group of students about circulation, the instructor determines that the teaching was successful when the students identify it as: a high to low pressure system. a semi-open system. single resistance system. a solitary course of blood flow.
a high to low pressure system. Circulation is a high to low pressure system. Circulation is a closed system. Circulation involves a resistance and capacitance system. Circulation follows two courses, a systemic and a pulmonary courses.
The nurse is assessing a newborn in the nursery. The nurse notes the infant has episodes in which breathing ceased for 20 seconds on 2 occasions. The nurse correctly recognizes this condition as: apnea hypercapnea orthopnea dyspnea
apnea Explanation: The newborn's breathing pattern is characterized by occasional pauses of several seconds between breaths. This periodic breathing is normal during the first 3 months of life, but frequent or prolonged periods of apnea (cessation of breathing 20 seconds or longer) are abnormal. Dyspnea refers to a shortness of breath. Orthopnea refers to difficulty breathing when lying flat. An elevation of carbon dioxide levels in the blood is termed hypercapnea.
Potassium is needed for neural, muscle, and: cardiac function. skeletal function. optic function. auditory function.
cardiac function. Explanation: Potassium is essential for normal cardiac, neural, and muscle function and contractility of all muscles.
Oxygen and carbon dioxide move between the alveoli and the blood by: diffusion. osmosis. negative pressure. hyperosmolar pressure.
diffusion. Explanation: Oxygen and carbon dioxide move between the alveoli and the blood by diffusion, the process in which molecules move from an area of greater concentration or pressure to an area of lower concentration or pressure.
The nurse is caring for a client who has been prescribed humidified oxygen at 6 L/minute. Which type of liquid will the nurse gather to set up the humidifier? tap water normal saline mineral oil distilled water
distilled water Explanation: Distilled water is used when humidification is desired. Other answers are incorrect.
A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? tremor dizziness persistent cough blurred vision
dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.
To drain the apical sections of the upper lobes of the lungs, the nurse should place the client in which position? Trendelenburg position left side with a pillow under the chest wall high-Fowler's position side-lying position, half on the abdomen and half on the side
high-Fowler's position Explanation: Postural drainage makes use of gravity to drain secretions from the lungs from smaller pulmonary branches into larger ones, where they can be removed by coughing. High-Fowler's position is used to drain the apical sections of the upper lobes of the lungs. Placing the client lying on the left side with a pillow under the chest wall helps to drain the right lobe of the lung. Placing the client in a side-lying position, half on the abdomen and half on the side, right and left, helps to drain the posterior sections of the upper lobes of the lungs. Trendelenburg position assists in draining the lower lobes of the lungs.
When explaining blood supply to the heart muscle, the nurse explains that the left circumflex artery supplies the: left ventricle. right side of the heart. conduction system. cardiac septum.
left ventricle. Left circumflex artery supplies most of the left ventricle. The right coronary artery supplies most of the right side of the heart. The left anterior descending artery feeds the septum and anterior areas including much of the conduction system. The left anterior descending artery feeds the septum and anterior areas, including much of the conduction system.
Assessment of the pulse amplitude is accomplished by: palpating the flow of blood through an artery. auscultating the area of the left ventricle. palpating the area of the left ventricle. auscultating the flow of blood through an artery.
palpating the flow of blood through an artery. Explanation: The pulse amplitude describes the quality of the pulse in terms of its fullness, and reflects the strength of left ventricular contraction. It is assessed by the feel of the blood flowing through an artery.
A nurse notices repetitive late decelerations on the fetal heart monitor. The best initial actions by the nurse include: prepare for birth, reposition the patient, and begin pushing. perform sterile vaginal examination, increase IV fluids, and apply oxygen. reposition the client, apply oxygen, and increase IV fluids. notify the provider, explain findings to the client, and begin pushing.
reposition the client, apply oxygen, and increase IV fluids. Explanation: Late decelerations on a fetal heart monitor indicate uteroplacental insufficiency. Interventions to improve perfusion include repositioning the client, oxygen, and IV fluids. A sterile vaginal exam is not indicated at this time. Late decelerations are not expected findings and do not indicate an imminent birth.
A group of nursing students is preparing a poster presentation describing the anatomy and function of the heart. In their diagram of the organ, they label the structure that separates the left and right sides of the heart as the: auricle. bundle of His. mitral valve. septum.
septum. The septum is a muscular wall that separates the right and left sides of the heart.
When describing Starling's law of the heart, the instructor compares this to: moving up and down on a staircase stretching of a rubber band pushing and pulling of a rope flowing of water through a pipe
stretching of a rubber band Starling's law of the heart is often compared with the stretching of a rubber band, such that the heart returns to its normal size after it is stretched—the further it is stretched, the stronger is the spring back to normal.
What is the action of codeine when used to treat a cough? antisuppressant antihistamine expectorant suppressant
suppressant Explanation: Codeine, which is an ingredient in many cough preparations, is generally considered to be the preferred cough suppressant ingredient.
