Ch 25 cardiac ALL

An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:

many people live with atrial fibrillation without even knowing they have it.

A client is lying in a recumbent position. In this client, approximately how much total blood volume is in the central circulation? A-15% - 20% B-20% - 25% C-25% - 30% D-30% - 35%

25% - 30% >>In the recumbent position, approximately 25 to 30 percent of the total blood volume is in the central circulation.

Which of the following is the correct sequence for blood flow through the heart? a) Left atrium - tricuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein -right atrium - mitral valve - right ventricle - aorta b) Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta c) Right atrium - bicuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein -left atrium - tricuspid valve - left ventricle - aorta d) Left atrium - bicuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein -right atrium - tricuspid valve - right ventricle - aorta

B

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins? a) Diuretic b) Vasoconstriction c) Vasodilation d) Natriuretic

B) Vasoconstriction

A patient has a narrowed pulse pressure. The nurse knows that the major factors that influence pulse pressure include which of the following? Select all that apply a) Heart rate b) Blood viscosity c) Duration of diastole d) Distensability of the arteries e) Stroke volume

D) Distensability of the arteries e) Stroke volume

A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor? a) Decreases the heart rate, which will cause a decrease in cardiac output b) Inhibit the movement of calcium into cardiac and vascular smooth muscle c) Decreases vascular volume by suppressing renal reabsorption of sodium d) Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction

D) Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction

Colloidal osmotic pressure acts differently than the osmotic effects of the plasma proteins. What is its action? A-Pulls fluid back into the capillary B-Pushes fluid into the extracellular spaces C-Controls the direction of the fluid flow in the large arteries D-Pulls fluid into the interstitial spaces

Pulls fluid back into the capillary >>The osmotic pressure caused by the plasma proteins in the blood tends to pull fluid from the interstitial spaces back into the capillary. This pressure is termed colloidal osmotic pressure so as to differentiate the osmotic effects of the plasma proteins, which are suspended colloids, from the osmotic effects of substances such as sodium and glucose, which are dissolved crystalloids.

Which blood vessel layer is made primarily of muscle? A)Tunica media B) Tunica intima C) Tunica externa D) Tunica adventitia

Tunica media

A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins? a) Right sided heart failure b) Left sided heart failure c) Cerebral vascular accident d) Shock

a) Right sided heart failure

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be: a) Physical inactivity and high serum high-density lipoprotein cholesterol b) History of cigarette smoking and elevated blood pressure c) Advanced age and low serum total and low-density lipoprotein cholesterol d) High serum high-density lipoprotein and diabetes

b) History of cigarette smoking and elevated blood pressure

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following? a) Tunica intima b) Tunica adventitia c) Tunica media d) Tunica externa

c) Tunica media Tunica media = middle layer, largely smooth muscle layer that constricts to regulate and control the diameter of the vessel. tunica externa (tunica adventitia) outermost layer; it is fibrous to protect & anchor the vessel Tunica intima innermost thin smooth layer of flattened endothelial cells that prevents platelet adherence and blood clotting.

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be: a) The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. b) The valve opening is incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium. c) The valve opening permits backward flow to occur when the valve should be closed. d) The valve opens backward permitting blood to flow from the right ventricle into the right atrium.

A The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.

When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which statements are accurate? Select all that apply. The AV node offers a two-way conduction area between the atria and the ventricles. The velocity of conduction through the AV junctional fibers is very fast, which greatly increases impulse transmission. A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. When there is an AV block, impulses from the atria and ventricles beat independently of each other, so the heart rhythm is usually chaotic and irregular.

A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. When there is an AV block, impulses from the atria and ventricles beat independently of each other, so the heart rhythm is usually chaotic and irregular. The AV node connects the atrial and ventricular systems and normally provides for a one-way conduction between the atria and ventricles. The velocity of conduction through the AV junctional fibers is very slow, which greatly delays impulse transmission. A further delay occurs as the impulse travels through the transitional fibers and into the AV bundle, known as the bundle of His. This delay provides a mechanical advantage whereby the atria can complete their ejection of blood before ventricular contraction begins. Under normal circumstances, the AV node provides the only connection between the atrial and ventricular conduction systems. The atria and ventricles would beat independently of each other if the transmission of impulses through the AV node were blocked.

The cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level. What is the normal young adult's percentage cardiac reserve? a) 300% - 400% b) 100% - 200% c) 200% - 300% d) 400% - 500%

A) 300% - 400%

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess. a) Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy b) Blood pressure 140/90 and glucose in the urine during the 36th week of pregnancy c) Blood pressure 90/60 and proteinuria in the second trimester d) Blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy

A) Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy

An elderly patient is diagnosed with orthostatic hypotension. For which of the following clinical manifestations should the nurse assess? a) Dizziness and fainting b) Nausea and vomiting c) Headache and double vision d) Chest pain and palpitations

A) Dizziness and fainting

Preload represents the volume work of the heart and is largely determined by: a) Venous blood return b) Vascular resistance c) Force of contraction d) Ventricular emptying

A) Venous blood return

A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following? a) Weight gain b) Shortness of breath c) Copious urination d) Decreased blood pressure

A) Weight gain

A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to "watch" for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which physiologic principle? A-Small diameter of this vessel will cause it to rupture more readily. B-The larger the aneurysm, the less tension placed on the vessel. C-As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture. D-The primary cause for rupture relates to increase in abdominal pressure, such as straining to have a bowel movement.

As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture. >>LaPlace Law P=T/r radius increases, Tension increases Because the pressure is equal throughout, the tension in the part of the balloon with the smaller radius is less than the tension in the section with the larger radius. The same holds true for an arterial aneurysm in which the tension and risk of rupture increase as the aneurysm grows in size. Wall tension is inversely related to wall thickness, such that the thicker the vessel wall, the lower the tension, and vice versa. Although arteries have a thicker muscular wall than veins, their distensibility allows them to store some of the blood that is ejected from the heart during systole, providing for continuous flow through the capillaries as the heart relaxes during diastole.

Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction? a) 61-year-old man whose pain started at 9 AM during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened b) 80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose c) 67-year-old woman whose pain started at 2 AM while she was asleep and that responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable d) 33-year-old man whose pain started at 7 AM during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable

B) 80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose

Persons with hypertension secondary to hyperaldosteronism may be treated with which of the following drugs? a) Alpha adrenergic antagonists b) Potassium-sparing diuretics c) Angiotensin converting enzyme inhibitors (ACEI) d) Beta adrenergic blockers

B) Potassium-sparing diuretics

A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure? a) Stage 1 Hypertension b) Prehypertension c) Normal blood pressure d) Stage 2 Hypertension

B) Prehypertension

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have? a) Will increase extracellular fluid and decrease venous pressure b) Will prevent the conversion of angiotensin I to angiotensin II c) Will increase oxygen consumption of the heart d) Will have a direct vasoconstrictive effect on vessels of splanchnic circulation

B) Will prevent the conversion of angiotensin I to angiotensin II

Which of the following cardiac alterations occurs during pregnancy?A. An increase in cardiac output and blood pressure B. An increase in cardiac volume and a decrease in blood pressure C. An increased heart rate and increased blood pressure D. An increased stroke volume with decreased cardiac output

B. An increase in cardiac volume and a decrease in blood pressure

A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the: A-Tricuspid valve B-Pulmonic valve C-Bicuspid valve D-Aortic valve

Bicuspid valve >>The bicuspid valve (also called the mitral valve) controls the flow of blood between the left atria and left ventricle. The aortic valve controls flow between the left ventricle and aorta. The tricuspid controls the flow between the right atria and ventricle. The pulmonic valve controls flow between the right ventricle and pulmonary artery.

Which of the following guidelines may be used to identify which heart sound is S1? A. S1 is louder than S2 at the base of the heart. B. S1 coincides with the A wave of the jugular venous pulse wave. C. S1 coincides with the carotid artery pulse. D. S1 coincides with the Q wave of the QRS electrocardiogram complex.

C. S1 coincides with the carotid artery pulse

Select the correct sequence of blood return to the heart. A-Capillaries, venules, veins, right atrium B-Capillaries, arterioles, arteries, right atrium C-Capillaries, arterioles, veins, left atrium D-Capillaries, venules, veins, left atrium

Capillaries, venules, veins, right atrium >>The correct pathway for blood returning back to the heart is the capillaries, venules, veins, and right atrium. The other options do not support normal blood flow.

The heart controls the direction of blood flow. What is the role of the aortic valve? A) Controls the direction of blood flow from the atria to the ventricles B) Controls the direction of blood flow from the left side of the heart to the lungs C) Controls the direction of blood flow from the left side of the heart to the systemic circulation D) Controls the direction of blood flow from the ventricles to the atria

Controls the direction of blood flow from the left side of the heart to the systemic circulation RATIONALE: The heart valves control the direction of blood flow from the atria to the ventricles (the AV valves), from the right side of the heart to the lungs (pulmonic valves) and from the left side of the heart to the systemic circulation (aortic valve).

When intracranial pressure (ICP) equals intra-arterial pressure, the central nervous system ischemic response is initiated. This response is directed at raising arterial pressure above ICP, thereby reestablishing blood flow to the vasomotor center of the brain. What is this response called? Cushing law Cushing response Cushing reflex Cushing syndrome

Cushing reflex (reaction) Cushing reflex is triggered by ischemia of the vasomotor center in the brain stem (hypertension, bradycardia, and widened pulse pressure) The Cushing reflex is a special type of central nervous system (CNS) reflex resulting from an increase in intracranial pressure (ICP). When the ICP rises to levels that equal intra-arterial pressure, blood vessels to the vasomotor center become compressed, initiating the CNS ischemic response. The purpose of this reflex is to produce a rise in arterial pressure to levels above ICP so that the blood flow to the vasomotor center can be reestablished. If the ICP rises to the point that the blood supply to the vasomotor center becomes inadequate, the vasoconstrictor tone is lost, and the blood pressure begins to fall. The elevation in blood pressure associated with the Cushing reflex is usually of short duration and should be considered a protective homeostatic mechanism. The brain and other cerebral structures are located within the rigid confines of the skull, with no room for expansion, and any increase in ICP tends to compress the blood vessels that supply the brain.

The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be: a) 41mm Hg b) 228 mm Hg c) 73 mm Hg d) 64 mm Hg

D

Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis? a) Cause bradycardia b) Vasoconstrict the capillary bed c) Activate erythropoiesis d) Release nitric oxide

D) Release nitric oxide

The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. The nurse knows that this finding indicates: A. Decreased fluid volume. B. Increased cardiac output. C. Narrowing of jugular veins. D. Elevated pressure related to heart failure.

D. Elevated pressure related to heart failure.

Lymphedema is: A. The indentation left after the examiner depresses the skin over swollen edematous tissue. B. A thickening and loss of elasticity of the arterial walls. C. An inflammation of the vein associated with thrombus formation. D. The swelling of an extremity caused by an obstructed lymph channel.

D. The swelling of an extremity caused by an obstructed lymph channel.

A client has just experienced stimulation of the vagus nerve. Which sign would the nurse anticipate the client to manifest? A-Decreased heart rate B-Increased cardiac contractility C-Increased heart rate D-Decreased blood coagulation

Decreased heart rate >> The neural control of the circulation occurs primarily through the sympathetic (SNS) and parasympathetic (PNS) divisions of the autonomic nervous system (ANS). The ANS contributes to the control of cardiovascular function through modulation of cardiac function (i.e., heart rate and cardiac contractility) and peripheral vascular resistance. Increased vagal activity (activation of the PNS) produces a slowing of heart rate. Increased cardiac contractility and heart rate refer to SNS stimulation. Blood coagulation is not affected by the autonomic nervous system.

A client is experiencing a sudden increase in heart rate resulting in less time in diastole. This can result in which potential complication? A-Increased blood viscosity B-Loss of action potential C-Decreased stroke volume D-Reduced cardiac contractility

Decreased stroke volume >>The time spent in diastole and filling of the ventricles becomes shorter as the heart rate increases. This leads to a decrease in stroke volume and, at high heart rates, may produce a decrease in cardiac output. Increased heart rate does not typically cause increased blood viscosity, a loss of action potential, or reduced cardiac contractility.

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?

Exchange gases, nutrients and wastes

A grandmother, a cook at a nearby school, was recently hospitalized when she lost an extensive amount of blood in a work-related accident. The grandmother tells the nurse that she heard that she would keep feeling faint until the brain made more blood. The nurse knows that when the blood pressure dropped, the pressure in the carotid arteries decreased. This was detected by baroreceptors in the carotid arteries. What did the baroreceptors do?

Increase sympathetic stimulation of the heart and blood vessels

If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations? A) Increased heart rate and increased contractility B) Increased heart rate and decreased contractility C) Decreased contractility and decreased heart rate D) Decreased rate and force of contraction

Increased heart rate and increased contractility RATIONALE: The sympathetic nervous system has an excitatory influence on heart rate and contractility, and it serves as the final common pathway for controlling the smooth muscle tone of the blood vessels. With stimulation of sympathetic nervous system, both heart rate and contractility would increase.

Which factor can cause turbulent blood flow? A-Increased velocity B-Short vessel length C-High blood viscosity D-Layering of blood cells

Increased velocity >>Under some conditions, blood flow switches from laminar flow (blood component layering) to turbulent flow. Turbulence can result from an increase in velocity of flow, a decrease in vessel diameter, or low blood viscosity. Vessel length affects the rate of flow rather than the type of flow.

A nursing instructor is explaining arterial circulation to a group of nursing students. What is the most appropriate information for the nurse to provide concerning arterial pressure gradient in the arterial side of systemic circulation? A-It contains one-sixth of the total blood volume. B-The vascular pressure is lower than the venous circulation. C-It contains approximately two-thirds of the total blood volume. D-Arteries are more distensible than veins.

It contains one-sixth of the total blood volume. >>The arterial side of the circulation contains approximately one-sixth of the blood volume. Arterial circulation exerts much greater pressure than the pressure on the venous side of the circulation. The venous side contains approximately two-thirds of the blood. Because of their thicker, muscular walls arteries are less distensible than veins.

Which of the following is true regarding pulmonary circulation? A) The system functions with an increased arterial pressure to circulate through the distal parts of the body. B) It is a low-pressure system that allows for improved gas exchange. C) It is the larger of the two circulatory systems. D) 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 lymph system correlates with the vascular system without actually being a part of the vascular system. Among other things, the lymph system is the main route for the absorption of fats from the gastrointestinal system. The lymph system empties into the right and left thoracic ducts, which are the points of juncture with the vascular system. What are these points of juncture?

Junctions of the subclavian and internal jugular veins

The lymph system correlates with the vascular system without actually being a part of the vascular system. Among other things, the lymph system is the main route for the absorption of fats from the gastrointestinal system. The lymph system empties into the right and left thoracic ducts, which are the points of juncture with the vascular system. What are these points of juncture? A-The bifurcation of the common carotid arteries B-The internal and external jugular veins C-Junctions of the subclavian and internal jugular veins D-The junction of the subclavian and the pulmonary veins

Junctions of the subclavian and internal jugular veins >>The lymph capillaries drain into larger lymph vessels that ultimately empty into the right and left thoracic ducts. The thoracic ducts empty into the circulation at the junctions of the subclavian and internal jugular veins. The lymphatic system only joins the vascular system in one place, so no other answer is accurate.

Which organ has larger capillary pores to allow the exchange of gases, nutrients, and/or waste products? A-Blood-brain barrier B-Kidney C-Liver D-Brain

Liver >>Liver capillaries have large pores so that substances can pass easily through the capillary wall, whereas the kidney has glomerular capillaries with fenestrations that assist with filtration. The brain has no involvement with the exchange of waste products.

The physician states that a client has adequate collateral circulation. The nurse interprets this as: A-Long-term compensatory regulation of blood flow B-Anastomosis of the arterial and venous circulation C-Establishment of compensatory lymphatic drainage D-Development of increased collagen

Long-term compensatory regulation of blood flow >>Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart and other vital structures, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. Lymph node removal requires establishment of compensatory lymphatic drainage. The aging process produces the development of increased collagen.

A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy 1 year ago. What does the nurse suspect is the problem? A-Venous stasis B-Lymphedema C-Arteriosclerosis D-Deep vein thrombosis

Lymphedema RAITONALE: The lymphatic system filters fluid at the lymph nodes and removes foreign particles such as bacteria. When lymph flow is obstructed, a condition called lymphedema occurs. Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema.

Which related circulatory complication can result from surgical treatment for metastatic breast cancer? A) Lymphedema in the affected arm B) Hypotension upon standing C) Tachycardia when at rest D) Irregular heart rate

Lymphedema in the affected arm RATIONALE: Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema. The other options are not related to the surgery that would have removed any affected lymph nodes.

The nurse assesses the electrocardiogram for depolarization of the atria. What does the nurse expect to assess?

P wave above the baseline

Which of the following factors represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?

Preload

Which factor represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction? A-Preload B-Afterload C-Cardiac contractility D-Heart rate

Preload >>Preload is the distending force that stretches the heart muscle just prior to the work of the onset of ventricular contraction. It represents the volume of blood stretching the ventricular muscle fibers at the end of diastole (i.e., end-diastolic volume) and is the sum of the blood remaining in the heart at the end of systole (end-systolic volume) and the venous return to the heart.

The heart is a four-chambered pump. What is the function of the right ventricle? A- Receives blood returning to the heart from the systemic circulation B- Receives oxygenated blood from the lungs C- Pumps blood to the lungs D- Pumps blood into the systemic circulation

Pumps blood to the lungs RATIONALE: The right ventricle pumps blood to the lungs. The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The left ventricle pumps blood into the systemic circulation.

A client says that when the hospital checked his blood pressure after he lost a lot of blood in a work-related accident, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. Why is this? A-Systemic vasoconstriction maintained the diastolic pressure. B-The stroke volume increased with blood loss. C-The heart rate increased with blood loss. D-Systemic vasodilation maintained the diastolic pressure.

Systemic vasoconstriction maintained the diastolic pressure. >>Systemic vasoconstriction, not vasodilation, would maintain the diastolic pressure. The stroke volume and heart would not affect the diastolic pressure with blood loss.

The heart and blood vessels receive both sympathetic and parasympathetic innervation from neural control. What controls the parasympathetic-mediated slowing of the heart rate? A-The vasomotor center B-The cardioinhibitory center C-The medullary center D-The innervation center

The cardioinhibitory center >>The medullary cardiovascular neurons are grouped into three distinct pools that lead to sympathetic innervation of the heart and blood vessels and parasympathetic innervation of the heart. The first two, which control sympathetic-mediated acceleration of heart rate and blood vessel tone, are called the vasomotor center. The third, which controls parasympathetic-mediated slowing of heart rate, is called the cardioinhibitory center.

Analysis has shown that a client's right atrial pressure is 30 mmHG. What is the most likely conclusion that the client's care team will draw from this piece of data?

The pressure is excessive given that the right atrium should be at atmospheric pressure.

Proper perfusion of vital organs requires which of the following conditions? Select all that apply. a) Ability of organs to extract oxygen and nutrients from blood b) Efficient renal function c) Intact vascular system d) Sufficient blood volume to fill the vascular compartment e) Efficient cardiac pumping ability

aCDe a) Ability of organs to extract oxygen and nutrients from blood c) Intact vascular system d) Sufficient blood volume to fill the vascular compartment e) Efficient cardiac pumping ability

A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock? a) Cardiogenic b) Hypovolemic c) Distributive d) Obstructive

b Hypovolemic shock

A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have to decrease blood pressure? a) Decrease heart rate b) Decrease vascular volume c) Increase vasoconstriction d) Decrease renin release

b) Decrease vascular volume

Which of the following statements regarding heart failure are true? Select all that apply a) Pulmonary hypertension is a frequent cause of left-sided failure. b) In uncompensated left heart failure, there is pulmonary congestion and edema. c) In compensated heart failure, cardiac output is normal. d) Myocardial infarction is a frequent cause of right-sided failure. e) In uncompensated right heart failure, there is peripheral venous congestion and edema.

bCe

A client with a history of heart failure has been assessed and the care team has determined that a reduction in myocardial workload would benefit his prognosis. Which intervention is most likely to meet this client's needs? a) Regular administration of inotropic drugs b) An implantable defibrillator c) Implantation of a ventricular assist device d) Cardioversio

c) Implantation of a ventricular assist device

A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension? a) Sustained diastolic pressure of 90-99 mm Hg b) Sustained systolic pressure of 140-159 mm Hg c) Sustained systolic pressure equal to or greater that 160 mm Hg d) Sustained diastolic pressure of 81-89 mm Hg

c) Sustained systolic pressure equal to or greater that 160 mm Hg

The physician states that a client has adequate collateral circulation. The nurse interprets this as: a) Development of increased collagen b) Establishment of compensatory lymphatic drainage c) Anastomosis of the arterial and venous circulation d) Long-term compensatory regulation of blood flow

d) Long-term compensatory regulation of blood flow Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart and other vital structures, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. Lymph node removal requires establishment of compensatory lymphatic drainage. The aging process produces the development of increased collagen.

A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is: · "You are just a lucky person since most people would have had a massive heart attack by now." · "With this amount of blockage, your red blood cells get through the vessel one by one and supply oxygen to the muscle." · "You must have been taking a blood thinner for a long time." · "You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked."

· "You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel.

A client is admitted to the emergency department after experiencing a motor vehicle accident and sustaining multiple injuries with significant blood loss. The nurse predicts that the client will display which of the following? · Decreased heart rate · Increased urinary output · Increased collateral circulation · Decreased urinary output

· Decreased urinary output Stimulation of sympathetic nervous system during stress causes constriction of veins and arterioles due to the release of norepinephrine from sympathetic nerve endings. Increasing sympathetic activity causes constriction of some vessels, such as those of the skin, the gastrointestinal tract, and the kidneys. Vasoconstriction results in decreased blood flow to the kidneys and a compensatory decrease in urinary output and an increase in heart rate. Collateral circulation is a mechanism for long-term regulation of blood flow.

Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability? · Prostaglandins · Arachidonic acid · Histamine · Serotonin

· Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.

Which of the following is true regarding pulmonary circulation? · The system functions with an increased arterial pressure to circulate through the distal parts of the body. · 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. · It is the larger of the two circulatory systems.

· It is a low-pressure system that allows for improved gas exchange. Pulmonary circulation consists of the right heart and the pulmonary artery, capillaries, and veins. It is the smaller of the systems and functions at a lower pressure to assist with gas exchange.

When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart? · Left ventricle · Right ventricle · Right atrium · Left atrium

· Left ventricle The aortic pressure reflects changes in the ejection of blood from the left ventricle, not the right ventricle or atrium.

Which related circulatory complication can result from surgical treatment for metastatic breast cancer? · Lymphedema in the affected arm · Irregular heart rate · Hypotension upon standing · Tachycardia when at rest

· Lymphedema in the affected arm Malignant tumors involve lymphatic structures and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema.

A cardiac nurse is describing to a colleague the relationship between the law of Laplace and a client's peripheral vascular disease. To express the law of Laplace in an equation, the nurses need to know which values? Select all that apply. · The client's mean, resting stroke volume · The pressure that exists in the lumen of a vessel · The tension that exists in the walls of a blood vessel · The thickness of a particular blood vessel · The radius of a particular blood vessel

· P pressure in lumen of a vessel · T tension in walls of blood vessel · Radius of blood vessel P = T/r T is wall tension P is the intraluminal pressure r is vessel radius The client's stroke volume is not directly relevant to the equation. The thickness of a vessel will affect wall tension, but this is not an explicit component of the equation.

Although pressure pulses usually are not transmitted to the capillaries, there are situations in which this does occur. Under what conditions do cardiac pulsations occur? Select all that apply. · Patent ductus arteriosus · Myocardial infarction · Aortic regurgitation · Cerebrovascular accidents

· Patent ductus arteriosus · Aortic regurgitation Capillary pulsations occur in conditions that cause exaggeration of aortic pressure pulses, such as aortic regurgitation or patent ductus arteriosus.

The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent? · Repolarization of the ventricles · Depolarization of the ventricular conduction system · Repolarization of the atrium · Depolarization of the sinoatrial node

· Repolarization of the ventricles P = depolarization of atria due to the sinoatrial node triggering. QRS complex = depolarization of the ventricles. T = repolarization of the ventricles

A client has had an acute myocardial infarction (MI). The brother of the client has a history of angina. The client asks how he will know if his brother's pain is angina or if the brother is actually having an MI. Which statement is correct? · Chest pain with angina only occurs at rest; MI pain occurs during a stressful time. · Pain is more severe and lasts longer with angina than with an MI. · Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. · Chest pain with angina only occurs during the day; MI pain is more likely at night.

· Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. Nitroglycerin causes release of NO in vascular smooth muscle so more blood can get to heart. Rest and intake of nitroglycerin relieve chest pain with angina but not with an MI. Pain with angina and MI is a subjective symptom for each client. Pain with angina and MI can occur at a variety of times.

If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? · Heart rate 150 beats/minute, labeled as supraventricular tachycardia · Slowing of heart rate to below 60 beats/minute · Complete cardiac standstill · Disorganized ventricular fibrillation

· Slowing of heart rate to below 60 beats/minute Acetylcholine, the parasympathetic neurotransmitter released during vagal stimulation of the heart, slows down the heart rate by decreasing the slope of phase 4. The catecholamines, the sympathetic nervous system neurotransmitters epinephrine and norepinephrine, increase the heart rate by increasing the slope or rate of phase 4 depolarization. Fibrillation is the result of disorganized current flow within the ventricle (ventricular fibrillation). Fibrillation interrupts the normal contraction of the atria or ventricles. In ventricular fibrillation, the ventricles quiver but do not contract. Thus, there is no cardiac output, and there are no palpable or audible pulses (i.e., cardiac standstill).

Local control of blood flow is regulated by mechanisms that match blood flow to the metabolic needs of the tissue. Over the short term autoregulation controls flow through the synthesis of vasodilators and vasoconstrictors. Which components of the vascular system are involved in the short term control of blood flow? Select all that apply A- Tissue B- Smooth muscle C- Endothelial cells D- Collateral circulation.

• Tissue • Smooth muscle • Endothelial cells Over the short term, the tissues autoregulate through the synthesis of vasodilators and vasoconstrictors derived from the tissue, smooth muscle, or endothelial cells; over the long term, blood flow is regulated by creation of collateral circulation.

The linear velocity of blood flow in the circulatory system varies widely. What is the linear velocity in the aorta? 20 to 25 cm/second 30 to 35 cm/second 40 to 45 cm/second 50 to 55 cm/second

30 to 35 cm/second >>The linear velocity of blood flow in the circulatory system varies from 30 to 35 cm/second in the aorta.

The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which of the following blood pressure findings can be characteristic of this condition? a) Blood pressure in arms 20 mm Hg higher than in the legs b) Prominent femoral pulses c) Widened pulse pressure in the legs d) Blood pressure in legs 20 mm Hg higher than in the arms

A

Which neurotransmitter is associated with the parasympathetic nervous system? A-Acetylcholine B-Dopamine C-Norepinephrine D-Epinephrine

Acetylcholine >>The actions of the autonomic nervous system are mediated by chemical neurotransmitters. Acetylcholine is the postganglionic neurotransmitter for parasympathetic neurons and norepinephrine is the main neurotransmitter for postganglionic sympathetic neurons. Sympathetic neurons also respond to epinephrine, which is released into the bloodstream by the adrenal medulla. The neurotransmitter dopamine can also act as a neurotransmitter for some sympathetic neurons.

Which neurotransmitter is associated with the parasympathetic nervous system? A) Acetylcholine B) Dopamine C) Norepinephrine D) Epinephrine

Acetylcholine RATIONALE: The actions of the autonomic nervous system are mediated by chemical neurotransmitters. Acetylcholine is the postganglionic neurotransmitter for parasympathetic neurons and norepinephrine is the main neurotransmitter for postganglionic sympathetic neurons. Sympathetic neurons also respond to epinephrine, which is released into the bloodstream by the adrenal medulla. The neurotransmitter dopamine can also act as a neurotransmitter for some sympathetic neurons.

A nurse is assessing a client in shock for complications of acute renal failure. The most important assessment for the nurse to obtain would be: a) Evaluating the blood for a decreased creatinine level b) Continuous measurement of urine output c) Asking the client if he is having bilateral flank pain d) Evaluating the blood for a decrease in the blood urea nitrogen level (BUN)

B) Continuous measurement of urine output

In assessing a patient's major risk factors for heart disease, which would the nurse want to include when taking a history? A. Family history, hypertension, stress, age B. Personality type, high cholesterol, diabetes, smoking C. Smoking, hypertension, obesity, diabetes, high cholesterol D. Alcohol consumption, obesity, diabetes, stress, high cholesterol

C. Smoking, hypertension, obesity, diabetes, high cholesterol

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system? A) Distribute oxygenated blood to the tissues B) Collect deoxygenated blood from the tissues C) Exchange gases, nutrients, and wastes D) Pump blood

Exchange gases, nutrients, and wastes RATIONALE: The circulatory system consists of the heart, which pumps blood; the arterial system, which distributes oxygenated blood to the tissues; the venous system, which collects deoxygenated blood from the tissues and returns it to the heart; and the capillaries, where exchange of gases, nutrients, and waste takes place.

A client took a weight loss drug that activated the alpha-adrenergic receptors in the sympathetic nervous system. Which manifestations would the nurse expect to occur? Select all that apply. A-Increased blood pressure of cardiac contraction B-Decreased myocardial contraction C-Decrease in respiration rate D-Increased cardiac cycle speed

Increased blood pressure of cardiac contraction Increased cardiac cycle speed >>Sympathetic nervous system control of vascular smooth muscle tone occurs through receptor-activated opening and closing of the calcium channels. In general, alpha adrenergic receptors are excitatory in that they cause the channels to open and produce vasoconstriction. Increased sympathetic activity produces an increase in the heart rate, BP and the velocity and force of cardiac contraction.

Which of the following is true regarding pulmonary circulation? A-The system functions with an increased arterial pressure to circulate through the distal parts of the body. B-It is a low-pressure system that allows for improved gas exchange. C-It is the larger of the two circulatory systems. D-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 and functions at a lower pressure to assist with gas exchange.

The nurse is teaching a client diagnosed with heart failure about preload. Which principle would be most appropriate to provide to the client? A-Preload represents the volume work of the heart. B-Preload is the pressure or tension work of the heart. C-Preload is the ability of the heart to change its force of contraction. D-Preload determines the frequency by which the ventricles contract and blood is ejected.

Preload represents the volume work of the heart. >>Preload is the distending force that stretches the heart muscle just prior to work of the onset of ventricular contraction. It represents the volume of blood stretching the ventricular muscle fibers at end of diastole (i.e., end-diastolic volume) and is the sum of the blood remaining in the heart at the end of systole (end-systolic volume) and the venous return to the heart. The pressure or tension work of the heart refers to afterload. The ability of the heart to change its force of contraction refers to cardiac contractility. The frequency by which the ventricles contract and blood is ejected refers to heart rate.

A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are nonmodifiable risk factors associated with this diagnosis? Select all that apply. a) Race b) Family history c) Obesity d) Stress e) Excessive alcohol consumption

a) Race b) Family history

In heart failure patients, the nurse knows that many compensatory mechanisms attempt to support cardiac output. Included among these mechanisms are which of the following? Select all that apply. a) Activitation of the renin angiotensin system (RAAS) b) Increased heart rate c) Vasoconstriction d) Decreased endothelin release e) Decreased sodium and water retention

abc a) Activitation of the renin angiotensin system (RAAS) b) Increased heart rate c) Vasoconstriction

The nurse is assessing a 77-year-old client who has been diagnosed with hypertension. Which age-related physiologic changes may have contributed to the client's diagnosis? Select all that apply. a) Decreased renal blood flow b) Increased friction at epithelial surfaces of large vessels c) Decreased blood viscosity d) Decreased sensitivity of baroreceptors e) Decreased compliance of the aorta

ade

A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following? a) Decreased rate and force of contraction b) Increased heart rate and increased contractility c) Decreased contractility and decreased heart rate d) Increased heart rate and decreased contractility

b) Increased heart rate and increased contractility The sympathetic nervous system has an excitatory influence on heart rate and contractility, and it serves as the final common pathway for controlling the smooth muscle tone of the blood vessels.

The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply. a) Aortic b) Mitral c) Tricuspid d) Pulmonary

b) Mitral (bicuspid) c) Tricuspid

Which of the following is the difference between the end-diastolic and end-systolic volumes? a) Cardiac output b) Stroke volume c) Ejection fraction d) Cardiac reserve

b) Stroke volume Stroke volume = difference between end-diastolic & end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Ejection fraction is the volume ejected from the left ventricle. Cardiac reserve is determined by cardiac output.

A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which of the following accounts for this lack of change in the diastolic pressure? a) Heart rate increased with blood loss. b) Systemic vasoconstriction maintained the diastolic pressure. c) Blood volume rapidly increased. d) Stroke volume increased with blood loss.

b) Systemic vasoconstriction maintained the diastolic pressure

A patient is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as which of the following? a) Pericardial effusion b) Valvular regurgitation c) Infective endocarditis d) Valvular stenosis

b) Valvular regurgitation

The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. a) The capillaries pump blood. b) The venous system collects deoxygenated blood from the tissues . c) The arterial system distributes oxygenated blood to the tissues. d) The heart exchanges gases, nutrients and wastes.

bc

The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below which of the following? a) 100/60 b) 100/90 c) 140/90 d) 140/60

c

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this patient most likely is experiencing which of the following types of shock? a) Anaphylactic b) Neurogenic c) Septic d) Cardiogenic

c septic

A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication? a) Hypoglycemia b) Diarrhea c) Decreased level of consciousness d) Symmetrical joint pain

c) Decreased level of consciousness

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms? a) Restlessness and nervousness b) Papilledema and lethargy c) Headache and confusion d) Stupor and hyperreflexia

c) Headache and confusion

A client with aortic insufficiency is experiencing an increase in afterload. The client will experience fatigue and activity intolerance due to: a) pressure applied to valves. b) residual blood in heart following contraction. c) resistance to ejection of blood from the heart. d) slow ventricular filling.

c) resistance to ejection of blood from the heart.

Anaphylactic shock is directly associated with: a) failure of the heart as a pump. b) loss of blood volume. c) bacterial blood infection. d) type I hypersensitivity response.

d) type I hypersensitivity response.

The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply. · Pulmonary artery · Right heart · Aorta · Capillaries

· Aorta · Capillaries systemic circulation includes the aorta and capillaries. pulmonary circulation includes the right heart & pulmonary artery.

local athlete is getting prepared for the upcoming national track and field championships. Since this athlete is performing extreme exercise, what would be the most probable cardiac output?

16 to 36 L/minute

The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body? A-1500 B-1600 C-1700 D-1800

1800 >>In one day, this pump moves more than 1800 gallons of blood throughout the body.

When a client experiences the Cushing reflex, what occurs with the body? A-An increase in arterial pressure to levels above the intracranial pressure B-The systemic blood pressure decreases to restore equal amounts of oxygen throughout the body. C-The pupils contract in response to light exposure. D-The toes fan outward in response to stimulation being applied to the bottom of the foot.

An increase in arterial pressure to levels above the intracranial pressure >>This reflex produces a rise in arterial pressure to levels above intracranial pressure so that the blood flow to the vasomotor center can be reestablished. Pupil contraction (papillary response) and the toe fanning (positive Babinski) do not relate with the Cushing reflex; neither does the oxygen supply to the body.

The nurse knows that hypertension can lead to nephrosclerotic damage. Which of the following occurs first in nephrosclerosis? a) Glomerular sclerosis b) Tubulointerstitial fibrosis c) Diabetic nephropathy d) Glomerular hypoperfusion

B

The ability of the heart to contract independently of any signals or stimulation is due to: A. Depolarization. B. Automaticity. C. Conduction. D. Repolarization.

B. Automaticity.

The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following? a) Pheochromocytoma b) Decreased renal blood flow c) Hyperaldosteronism d) Unknown

D

Which compensatory mechanism is associated with long term regulation of blood flow? A-DNA B-RNA C-Fibroblast growth factor D-Serotonin

Fibroblast growth factor >>Fibroblast growth factors participate in the regulation of blood flow, which is a compensatory mechanism to decrease oxygen debt. Serotonin is liberated from aggregating platelets during the clotting process and causes vasoconstriction. DNA is a self-replicating material which is present in nearly all living organisms as the main constituent of chromosomes. It is the carrier of genetic information. RNA acts as a messenger carrying instructions from DNA for controlling the synthesis of proteins, although in some viruses RNA rather than DNA carries the genetic information.

A client has suffered damage to his pericardium following a motor vehicle accident. Which consequence could be a possible complication of damaged pericardium that his care providers should assess for?

Impaired regulation of myocardial contraction

When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart? A-Right ventricle B-Left ventricle C-Right atrium D-Left atrium

Left ventricle >>The aortic pressure reflects changes in the ejection of blood from the left ventricle, not the right ventricle or atrium.

A nurse is teaching a client the correct technique for taking an arterial pulse. The nurse explains that the pulsations are: A-Pressure pulses B-Korotkoff sounds C-Blood flow in the veins D-Turbulence of the blood flow

Pressure pulses >>The arterial pressure pulse represents the energy that is transmitted from molecule to molecule along the length of the vessel. When taking a pulse, it is the pressure pulses that are felt. Pressure pulses have no direct relation to the blood flow. It is the pressure pulses that produce the Korotkoff sounds heard during blood pressure measurement. Pressure pulses would be felt even if there was no blood flow at all.

The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium? A-Receives blood returning to the heart from the systemic circulation B-Receives oxygenated blood from the lungs C-Pumps blood into the systemic circulation D-Pumps blood to the lungs

Receives blood returning to the heart from the systemic circulation RAITOANLE: The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.

Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?

SA node - AV node - bundle of His - bundle branches - Purkinje fibers

The troponin complex is one of a number of important proteins that regulate actin-myosin binding. Troponin works in striated muscle to help regulate calcium-mediated contraction of the muscle. Which of the troponin complexes is diagnostic of a myocardial infarction? A-Troponin C and troponin T B-Troponin A and troponin I C-Troponin T and troponin I D-Troponin A and troponin C

Troponin T and troponin I >>In clinical practice, the measurement of the cardiac forms of troponin T and troponin I is used in the diagnosis of myocardial infarction. Troponin C is not diagnostic of a myocardial infarction. Troponin A is not one of the troponin complexes.

Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?

Ventricular fibrillation

The nurse knows that the primary long-term regulation of blood pressure is exerted by which of the following? a) The kidneys b) Neural mechanisms c) Humoral influence d) Hormonal activity

a

The heart consists of four valves. Which are the semilunar valves? Select all that apply. a) Aortic b) Mitral c) Tricuspid d) Pulmonary

a) Aortic d) Pulmonary

The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock? a) Septic b) Cardiogenic c) Hypovolemic d) Neurogenic

b

Which serum biomarker is highly specific for myocardial tissue? a) Creatine kinase b) Troponin c) C-reactive protein d) White blood cells

b

What are the physiologic signs and symptoms of cardiogenic shock? (Select all that apply.) a) Hypercapnic lips and nail beds b) Increased extraction of O2 from hemoglobin c) Decrease in mean arterial blood pressures d) Increased urine output related to increased renal perfusion e) Rise in central venous pressure (CVP)

bCE

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another? a) Axially b) Crosswise c) Turbulent d) Laminar

d) Laminar Laminar blood flow reduces friction by allowing the blood layers to slide smoothly over one another. Plasma is adjacent to the endothelial surface. Blood components are in the center and clotting factors are prevented from contacting vessel wall. Middle moves fastest. Axially, crosswise, and turbulent blood flow would result in increased friction. In turbulent flow, the laminar stream is disrupted and the flow becomes mixed, moving radially (crosswise) and axially (lengthwise).

The heart valves control the direction of blood flow. What is the function of the pulmonic valve? a) Controls the direction of blood flow from the right side of the heart to the systemic circulation b) Controls the direction of blood flow from the left side of the heart to the lungs c) Controls the direction of blood flow from the left side of the heart to the systemic circulation d) Controls the direction of blood flow from the right side of the heart to the lungs

d) Pulmonic valve Controls the direction of blood flow from the right side of the heart to the lungs AV valves direction of blood flow from the atria to the ventricles Aortic Valve direction of blood flow from the left side of the heart to the systemic

Starting with the right atrium, which sequence is the correct pathway for blood flow through the heart? · right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta

right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta

A nurse working with a client in heart failure is explaining why the symptoms of the heart failure were not evident for a long period of time. When describing the Frank-Starling mechanism, the nurse will explain: A-the high oxygenation needs of cardiac muscle and the role of coronary circulation. B-the relationship between venous return and stroke volume. C-the molecular structure of actin and myosin and their effect on contraction. D-the physiologic function of chemoreceptors and baroreceptors.

the relationship between venous return and stroke volume. >>The Frank-Starling principle addresses the relationship between venous return and stroke volume. It does not directly address the characteristics of actin and myosin. The principle is unrelated to coronary circulation, chemoreceptors and baroreceptors.

A physician is teaching a group of medical students about the physiological basis for damage to the circulatory and neurological system that can accompany hypotension. Which of the following responses by a student would warrant correction by the physician?

"Tension and vessel thickness increase proportionately." LaPlace law: P = T/r

As part of pre-surgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which of the following teaching points best conveys an aspect of the human circulatory system?

"The blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation."

A client has suffered chest injuries following a automobile accident. The chest injury has resulted in an increase in intrathoracic pressure. There can be a transient shift from the pulmonary to the systemic circulation of how much blood? 150 mL 200 mL 250 mL 300 mL

250 mL >>An increase in intrathoracic pressure, which impedes venous return to the right heart, can produce a transient shift from the pulmonary to the systemic circulation of as much as 250 mL of blood.

A client is having blood work done. What percentage of red blood cells represents the formed elements of the blood? 30 - 35% 40 - 45% 50 - 55% 60 - 65%

40 - 45% >>The red blood cells constitute 40 to 45 percent of the formed elements of the blood.

A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography? 35% - 55% 45% - 65% 55% - 75% 65% - 85%

55% - 75% >>The normal left ventricular ejection fraction is usually 55 percent to 75 percent when determined by angiocardiography.

The semilunar valves of the heart open at the onset of the ejection period. Approximately what percentage of the stroke volume is ejected during the first quarter of systole?

60%

The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading? a) The client just smoked a cigarette. b) The client took her antihypertensive medication 2 hours ago. c) The client left work 1 hour ago. d) The client ate a hamburger 45 minutes prior to the reading.

A

The nurse knows that which group of antihypertensive drugs is usually the least expensive and is well tolerated? a) Diuretics b) Calcium channel blockers c) Beta adrenergic blockers d) Angiotensin converting enzyme inhibitors

A (I knew this)

A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the client about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium? A- The outer muscular layer of the heart B- The innermost lining of the heart chambers C- A membranous sac that encloses the heart D- The electrical conduction system of the heart

A membranous sac that encloses the heart RATIONALE: The pericardium forms a fibrous covering around the heart, holding it in a fixed position in the thorax and providing physical protection and a barrier to infection. The pericardium is a tri-layer sac consisting of a tough, outer fibrous layer and a thin, inner serous layer.

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion? a) 20 mL/hour b) 80—60 mL/hour c) 40—20 mL/hour d) 60—40 mL/hour

A) 20 mL/hour

The jugular venous pressure is an indirect reflection of the: A. Heart's efficiency as a pump .B. Cardiac cycle. C. Conduction effectiveness .D. Synchronization of mechanical activity.

A. Heart's efficiency as a pump.

Heart failure may be systolic or diastolic dysfunction. Which of the following statements regarding systolic and diastolic dysfunction are correct? Select all that apply. a) Separation into systolic or diastolic dysfunction is based on ventricular ejection fraction. b) In systolic dysfunction, the ejection fraction is decreased. c) In systolic dysfunction, preload increases. d) In diastolic dysfunction, the ejection fraction decreases. e) In diastolic dysfunction, preload increases.

ABC a) Separation into systolic or diastolic dysfunction is based on ventricular ejection fraction. b) In systolic dysfunction, the ejection fraction is decreased.c) In systolic dysfunction, preload increases.

A client diagnosed with secondary hypertension has begun to experience manifestations that are consistent with decreased cardiac output. Which determinants of cardiac output is hypertension most likely to affect directly? A) Preload B) Afterload C) Contractility D) Heart rate

Afterload

When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse? A-An ejection fraction of 40% B-Blood pressure of 146/80 C-Point of maximum impulse is located midclavicular at the 5th intercostal space D-A heart rate (HR) of 62 beats/minute

An ejection fraction of 40% >>This ejection fraction is below normal (normal is about 55% to 75%) and indicates a poor prognosis. This low ejection fraction is a result of the complications of long-standing hypertension.

When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?

An ejection fraction of 40% left ventricular ejection fraction should be 55-75%

An increase in venous return stimulates what mechanism within the heart? A-A decrease in blood pressure B-An increase in oxygen consumption C-A decrease in cardiac output D-An increase in heart rate

An increase in heart rate >>An increase in venous return stimulates right atrial stretch receptors that initiate an increase in heart rate. The other assessments are not found with increased venous return. An increase in blood pressure and increase in cardiac output are found.

During a physical examination of a client, the nurse palpates the point of maximal impulse (PMI) in the seventh intercostal space lateral to the left midclavicular line. What is the most appropriate action for the nurse to take? A-Assess the client for symptoms of left ventricular hypertrophy. B-Document that the PMI is in the normal anatomic location. C-Auscultate both of the carotid arteries for the presence of a bruit. D-Notify the physician.

Assess the client for symptoms of left ventricular hypertrophy. >>When the hand is placed on the thorax, the main impact of the heart's contraction is felt against the chest wall at a point between the fifth and sixth ribs, a little below the nipple and approximately 3 inches to the left of the midline. This is called the point of maximum impulse (PMI). A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy.

The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher. a) 151 b) 140 c) 160 d) 90

B

The nurse knows that there are many different groups of antihypertensive drugs having varied mechanisms of action. Which one of the following drugs decreases the exit of adrenergic (sympathetic) stimulation from the central nervous system? a) An alpha-1 adrenergic antagonist b) An alpha-2 adrenergic agonist c) An alpha-2 adrenergic antagonist d) An angiotensin converting enzyme inhibitor (ACEI)

B

The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope? a) Over the aorta b) Over the sternum c) At the apex of the heart d) At the carotid arteries

C (relates to HAP)

The distensibility of the blood vessel is the major factor in which of the vessel's characteristics?

Compliance

While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?

Decreased heart rate as a result of parasympathetic innervation of the heart

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system? A-Distribute oxygenated blood to the tissues B-Collect deoxygenated blood from the tissues C-Exchange gases, nutrients, and wastes D-Pump blood

Exchange gases, nutrients, and wastes >>The circulatory system consists of the heart, which pumps blood; the arterial system, which distributes oxygenated blood to the tissues; the venous system, which collects deoxygenated blood from the tissues and returns it to the heart; and the capillaries, where exchange of gases, nutrients, and waste takes place.

A 72 year old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds:

Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.

Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability. A-Norepinephrine B-Serotonin C-Prostaglandins D-Histamine

Histamine RATIONALE: Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Norepinephrine is a powerful vasoconstrictor. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.

Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability? A- Histamine B- Serotonin C- Prostaglandins D- Arachidonic acid

Histamine RATIONALE: Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins (synthesized from constituents of the cell membrane like long-chain fatty acid, arachidonic acid) produce either vasoconstriction or vasodilation.

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another? A) Laminar B) Turbulent C) Crosswise D) Axially

Laminar RATIONALE: Laminar blood flow reduces friction by allowing the blood layers to slide smoothly over one another, with the axial layer having the most rapid rate of flow. Axially, crosswise, and turbulent blood flow would result in increased friction. In turbulent flow, the laminar stream is disrupted and the flow becomes mixed, moving radially (crosswise) and axially (lengthwise).

The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation? A- Right atrium B- Left atrium C- Right ventricle D- Left ventricle

Left ventricle RATIONALE: The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.

The pericardium is a tri-layer sac. Which layer prevents acute dilation of the heart chambers and exerts a restraining effect on the left ventricle?

Outer fibrous layer

The pericardium is a tri-layer sac. Which layer prevents acute dilation of the heart chambers and exerts a restraining effect on the left ventricle? A-Outer fibrous layer B-Inner serous layer C-Visceral layer D-Parietal layer

Outer fibrous layer >>The outer fibrous layer prevents acute dilation of the heart chambers. The inner serous layer consists of a visceral layer and a parietal layer.

Resistance to flow is determined by the diameter of the blood vessels and the blood vessel itself. An equation has been developed for understanding the relationship between the diameter of the blood vessel, the viscosity of the blood, and resistance. What is the equation called?

Poiseuille law

The nurse is teaching a client diagnosed with heart failure about preload. Which of the following would be the most appropriate information to provide?

Preload represents the volume work of the heart.

Which blood vessels function without the benefit of having walls comprised of three muscular layers? A-Capillaries B-Veins C-Arteries D-Arterioles

Capillaries RAITONALE: The capillaries are small, thin-walled vessels that link the arterial and venous sides of the circulation and allow the exchange of oxygen and metabolites generated by the various tissues. The walls of all blood vessels, except the capillaries, are composed of three layers: tunica externa, tunica media, and tunica intima.

The difference between the end-diastolic and end-systolic volumes is called what? A-Stroke volume B-Cardiac output C-Ejection fraction D-Cardiac reserve

Stroke volume RAITONALE: Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Ejection fraction is the volume ejected from the left ventricle. Cardiac reserve is determined by cardiac output.

The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:

Stroke volume × heart rate CO = SV x HR

A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?

Sympathetic nervous system

A nurse is evaluating a client to determine the effectiveness of medications given to reduce left ventricular afterload. Which hemodynamic parameter is most appropriate for the nurse to monitor? A-Mean arterial pressure (MAP) B-Systemic vascular resistance (SVR) C-Blood pressure D-Pulmonary artery wedge pressure (PAWP)

Systemic vascular resistance (SVR) >>Afterload is resistance to ejection of blood from the heart. Resistance is the opposition to flow caused by friction between the moving blood and the stationary vessel wall. In the peripheral circulation, the collective resistance of all the vessels in that part of the circulation is referred to as the peripheral vascular resistance (PVR), also known as the systemic vascular resistance.

The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. A-The heart exchanges gases, nutrients, and wastes. B-The arterial system distributes oxygenated blood to the tissues. C-The venous system collects deoxygenated blood from the tissues. D-The capillaries pump blood.

The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues. RATIONALE: The circulatory system consists of the heart, which pumps blood; the arterial system, which distributes oxygenated blood to the tissues; the venous system, which collects deoxygenated blood from the tissues and returns it to the heart; and the capillaries, where exchange of gases, nutrients, and waste takes place.

What does the nurse teach is the principal factor that determines how long the client can exercise? A) The client's age B) The client's mental status C) The client's medical history D) The client's heart and lung capacity

The client's heart and lung capacity RATIONALE: The principal factor that determines how long and effectively a person will be able to exercise is the capacity of the heart, lungs, and circulation to deliver oxygen to the working muscles. Cardiac performance is influenced by the work demands of the heart and the ability of the coronary circulation to meet its metabolic needs.

The circulatory system is a closed system that is divided into two parts. Which statement is correct about the closed system? A-The low pressure pulmonary circulation links circulation and gas exchange in the lungs. B-The low pressure systemic circulation system provides oxygen and nutrients to the tissues. C-The high pressure systemic circulation system links circulation and gas exchange in the lungs D-The high pressure pulmonary circulation provides oxygen and nutrients to the tissues.

The low pressure pulmonary circulation links circulation and gas exchange in the lungs. >>The low pressure pulmonary circulation links circulation and gas exchange in the lungs, and the high pressure systemic circulation provides oxygen and nutrients to the tissues.

A client has a blood pressure of 68/38 mm Hg and fainted after donating a unit of blood. The client is experiencing low preload from loss of blood volume. What is preload? A-Blood ejected from each ventricle with each contraction B-Blood pumped by each ventricle in 1 minute C-Venous return to the heart D-Resistance to ventricular emptying

Venous return to the heart >>Preload is the amount of venous return to the heart. Afterload is the pressure in which the muscle exerts its contractile force in order to move blood into the aorta. Contractility is the ability of the heart to change its force of contraction without changing its resting length.

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as: A-Tunica media B-Tunica adventitia C-Tunica externa D-Tunica intima

Tunica media RATIONALE: The tunica media, the middle layer, is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The tunica externa, also known as the tunica adventitia, refers to the outermost layer of a vessel. The tunica intima refers to the innermost layer that prevents platelet adherence and blood clotting.

Preload, the stretch on the heart before contraction, is largely determined by which factor? A-Venous blood return B-Vascular resistance C-Force of contraction D-Ventricular emptying

Venous blood return RAIONTALE: Preload represents the amount of blood the heart must pump with each beat and represents the volume of blood stretching the ventricular muscle fibers at the end of diastole. Pressure (resistance), contraction, and ventricular emptying relate to afterload.

The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole? A-Ventricles contract and blood is ejected from the heart. B-Atria contract and blood is ejected from the heart. C-Ventricles relax and blood fills the heart. D-Atria relax and blood fills the heart.

Ventricles contract and blood is ejected from the heart. RAITONALE: Systole occurs when the ventricles contract and blood is ejected from the heart. Diastole occurs when the ventricles are relaxed and blood fills the heart.

A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain. His subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?

Ventricular repolarization

For which of the following types of shock might intravenous antibiotic therapy be indicated? a) Distributive shock b) Obstructive shock c) Hypovolemic shock d) Cardiogenic shock

a (Septic shock is a subtype of distributive shock. The treatment of sepsis and septic shock focuses on control of the causative agent and support of the circulation and the failing organ systems. The administration of antibiotics that are specific for the infectious agent is essential. Swift and aggressive fluid administration is needed to compensate for third spacing, though which type of fluid is optimal remains controversial. Equally, aggressive use of vasopressor agents, such as norepinephrine or epinephrine, is needed to counteract the vasodilation caused by inflammatory mediators.)

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often accompanies the vascular response in anaphylaxis? a) Laryngeal edema b) Gastrointestinal relaxation c) Uterine smooth muscle relaxation d) Bronchodilation

a) Laryngeal edema

A client has entered hypovolemic shock after massive blood loss in a car accident. Many of the client's peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon? a) Blood pressure is no longer able to overcome vessel wall tension. b) Wall thickness of small vessels has decreased due to hypotension. c) Decreasing vessel radii have caused a decrease in blood pressure. d) Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii.

a) blood pressure is no longer able to overcome vessel wall tension. P=T/r

A client who has suffered a myocardial infarction is being treated in the emergency room. His pain remains severe even though he was given nitrates and oxygen. The physician now orders morphine for the pain. What method should the nurse to administer the morphine? a) By mouth in a liquid b) Intravenous c) Subcutaneous d) By mouth in pill form

b) Intravenous

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis? a) Dyspnea, cough b) Peripheral edema weight gain c) Vertigo, headache d) Weakness, palpitations

b) Peripheral edema weight gain

A patient has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the patient's end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this? a) Afterload b) Preload c) Inotropy d) Cardiac contractility

b) Preload

The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is: a) 80 mL/hour b) 40 mL/hour c) 20 mL/hour d) 60 mL/hour

c

Which of the following blood vessels function without the benefit of having walls comprised of three muscular layers?

capillaries

The nurse knows that which of the following persons is at greatest risk for malignant hypertension? a) A 60-year-old woman with newly diagnosed mild hypertension b) An obese 46-year old Caucasian man c) A 30-year-old woman with three children d) A 25-year-old African-American man

d

Which of the following is the best modality to diagnose hypertension? a) Laboratory blood analysis b) Tissue analysis c) X-ray d) Repeated blood pressure determinations

d

Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem? a) Pericarditis b) Cor pulmonale c) Right-sided heart failure d) Cardiogenic shock

C) Right-sided heart failure (A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease.)

When listening to heart sounds, the nurse knows that the valve closures that can be heard best at the base of the heart are: A. Mitral and tricuspid B. Tricuspid and aortic C. Aortic and pulmonic D. Mitral and pulmonic

C. Aortic and pulmonic

The leaflets of the tricuspid and mitral valves are anchored by __________________ to the _________________, which are embedded in the ventricular floor. A. Endocardial ligaments; mediastinal muscles B. Atrioventricular tendons; pericardial bundles C. Chordae tendineae; papillary muscles D. Pericardial cords; ventricular sheaths

C. Chordae tendineae; papillary muscles

A client with a history of heart failure has the following echocardiogram results: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction (EF)? · 50% · 2 mL · 0.80 · 180 mL

· 50% Ejection fraction = stroke volume ÷ end-diastolic volume. Stroke volume equals the difference between end-diastolic and end-systolic volume. EF = 60 ÷ 120, or 50%.

Release of which humoral factors will result in vasodilation? · Angiotensin II · Norepinephrine · Serotonin · Histamine

· Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Norepinephrine, angiotensin II, and serotonin are all potent vasoconstrictors.

Which sequence is the correct pathway for blood flow through the heart? A- right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta B- left atrium - tricuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein - right atrium - mitral valve - right ventricle - aorta C- left atrium - bicuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein - right atrium - tricuspid valve - right ventricle - aorta D- right atrium - bicuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - tricuspid valve - left ventricle - aorta

right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta RAITONALE: The correct pathway for blood flow through the heart is the right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta.

The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in: a) A reading that is too high b) A reading that is too low c) A decreased pulse pressure reading d) An accurate BP assessment

A (Just like HAP)

The health care provider is preparing to assess a client who has been diagnosed with hypertrophic cardiomyopathy. The provider anticipates the assessment data will include: a) Systolic dysfunction b) Enlarged chamber size c) Orthopnea d) Reduced chamber size

B (Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the ventricular septum, abnormal diastolic filling, cardiac arrhythmias and, in some cases, intermittent left ventricular outflow obstruction. The other choices are findings in dilated cardiomyopathy.)

A nurse is assessing a client who lost consciousness during a wrestling match when his opponent applied a neck hold. The client likely lost consciousness because: · a baroreceptor was stimulated. · the position caused bradycardia. · cardiac output suddenly dropped. · the client experienced temporary cardiac ischemia.

· a baroreceptor was stimulated. The baroreceptors of the carotid body monitor blood pressure. The hold likely increased the pressure on the baroreceptor and mimicked an increase in BP, with a resultant extreme decrease in BP and unconsciousness. Neck pressure would be unlikely to cause ischemia, bradycardia, or a reduction in CO.

Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply. A-Abdominal B-Femoral C-Carotid D-Thoracic

Abdominal Thoracic RATIONALE: There are no valves in the abdominal or thoracic veins. Therefore, pressure in the abdominal and thoracic cavities heavily influence blood flow in these veins.

A clinically obese patient diagnosed with stage 2 hypertension is resistant to taking antihypertensive medication because he has no symptoms and "feels fine." The nurse will encourage this patient to attempt lowering his blood pressure in order to decrease the risk of developing which of the following? Select all that apply. a) Coronary artery disease b) Diabetes c) Dementia d) Renal failure e) Loss of vision

Acde a) Coronary artery disease c) Dementia d) Renal failure e) Loss of vision

A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which assessment should the nurse complete? · Palpate the pericardium for a heave or thrill. · Auscultate for an extra heart sound due to incomplete semilunar valve closure. · Monitor the blood pressure. · Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves.

Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves. When closed, the AV valves prevent backflow of blood from the ventricles to the atria during systole. The AV valves are supported by the papillary muscles, which project from the wall of the ventricles. Contraction of the papillary muscles at the onset of systole ensures closure by producing tension on the leaflets of the AV valves before the full force of ventricular contraction pushes against them.

Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Stimulation of the sympathetic nervous system during stress or exercise causes local constriction because of the release of which hormone? a) Histamine b) Norepinephrine c) Angiotensin II d) Epinephrine

B Norepinephrine

The first heart sound is produced by the: A. Closure of the semilunar valves .B. Closure of the AV valves. C. Opening of the semilunar valves. D. Opening of the AV valves.

B. Closure of the AV valves.

Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease? · The reflected wave is transmitted more rapidly through the aorta. · Downstream peripheral pulses are increased even more than normal. · Downstream peripheral pulses are greater than upstream pulses. · The pulse decreases, rather than increases, in amplitude.

· The pulse decreases, rather than increases, in amplitude. With peripheral arterial disease, there is a delay in the transmission of the reflected wave so that the pulse decreases, rather than increases, in amplitude.

The nurse knows that acute regulation of blood pressure involves which of the following physiological processes? Select all that apply. a) Arterial chemoreceptors b) Adrenergic (sympathetic) stimulation c) Vagal nerve impulses d) Carotid baroreceptors e) Renal regulation of blood volume

AbCd

Considering the PQRST complex of an electrocardiogram (ECG), which of the following letter designations represents atrial depolarization?

P wave

Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues? · Calcium channel blocker · Antithrombin factor · Nitric oxide · Platelet-aggregating factor

· Nitric oxide nitric oxide is released into the vessel lumen (to inactivate platelets) and away from the lumen (to relax smooth muscle) suggests that it protects against both thrombosis and vasoconstriction. Nitroglycerin, which is used in the treatment of angina, produces its effects by releasing nitric oxide in vascular smooth muscle of the target tissues. None of the other options are released by nitroglycerin.

During an assessment of a client with ankle swelling, the nurse observes jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. What is the correct interpretation of this finding? · The client has decreased fluid volume. · The client has stenosis of the jugular veins. · The client has increased pressure related to right-sided heart failure. · The client has an increased cardiac output.

· The client has increased pressure related to right-sided heart failure. The jugular veins are normally flat or collapsed. Since there are no valves at the atrial sites (i.e., venae cavae and pulmonary veins) where blood enters the heart, they can become prominent in severe right-sided heart failure. This means that excess blood is pushed back into the veins when the atria become distended.

A patient is diagnosed with orthostatic hypotension. The nurse knows that drugs which can predispose a patient to orthostasis include which of the following? Select all that apply. a) Psychotropics b) Bronchodilators c) Antibiotics d) Antihypertensives e) Diuretics

A) Psychotropics d) Antihypertensives e) Diuretics

In the circulatory system, pressure is inversely related to which factor? A-Velocity B-Volume C-Tension D-Viscosity

Volume >> In the circulatory system, pressure is inversely related to volume. Arterial circulation contains a lower percentage of total blood volume and has higher pressure than the venous circulation, which contains the majority of circulating blood. Flow is related to viscosity and radius is related to wall tension. Velocity is inversely proportional to the cross-sectional area of the vessel.

A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing: a) Onset of STEMI b) Gastroesophageal reflux disease (GERD) c) Acute respiratory distress syndrome (ARDS) d) Pneumonia

a) Onset of STEMI