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Which type of pulse would the nurse expect when assessing a patient who is anxious? 1 Rapid 2 Thready 3 Irregular 4 Pulsus alternans
1 A rapid pulse, tachycardia, is associated with anxiety caused by increased adrenaline. A thready pulse is associated with peripheral arterial disease, aortic valve disease, and decreased cardiac output. The pulse is irregular in patients with cardiac dysrhythmias. Pulsus alternans is observed in patients with heart failure and cardiac tamponade.
The nurse is providing information about cardiac output to a group of nursing students. Which information about calculating cardiac output should be included? 1 It is calculated by multiplying the patient's stroke volume by the heart rate. 2 It is the average amount of blood ejected during one complete cardiac cycle. 3 It is determined by measuring the electrical activity of the heart and the patient's heart rate. 4 It is the patient's average resting heart rate multiplied by the patient's mean arterial BP.
1 Cardiac output is calculated by multiplying the patient's stroke volume and heart rate, thus identifying how much blood is pumped by the heart over a one-minute period. The amount of blood ejected from the heart in one minute is the stroke volume. The electrical activity of the heart and heart rate would not provide enough information to calculate cardiac output. The heart rate and blood pressure would not provide direct information to calculate cardiac output.
The nurse performing a cardiovascular assessment on an 85-year-old patient expects which age-related finding? 1 Presence of S4 2 Decreased resting supine heart rate 3 Increased response to physical stress 4 Slight shortening of QRS complex interval 00:00:03 Question Answer Confidence ButtonsJust a guessPretty sureNailed it
1 Due to changes in the heart with aging, a fourth heart sound (S4) might be heard. The supine heart rate is not affected by aging. The response to physical stress is decreased. The QRS complex interval may lengthen.
A patient with pericarditis is admitted to the hospital. In which patient position would the nurse assess for a pericardial friction rub? 1 Ask the patient to sit and lean forward. 2 Place the patient in a standing position. 3 Maintain the patient in a supine position. 4 Place the patient in three positions: supine, sitting, and standing.
1 In a patient with pericarditis, a high-pitched sound can be auscultated. This sound can be heard during heart sound S1 or S2 at the apex. The best position for hearing this sound is when the patient is in a sitting position and leaning forward. The sound is not well heard in other positions, such as supine or standing.
What does the P wave in this figure represent?
1 The P wave indicates atrial depolarization. The QRS complex represents depolarization from the AV node throughout the ventricles. The PR interval represents the time it takes the impulse to spread through the atria, AV node, bundle of His, bundle branches, and Purkinje fibers to the point immediately preceding ventricular contraction. The U wave, if seen, represents repolarization of Purkinje fibers, or the U wave may be associated with hypokalemia.
Which portion of the vascular system exchanges cellular nutrients and metabolic end products? 1 Capillary vessels 2 Smooth muscle of the arteriole 3 Endothelial layer of the arteries 4 Elastic middle layer of the veins
1 The exchange of cellular nutrients and metabolic end products takes place through the thin-walled capillaries, which connect the arterioles and the venules. Exchange of cellular nutrients and metabolic end products does not occur in the arteriole, arteries, or veins.
Which vessel carries oxygenated blood from the lungs to the heart? 1 Pulmonary vein 2 Pulmonary artery 3 Inferior vena cava 4 Superior vena cava
1 The pulmonary vein, in contrast to all other veins, carries oxygenated blood toward the heart from the lungs. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs. The inferior vena cava carries deoxygenated blood from the legs and abdomen to the right atrium of the heart. The superior vena cava carries deoxygenated blood from the arms and head to the right atrium of the heart.
A patient presents to the emergency department reporting chest pain. Which component of the patient's blood work would most specifically indicate an acute myocardial infarction (MI)? 1 Troponin 2 Myoglobin 3 Creatine kinase (CK) 4 C-reactive protein (CRP)
1 Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of other markers. CK enzymes are found in a variety of organs and tissues. Myoglobin elevation is a sensitive indicator of very early myocardial injury but lacks specificity for MI. CRP levels are not used to diagnose acute MI; rather, an increased level has been linked with the presence of atherosclerosis.
How will the nurse document a weakly palpable pulse?
1+ A weak pulse in a patient with cardiovascular disease is indicated by 1+. The absence of a pulse is indicated by 0. A normal pulse rate is indicated by 2+, and 3+ indicates an increased, full, bounding pulse.
Which are the major factors that influence BP? Select all that apply. 1 Capillary refill 2 Cardiac output 3 Oxygen saturation 4 Pulmonary pressure 5 Systemic vascular resistance
2 5 The two main factors influencing BP are cardiac output and systemic vascular resistance. Capillary refill, oxygen saturation, and pulmonary pressure do not influence BP.
A patient's laboratory report reveals increased creatine kinase (CK-MB) enzymes. Which condition is consistent with this result? 1 Stroke 2 Myocardial infarction (MI) 3 Coronary artery disease (CAD) 4 Peripheral vascular disease (PVD)
2 CK-MB enzymes are present in the cardiac muscle and are released into the blood as a result of cell injury. An increase in CK-BB enzymes indicates brain injury. Homocysteine is an amino acid produced during protein catabolism; elevated levels of this amino acid are an indication of stroke, CAD, and PVD.
Which action would the nurse take to assess a patient for jugular venous distention? 1 Place the patient in a supine position. 2 Raise the patient to about 45 degrees. 3 Place the patient in a sitting position, leaning forward. 4 Observe the vein in three positions: supine, sitting, and standing.
2 Jugular venous distention can be seen in right-sided heart failure. In this condition, the large veins in the neck are distended as a result of the back pressure exerted by the blood. It is best appreciated when the patient is raised to approximately 45 degrees or slightly less. This exerts pressure and helps in the visualization of the jugular veins. Placing the patient in other positions, such as supine, sitting, leaning, or standing, does not help in clear visualization of jugular venous distention.
Which action does the T wave in a patient's electrocardiogram (ECG) represent? 1 Depolarization of the atria 2 Repolarization of the ventricles 3 Repolarization of the Purkinje fibers 4 Delayed repolarization in hypokalemia
2 On an ECG, the T wave represents repolarization of the ventricles. Depolarization of the atria is represented by the P wave. The U wave, if present, can represent either repolarization of the Purkinje fibers or hypokalemia.
Which artery supplies the atrioventricular (AV) node and the bundle of His in most people? 1 Circumflex artery 2 Right coronary artery 3 Left main coronary artery 4 Left anterior descending artery
2 The right coronary artery supplies blood to the bundle of His and the AV node in the heart for 90% of the population, and a blockage of this artery can affect the blood supply to the bundle of His. The circumflex artery, left main coronary artery, and left anterior descending artery do not supply blood to the bundle of His.
Which abnormality is likely to result in a heart murmur? 1 Increased viscosity of the patient's blood 2 Turbulent blood flow across a heart valve 3 Friction between the heart and the pericardium 4 A deficit in heart conductivity that impairs contractility
2 Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity or conductivity. Friction between the heart and pericardium may cause an audible friction rub.
The nurse observes a bluish tinge around the ears of a patient with cardiovascular disease. Which condition is likely to be present? 1 Diabetes 2 Endocarditis 3 Vasoconstriction 4 Venous thromboembolism
3 A bluish tinge around the ears or in the ears indicates peripheral cyanosis, which is characterized by vasoconstriction. Vasoconstriction is the narrowing of blood vessels as a result of the contraction of the muscular walls of the vessels, resulting in reduced blood flow. This reduced blood flow will result in insufficient oxygen supply by the heart to other parts of the body, causing a bluish tinge in the extremities of ears. Diabetes causes ulcers in patients with cardiovascular disease. Endocarditis causes clubbing of the nail beds. Venous thromboembolism results in asymmetry in limb circumference.
Which action does the QRS complex represent in an electrocardiogram? 1 Depolarization of the atria 2 Repolarization of the ventricles 3 Depolarization of both ventricles 4 Repolarization of the Purkinje fibers
3 An electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the cause of chest pain. The time taken for depolarization of both the ventricles is represented by the QRS interval. Depolarization of the atria is represented by the P wave. The T wave in the electrocardiogram should be upright, and it represents the time for ventricular repolarization. If present, the U wave indicates the repolarization of the Purkinje fibers.
Which blood component is a marker of inflammation reflecting an increased risk of cardiovascular disease? 1 Myoglobin 2 N-terminal pro-brain natriuretic peptide (NT-Pro-BNP) 3 C-reactive protein (CRP) 4 B-type natriuretic peptide (BNP)
3 CRP is a marker of inflammation that can predict the risk of cardiac events and cardiac diseases. Myoglobin is a low-molecular-weight protein that is sensitive to myocardial injury. NT-Pro-BNP helps in assessing the severity of heart failure. BNP is a peptide that causes natriuresis, and its elevation distinguishes a cardiac versus respiratory cause of dyspnea.
Which medication listed in a patient's health record is a potential cause of the patient's cardiomyopathy? 1 Ibuprofen 2 Prednisone 3 Doxorubicin 4 Chlorpromazine
3 Doxorubicin is an anticancer medication that results in cardiomyopathy. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that results in hypertension, myocardial infarction, and stroke. Prednisone is a corticosteroid that causes hypotension, edema, and potassium depletion. Chlorpromazine is an antipsychotic medication that results in dysrhythmias and orthostatic hypotension.
Which location would the nurse assess for edema caused by a cardiac condition? 1 Face 2 Wrist 3 Ankle 4 Chest
3 Edema is a common and early symptom of cardiovascular conditions. The nurse would look for edema by depressing the skin over the tibia or medial malleolus for five seconds. This edema is commonly seen in dependent areas, such as on the feet and the ankle, as a result of gravity. Edema on the face, wrist, or chest may be caused by other, noncardiac conditions.
Which part of the heart's beat is represented by the QRS complex on a patient's electrocardiogram (ECG)? 1 Depolarization of the atria 2 Repolarization of the ventricles 3 Depolarization from the atrioventricular (AV) node through the ventricles 4 The length of time for the impulse to travel from the atria to the ventricles
3 The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles.
Which structure initiates the action potential in the heart? 1 Bundle of His 2 Purkinje fibers 3 Sinoatrial node 4 Left bundle branch
3 The sinoatrial node is called the pacemaker of the heart, and it initiates the electrical impulse, or action potential, in the heart. By way of the Purkinje fibers, the action potential moves through the walls of ventricles, but it is not initiated at this point. The action potential moves from the atrioventricular node through the bundle of His and the right and left bundle branches, but it is not initiated at these points.
Which technique would the nurse use to assess for the presence of a pulse deficit? 1 Ask the patient to take a deep breath and hold it. 2 Position the patient supine and palpate the pedal pulses. 3 Palpate the radial pulse while auscultating the apical pulse. 4 Use the bell of the stethoscope when auscultating S1 and S2.
3 To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. Palpating the pedal pulses will not indicate a pulse deficit. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation. The diaphragm is more appropriate than the bell when auscultating S1 and S2.
The BP of a patient is 90/60 mm Hg. What should the nurse document as the patient's pulse pressure? Record the answer using a whole number. ________ mm Hg
30 The difference between the systolic BP (SBP) and diastolic BP (DBP) is the pulse pressure. The patient's SBP is 90, and the DBP is 60; therefore the pulse pressure is 90 - 60 = 30 mm Hg.
Which term would the nurse use to document a patient's report of awakening during the night with sudden shortness of breath? 1 Orthopnea 2 Atrial fibrillation 3 Intermittent claudication 4 Paroxysmal nocturnal dyspnea
4 Paroxysmal nocturnal dyspnea is defined as attacks of shortness of breath, especially at night, which awaken the patient. Orthopnea is the need to sleep in an upright position. Intermittent claudication affects the muscles of the leg during exercise related to decreased oxygen delivery to the muscle. Atrial fibrillation is a conduction abnormality of the heart.
Which anatomic feature of the heart directly stimulates ventricular contractions?
4 The Purkinje fibers (4) move the electrical impulse or action potential through the walls of both ventricles, triggering synchronized right and left ventricular contraction. The sinoatrial (SA) node (1) initiates the electrical impulse that results in atrial contraction. The atrioventricular (AV) node (2) receives the electrical impulse through internodal pathways. The bundle of His (3) receives the impulse from the AV node.
The nurse is teaching a group of nursing students about the anatomic characteristics of the heart. Which information would the nurse include? 1 The right and the left atria are similar in size. 2 The atrial myocardium is thicker than that of the ventricles. 3 The right ventricular wall is three times thicker than the left ventricle. 4 The left ventricle is thicker to pump the blood into the systemic circulation.
4 The left ventricle is thicker because it needs to pump the blood into circulation. The right and left atria are different sizes and have different wall thicknesses. The atrial myocardium is thinner than that of the ventricles. The left ventricular wall is two or three times thicker than the right ventricular wall.
During a physical examination, where would a nurse auscultate for the patient's aortic area? 1 Fifth intercostal space to the left of the sternum 2 Second intercostal space to the left of the sternum 3 Fifth intercostal space to the right of the sternum 4 Second intercostal space to the right of the sternum
4 The surface anatomy for the aortic area is in the second intercostal space to the right of the sternum. The pulmonic area is in the second aortic area to the left of the sternum. The tricuspid area is in the fifth left intercostal space. No auscultation is performed in the fifth right intercostal space.
In what order does blood flow through the heart?
Blood flows (from the body via the superior and inferior vena cava) into the right atrium. Blood passes from the right atrium (through the tricuspid valve) into the right ventricle, then (via the pulmonic valve into the pulmonic artery) the lungs. Blood flows back from the lungs (via the pulmonary veins) into the left atrium. Blood flows from the left atrium through the mitral valve into the left ventricle and then (via the aortic valve) to the aorta and the body.
In which order would the nurse perform the actions to measure a patient's BP?
The nurse would first place the appropriate size of cuff on the upper arm. This is because the brachial artery is the recommended site for measuring the BP, and the wrong cuff size can give an inaccurate reading. The cuff is then inflated to a pressure 20 to 30 mm Hg above the most recently recorded SBP. This causes the blood flow in the artery to cease. The nurse would then lower the pressure in the cuff while auscultating the artery and also note the first phase of the Korotkoff sound. It is a tapping sound caused by the spurt of blood into the constricted artery. This is the SBP. Finally, when the sound disappears, the nurse notes the diastolic pressure.
