Hoff Ch 28 Assessment of Cardiovascular Function

The nurse correlates which assessment finding to activation of the renin-angiotensin-aldosterone system? Select all that apply. 1. Increased blood pressure 2. Increased heart rate 3. Increased sodium reabsorption 4. Increased urine output 5. Increased oxygen saturation

1, 3 This is correct. Renin reacts with angiotensinogen to create angiotensin I. Angiotensin I is then converted in the lungs to angiotensin II via angiotensin-converting enzyme. Angiotensin II is a potent vasoconstrictor that increases blood pressure. Angiotensin II acts on the adrenals to release aldosterone that promotes sodium and water reabsorption in the kidneys, which increases circulating fluid volume.

Which information should the nurse include when documenting the findings of a patient's heart sounds? Select all that apply. 1) Pitch 2) Clicks 3) Quality 4) Intensity 5) Location

1, 3, 4, 5 When describing heart sounds it is important to note pitch, quality, intensity, and location

The nurse correlates which variables as directly influencing stroke volume? Select all that apply. 1. Afterload 2. Conductivity 3. Contractility 4. Coronary circulation 5. Preload

1, 3, 5 This is correct. Stroke volume is the amount of blood ejected with each ventricular contraction and is influenced by three variables: preload, afterload, and contractility.

The nurse is preparing content for a community health fair on risk factors for heart disease. What should the nurse include as nonmodifiable risk factors? Select all that apply. 1) Age 2) Weight 3) Alcohol intake 4) Ethnic background 5) Parents' health history

1, 4, 5 Age, Ethnic background, and family history is a nonmodifiable risk factor.

The nurse assesses for which heart sound in the patient diagnosed with mitral valve stenosis? 1. Click 2. Friction rub 3. Atrial gallop 4. Ventricular gallop

1. A click is a high-pitch heart sound that is anticipated when auscultating the chest of a patient who is diagnosed with mitral valve stenosis.

A patient is being assessed for heart disease. For which laboratory test should the nurse instruct to avoid eating and drinking fluids for 12 hours? 1) Lipid panel 2) Homocysteine 3) C-reactive protein 4) Partial thromboplastin time

1. A lipid panel requires the patient to fast for approximately 8 to 12 hours prior to the test.

A patient with a blood pressure of 88/50 mm Hg has a heart rate of 112 beats per minute. Which mechanism should the nurse realize is occurring in this patient? 1) Positive chronotropic effect 2) Negative chronotropic effect 3) Force of the mechanical contraction 4) Reaction to ventricular volume at the end of diastole

1. Stimulus from the sympathetic nervous system initiated by information from baroreceptors in the aortic arch and the carotids that are sensitive to changes in BP increase the HR through the release of norepinephrine. This is called a positive chronotropic effect.

The nurse is preparing teaching about the coronary arteries for a group of patients scheduled for heart surgery. Which information should the nurse include in this teaching? 1) The coronary arteries originate in the cusps of the aortic valve. 2) The coronary arteries prevent the backflow of blood into the atria. 3) The coronary arteries respond to changes in pressure within the heart. 4) The coronary arteries prevent the backflow of blood into the ventricles.

1. The left and right coronary arteries are the first arteries branching off of the aorta as it leaves the left ventricle and actually originate in the cusps of the aortic valve.

The nurse correlates which arterial blood gas result to the activation of chemoreceptors in the carotid bodies and aortic arch that lead to an increased respiratory rate? 1. HCO3- 24 mEq/L 2. PaCO2 30 mm Hg 3. PaO2 60 mm Hg 4. pH 7.42

1. This is a normal bicarbonate level (22-26 mEq/L). Chemoreceptors respond to changes in oxygen and carbon dioxide concentrations.

9. Which of the following statements from a patient having an annual physical indicates the need for further teaching regarding normal blood pressure parameters? 1. "As long as my blood pressure is not above 120/80, I know that I am fine." 2. "The bottom number needs to be below 80 to be considered normal." 3. "The top number needs to be below 120 to be considered normal." 4. "If the bottom number is above 90, I may have hypertension."

1. This statement indicates the need for further teaching. Blood pressure readings greater than 120/80 indicate elevated blood pressure. This is particularly important teaching for older adults because in the past 120/80 was considered a normal blood pressure reading.

The nurse documents a patient's heart sounds. Which descriptors does the nurse use for intensity of heart sounds? Select all that apply. 1. High 2. Faint 3. Loud 4. Harsh 5. Medium

2, 3 This is correct. Descriptors for the intensity of the patient's heart sounds include faint, loud, and quiet.

The nurse is preparing a teaching tool about the cardiac electrical conduction system. In which order should the nurse explain the route of the action potential? 1) Impulse travels to the bundle of His 2) Sinoatrial node fires in the right atrium 3) Impulse extends through Purkinje fibers 4) Impulse travels through bundle branches 5) Impulse travels to the atrioventricular node 6) Impulse spreads through atrial myocardium

2-6-5-1-4-3 The action potential begins in the sinoatrial node, which fires in the right atrium. Then the impulse spreads through the atrial myocardium and travels to the atrioventricular node. It then travels to the bundle of His, through the bundle branches, and extends through the Purkinje fibers.

While auscultating a patient's heart rate the nurse hears scratching sounds. What is most likely causing this sound? 1) Epicardium adhering to the heart surface 2) Low level of fluid in the pericardial cavity 3) Parietal pericardium adhering to the sternum 4) Endocardium adhering to the heart chambers

2. Between the two layers of the heart is a pericardial cavity containing serous fluid that provides a lubricant that allows the heart to beat without friction.

An older patient is being evaluated for a cardiac click audible upon auscultation. Which age-related change should the nurse realize might be causing this heart sound? 1) Hypertension 2) Valve stenosis 3) Atrial fibrillation 4) Congestive heart failure

2. A cardiac click is associated with valve stenosis.

The nurse auscultates a cardiac click and recognizes that this may be caused by which cardiac disorder? 1. Aortic regurgitation 2. Mitral valve stenosis 3. Pericarditis 4. Aortic stenosis

2. A click is associated with mitral valve stenosis.

The nurse notes that an older patient's point of maximum impulse is displaced to the left. What age-related change should the nurse suspect as causing this assessment finding? 1) Valvular stenosis 2) Left ventricular atrophy 3) Arterial wall narrowing 4) Fibrosis of heart chambers

2. Aging produces a number of physiological changes in the anatomy and physiology of the cardiovascular system. Physical deconditioning can result in atrophy of the left ventricle, which would displace the point of maximum impulse.

The nurse notes that a patient is scheduled for a brain natriuretic peptide level to be drawn. What patient teaching should the nurse prepare for this patient? 1) Low-fat diet 2) Signs of heart failure 3) Symptoms of a heart attack 4) Lung versus heart problems

2. Brain natriuretic peptide is released from overstretched ventricular tissue. Elevations are an indicator of heart failure.

The nurse notes that a patient is scheduled for a brain natriuretic peptide level to be drawn. What patient teaching should the nurse prepare for this patient? 1. Low-fat diet 2. Signs of heart failure 3. Symptoms of a heart attack 4. Lung versus heart problems

2. Brain natriuretic peptide is released from overstretched ventricular tissue. Elevations are an indicator of heart failure.

After palpating a patient's radial pulses, the nurse proceeds to palpate the brachial, carotid, femoral, popliteal, and posterior tibial pulses. What condition caused the nurse to make this more thorough physical assessment? 1) Skin warm and dry 2) Various skin temperatures 3) Edema of the left lower extremity 4) Respiratory rate of 24 and labored

2. Variations in temperature between different parts of the body may indicate vasoconstriction or vascular disease in the affected extremities. A more extensive examination includes femoral, popliteal, and posterior tibial pulses.

The nurse recognizes which hemodynamic parameters as measurements of afterload? Select all that apply. 1. Central venous pressure 2. Left atrial pressure 3. Pulmonary vascular resistance 4. Right atrial pressure 5. Systemic vascular resistance

3, 5 This is correct. Afterload refers to the resistance to flow the ventricle must overcome to open the semilunar valves and eject its contents, and is measured as systemic vascular resistance and pulmonary vascular resistance.

A patient who is admitted for a potential heart attack is prescribed serial blood draws for creatine kinase (CK), creatine kinase myocardial bands (CK-MB), and troponin. After blood is drawn for the baseline, which frequency does the nurse schedule for the follow-up blood draws for the next 12 hours? 1. Every 1 to 2 hours 2. Every 2 to 3 hours 3. Every 3 to 4 hours 4. Every 4 to 5 hours

3. After the baseline blood draw is completed, the nurse schedules subsequent draws every 3 to 4 hour for a period of 12 hours.

A patient's blood pressure is 174/98 mm Hg. Which aspect of cardiac output is most affected by this elevated reading? 1) Preload 2) Heart rate 3) Afterload 4) Contractility

3. Afterload is the resistance to flow the ventricle must overcome to open the semilunar valves and eject its contents. This is related to BP in that hypertension on the right or left is implicated in the negative effects of increased afterload.

The nurse suspects that a patient is experiencing a release of norepinephrine from the adrenal medulla. Which assessment finding did the nurse use to make this clinical decision? 1) Blood pressure 94/48 mm Hg 2) Heart rate 68 beats per minute 3) Heart rate 120 beats per minute 4) Blood pressure 180/100 mm Hg

3. Chemicals that can increase HR include norepinephrine released from the adrenal medulla.

The nurse is caring for a patient with respiratory acidosis. Based on the actions of these chemoreceptors to this acidosis, the nurse assesses for which physiological response? 1. Decreased blood pressure 2. Decreased heart rate 3. Increased respiratory rate 4. Increased temperature

3. Chemoreceptors respond to changes in oxygen and CO2 concentrations. Decreased levels of oxygen with increased levels of CO2 produce acidosis. The chemoreceptors respond to the acidosis by inducing vasoconstriction to increase BP and increase blood flow to the lungs, facilitating oxygen and CO2 exchange. Respiratory rate is also increased.

The nurse notes that a patient has a low serum potassium level. Which phase of the cardiac action potential will be most affected by this blood level? 1) Phase 0 2) Phase 1 3) Phase 3 4) Phase 4

3. In phase 3 final repolarization occurs, which is caused by the closing of the Ca++ channels and the rapid outflow of K+.

The nurse is preparing to auscultate the heart sounds of a patient with mitral valve regurgitation. Which sound should the nurse expect to hear? 1) Rub 2) Click 3) Murmur 4) Atrial gallop

3. Murmurs are usually caused by turbulent flow through the valves. That turbulence can be caused by regurgitation of blood through an incompetent valve.

A patient's QRS complex is becoming increasingly wider. What is occurring within the heart muscle that is reflected on this tracing? 1) The ventricles are repolarizing. 2) Atrial repolarization is occurring. 3) Ventricular depolarization is prolonged. 4) The atria depolarize and the impulse at the AV node is delayed.

3. The QRS complex corresponds to ventricular depolarization. If the complex is widening, then ventricular depolarization is taking longer to complete.

A patient is prescribed to have capillary blood glucose readings every four hours. What should the nurse include when explaining capillaries to the patient? 1) It is a low-pressure vascular circuit. 2) Capillaries are the largest vessel within the arterial system. 3) The real work of the vascular system occurs at the capillary level. 4) They are flexible to adapt to changes in volume without large changes in pressure.

3. The real work of the vascular system is done at the capillary bed.

The clinical trainer is reviewing the renin-angiotensin-aldosterone system with graduate nurses during orientation to the telemetry unit. In which order should the trainer discuss this system? 1) Sodium and water reabsorbed in the kidneys 2) Renin reacts with angiotensin to create angiotensin 1 3) Angiotensin I is converted to angiotensin II in the lungs 4) Kidneys release renin in response to a drop in blood pressure 5) Angiotensin II influences adrenal glands to release aldosterone

4-2-3-5-1 When the blood pressure drops, the kidneys respond by releasing the enzyme renin. Renin reacts with angiotensin to create angiotensin I. Angiotensin I is then converted in the lungs to angiotensin II via angiotensin-converting enzyme. Angiotensin II acts on the adrenal glands to release aldosterone. The release of aldosterone promotes sodium and water reabsorption in the kidneys, which increases circulating fluid volume.

The nurse notes that a patient has bilateral lower extremity edema. For which health problem should the nurse assess further? 1) Pericarditis 2) Cardiac tamponade 3) Lymph obstruction 4) Venous insufficiency

4. Bilateral lower extremity edema generally indicates venous insufficiency.

The nurse is reviewing the anatomy of the heart with a patient scheduled for cardiac surgery. Which patient statement indicates additional teaching is required? 1) "Oxygenated blood returns to the left atrium through the pulmonary vein." 2) "The right atrium receives blood from the superior and inferior vena cava." 3) "Blood leaves the right ventricle and travels through the pulmonary vein to the lungs." 4) "Blood leaves the right ventricle and travels through the pulmonary artery to the lungs."

4. Blood leaves the right ventricle and travels through the pulmonary vein to the lungs. Deoxygenated blood is delivered to the pulmonary circuit through the pulmonary artery.

A patient is recovering from a cardiac catheterization that was performed via the right groin. Which assessment requires the nurse to notify the healthcare provider immediately? 1. Pain at the insertion site 2. Urine output 250 mL/2 hours 3. Oozing serosanguinous drainage at the puncture site 4. Decreased pulses in the right foot

4. Decreased pulses distal to the insertion site for the procedure may indicate occlusion of the femoral artery by a hematoma and should be immediately reported to the healthcare provider.

The nurse is reviewing data collected during the assessment of an older patient. Which finding should the nurse consider as being an age-related change of the cardiovascular system? 1) First heart sound louder 2) Friction rub auscultated 3) Heart rate 64 and regular 4) Blood pressure 168/96 mm Hg

4. Hypertension is a common cardiovascular health issues related to aging.

A patient is scheduled for a transesophageal echocardiogram (TEE). What information should the nurse expect to be provided from this test? 1) Cardiac filling pressures 2) Integrity of cardiac arteries 3) Heart function during stress 4) Presence of clots in the atria

4. Information about the presence of clots in the atrium, a risk factor for stroke, is more easily viewed through TEE.

The nurse is preparing to determine a patient's cardiac output. Which measurement should be used for preload? 1) Heart rate 2) Blood pressure 3) Oxygen saturation 4) Central venous pressure

4. Preload is reflected by measurements obtained through a centrally located IV line. For preload the central venous pressure is used.

A patient is recovering from a cardiac catheterization. For which finding should the nurse notify the health-care provider? 1) Warm right foot 2) Urine output 250 mL/2 hours 3) Discomfort lying flat for six hours 4) Hematoma formation at puncture site

4. The puncture site should be monitored for hematoma formation. This could cause occlusion of the femoral artery and should be reported to the health-care provider.

8. The nurse correlates which blood pressure readings with stage 2 hypertension? 1. The patient with average blood pressure readings of 128/70 on three separate occasions 2. The patient with average blood pressure readings of 128/90 on three separate occasions 3. The patient with average blood pressure readings of 138/88 on three separate occasions 4. The patient with average blood pressure readings of 142/92 on three separate occasions

4. This BP is classified as stage 2 hypertension because the SBP is greater than 140 mm Hg and the DBP is greater than 90 mm Hg.

A patient is being evaluated for a possible myocardial infarction, but the patient is not sure when the pain started because he has a history of gastroesophageal reflux. He has had intermittent chest pain, with some episodes of dizziness and fatigue, over the last week. Which diagnostic result will be most helpful in determining whether the patient has suffered cardiac injury? 1. Elevated creatine kinase (CK) 2. Elevated creatine kinase myocardial bands (CK-MB) 3. Elevated myoglobin 4. Elevated troponin

4. Troponin is a specific marker of cardiac muscle damage and is the preferred method for diagnosing cardiac injury. It is a protein released from damaged tissue and can elevate within 4 hours of injury. Because it can stay elevated up to 10 days (longer than CK-MB), it is a valuable marker when attempting to diagnose injury in the recent past.

A patient is prescribed a 12-lead electrocardiogram. In which order should the nurse apply the V leads? 1) Midaxillary line 2) Between V2 and V4 3) Midclavicular line 5th intercostal space 4) 4th intercostal space left of the sternum 5) 4th intercostal space right of the sternum 6) Between V4 and V6 anterior axillary line

5-4-2-3-6-1 The chest positions for the V leads are: V1: 4th intercostal space, just to the right of the sternum; V2: 4th intercostal space, just to the left of the sternum; V3: Between V4 and V2; V4: on the midclavicular line and 5th intercostal space; V5: between V6 and V4 on the anterior axillary line; and V6: on the midaxillary line, horizontal with V4.