N343 Quiz 5

A client has developed disseminated intravascular coagulation (DIC). The nurse knows that which statements regarding DIC are true? Select all that apply. Thrombotic occlusion occurs in small and midsized blood vessels. Bleeding may accompany coagulation. Generation of thrombin increases. Endogenous anticoagulation mechanisms are suppressed. Fibrin removal increases.

124 Explanation: In disseminated intravascular coagulation, generation of thrombin activates formation of fibrin clots that occlude small and midsized blood vessels. Platelets and coagulation factors are depleted as they form clots, and simultaneous bleeding can occur. Endogenous anticoagulant factors are suppressed, decreasing removal of fibrin. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock, p. 829.

The nurse knows that peripheral vascular resistance is an important factor in blood pressure regulation. Which statements regarding peripheral vascular resistance are correct? Select all that apply. Mean arterial pressure is determined by cardiac output and peripheral vascular resistance. Peripheral resistance is influenced by blood viscosity. Blood pressure can be maintained despite changes in cardiac output and resistance. Changes in cardiac output or resistance rapidly result in major increase or decrease in blood pressure. Peripheral resistance is influenced by arteriolar constriction.

124 Explanation: Mean arterial pressure is influenced by cardiac output and peripheral vascular resistance. That resistance is influenced by arteriolar radius and blood viscosity or resistance to flow. Cardiac output can adjust to changes in resistance, and resistance can adjust to changes in cardiac output to maintain blood pressure. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, p. 716.

A nurse is caring for a client with an average heart rate of 56 beats/min. The client has no adverse symptoms associated with this heart rate and is receiving no treatment. Which activity modification should the nurse suggest to avoid further slowing of the heart rate? "Avoid stress or overexcitement." "Avoid bearing down while having a bowel movement." "Avoid strenuous aerobic exercise." "Limit your intake of caffeinated drinks."

You Selected: "Avoid strenuous aerobic exercise." Correct response: "Avoid bearing down while having a bowel movement." Explanation: Bearing down during a bowel movement stimulates the vagus nerve and results in a slowing of the heart rate. Vagal stimulation as well as some medications decreases the firing rate of the sinoatrial node and conduction through the atrioventricular node to cause a decrease in heart rate. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 28: Disorders of Cardiac Conduction and Rhythm, p. 845.

A client awaiting a heart transplant is experiencing decompensation of the left ventricle that will not respond to medications. The health care provider (HCP) suggests placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. Which response most accurately describes the purpose of a VAD? "Pulls your blood from the right side of the heart and runs it through a machine to oxygenate it better, and then return it to your body." "Measures the pressures inside your heart continuously to asses pumping ability of your left ventricle." "Has a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." "Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

You Selected: "Pulls your blood from the right side of the heart and runs it through a machine to oxygenate it better, and then return it to your body." Correct response: "Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure." Explanation: Although the response is technical in nature, it is the most accurate. The nurse will use the most accurate terms and then follows up with an explanation of these terms based on the client's level of understanding of the terminology. Decompensated, refractory heart failure reflects deterioration in cardiac function that is unresponsive to medical or surgical interventions. Ventricular assist devices (VADs) are mechanical pumps used to support ventricular function. VADs are used to decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure. This decreases the workload on the ventricle and allows it to rest and recover. The rest of the distractors relate to the monitoring in an ICU of cardiac functioning. Invasive hemodynamic monitoring may be used for assessment in acute, life-threatening episodes of heart failure. With the balloon inflated, the catheter monitors pulmonary capillary pressures (i.e., pulmonary capillary wedge pressure or pulmonary artery occlusion pressure), which reflect pressures from the left ventricle. The pulmonary capillary pressures provide a means of assessing the pumping ability of the left ventricle. One type of pulmonary artery catheter is equipped with a thermistor probe to obtain thermodilution measurements of cardiac output. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock, Heart Failure in Adults: Treatment, p. 804.

An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate? "Everyone over the age of 50 tends to have their blood pressure creep up over the years." "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." "Your heart has to work harder to pump blood through your vessels as you get older." "If you slow down and rest more, your blood pressure will more than likely return to its normal level."

You Selected: "Your heart has to work harder to pump blood through your vessels as you get older." Correct response: "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." Explanation: Systolic blood pressure rises almost linearly between 30 and 84 years of age, whereas diastolic pressure rises until 50 years of age and then levels off or decreases. This rise in systolic pressure is thought to be related to increased stiffness of the large arteries. With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, p. 746.

The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below: 140/90 140/60 100/60 100/90

You Selected: 100/60 Correct response: 140/90 Explanation: The main objective of hypertension management is to achieve a pressure of 140/90, although persons with renal disease or diabetes are advised to aim for 130/80 or lower. Persons with blood pressure between 140/90 and 120/80 are considered to be prehypertensive and should be monitored at regular intervals to detect any rise in pressure. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, pp. 742-746.

The physician understands that which client is at risk for developing primary hyperlipoproteinemia? A client with familial hypercholesterolemia A client with hypothyroidism A client receiving beta-blockers A client with obstructive liver disease

You Selected: A client with obstructive liver disease Correct response: A client with familial hypercholesterolemia Explanation: Many types of primary hyperlipoproteinemia have a genetic basis. The LDL receptor is deficient or defective in the genetic disorder known as familial hypercholesterolemia. The other options cause secondary hyperlipoproteinemia. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, p. 724.

A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have? Myocardial infarction Abdominal aortic aneurysm Pericarditis Pneumonia

You Selected: Abdominal aortic aneurysm Correct response: Pericarditis Explanation: This client is demonstrating signs and symptoms of pericarditis, which includes a triad of chest pain, pericardial friction rub, and EKG changes. Other signs are that the pain is usually abrupt in onset, occurs in the pericardial area, and may radiate to the neck, back, abdomen or side. It is usually worse with deep breathing and swallowing, and the person often finds relief when sitting up and leaning forward. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock, pp. 755-756.

A client with high blood pressure has swollen ankles. Which physiologic factor could relieve this condition? An increase in the colloidal pressure in circulation that drives fluid into the tissue An increase in the colloidal pressure in tissue that drives the fluid into the tissue A decrease in the hydrostatic pressure that drives fluid into the tissue An increase in the hydrostatic pressure that drives fluid into circulation

You Selected: An increase in the hydrostatic pressure that drives fluid into circulation Correct response: A decrease in the hydrostatic pressure that drives fluid into the tissue Explanation: The mean arterial pressure is the driving hydrostatic force and results in an increase of fluid in tissues. The colloidal pressure does influence fluid distribution but is not related to hypertension. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, pp. 707-708.

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

You Selected: Anastomosis of the arterial and venous circulation Correct response: Long-term compensatory regulation of blood flow Explanation: 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. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, p. 704.

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: Prompt diagnosis and treatment of streptococcal infections Yearly electrocardiography after the age of 50 Annual blood specimen assessed for rheumatoid factor Avoiding frequent dental examinations

You Selected: Annual blood specimen assessed for rheumatoid factor Correct response: Prompt diagnosis and treatment of streptococcal infections Explanation: Rheumatic heart disease is normally caused by streptococcal infections; therefore, early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a client has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease. The client should have regular dental examinations. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock, p. 783.

The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels? Arterioles Aorta Capillaries Venules

You Selected: Aorta Correct response: Arterioles Explanation: Arterioles can constrict or dilate selectively and control the resistance to blood flow into capillaries. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, p. 716.

An emergency room nurse is caring for a client with cardiomyopathy who has chest pain and shortness of breath. Vital signs include heart rate 100, blood pressure 84/62, RR 30 and temperature 37.0°C. Cardiac monitor reveals an irregular rhythm with frequent premature ventricular complexes. The nurse understands that this client is at risk for: Heart failure Serious dysrhythmias Atrial fibrillation Hypertension

You Selected: Atrial fibrillation Correct response: Serious dysrhythmias Explanation: Cardiomyopathy is disease of the cardiac muscle and premature ventricular contractions increase the risk for more lethal dysrhythmias to occur. Heart failure is also a possibility; however, there is not enough information in the question to support heart failure. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 28: Disorders of Cardiac Conduction and Rhythm, p. 848.

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? Auscultate for an extra heart sound due to incomplete semilunar valve closure. Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves. Palpate the pericardium for a heave or thrill. Monitor the blood pressure.

You Selected: Auscultate for an extra heart sound due to incomplete semilunar valve closure. Correct response: Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves. Explanation: 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. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, p. 689.

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

You Selected: Blood-brain barrier Correct response: Liver Explanation: 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. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, p. 706.

After an acute myocardial infarction, the client undergoes a cardiac catheterization that reveals severe atherosclerosis. The nurse reviews the laboratory results and finds the client has low-density lipoprotein (LDL) cholesterol blood level of 950 mg/dl (24.6 mmol/l). The nurse will investigate for which condition that is most likely to have contributed to this result? homogenous familial hypercholesterolemia heterogenous familial hypercholesterolemia secondary dyslipidemia Buerger disease

You Selected: Buerger disease Correct response: homogenous familial hypercholesterolemia Explanation: Familial hypercholesterolemia is an autosomal dominant disorder that causes a mutation in a gene that codes for an LDL receptor. Because the client's LDL cholesterol level is so high, this mostly likely supports the more rare homozygous form of the condition that can lead to LDL levels up to 1,000 mg/dl (26 mmol/l). In the heterozygous form, LDL cholesterol levels are not as elevated, with a mean value of 350 mg/dl (9.06 mmol/l). These clients are at higher risk for death from myocardial ischemic disease during the young adult years. Thus, it is important for people with the homozygous form to receive early pharmacologic treatment to lower blood levels of LDL cholesterol. Secondary dyslipidemia develops due to factors such as diet, obesity, and type 2 diabetes mellitus and would not lead to values of LDL cholesterol that are this high. Buerger disease is a type of vasculitis known as thromboangiitis obliterans that causes thrombus formation and is not related to LDL cholesterol level. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, Dyslipidemia, pp. 722-724.

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent: Pulmonary embolism Acute myocardial infarction Loss of pulses in the limb Cerebrovascular accident

You Selected: Cerebrovascular accident Correct response: Pulmonary embolism Explanation: The most common site of a deep vein thrombosis (DVT) is in the venous sinuses in the soleus muscle and posterior tibial and peroneal veins. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT. The other options are caused by occlusions in the arterial system. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, pp. 740-741.

A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure? Coarctation of the aorta Increased levels of adrenocortical hormones Activation of the renin-angiotensin-aldosterone mechanism Increased sympathetic stimulation by the autonomic nervous system

You Selected: Coarctation of the aorta Correct response: Activation of the renin-angiotensin-aldosterone mechanism Explanation: The largest single cause of secondary hypertension is renal disease. The reduced renal blood flow that occurs with renovascular disease causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II and raising blood pressure. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, pp. 743-744.

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 pulse decreases, rather than increases, in amplitude. 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.

You Selected: Downstream peripheral pulses are greater than upstream pulses. Correct response: The pulse decreases, rather than increases, in amplitude. Explanation: 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. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, p. 703.

ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this? Most ECG-detected ischemic events are clinically silent. The ECG can look at ischemic events from different directions. ECG monitoring is reliable only when the client remains still. Most ECG-detected ischemic events cause a great deal of pain.

You Selected: ECG monitoring is reliable only when the client remains still. Correct response: Most ECG-detected ischemic events are clinically silent. Explanation: Persons with acute coronary syndrome are at risk for developing extension of an infarcted area, ongoing myocardial ischemia, and life-threatening dysrhythmias. Research has revealed that 80% to 90% of ECG-detected ischemic events are clinically silent. Thus, ECG monitoring is more sensitive than a client's report of symptoms for identifying transient ongoing myocardial ischemia. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 28: Disorders of Cardiac Conduction and Rhythm, p. 842.

What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise? Exercise is not recommended in this population. Clients with intermittent claudication should exercise only their arms. Aerobic exercise is not recommended but isometric exercise is. Exercise can increase blood vessel growth and help to decrease symptoms.

You Selected: Exercise is not recommended in this population. Correct response: Exercise can increase blood vessel growth and help to decrease symptoms. Explanation: Adaptation to exercise induces angiogenesis with an increased growth of vessels to support blood flow to the exercising muscle. Exercise may help to decrease pain in clients with peripheral vascular disease. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, p. 732.

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

You Selected: Hypotension upon standing Correct response: Lymphedema in the affected arm Explanation: 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. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, p. 708.

A client has been admitted after being resuscitated from a cardiac arrest. The client is prescribed Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client? Continuous cardiac monitoring Intermittent cardiac monitoring Monitoring only with chest pain No monitoring is indicated

You Selected: Intermittent cardiac monitoring Correct response: Continuous cardiac monitoring Explanation: The American Heart Association has published practice standards for electrocardiogram monitoring in hospital settings. The rating system has three categories. Class I clients require cardiac monitoring consistently. Class II clients may need monitoring but it is not essential. Class III clients do not have monitoring indicated. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 28: Disorders of Cardiac Conduction and Rhythm, p. 842.

Respiratory sinus dysrhythmia is considered a more optimal rhythm than a rhythm where all RR intervals are equal. In respiratory sinus dysrhythmia, what is the variation in cardiac cycles related to? Intra-abdominal pressure changes that occur with respiration Intrathoracic pressure changes that occur with respiration Intra-abdominal pressure changes due to vagal nerve stimulus Intrathoracic pressure changes due to inadequate oxygenation

You Selected: Intrathoracic pressure changes due to inadequate oxygenation Correct response: Intrathoracic pressure changes that occur with respiration Explanation: Today, it is accepted that a more optimal rhythm is respiratory sinus dysrhythmia. Respiratory sinus dysrhythmia is a cardiac rhythm characterized by gradual lengthening and shortening of RR intervals. This variation in cardiac cycles is related to intrathoracic pressure changes that occur with respiration and resultant alterations in autonomic control of the sinoatrial node. The other answers do not cause the variation in cardiac cycles related to respiratory sinus dysrhythmia. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 28: Disorders of Cardiac Conduction and Rhythm, p. 844.

The student attends a health fair and has his serum cholesterol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol? It has a low cholesterol content. It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. It transports cholesterol away from cells to the liver for excretion. It is associated with a low intake of saturated fats.

You Selected: It transports cholesterol away from cells to the liver for excretion. Correct response: It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. Explanation: Hyperlipidemia, particularly LDL, with its high cholesterol content, is also believed to play an active role in the pathogenesis of the atherosclerotic lesion. Dietary cholesterol tends to increase LDL cholesterol. HDL participates in the reverse transport of cholesterol by carrying cholesterol from the peripheral tissues back to the liver. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, p. 729.

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

You Selected: Pumps blood to the lungs Correct response: Receives blood returning to the heart from the systemic circulation Explanation: 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. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, p. 690.

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

You Selected: SA node - AV node - bundle branches - Purkinje fibers - bundle of His Correct response: SA node - AV node - bundle of His - bundle branches - Purkinje fibers Explanation: The atrial conduction begins with the sinoatrial (SA) node, serving as the pacemaker of the heart. Impulses originating in the SA node travel through the atria to the atrioventricular (AV) node. There are three internodal pathways between the SA node and the AV node, including the anterior (Bachmann), middle (Wenckebach), and posterior (Thorel) internodal tracts. These three tracts anastomose with each other proximally to the AV node. The AV junction connects the two conduction systems and provides for one-way conduction between the atria and the ventricles. The impulse travels through the nodal region into the natriuretic hormone region, which connects with the bundle of His (also called the AV bundle). The fibers of the AV node proceed to form the bundle of His, which extends through the fibrous tissue between the valves of the heart and into the ventricular system. The bundle of His penetrates into the ventricles and almost immediately divides into right and left bundle branches that straddle the interventricular septum. The bundle branches move through the subendocardial tissues toward the papillary muscles and then subdivide into the Purkinje fibers, which branch out and supply the outer walls of the ventricles. The Purkinje system, which initiates ventricular conduction, has large fibers that allow for rapid conduction. Once the impulse enters the Purkinje system, it spreads almost immediately to the whole ventricle. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 28: Disorders of Cardiac Conduction and Rhythm, p. 837.

A 62-year-old female client presents to the emergency department and is diagnosed with acute heart failure syndrome. Which assessment finding would the nurse expect? Productive cough with frothy sputum. Increased urination and dry skin. Shortness of breath and bradycardia. Slowed breathing and dehydration.

You Selected: Slowed breathing and dehydration. Correct response: Productive cough with frothy sputum. Explanation: The signs and symptoms of acute heart failure syndromes include shortness of breath and other respiratory manifestations (i.e., exertional dyspnea, orthopnea), fatigue and limited exercise tolerance, fluid retention and edema, cachexia and malnutrition, and cyanosis. Acute pulmonary edema is the most dramatic symptom of AHFS. The client would have an increased heart rate as a result of the exertional process. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock, p. 800.

Which client will the nurse assess first? The client with sinus dysrhythmia The client with sinus bradycardia The client with premature atrial contractions The client with premature ventricular contractions

You Selected: The client with sinus bradycardia Correct response: The client with premature ventricular contractions Explanation: The nurse should first assess the client with premature ventricular contractions, as ventricular dysrhythmias are most often life-threatening. The other rhythms are not placing the clients in immediate danger. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 28: Disorders of Cardiac Conduction and Rhythm, p. 848.

When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate? The end result of oxidation is rupture of the plaque, resulting in hemorrhage. Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Oxidized free radicals produce toxic metabolic waste that can kill liver cells. Activated cells roam the vascular system looking for inflammatory cells to engulf.

You Selected: The end result of oxidation is rupture of the plaque, resulting in hemorrhage. Correct response: Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Explanation: Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 26: Disorders of Blood Flow, p. 729.

Paroxysmal supraventricular tachycardia arises from which form of reentry? Atrioventricular (AV) nodal Bundle of His nodal Orthodromic True

You Selected: True Correct response: Atrioventricular (AV) nodal Explanation: Paroxysmal supraventricular tachycardia refers to tachydysrhythmias that originate above the bifurcation of the bundle of His and have a sudden onset and termination. It may be the result of AV nodal reentry. The other options are not responsible for paroxysmal supraventricular tachycardia. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 28: Disorders of Cardiac Conduction and Rhythm, p. 847.

Which blood vessel layer is made primarily of muscle? Tunica media Tunica intima Tunica externa Tunica adventitia

You Selected: Tunica intima Correct response: Tunica media Explanation: The middle layer (tunica media) of a vessel is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The outermost layer of a vessel is called the tunica externa (or tunica adventitia) and is composed of loosely woven collagen fibers. The innermost layer is the tunica intima, which consists of a single layer of flattened endothelial cells. Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, p. 701.

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

You Selected: Turbulent Correct response: Laminar Explanation: 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). Reference: Norris, T. L., Porth's Pathophysiology: Concepts of Altered Health States, 10th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 25: Structure and Function of the Cardiovascular System, p. 700.