Patho- Exam 3- Cardiology

The heart is a four-chambered pump. What is the function of the right ventricle?

Pumps blood to the lungs (pg. 376)

Which of the following instructions should the nurse give to a patient with a new prosthetic mitral valve? Select all that apply. "Have cholesterol levels monitored every 6 months." "Lifelong anticoagulants are necessary to prevent blood clots." "Avoid standing close to a running engine." "Avoid drinking caffeinated beverages." "Expect to take prophylactic antibiotics for dental work."

"Expect to take prophylactic antibiotics for dental work." "Lifelong anticoagulants are necessary to prevent blood clots." 457

The linear velocity of blood flow in the circulatory system varies widely. What is the linear velocity in the aorta?

30 to 35cm/second pg. 378)

A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention? A. A 69-year-old woman who has entered ventricular fibrillation. B. A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia. C. A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation. D. A 60-year-old woman who has just been diagnosed with a first-degree AV block.

A 69-year-old woman who has entered ventricular fibrillation. (Pg. 389)

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

A. Abdominal C. Thoracic (pg. 396)

A client is admitted to the hospital with severe bradycardia, heart rate in low to upper 40s, after contracting Lyme disease. She asks the nurse why the heart rate is so slow. The most accurate response would be a possible disassociation between the atria and ventricles due which of the following? A. Purkinje system block B. Inflammation of the SA node C. AV nodal block D. SA node excitation

AV nodal block (pg. 389)

Which of the following factors affect cardiac performance? Select all that apply.

Afterload Preload Myocardial contractility (Pg. 392)

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

P Wave (Chapter 17: pg 389)

The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?

At the apex of the heart 462

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 venous system collects deoxygenated blood from the tissues . C. The arterial system distributes oxygenated blood to the tissues. D. The capillaries pump blood.

B. The venous system collects deoxygenated blood from the tissues . C. The arterial system distributes oxygenated blood to the tissues. (pg. 394)

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:

Bicuspid valve (pg. 389)

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?

Decreased level of consciousness 450

When explaining to a patient why they only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to: A. Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually. B. The possibility that the person has elevated INR levels that prevents blood from backlogging in the vessel. C. The release of substances formed by special glands that transport the blood cell-by-cell through smaller spaces. D. Good genetic makeup that allows occluded arteries to keep vasodilating to meet metabolic needs.

Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually. (Pg. 399)

Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis? A. Have the client breathe deeply. B. Have the client change positions to unaffected side. C. Have the client sit up and lean forward. D. Have the client swallow slowly and frequently.

Have the client sit up and lean forward (pg. 466)

Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability?

Histamine (Pg. 399)

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. Advanced age and low serum total and low-density lipoprotein cholesterol C. High serum high-density lipoprotein and diabetes D. History of cigarette smoking and elevated blood pressure

History of cigarette smoking and elevated blood pressure (pg. 456)

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

Laminar (Page 378)

The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?

Left Ventricle (p.378)

Oxygenated Blood Circulation

Lungs --> Pulmonary Veins --> Left atrium --> mitral valve --> Left Ventricle --> Aorta --> Rest of the Body

The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain? A. Codeine B. Fentanyl C. Morphine D. Demerol

Morphine (pg. 441)

A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?

Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. (pg. 399)

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 (pg. 387)

serum biomarkers for ACS

Serum biomarkers for ACS, referred to as a cardiac panel, include cardiac-specific troponin I (TnI) and troponin T (TnT), creatine kinase MB (CK-MB), and myoglobin

When trying to explain to a new dialysis patient the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:

Small openings that allow large amounts of smaller molecular substances to filter through the gomeruli. (pg. 396)

Deoxygenated Blood Circulation

Superior/Inferior Vena Cava --> Right Atrium --> Tricuspid Valve --> Right Ventricle--> Pulmonary arteries --> Lungs

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 (pg. 399)

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?

Systemic Vascular Resistance (SVR) (Chapter 17: Page 393)

The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?

The disabling effects that result from involvement of heart valves 458

A client is visiting the primary physician and appears extremely nervous. The intake nurse does his vital signs and notes an increase in both his heart rate and blood pressure. In an effort to better understand the client's presenting signs and symptoms the nurse asks the client about his concerns and the client states that the person who performed his pre-visit told him that he had an arrhythmia. Which is the most therapeutic response about cardiac arrhythmias that the nurse can make?

They can occur in diseased or healthy hearts. (pg. 389)

Which serum biomarker is highly specific for myocardial tissue?

Troponin (pg. 449)

When a physician suspects a patient has suffered an acute myocardial infarction, which serum biomarkers should he order? Select all that apply. A. Troponin 1 B. Troponin T C. Creatine kinase D. Phosphorous E. Magnesium

Troponin 1 Creatine kinase Troponin T (pg. 449)

A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?

Troponin level 449

The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?

Ventricles contract and blood is ejected from the heart. (Pg. 390)

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

Ventricular fibrillation (pg. 389)

Persistent patency of the ductus arteriosus

a duct that remains open beyond 3 months in the full-term infant. A murmur is detected within days of birth. It is loudest at the 2nd Left intercostals space, continuous through systole and diastole. A wide pulse pressure is common (BP 84/30).

Pericarditis

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. Viral infections are the most common cause

Pericardial effusion

accumulation of fluid in the pericardial vacuity, usually as a result of an inflammatory or infectious process. A sudden accumulation of even 200ml of fluid may raise intracardiac pressure to levels that will cause symptoms similar to right-sided heart failure.

coronary artery disease (CAD)

describes heart disease caused by impaired coronary blood flow.

Constrictive pericarditis

fibrous, calcified scar tissue develops between the visceral and parietal layers of the serous pericardium

Rheumatic fever

immune-mediated inflammatory disease that occurs a few weeks after a group A strep (sore throat). It can manifest as an acute, recurrent or chronic disorder.

Risk factors CAD

include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.

STEMI

involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. The pain associated with MI is more prolonged and not relieved by rest or nitroglycerin

Kussmaul sign

is an inspiratory distention of the jugular veins caused by the inability of the right atrium, encased in its rigid pericardium, to accommodate the increase in venous return that occurs with inspiration.

NSTEMI

non-ST elevation myocardial infarction

The heart consists of four valves. Which are the semilunar values? Select all that apply. - Tricuspid - Pulmonary - Mitral - Aortic

Pulmonary Aortic (Pg. 385)

Only veins to carry oxygenated blood?

Pulmonary Veins

Only arteries to carry deoxygenated blood?

Pulmonary arteries

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?

Tunica media (Pg. 394)

In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up (Pg. 377)

A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?

Increased heart rate and increased contractility (Pg. 399)