maybe ignore for now Chapter 21 assessment of cardiovascular function

a nurse is describing the process by which blood is ejected into circulation as the chamber of the heart become smaller. the instructor categorizes this as what action?

a. systole

b. diastole

c. repolarization

d. ejection fraction

A. systole

systole is the action of the chamber of the heart becoming smaller and ejecting blood.

During a shift assessment, the nurse is identifying the client's point of maximum impulse (PMI). Where will the nurse best palpate the PMI?

A)

Left midclavicular line of the chest at the level of the nipple

B)

Left midclavicular line of the chest at the fifth intercostal space

C)

Midline between the xiphoid process and the left nipple

D)

Two to three centimeters to the left of the sternum

B) left midclavicular line of the chest at the fifth intercostal space

the left ventricle is responsible for the apical beat or the PMI, which is normally palpated in the left midclavicular line of the chest wall at fifth intercostal space.

the nurse is calculating a cardiac client's pressure. if the client's blood pressure is 122/76, what is the clients pulse pressure?

a. 46 mm Hg

b. 99 mm Hg

c. 198 mm Hg

d. 76 mm Hg

a. 46 mm Hg

pulse pressure is the difference between the systole and diastolic pressure.

a client has been admitted to the intensive care unit (ICU) after an ischemic stroke, and a central venous pressure (CVP) monitoring line was placed. the nurse notes a low CVP. which condition is the most likely reason for a low CVP?

a. hypovolemia

b. myocardial infraction

c. left side heart failure

d. aortic valve regurgitation

A. hypovolemia

CVP is a measurement of the pressure in the vena cava or right atrium. a low CVP indicates a reduces right ventricular preload, most often from hypovolemia.

while auscultating a client's heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). an audible S3 would be considered an expected finding in which client?

a. a 47 yr old client

b. a 20 yr old client

c. a client who has undergone valve replacement

D. a client who takes a beta-adrenergic blocker

b. a 20 yr old client

S3 represents a normal finding in children and adults up to 35 or 40 years of age. it is called a physiologic S3.

the physical therapist notifies the nurse that a client with coronary artery disease (CAD) experienced a significant increase in heart rate during physical therapy. the nurse recognizes that an increase in heart rate in a client with CAD may result in which outcome?

a. development of an atrial-septal defect

b. myocardial ischemia

c. formation of a pulmonary embolism

d. release of potassium ions from cardiac cells

b. myocardial ischemia

unlike other arteries, the coronary arteries are perfused during diastole. an increase in HR shorten diastole and can decrease myocardial perfusion. clients w/CAD can develop myocardial ischemia.

the nurse is caring for a client who has a history of heart disease. what factor should the nurse identify as possibly contributing to a decrease in cardiac output?

a. a change in position from standing to sitting

b. a heart rate of 54 bpm

c. a pulse oximetry reading of 94%

d. an increase in preload related to ambulation

b. a heart rate of 54 BPM

cardiac output is computed by multiplying the stroke volume by the heart rate. cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm.

a client is admitted to a cardiac unit with the diagnosis of syncope. orthostatic blood pressures are ordered every 8 hours. which blood pressure readings would best indicate that the nurse should notify the health care provider of a positive finding?

a. supine 146/70, sitting 132/68, standing 130/66

b. supine 110/62, sitting 108/58, standing 106/56

c. supine 128/72, sitting 118/70, standing 110/66

d. supine 138/76, sitting 132/66, standing 122/52

d. supine 138/76, sitting 132/66, standing 122/52

postural orthostatic hypotension is a significant drop in blood pressure (systolic: 20mm Hg Diastolic: 10 mm Hg) with in 3 minutes of moving from lying or sitting to a standing position to indicate a positive result.

the critical care nurse is caring for a client with a central venous pressure CVP monitoring system. the nurse notes that the client's CVP is increasing. this may indicate:

a. psychosocial stress

b. hypervolemia

c. dislodgment of the catheter

d. hypomagnesemia

b. hypervolemia

CVP is a useful hemodynamic parameter to observe when managing an unstable client's fluid volume status. an increasing pressure may be caused by hypervolemia or by a condition, such as heart failure, that results in decreased myocardial contractility.

the critical care nurse is caring for a client with a pulmonary artery pressure monitoring system. in addition to assessing left ventricular function, what is an additional function of a pulmonary artery pressure monitoring system?

a. to assess the client's response to fluid and drug administration

b. to obtain specimens for arterial blood gas measurements

c. to dislodge pulmonary emboli

d. to diagnose the etiology of chronic obstructive pulmonary disease

a. to assess the client's response to fluid and drug administration.

pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the client's response to medical interventions, such as fluid administration and vasoactive medication.

the cardiac care nurse is reviewing the conduction system of the heart. the nurse is aware that electrical conduction of the heart usually originates in the sinoatrial (SA) node and then proceeds in which sequence?

a. bundle of His to atrioventricular (AV) node to purkinje fibers

b. AV node to purkinje fibers to bundle of His

c. bundle of His to purkinje fibers to AV node

d. AV node to bundle of His to purkinje fibers

D. Av node to bundle of His to purkinje fibers

the normal electrophysiological conduction route is SA node to the AV node to bundle of his to purkinje fibers.

a client has had a myocardial infraction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. this client experienced damage to which area of the heart?

a. endocardium

b. pericardium

c. myocardium

d. visceral pericardium

c. myocardium

the middle layer of the heart, or myocardium, is made up of muscle fibers and is responsible for the pumping action.

the nurse working on a cardiac care unit is caring for a client whose stroke volume has increased. the nurse is aware that afterload influences a client's stroke volume. the nurse recognizes that which factor increases afterload?

a. arterial vasoconstriction

b. venous vasoconstriction

c. arterial vasodilation

d. venous vasodilation

a. arterial vasoconstriction

afterload, or resistance to ejection of blood from the ventricle, is one determinant of stroke volume. there is a inverse relationship between afterload and stroke volume. Arterial vasoconstriction increases afterload, which leads to decreased stroke volume

the nurse is caring for a client admitted with angina who is scheduled for cardiac catheterization. the client is anxious and asks the reason for this test. the nurse should explain that cardiac catheterization is most commonly done for which purpose?

a. to assess how blocked or open a client's coronary arteries are

b. to detect how efficiently a client's heart muscles contracts

c. to evaluate cardiovascular response to stress

d. to evaluate the cardiac electrical activity

a. to assess how blocked or open a client's coronary arteries are

cardiac catheterization is usually use to assess coronary patency to determine whether revascularization procedures are necessary.

a client is brought into the emergency department (ED) by a family member, who tells the nurse that the client grabbed their chest and reported substernal chest pain. the care team recognizes that need to monitor the clients cardiac function closely while interventions are performed. which form of monitoring should the nurse anticipate?

a. left-side heart catheterization

b. cardiac telemetry

c. transesophageal echocardiography

d. hardwire continuous electrocardiogram

D. hardwire continuous electrocardiogram (ECG) monitoring.

two types of continuous ECG monitoring techniques are used in health care setting: Hardwire cardiac monitoring(emergent) and cardiac catheterization (non emergent).

the nurse's assessment of an older adult client reveals the following data:

lying bp: 144/82

sitting: 121/69

standing: 98/56

the nurse should identify the priority nursing diagnosis of a risk for which outcome in the client's plan of care?

a. ineffective breathing pattern related to hypotension

b. falls related to orthostatic hypotension

c. ineffective role performance related to hypotension

d. imbalanced fluid balance related to hemodynamic variability

b. falls related to orthostatic hypotension

orthostatic hypotension creates a significant risk for falls due to the dizziness and lightheadness that accompany it.

a brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult client who has been experiencing vital fatigue and shortness of breath. this test will allow the care team to investigate the possibility of what diagnosis?

a. pleurisy

b. heart failure

c. valve dysfunction

d. cardiomyopathy

b. heart failure

the level of BNP in the blood increase as the ventricular walls expand from increasing pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF.

a lipid profile has been ordered for a client who has been experiencing cardiac symptoms. when should the lipid profile be drawn in order to maximize the accuracy of results?

a. as a close to end of the day as possible

b. after a meal high in fat

c. after a 12 hour fast

d. thirty minutes after a normal meal

c. after a 12 fast

although cholesterol levels remain relatively constant over 24 hours, the blood specimen for a lipid profile should be obtained after a 12 hour fast.

the nurse is doing discharge teaching with a client who has coronary artery disease. the client asks why they have to take an aspirin every day if they don't have any pain. which rationale for this intervention would be best?

a. to help restore the normal function of the heart

b. to help prevent blockages that can cause chest pain or heart attacks

c. to help the blood penetrate the heart more freely

d. to help the blood carry more oxygen than it would otherwise

b. to help prevent blockages that can cause chest pain or heart attacks

the health care provider has ordered a high sensitivity C-reactive protein (hs-CRP) drawn on a client. the results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis?

a. immunosuppression

b. inflammation

c. infection

d. hemostasis

b. inflammation

high sensitivity CRP is a protein produced by the liver in response to systemic inflammation.

a client with complex cardiac history is scheduled for a transthoracic echocardiography. what should the nurse teach the client in anticipation of his diagnostic procedure?

a. test is noninvasive, and nothing will be inserted into the client's body.

b. the client's pain will be managed aggressively during the procedure

c. the test will provide a detailed profile of the heart's electrical activity.

d. the client will remain on bed rest for 1-2 hours after the test.

a. test is noninvasive, and nothing will be inserted into the client's body.

before transthoracic echocardiography, the nurse informs the client about the test, explaining that it is painless.

a client has been scheduled for cardiovascular computed tomography (CT) with contrast. to prepare the client for this test, what action should the nurse perform?

a. keep the client NPO for at least 6 hours prior to the test.

b. establish peripheral IV access.

c. limit the client's activity for 2 hours before the test

d. teach the client to perform incentive spirometry

b. establish peripheral IV access.

an IV is necessary if contrast is to be used to enhance the images of the CT.

the nurse is caring for a client who is undergoing an exercise stress test. prior to reaching the target heart rate, the client develops chest pain. what is the nurse's most appropriate response?

a. administer sublingual nitroglycerin to allow the client to finish the test.

b. initiate cardiopulmonary resuscitation.

c. administer analgesia and slow the test

d. stop the test and monitor the client closely

d. stop the test and monitor the client closely

the client is may experience signs of myocardial ischemia would necessitate stopping the test.

the nurse is caring for a client admitted with unstable angina. the laboratory result for the initial troponin 1 is elevated in this client. the nurse should recognize what implication of this assessment finding?

a. this is only an accurate indicator of myocardial damage when it reaches its peak in24 hours

b. because the client has a history of unstable angina, this is a poor indicator of myocardial injury

c. this is an accurate indicator of myocardial injury.

d. this result indicates muscle injury but does not specify the source

c. this is an accurate indicator of myocardial injury.

troponin 1, which is specific to cardiac muscle, is elevated within hours after myocardial injury.

the nurse is conducting client teaching about cholesterol levels. when discussing the client's elevated LDL and lower HDL levels, the client shows an understanding of the significance of these levels by making what statement?

a. increased LDL and decreased HDL increase the risk of coronary artery disease.

b. increased LDL has the potential to decrease my risk of heart disease.

c. the decreased HDL level will increase the amount of cholesterol moved away from the artery wall

d. the increased LDL will decrease the amount of cholesterol deposited on the artery walls."

a. increased LDL and decreased HDL increase the risk of coronary artery disease.

Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.

a resident of a long-term care facility has reported chest pain to the nurse. what aspect of the resident's pain would be most suggestive of agina as the cause?

a. the pain is worse when the resident inhales deeply

b. the pain occurs immediately following physical exertion

c. the pain is worse when the resident coughs

d. the pain is most severe when the resident moves the upper body

b. the pain occurs immediately following physical exertion

chest pain associated with angina is often precipitated by physical exertion.

the nurse is performing an intake assessment on a client with a new diagnosis of coronary artery disease. what would be the most important determination to make during this intake assessment?

a. whether the client and involved family members understand the role of genetics in the etiology of the disease

b. whether the client and involved family members understand dietary changes and the role of nutrition

c. whether the client and involved family member are able to recognize symptoms of an acute cardiac problem and respond appropriately.

d. whether the client and involved family members understand the importance of social support and community agencies.

c. whether the client and involved family member are able to recognize symptoms of an acute cardiac problem and respond appropriately.

involved family members are able to recognize symptoms of an acute cardiac problem, such as acute coronary syndrome (ACS) or HF, and seek timely treatment for these symptoms