NU551 Unit 6

A 65-year-old male is transported to the ER for chest pain. An electrocardiogram reveals a prolonged QRS interval. What is the nurse monitoring when the nurse observes the QRS complex on the electrocardiogram? The QRS complex reflects:

a. Pulmonary artery closure

b. Mitral valve opening

c. Aortic valve closing

d. Ventricular activity

d. VENTRICULAR ACTIVITY

The nurse is planning care for a patient with heart problems. Which information should the nurse remember? The _____ artery travels down the interventricular septum and delivers blood to portions of the left and right ventricle.

a. Left anterior descending

b. Right coronary

c. Circumflex

d. Cardiac

a. LEFT ANTERIOR DESCENDING

While viewing the electrocardiogram, the nurse recalls the _____ conducts action potentials down the atrioventricular septum.

a. Bundle of His

b. Atrioventricular node

c. Sinoatrial node

d. Bachmann bundle

a. BUNDLE OF HIS

When a student nurse asks the nurse how the cardiac electrical impulse normally begins, what is the most correct response? The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because it:

a. Has rich sympathetic innervation via the vagus nerve

b. Depolarizes more rapidly than other automatic cells of the heart

c. Has a superior location in the right atrium

d. Is the only area of the heart capable of spontaneous depolarization

b. DEPOLARIZES MORE RAPIDLY THAN OTHER AUTOMATIC CELLS OF HEART

A 54-year-old male is diagnosed with left bundle branch block. Which of the following structures would not receive an electrical impulse?

a. The left ventricle

b. Bundle of His

c. Atrioventricular (AV) node d. Sinoatrial (SA) node

a. THE LEFT VENTRICLE

A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?

a. Increased intranodal conduction time

b. Increased cardiac conduction

c. Decreased heart rate

d. Decreased myocardial contraction

b. INCREASED CARDIAC CONDUCTION

The chamber of the heart that generates the highest pressure is the:

a. Right atrium

b. Left atrium

c. Right ventricle

d. Left ventricle

d. LEFT VENTRICLE

A 28-year-old female with seizure disorder has a vagus nerve stimulator implanted to help control seizure activity. Which of the following would the nurse also expect to occur?

a. Increased speed of cardiac cycle

b. Decreased cardiac conduction

c. Increased cardiac contractility

d. Decreased vasodilation

b. DECREASED CARDIAC CONDUCTION

The nurse is reviewing a normal electrocardiogram. The nurse assesses the PR interval because it represents:

a. "Electrical systole" of the ventricles

b. Onset of atrial activation to onset of ventricular activity

c. Ventricular depolarization

d. Atrial depolarization

b. ONSET OF ATRIAL ACTIVATION TO ONSET OF VENTRICULAR ACTIVITY

Which statement indicates the nurse understands blood flow? Oxygenated blood flows through the:

a. Cardiac veins

b. Superior vena cava

c. Pulmonary artery

d. Pulmonary veins

d. PULMONARY VEINS

Which principle should the nurse remember when planning nursing care for a patient with heart problems? As stated by the Frank-Starling law, there is a direct relationship between the _____ of the blood in the heart at the end of diastole and the _____ of contraction during the next systole.

a. Volume, force

b. Viscosity, force

c. Viscosity, duration

d. Pressure, duration

a. VOLUME, FORCE

The molecule that aids in bonding of the troponin complex to actin and tropomyosin is troponin:

a. T

b. M

c. C

d. I

a. T

While planning care for a heart patient, which principle should the nurse recall? Right ventricular afterload is affected by:

a. Vascular resistance in the systemic vessels

b. Pulmonary vascular resistance

c. Right end-diastolic pressure

d. Pressures in the vena cava

b. PULMONARY VASCULAR RESISTANCE

A nurse is evaluating the direct end effect of the renin-angiotensin-aldosterone system. Which principle should the nurse remember?

a. Renin promotes the excretion of sodium and water in the renal tubules.

b. Aldosterone increases renal retention of water only.

c. Angiotensin I promotes sodium and water reabsorption by the kidneys.

d. Angiotensin II causes systemic vasoconstriction.

d. ANGIOTENSIN II CAUSE SYSTEMIC VASOCONSTRICTION

A 50-year-old female was prescribed a drug that acts as a negative inotrope. Which of the following endogenous substances would be most similar?

a. Acetylcholine

b. Epinephrine

c. Dopamine

d. Thyroid hormone

a. ACETYLCHOLINE

A nurse is discussing the different types of regulation. Which regulation is the nurse describing? Local myogenic regulation of blood vessel diameter and thus blood flow through a vessel is an example of:

a. Somatic regulation

b. Autonomic regulation

c. Metabolic regulation

d. Autoregulation

d. AUTOREGULATION

A cardiologist is discussing valves with the staff. Which information should the cardiologist include? _____ are the anchors of the atrioventricular valves.

a. Coronary ostia

b. Chordae tendineae cordis

c. Great vessels

d. Trabeculae carneae

b. CHORDAE TENDINEAE CORDIS

A nurse recalls the internal lining of the cardiovascular system is formed by what tissue?

a. Mesothelium

b. Tunica adventitia

c. Connective

d. Endothelium

d. ENDOTHELIUM

A ICU nurse is multiplying the heart rate by stroke volume. What is being measured?

a. Vascular resistance

b. Preload

c. Cardiac output

d. Ejection fraction

c. CARDIAC OUTPUT

When a nursing student wants to know where the primary cardiovascular control center is located, what is the nurse's best response? In the:

a. Midbrain

b. Cerebral cortex

c. Medulla

d. Cervical spinal cord

c. MEDULLA

A RN is teaching about the period that follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated. What is the RN describing?

a. Absolute refractory

b. Threshold

c. Resting

d. Hyperpolarization

a. ABSOLUTE REFRACTORY

A 50-year-old female received trauma to the chest that caused severe impairment of the primary pacemaker cells of the heart. Which of the following areas received the greatest damage?

a. Ventricles

b. Sinoatrial (SA) node

c. Atrioventricular (AV) node

d. Bundle of His

b. SINOATRIAL (SA) NODE

After activation of the Bainbridge reflex in a patient, the nurse assesses for:

a. Decreased myocardial contractility

b. Increased heart rate

c. Decreased blood pressure

d. Increased rate and depth of respirations

b. INCREASED HEART RATE

A nurse is discussing the pressure generated at the end of diastole. Which term is the nurse describing?

a. Preload

b. Afterload

c. Total peripheral resistance

d. Systemic vascular resistance

a. PRELOAD

A 65-year-old male develops blockage in the pulmonary artery. As a result of the blockage, blood would first back up into the:

a. Pulmonary veins

b. Aorta

c. Left ventricle

d. Right ventricle

d. RIGHT VENTRICLE

A 52-year-old female is admitted to the cardiac unit with a diagnosis of pericarditis. She asks the nurse to explain where the infection is. In providing an accurate description, the nurse states that the pericardium is:

a. The heart's fibrous skeleton

b. The innermost layer of the heart chambers

c. The outer muscular layer of the heart

d. A membranous sac that encloses the heart

d. MEMBRANOUS SAC THAT ENCLOSES THE HEART

Within a normal physiologic range, an increase in left ventricular end-diastolic volume would lead the nurse to monitor for:

a. A decrease in cardiac output

b. Heart failure

c. An increased force of contraction

d. An increase in heart rate

C. INCREASED FORCE OF CONTRACTION

A 50-year-old female presents with a low heart rate and low blood pressure. She is given an intravenous (IV) infusion of fluids. The increase in atrial distension results in:

a. Depressed myocardial contractility

b. Renal retention of fluids

c. Increased heart rate

d. Release of acetylcholine

c. INCREASED HEART RATE

Baroreceptors are located in the:

a. Carotid sinus

b. Circle of Willis

c. Superior vena cava

d. Renal artery

a. CAROTID SINUS

A nurse assesses the heart after acetylcholine because the effect of acetylcholine on the heart is to:

a. Increase calcium influx

b. Decrease the refractory period

c. Increase the strength of myocardial contraction

d. Decrease the heart rate

D. DECREASE THE HEART RATE

A 60-year-old male presents to his primary care provider reporting chest pain. He is

diagnosed with atherosclerosis. This disease is caused by

Atherosclerosis is a form of arteriosclerosis characterized by thickening and hardening of the vessel

wall.

A patient wants to know what causes atherosclerosis. How should the nurse respond?

In general, atherosclerosis is caused by

Atherosclerosis begins with injury to the endothelial cells that line artery walls

A staff member asks a nurse what foam cells are. What is the nurses best response? Foam

cells in a fatty streak are

Foam cells are lipid-laden macrophages that engulf LDL.

A nurse takes an adult patients blood pressure and determines it to be normal. What

reading did the nurse obtain

Normal blood pressure has a systolic pressure less than 120 mm Hg and diastolic pressure less than

80 mm Hg.

Most cases of combined systolic and diastolic hypertension have no known cause and

are documented on the chart as ______ hypertension

Most cases of hypertension are diagnosed as primary hypertension

A 30-year-old Caucasian female was recently diagnosed with primary hypertension. She

reports that she eats fairly well, usually having red meat and potatoes daily. She also reports

that her father has hypertension as well. A nurse determines which of the following risk factors

is most likely associated with this diagnosis

Genetic factors, such as family history of hypertension, are the number one factor in the

development of hypertension

A 65-year-old male presents for a routine checkup. A blood pressure check reveals a

systolic pressure of 160 mm Hg and a diastolic pressure of 70 mm Hg. Which of the following

is the most likely cause of this type of pressure elevation?

Older adults experience stiffening of the arteries, which could lead to hypertension

A 52-year-old male is diagnosed with primary hypertension. He has no other health

problems. Present treatment would cause the nurse to anticipate administering which drug to the

patient?

Diuretics have been shown to be the safest and most effective medications for lowering blood

pressure and preventing the cardiovascular complications of hypertension.

A 55-year-old female has undiagnosed hypertension. She presents to her primary care

provider reporting impaired vision and chronic edema. Lab tests reveal that she also has renal

insufficiency. While planning care, the nurse realizes the most likely cause for these findings is:

The patient is experiencing end-organ damage, as indicated by renal insufficiency. The

patient is not experiencing gangrene, but end-organ damage.

A nurse monitors the patient for _____ when rapid onset of malignant hypertension results.

Malignant hypertension leads to cerebral edema and cerebral dysfunction (encephalopathy) and even

death.

When a nurse checks the patient for orthostatic hypotension, what did the nurse have the patient do?

Orthostatic hypotension refers to a drop in blood pressure when standing up.

A 50-year-old male is diagnosed with orthostatic hypotension. Which of the

following symptoms would he most likely experience?

Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and

syncope or fainting.

A 65-year-old female presents to the emergency department reporting difficulty

swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the:

Thoracic aortic aneurysms can cause dysphagia (difficulty swallowing) and dyspnea

(breathlessness).

60-year-old male is diagnosed with cerebral aneurysm. Where does the nurse suspect

the cerebral aneurysm is located?

Cerebral aneurysms often occur in the circle of Willis

What term should the nurse document for a detached blood clot?

Thromboembolus

A 32-year-old female presents with lower leg pain, with swelling and redness.

While obtaining the patients history, which finding could have caused her condition?

thrombus formation in the vein leads to inflammation that may cause pain and redness with

obstruction. Increased pressure in the vein behind the clot may lead to edema of the extremity.

A 28-year-old female presents with severe chest pain and shortness of breath. She

is diagnosed with pulmonary embolism, which most likely originated from the:

The most likely origin of the embolism is from the deep veins of the legs.

Individuals with Raynaud disease need to be counseled to avoid which of the

following conditions to prevent severe symptoms?

Raynaud disease consists of vasospastic attacks triggered by brief exposure to cold.

A 75-year-old obese female presents to her primary care provider reporting edema in

the lower extremities. Physical exam reveals that she has varicose veins. Upon performing

the history, which of the following is a possible cause for the varicose veins?

The probable cause of the patients varicose veins is gradual venous distention caused by the action

of gravity on blood in the legs due to long periods of standing.

52-year-old male presents with pooling of blood in the veins of the lower extremities and

edema. The diagnosis is chronic venous insufficiency, and an expected assessment finding of

this disorder is:

Symptoms include edema of the lower extremities and hyperpigmentation of the skin of the feet and

ankles. Edema in these areas may extend to the knees.

While planning care for a patient with superior vena cava syndrome (SVCS), which

principle should the nurse remember? SVCS is a progressive _______ of the superior vena cava

(SVC) that leads to venous distention of the upper extremities and head.

SVCS is a progressive occlusion of the SVC that leads to venous distention in the upper

extremities and head.

A 50-year-old male with a 30-year history of smoking was diagnosed with bronchogenic

cancer. He developed edema and venous distention in the upper extremities and face. Which of the following diagnosis will the nurse observe on the chart?

SVCS is a progressive occlusion of the superior vena cava that leads to venous distention in the

upper extremities and head.

A 52-year-old female is diagnosed with coronary artery disease. The nurse assesses

for myocardial

Coronary artery disease leads to myocardial ischemia.

56-year-old male is diagnosed with coronary artery disease. Which of the

following modifiable risk factors would the nurse suggest the patient change?

Cigarette smoking leads to vasoconstriction and should be the first behavior the patient changes

A 50-year-old obese male with hypertension and coronary artery disease visits a nutritionist

for food counseling. He has an elevated level of low-density lipoprotein (LDL) and a low level

of high-density lipoprotein (HDL). Which of the following should the nurse advise him to

avoid?

Trans fats are primarily found in artificially solidified (hydrogenated) oils (e.g., margarine and

vegetable shortening). By becoming more solid, they lose essential fatty acids (EFAs). They can

raise LDL and lower HDL levels.

When a patient asks the nurse what is the most common cause of myocardial ischemia,

which statement is the correct response? The most common cause of myocardial ischemia is:

Atherosclerosis, not vasospasm, is the major cause of myocardial ischemia.

A 51-year-old male presents with recurrent chest pain on exertion. He is diagnosed with

angina pectoris. When he asks what causes the pain, how should the nurse respond? The

pain occurs when:

Angina is chest pain caused by myocardial ischemia, which develops if the flow or oxygen content

of coronary blood is insufficient to meet the metabolic demands of myocardial cells.

A 62-year-old male presents to his primary care provider reporting chest pain at rest and

with exertion. He does not have a history of coronary artery disease and reports that the pain

often occurs at night. He is most likely experiencing which type of angina?

Chest pain that occurs at rest and at night is descriptive of Prinzmetal angina.

A 51-year-old male is at the health clinic for an annual physical exam. After walking from

the car to the clinic, he developed substernal pain. He also reported discomfort in his left

shoulder and his jaw, lasting 2 to 3 minutes and then subsiding with rest. He indicates that this

has occurred frequently over the past few months with similar exertion. The nurse suspects he

is most likely experiencing:

Stable angina is associated with activity and subsides with rest

A 49-year-old male presents to his primary care provider reporting chest pain. EKG

reveals ST elevation. He is diagnosed with myocardial ischemia. Which of the following

interventions would be most beneficial?

Increase myocardial oxygen supply is indicated to treat ischemia.

A 68-year-old male presents to the ER reporting chest pain. He has a history of stable

angina that now appears to be unstable. He most likely has:

Unstable angina is an indication of impending MI.

An 8-week-old infant presents to his pediatrician for a well-baby checkup. Physical

exam reveals a murmur and an echocardiogram confirms a ventricular septal defect. Which

of the following genetic factors should the nurse assess for as it would most likely accompany this diagnosis?

Down syndrome is the genetic factor that would most likely accompany the diagnosis of a

congenital heart defect.

A newborn child is diagnosed with tetralogy of Fallot. What symptoms would the nurse

expect to observe in the child?

The child will experience cyanosis and hypoxia.

A newborn is diagnosed with congenital heart disease. Which of the following

intrauterine factors should the nurse focus on during the history that could have caused this

disorder?

One of the identified causes of cardiac defects, such as pulmonic stenosis, is maternal conditions, such as intrauterine viral infections, especially rubella.

When a staff member asks what coarctation of the aorta is, how should the nurse respond? Coarctation of the aorta is the local narrowing of the aorta near the:

Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus.

A newborn is suspected of having coarctation of the aorta. Which of the

following assessments would aid in diagnosis?

The newborn will have weak or absent femoral pulses because blood flow is obstructed near the lower extremities.

A 1-month-old infant visits his primary care provider for a well-baby check. Physical exam reveals decreased cardiac output, hypotension, tachycardia, and a loud murmur

suggestive of aortic stenosis. Which of the following would be expected with this diagnosis?

The infant with aortic stenosis will also be experiencing ventricular hypertrophy because of the resistance of blood flow from the left ventricle into the aorta.

A newborn develops a murmur and cyanosis shortly after birth. She is diagnosed

with pulmonic stenosis (PS) after an echocardiogram revealed narrowing of the

pulmonary:

PS is a narrowing or stricture of the pulmonary valve causing resistance to blood flow from the right

ventricle to the pulmonary artery.

When a staff member asks what the patent opening between the aorta and pulmonary artery

in a fetus is called, how should the nurse reply? It is the:

In the fetal circulation, the ductus arteriosus is an opening between the aorta and the pulmonary

artery.

A 2-week-old infant presents with poor feeding, fatigue, dyspnea, and a murmur. She is

diagnosed with a patent ductus arteriosus (PDA). A nurse recalls this condition results in

a(n):

PDA is failure of the fetal ductus arteriosus to close. The continued patency of this vessel allows blood

to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a left-to-right

shunt.

An infant undergoes an echocardiogram for a suspected heart defect. Tests reveal an

opening in the middle of the atrial septum. What term would the nurse use to describe this

defect?

An opening in the middle of the atrial septum is referred to as an ostium secundum ASD.

Which is the most common type of congenital heart defect the nurse should assess for

in infants?

The most common type of congenital heart defect is a VSD.

An 8-week-old infant presents to her primary care provider for a well-baby check.

Physical exam reveals a murmur, and an echocardiogram shows a large ventricular septal

defect. If left untreated, what condition should the nurse discuss with the parents?

If the degree of shunting is significant and not corrected, the child is at risk for developing

pulmonary hypertension.

A 22-year-old pregnant woman presents to her OB/GYN for a prenatal checkup. The

heartbeat sounds irregular, and a fetal echocardiogram reveals an atrioventricular canal (AVC) defect. This defect is the result of:

AVC defect is the result of incomplete fusion of endocardial cushions. A

patent ductus is the failure of the ductus arteriosus to close.

A newborn experiences frequent periods of cyanosis, usually occurring during crying or

after feeding. Which of the following is the most likely diagnosis the nurse will observe on the chart?

Infants with tetralogy of Fallot experience cyanosis after crying or during feeding.

A newborn child has a murmur and cyanosis. An echocardiogram reveals that the

tricuspid valve failed to develop and no blood flows between the right atrium and ventricle.

What term will the nurse use to describe this condition? Tricuspid:

Tricuspid atresia is failure of the tricuspid valve to develop; consequently, there is no

communication from the right atrium to the right ventricle.

When the pediatrician cardiologist discusses total anomalous pulmonary venous

connection, which of the following statements BEST describes this condition?

The pulmonary venous return is connected to the right side of the circulation, rather than to the left

atrium.

A newborn baby is severely cyanotic. An echocardiogram reveals transposition of the

great arteries. A nurse assesses for which of the following, as it usually occurs with this

defect?

In transposition of the great arteries, the pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle.

A 1-month-old infant was diagnosed with truncus arteriosus (TA) with a ventricular septal defect. Which of the following would the nurse also expect?

TA is failure of normal separation and division of the embryonic outflow track into a pulmonary artery

and an aorta, resulting in a single vessel that exits the heart.

A 22-year-old pregnant female presents for a fetal echocardiogram. Tests reveal small left

atrium and mitral valve and an absent left ventricle and aortic valve. The diagnosis is

hypoplastic left heart syndrome (HLHS). The nurse will anticipate that the treatment for this

defect is:

An indication for neonatal heart transplant

A 1-year-old female with a ventricular septal defect is experiencing left-sided heart

failure. Which of the following symptoms will most likely occur?

Left heart failure in infants is manifested as poor feeding and sucking, often leading to failure to

thrive and periorbital edema.

A 3-year-old male is diagnosed with Kawasaki disease. Which of the following does

the nurse suspect is the most likely cause?

Kawasaki disease is related to inflammation of small capillaries.

A 5-year-old female is found to have hypertension during three separate visits to her primary care provider. The nurse would expect tests to suggest that the hypertension is secondary to:

Hypertension in a 5-year-old is related to renal disease

A 40-year-old pregnant woman is concerned about the health of her unborn child. She has

phenylketonuria (PKU) and recently had a viral infection. If the child is born with a

congenital heart defect, which of the following is the most likely based on the mothers

history? (Select all that apply.)

Coarctation of the aorta and patent ductus arteriosus are the disorders found in infants of mothers with

PKU.

A newborn child is diagnosed with trisomy 18. Which of the following congenital

heart defects should the nurse assess for in the infant? (Select all that apply.)

The infant with trisomy 18 could present with a ventricular septal defect, a patent ductus, or

pulmonary stenosis

depolarization

Definition: Electrical activation caused by positive ion movement into the cell.

SA node

Definition: Primary pacemaker of the heart that initiates electrical impulses.

Sinoatrial (SA) Node Location

Definition: Junction of the right atrium and superior vena cava, superior to the tricuspid valve.

Atrial Depolarization

Definition: Electrical activation of the atria resulting in atrial contraction.

AV Node

Definition: Conducts impulses from the atria to the ventricles and slows conduction.

AV Node Location

Definition: Right atrial wall near the tricuspid valve and coronary sinus.

Vagus Nerve Effect on AV Node

Definition: Parasympathetic stimulation slows AV nodal conduction.

Bundle of His

Definition: Conducting fibers that transmit impulses from the AV node into the ventricles.

Right Bundle Branch (RBB)

Definition: Thin structure with minimal branching makes it prone to interruption.

Left Bundle Branch (LBB)

Definition: Main left ventricular conduction pathway that divides into fascicles.

Repolarization

Definition: Return of the cell to resting electrical state.

Membrane Potential

Definition: Electrical voltage difference across the cell membrane.

Calcium’s Role in Cardiac Cells

Definition: Influences conduction and contraction; calcium channel drugs alter heart rate.

Hyperpolarization

Definition: Membrane becomes more negative than resting potential.

sarcomere

powerhouse - contractile unit of cell