Chapter 25: Structure and Function of the Cardiovascular System PrepU

The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?

1. Depolarization of the sinoatrial node

2. Depolarization of the ventricular conduction system

3. Repolarization of the atrium

4. Repolarization of the ventricles

4

Which factor has a powerful vasodilatory effect on arterioles and increases capillary permeability?

1. histamine

2. norepinephrine

3. prostaglandins

4. serotonin

1

A client with a history of heart failure has the following echocardiogram results: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction (EF)?

1. 50%

2. 2 mL

3. 180 mL

4. 0.80

1

Which blood vessel layer is made primarily of muscle?

1. Tunica intima

2. Tunica adventitia

3. Tunica externa

4. Tunica media

4

There are three main atrial pressure waves that occur during the cardiac cycle. What are the three main atrial pressure waves? Select all that apply.

1. b

2. a

3. v

4. c

2,3,4

The heart consists of four valves. Which are the semilunar valves? Select all that apply.

1. Pulmonary

2. Mitral

3. Tricuspid

4. Aortic

1,4

Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability?

1. Serotonin

2. Histamine

3. Prostaglandins

4. Arachidonic acid

2

The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?

1. Pumps blood to the lungs

2. Receives oxygenated blood from the lungs

3. Pumps blood into the systemic circulation

4. Receives blood returning to the heart from the systemic circulation

4

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as:

1. Tunica externa

2. Tunica media

3. Tunica intima

4. Tunica adventitia

2

Which of the following is true regarding pulmonary circulation?

1. It is the larger of the two circulatory systems.

2. It consists of the left side of the heart, the aorta, and its branches.

3. It is a low-pressure system that allows for improved gas exchange.

4. The system functions with an increased arterial pressure to circulate through the distal parts of the body.

3

A client took a weight loss drug that activated the alpha-adrenergic receptors in the sympathetic nervous system. Which manifestations would the nurse expect to occur? Select all that apply.

1. Increased cardiac cycle speed

2. Decreased myocardial contraction

3. Increased blood pressure of cardiac contraction

4. Decrease in respiration rate

1,3

A nurse is assessing a client who lost consciousness during a wrestling match when their opponent applied a neck hold. The client likely lost consciousness because:

1. the client experienced temporary cardiac ischemia.

2. a baroreceptor was stimulated.

3. cardiac output suddenly dropped.

4. the position caused bradycardia.

2

The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.

1. Aortic

2. Pulmonary

3. Mitral

4. Tricuspid

3,4

The nurse is caring for a client with a deep vein thrombosis (DVT), which is occluding the client's left posterior tibial vein. For which potential complications would the nurse monitor the client? Select all that apply.

1. Infarction of left lower leg

2. Thrombotic stroke

3. Pulmonary embolism

4. Left lower leg edema

5. Myocardial infarction

3,4

The heart controls the direction of blood flow. What is the role of the aortic valve?

1. Controls the direction of blood flow from the ventricles to the atria

2. Controls the direction of blood flow from the atria to the ventricles

3. Controls the direction of blood flow from the left side of the heart to the systemic circulation

4. Controls the direction of blood flow from the left side of the heart to the lungs

3

A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?

1. Right-sided heart failure

2. Shock

3. Cerebrovascular accident (stroke)

4. Left-sided heart failure

1

Which is the correct sequence of blood return to the heart?

1. capillaries, arterioles, arteries, right atrium

2. capillaries, arterioles, veins, left atrium

3. capillaries, venules, veins, left atrium

4. capillaries, venules, veins, right atrium

4

If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations?

1. Decreased contractility and decreased heart rate

2. Decreased rate and force of contraction

3. Increased heart rate and increased contractility

4. Increased heart rate and decreased contractility

3

Which related circulatory complication can result from surgical treatment for metastatic breast cancer?

1. Hypotension upon standing

2. Lymphedema in the affected arm

3. Irregular heart rate

4. Tachycardia when at rest

2

A client has just experienced stimulation of the vagus nerve. Which sign would the nurse anticipate the client to manifest?

1. Increased cardiac contractility

2. Decreased heart rate

3. Decreased blood coagulation

4. Increased heart rate

2

The health care provider states that a client has adequate collateral circulation. The nurse interprets this as:

1. long-term compensatory regulation of blood flow.

2. anastomosis of the arterial and venous circulation.

3. development of increased collagen.

4. establishment of compensatory lymphatic drainage.

1

Which blood vessels function without the benefit of having walls comprised of three muscular layers?

1. Arteries

2. Capillaries

3. Arterioles

4. Veins

2

If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern?

1. Slowing of heart rate to below 60 beats/minute

2. Disorganized ventricular fibrillation

3. Heart rate 150 beats/minute, labeled as supraventricular tachycardia

4. Complete cardiac standstill

1

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?

1. Collect deoxygenated blood from the tissues

2. Exchange gases, nutrients, and wastes

3. Distribute oxygenated blood to the tissues

4. Pump blood

2

Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease?

1. The reflected wave is transmitted more rapidly through the aorta.

2. Downstream peripheral pulses are increased even more than normal.

3. Downstream peripheral pulses are greater than upstream pulses.

4. The pulse decreases, rather than increases, in amplitude.

4

Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?

1. Calcium channel blocker

2. Antithrombin factor

3. Nitric oxide

4. Platelet-aggregating factor

3

Release of which humoral factors will result in vasodilation?

1. Angiotensin II

2. Histamine

3. Serotonin

4. Norepinephrine

2

A client says that when the hospital checked their blood pressure after they lost a lot of blood in a work-related accident, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. Why is this?

1. Systemic vasodilation maintained the diastolic pressure.

2. Systemic vasoconstriction maintained the diastolic pressure.

3. The stroke volume increased with blood loss.

4. The heart rate increased with blood loss.

2

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:

1. Pulmonic valve

2. Tricuspid valve

3. Bicuspid valve

4. Aortic valve

3

The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply.

1. Right heart

2. Aorta

3. Pulmonary artery

4. Capillaries

2,4

During a physical examination of a client, the nurse palpates the point of maximal impulse (PMI) in the seventh intercostal space lateral to the left midclavicular line. What is the most appropriate action for the nurse to take?

1. Notify the health care provider.

2. Assess the client for symptoms of left ventricular hypertrophy.

3. Auscultate both of the carotid arteries for the presence of a bruit.

4. Document that the PMI is in the normal anatomic location.

2

A nurse working with a client in heart failure is explaining why the symptoms of the heart failure were not evident for a long period of time. When describing the Frank–Starling mechanism, the nurse will explain:

1. the molecular structure of actin and myosin and their effect on contraction.

2. the relationship between venous return and stroke volume.

3. the physiologic function of chemoreceptors and baroreceptors.

4. the high oxygenation needs of cardiac muscle and the role of coronary circulation.

2

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?

1. Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves.

2. Monitor the blood pressure.

3. Auscultate for an extra heart sound due to incomplete semilunar valve closure.

4. Palpate the pericardium for a heave or thrill.

1

During an assessment of a client with ankle swelling, the nurse observes jugular venous pulsations 5 cm above the sternal angle when the head of their bed is elevated 45 degrees. What is the correct interpretation of this finding?

1. The client has increased pressure related to right-sided heart failure.

2. The client has stenosis of the jugular veins.

3. The client has decreased fluid volume.

4. The client has an increased cardiac output.

1

A client is diagnosed with an abdominal aortic aneurysm that the health care provider just wants to “watch” for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which physiologic principle?

1. The primary cause for rupture relates to increase in abdominal pressure, such as straining to have a bowel movement.

2. As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture.

3. The larger the aneurysm, the less tension placed on the vessel.

4. Small diameter of this vessel will cause it to rupture more readily.

2

Colloidal osmotic pressure acts differently than the osmotic effects of the plasma proteins. What is its action?

1. Pulls fluid back into the capillary

2. Pushes fluid into the extracellular spaces

3. Controls the direction of the fluid flow in the large arteries

4. Pulls fluid into the interstitial spaces

1

The troponin complex is one of a number of important proteins that regulate actin–myosin binding. Troponin works in striated muscle to help regulate calcium-mediated contraction of the muscle. Which of the troponin complexes is diagnostic of a myocardial infarction?

1. Troponin T and troponin I

2. Troponin C and troponin T

3. Troponin A and troponin C

4. Troponin A and troponin I

1

The nurse is teaching a client diagnosed with heart failure about preload. Which principle would be most appropriate to provide to the client?

1. Preload determines the frequency by which the ventricles contract and blood is ejected.

2. Preload represents the volume work of the heart.

3. Preload is the ability of the heart to change its force of contraction.

4. Preload is the pressure or tension work of the heart.

2

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

1. 40 to 45 cm/second

2. 20 to 25 cm/second

3. 50 to 55 cm/second

4. 30 to 35 cm/second

4

A grandparent who works as a cook at a nearby school was recently hospitalized when they lost an extensive amount of blood in a work-related accident. The grandparent tells the nurse that they heard that they would keep feeling faint until the brain made more blood. The nurse knows that when the blood pressure dropped, the pressure in the carotid arteries decreased. This was detected by baroreceptors in the carotid arteries. What did the baroreceptors do?

1. Increase sympathetic stimulation of the heart and blood vessels

2. Increase parasympathetic stimulation of the heart and blood vessels

3. Stimulate the brain to form new red blood cells

4. Inhibit renin release from the kidneys to promote fluid retention

1

The circulatory system is divided into two parts. What does the pulmonary circulation include? Select all that apply.

1. Pulmonary veins

2. Vena cava

3. Pulmonary artery

4. Aorta

5. Right heart

1,3,5

When intracranial pressure (ICP) equals intra-arterial pressure, the central nervous system ischemic response is initiated. This response is directed at raising arterial pressure above ICP, thereby reestablishing blood flow to the vasomotor center of the brain. What is this response called?

1. Cushing law

2. Cushing syndrome

3. Cushing reflex

4. Cushing response

3

The heart valves control the direction of blood flow. What is the function of the pulmonic valve?

1. Controls the direction of blood flow from the left side of the heart to the systemic circulation

2. Controls the direction of blood flow from the right side of the heart to the systemic circulation

3. Controls the direction of blood flow from the right side of the heart to the lungs

4. Controls the direction of blood flow from the left side of the heart to the lungs

3

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

1. Preload

2. Myocardial contractility

3. Heart rhythm

4. Afterload

1,2,4

A client is experiencing a sudden increase in heart rate resulting in less time in diastole. This can result in which potential complication?

1. Loss of action potential

2. Reduced cardiac contractility

3. Decreased stroke volume

4. Increased blood viscosity

3

The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body?

1. 1700

2. 1500

3. 1600

4. 1800

4

Preload, the stretch on the heart before contraction, is largely determined by which factor?

1. Vascular resistance

2. Venous blood return

3. Force of contraction

4. Ventricular emptying

2

Which factor represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?

1. Afterload

2. Cardiac contractility

3. Heart rate

4. Preload

4

A client with aortic insufficiency is experiencing an increase in afterload. The client will experience fatigue and activity intolerance due to:

1. resistance to ejection of blood from the heart.

2. residual blood in heart following contraction.

3. pressure applied to valves.

4. slow ventricular filling.

1

When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart?

1. Right ventricle

2. Left atrium

3. Right atrium

4. Left ventricle

4

During ventricular systole, closure of the atrioventricular (AV) valves coincides with which physiologic event?

1. Isovolumetric contraction

2. Atrial chamber filling

3. Semilunar valves opening

4. Aortic valve opening

1

The nurse teaches a client with peripheral edema to elevate their legs above the level of the heart several times a day. The nurse explains this action decreases _______ and increases ________ in order to reduce edema.

A:

B:

A: venous capillary hydrostatic pressure

B: preload to the right ventricle

A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography?

1. 55% - 75%

2. 65% - 85%

3. 45% - 65%

4. 35% - 55%

1

A nurse is teaching a client the correct technique for taking an arterial pulse. The nurse explains that the pulsations are:

1. Turbulence of the blood flow

2. Blood flow in the veins

3. Korotkoff sounds

4. Pressure pulses

4

When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?

1. Blood pressure of 146/80

2. Point of maximum impulse is located midclavicular at the 5th intercostal space

3. An ejection fraction of 40%

4. A heart rate (HR) of 62 beats/minute

3

Which neurotransmitter is associated with the parasympathetic nervous system?

1. Norepinephrine

2. Acetylcholine

3. Epinephrine

4. Dopamine

2

The ability in the heart to increase output as needs of the body change depends on which physiologic factors? Select all that apply.

1. Preload

2. Heart rate

3. Afterload

4. Cardiac contractility

5. Cardiac reserve

1,2,3,4

The difference between the end-diastolic and end-systolic volumes is called what?

1. Cardiac reserve

2. Stroke volume

3. Ejection fraction

4. Cardiac output

2

The pericardium is a tri-layer sac. Which layer prevents acute dilation of the heart chambers and exerts a restraining effect on the left ventricle?

1. Outer fibrous layer

2. Inner serous layer

3. Parietal layer

4. Visceral layer

1

Local control of blood flow is regulated by mechanisms that match blood flow to the metabolic needs of the tissue. Which components of the vascular system are involved in the short-term control of blood flow? Select all that apply.

1. Tissue

2. Collateral circulation

3. Smooth muscle

4. Endothelial cells

1,3,4

Vascular smooth muscle cells produce vasoconstriction or dilation of blood vessels. Which local tissue factors are correlated with smooth muscle contraction and relaxation? Select all that apply.

1. Increased hydrogen ion concentrations

2. Decreased hydrogen ion concentrations

3. Lack of carbon dioxide

4. Lack of oxygen

1,4

Which statements are true regarding the capillary system? Select all that apply.

1. Flow into the system is controlled by colloidal osmotic pressure.

2. Normal function requires that all fluid that leaves the capillary beds be reabsorbed.

3. Fluid leaves the capillary beds via lymphatic channels.

4. Flow out of the system is controlled by hydrostatic pressure.

5. Albumin plays a significant role in maintaining the function of this system.

1,4,5

A client is lying in a recumbent position. In this client, approximately how much total blood volume is in the central circulation?

1. 20% - 25%

2. 25% - 30%

3. 15% - 20%

4. 30% - 35%

2

A nurse is caring for a client with right heart failure caused by pulmonary hypertension. Which hemodynamic parameter is most appropriate for the nurse to monitor?

1. Central venous pressure (CVP)

2. Pulmonary arterial pressure (PAP)

3. Systemic vascular resistance (SVR)

4. Blood pressure

2

A client comes to the emergency department reporting a “racing” heart and feeling “anxious.” On a heart monitor, the nurse notes a heart rate of 134 and proceeds to monitor for which complications related to tachycardia? Select all that apply.

1. Decrease in oxygen levels

2. Risk for angina

3. Decrease in stroke volume

4. Decrease in blood pressure

5. Increase in cardiac output

1,2,3,4

A client is having blood work done. What percentage of red blood cells represents the formed elements of the blood?

1. 60 - 65%

2. 40 - 45%

3. 30 - 35%

4. 50 - 55%

2