ch 33 Rational

Chapter 33: Cardiovascular System Introduction

Linton: Medical-Surgical Nursing, 8th Edition

2.

 An increase blood pressure creates an increase in afterload because the heart must work harder

3. 

Ventricular gallops are considered normal in individuals younger than 30 years of age. All

other options are pathologic abnormalities.

4. 

TEE evaluates the efficiency of the valves.

5. 

NSR requires the presence of P, Q, R, S, and T waves, in that order, and all pointing in the

same direction, with a rate of 60 to 100 seconds. Normal intervals are a PR interval of 0.12 to

0.20 seconds and a QRS complex less than 0.10 second.

6. 

ACE inhibitors suppress the excretion of angiotensin, which lowers the blood pressure,

reduces fluid retention, and leads to increased urine output.

7. 

A cardioversion has risks, such as ventricular fibrillation. Emergency equipment should be

available. The digoxin dose is held before a cardioversion, and the patient is given a

short-acting sedative such as Versed or Valium, which will require recovery. The

electrocardiogram R wave is synchronized via the computer, and no pacemaker is involved.

8. 

Therapeutic implementations identify and acknowledge feelings. Do not assume that you

know how the patient feels and do not give false assurances.

9. 

Cardiac rehabilitation programs are supervised by a team of experts who arrange for

telemetry-supervised exercise and other modalities, such as diet and medical protocol

management. The focus is on the family, as well as the patient. Although some patients reject

the program, they are rarely rejected by the rehabilitation center.

10. 

Heart murmurs indicate turbulent blood flow and can be caused by valves that are stiff and do

11. 

Pulse oximetry measures arterial oxygen saturation noninvasively by attaching a clip to a

digit, an ear, or a nose.

12. 

A stress test is a noninvasive test that consists of a patient walking on a treadmill while an

electrocardiogram records the activity. A consent form is required.

13. 

Cardiac catheterizations are invasive procedures during which a catheter is threaded through

an artery. Postprocedure care requires bed rest and monitoring the puncture site.

14.

The abnormal waveform of the inverted T wave is an indicator that tissue death has occurred

in part of the cardiac wall. The cardiac wall now has no ability to conduct or to contract and

sends that message to the ECG via the inverted T. The tissue will take 6 weeks to regenerate.

15. 

Troponin is elevated within 3 to 6 hours and is often measured in the emergency department.

CPK-MB is elevated in 12 to 24 hours. Three serial samples are drawn. The LDH increases

with heart damage within 3 to 6 days. The lipid profile is not elevated with heart damage.

16. 

The dye injected during the cardiac catheterization is iodine based. An allergy to seafood is

correlated with a reaction to this dye as well.

17. 

Atropine increases the heart rate. The nurse should watch for tachycardia, which increases the

workload of the heart. This medication causes urinary retention.

18. 

Dopamine has a direct effect by elevating the blood pressure. The criterion is to titrate to the

target blood pressure. Urinary output should also be monitored for a decreased amount

because a heightened blood pressure may slow urine filtration and reduce urine output.

19.

The drug amiodarone is meant to quiet atrial activity and modify rapid pulse rate, high blood

pressure, and decreased cardiac output caused by the dysrhythmia. The drug interferes with

the thyroid and causes an ataxic gait and trembling of hands as adverse effects.

20. 

The reading that has both an HDL level above 40 mg/dL and an LDL level below 100 mg/dL

is in the therapeutic target range.

21. 

Increased urinary output, weight loss, and thirst are all anticipated consequences of the

therapy. Muscle weakness is a sign of hypokalemia.

22. 

The dose should be held if the apical rate is less than 60 beats/min for 1 minute.

23. 

Beta-blockers should never be stopped abruptly because they can cause angina or MI. Patients

are gradually weaned off these medications.

24. 

A temperature that goes up drastically indicates an adverse reaction to lidocaine, malignant

hyperthermia. The slowed ventricular rate, even with occasional PVCs, is an expected

outcome of lidocaine infusion. Nausea and vomiting are adverse effects.

25. 

A “1” in a pulse evaluation indicates a thready pulse that is easily obliterated by pressure.

26. 

The code is A (chamber-paced) atria, A (sense impulse) atria only, I (inhibit) inhibit firing

from the pacemaker, O (rate modification) no rate modification, and O (multichamber) no

other chambers to be stimulated by the pacemaker. If the SA fires on its own, the pacemaker

does nothing until it fails to sense an impulse.

27. 

As adults age, their peripheral vessels become stiff, their oxygen capacity and stroke volume

are reduced, and their aorta thickens and calcifies.

28. 

Capillary refill is determined by compressing the nail bed until it blanches. With a normal

capillary refill, color returns to the blanched skin within 3 seconds.

29. 

A positive Homans sign indicates the possible presence of a DTV because of the pain

produced in the calf of the leg when the foot is dorsiflexed.

30. 

The Allen test is performed to evaluate circulation in the hand, both in the radial and the ulnar

arteries. The patient is asked to make a fist. The nurse compresses both the ulnar and the

radial artery to blanch the hand. The patient is asked to open the hand as the nurse releases

pressure on one or the other of the arteries. Color returning to the hand confirms perfusion.

31. 

Edema is measured by the depth of the depression of the thumb: 1 = less than inch, 2 = to

32. 

Checking and recording the presence and strength of the pulses in the affected leg ensure that

the injection site has not occluded the vessel and that vascular spasm has not

impaired circulation. An inquiry about an iodine allergy is made before the procedure.

33.

The examination requires the patient to walk at a rate of approximately 1.5 miles per hour.

The exercise is continually monitored and is terminated if the patient experiences pain or

dyspnea.

34. 

boosts circulation.

Walking is helpful because the muscle action of the legs that massage the valves of the veins

35. 

Buerger-Allen exercises promote emptying of the blood vessels by gravity. Initially, lying on

the back and elevating the legs will result in pallor, and then lowering the legs will allow color

to return.

36. 

Employment as an air controller is a stressful occupation. Stress increases vasoconstriction

and increases vascular resistance. Wine and chocolate actually have beneficial effects on

circulation, as does bicycle riding.

37. 

Elastic stockings improve blood flow. They should be applied early in the morning. They

should be removed twice daily for 20 to 30 minutes, and the skin integrity of the feet should

38.

Dangling legs can use gravity to help with arterial circulation. Vigorous rubbing of the legs is

contraindicated, and prolonged standing strains the vascular system. The patient should never

walk barefoot.

39. 

LMWH can be given as a fixed dose without waiting for the results of the PTT. It is only

given subcutaneously and does not have an immediate effect. PTT is not done to monitor

LMWH.

40. 

Anticoagulants, such as warfarin (Coumadin), can cause bleeding. A sign of bleeding may be

bruising, tea- or cola-colored urine, or dark-colored stool.

41. 

42.

The conduction pathway begins in the SA node, travels down the atrial wall, depolarizing the

atria, to the AV node, bundle branches, and Purkinje fibers, contracting the ventricles.