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Med-Surg Spring 2024 > Chapter 35 - Assessment: Cardiovascular Sx - Exam 2 > Flashcards

Chapter 35 - Assessment: Cardiovascular Sx - Exam 2 Flashcards

1
Q

The heart is composed of 3 layers:
- a thin inner layer, ______
- a layer of muscle,_______
- an outer layer, _________

A

endocardium
myocardium
epicardium

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2
Q

A fibroserous sac called the __________ covers the heart

A

pericardium

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3
Q

The cusps of the mitral and tricuspid valves are attached to thin strands of fibrous tissue called

A

chordae tenineae

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4
Q

the p wave represents

A

depolarization of the atria
(contraction)

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5
Q

the QRS wave represents

A

depolarization from the av node to the ventricles
(ventricular contraction)

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6
Q

the t wave represents

A

repolarization of ventricles
(relaxation)

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7
Q

the u wave represents

A

repolarization of the purkinje fibers,
(relaxation)
a large u wave may represent hypokalemia

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8
Q

During ventricular contraction (depolarization), the tricuspid and mitral (atrioventricular valves) are

A

closed

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9
Q

During ventricular contraction (depolarization) the pulmonic and aortic (the semilunar valves) are

A

open

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10
Q

During ventricular relaxation (repolarization) the tricuspid and mitral (atrioventricular) valves are

A

open

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11
Q

During ventricular relaxation (repolarization) the pulmonic and aortic (semilunar) valves are

A

closed

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12
Q

Nodal (SA or AV node) and Purkinje electrical cells
Characteristics:
1. automaticity

A
  1. they initiate electrical impulse
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13
Q

Nodal (SA or AV node) and Purkinje electrical cells
Characteristics:
2. excitability

A
  1. they respond to electrical impulse
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14
Q

Nodal (SA or AV node) and Purkinje electrical cells
Characteristics:
3. conductivity

A
  1. they have an ability to transmit electrical impulse
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15
Q

SA node - what is it commonly called? and how many beats/min?

A

pace maker (primary one)
60-100 b/min

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16
Q

AV node - if the SA node fails, how many b/min can it produce

A

40-60 b/min

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17
Q

If the SA and AV node fail, how many beats/min can the ventricular cells produce?

A

30-40 b/min

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18
Q

_______. ________, and calcium contain ions that stimulate myocytes to exchange an electrical charge and contract

A

sodium, potassium

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19
Q

when the heart contracts this is called

A

depolarization

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20
Q

Once the myocytes discharge their energy and contract, the then rest and recharge, this is called

A

repolarization

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21
Q

________ moves through the fast channels to create fast depolarization (contraction) of myocytes

A

sodium

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22
Q

SA and AV nodes depolarize when ________ enters the electrical cells

A

calcium

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23
Q

the myocardial cells need to repolarize during ________periods

A

refractory

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24
Q

heart muscle cells have a compensatory mechanism that makes them unresponsive or _________ to restimulation during action potential

A

refractory

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25
Q

what is the “Cardiac Cycle”

A

events that occur in the heart from one beat to the next beat:
Diastole (all chambers resting), atrial systole (contraction), ventricular systole (contraction)

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26
Q

what is “atrial kick”

A

At the end of diastole, the atria contract a fraction faster than the ventricles. It SHOVES what blood it had in side it INTO the ventricle, adding 15-25% more blood, JUST BEFORE the ventricle contracts.

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27
Q

what is “cardiac output”

A

is the amount of blood pumped by each ventricle in 1 minute
(measured in liters)

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28
Q

A healthy, resting adult put about about _____liter per minute (aka cardiac output)

A

4-6L

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29
Q

what is “stroke volume”

A

Amount of blood ejected by the left ventricle during one contraction

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30
Q

Stroke volume is the amount of blood ejected by the ________ during one __________

A

left ventricle, contraction

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31
Q

Stroke volume is super effing important, what is one type of recepter that tells the heart how much blood the body needs right now

A

baroreceptor

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32
Q

where are the baroreceptors located?

A

aortic arch and carotid arteries

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33
Q

what actions do baroreceptors cause

A

vasoconstriction AND vasodilation

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34
Q

Stroke volume is also affected by preload and afterload.
What is preload?
What is afterload?

A

preload - how much can cardiac muscle stretch just before contraction (so during relaxation)

afterload - resistance the ventricles must overcome to eject blood out of the heart ie how constricted are the vessels due to blood clots, plaque, smoking, meds, the weather

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35
Q

The Frank-Starling Law states that, to a point, the more the myocardial fibers are stretched, the greater their force of contraction. The volume of blood STRETCHING the ventricles at the end of diastole, before the next contraction is called

A

preload

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36
Q

Preload can be increased by conditions such as __________, aortic valve disease, and hypervolemia

A

hypertension

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37
Q

Preload is decreased when a rapid ______ or hypovolemia reduces ventricular filling during diastole

A

heart rate

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38
Q

________ is the peripheral resistance against which the left ventricle must pump

A

afterload

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39
Q

Afterload depends on the size of the _________, wall tension, and arterial BP

A

ventricle

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40
Q

If the arterial BP is elevated, the ventricles meet increased resistance to the ejection of blood, increasing work demand. Eventually this results in

A

ventricular hypertrophy, an enlargement of the heart muscle without an increase in cardiac output or the size of the chambers. not good.

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41
Q

Calculate cardiac output by multiplying the amount of blood ejected from the ventricle with each heartbeat:
how do we write this equation

A

CO = SV X HR

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42
Q

Ejection fraction is?

A

percentage of blood ejected from the heart at the end of each beat.

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43
Q

the left ventricle usually ejects about 55%-___%

A

65%

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44
Q

If the left ventricle usually ejects about 55-65% of blood in the heart, a lower percentage would tell us

A

this is possibly a weaker heart or the vessels are gunky and malfunctioning, some type of heart failure

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45
Q

the CV sx must respond to many situation in health and illness, the ability to respond to these demands by maintaining or increasing CO is the

A

cardiac reserve

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46
Q

the 3 major types of blood vessels are

A

arteries, veins, capillaries

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47
Q

the large ______ have thick walls composed mainly of elastic tissue

A

arteries

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48
Q

The elastic property of arteries properly cushions the impact of the pressure from ventricular ______

A

contraction

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49
Q

capillaries connect the _______and the _______

A

arterioles and venules

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50
Q

The largest veins are

A

superior and inferior vena cava

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51
Q

elevated right atrial pressure can cause distended ______veins

A

neck

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52
Q

The autonomic nervous system consists of the ____________and ____________

A

sympathetic ns and the parasympathetic ns

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53
Q

stimulation of the Sym NS increases HR, speed of impulse conduction thru the AV node, and force of contractions. This effect is mediated by specific sites in the heart called ___________receptors

A

beta-adrenergic receptors

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54
Q

beta-adrenergic receptors are receptors for

A

norepinephrine and epinephrine

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55
Q

In contrast, stimulation of the parasym NS (mediated by the _____ nerve) slows the _______ by decreasing the impulses from the SA node and conduction through the AV node

A

vagus, heart rate

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56
Q

The source of neural control of blood vessels is the __________nervous system

A

sympathetic

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57
Q

_______________ receptors are found in vascular smooth muscles

A

alpha-adrenergic receptors

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58
Q

Stimulation of alpha-adrenergic results in

A

vasoconstriction

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59
Q

decreased stimulation of alpha-adrenergic receptors causes

A

vasodilation

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60
Q

baroreceptors in the aoritc arch and carotid sinus are sensitive to _____or ______withing the arterial system

A

stretch or pressure

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61
Q

Chemoreceptors are found in the aortic and carotid bodies and the medulla. They can cause changes in ______ and __________ in response to hypercapnia

A

RR and BP

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62
Q

what is a carotid artery

A

major blood vessels that provide brain’s blood supply

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63
Q

the arterial blood pressure is a measure of

A

the force exerted by the blood against the walls of the arterial system

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64
Q

the _____________ is the peak pressure exerted against the arteries when the heart contracts

A

systolic blood pressure

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65
Q

The ______________ is the residual pressure in the artrial system during ventricular relaxation or filling

A

diastolic blood pressure

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66
Q

Pulse pressure is the difference between SBP and DBP. It is normally 1/3 of the SBP.
if the blood pressure is 120/80 mm Hg, the pulse pressure is

A

40 mm Hg

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67
Q

_________is the difference between SBP and DBP

A

pulse pressure

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68
Q

One of the greatest risk factors for CVD is

A

age

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69
Q

The most common problem is coronary artery disease caused by

A

atherosclerosis

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70
Q

what is atherosclerosis

A

build up of plague, cholestorl, fats on the inner walls of arteries

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71
Q

Heart valves thicken and stiffen due to 3 things which are

A

lipid accumulation
collagen degeneration
fibrosis

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72
Q

The _______valves are most often thicken and stiffened

A

aortic and mitral

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73
Q

because the valves dont function properly this results in _______of blood when the valve should be closed or narrowing

A

regurgitation of blood

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74
Q

an older patient has kyphosis, during assessment we may notice

A

altered chest landmarks for palpation, percussion, and auscultation. Distant heart sounds

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75
Q

urbulent blood flow across an affected valve is heard as a whoosing sound or ________between heart beats

A

murmur

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76
Q

The number of pacemaker cells in the SA node and conduction cells, bundle of his, and bundle branches _______with age

A

decreases

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77
Q

The number and unction of b-adrenergic receptors in the heart _____with age

A

decreases

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78
Q

with age arteries and veins _____ and become less__________

A

thicken, elastic

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79
Q

Valves in the large leg veins return blood to the heart less effectively, often resulting in

A

dependent edema

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80
Q

when an older adult changes position, the sym nerve pathway produces a blunted (reduced) response, which may lead to a drop in _____, and sense of lightheadedness on arising. this is called

A

blood pressure, orthostatic hypotension

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81
Q

an older adult has arterial stiffening caused by loss of elastin in arterial walls, thickening of intima of arteries, and progressive fibrosis of media. upon assessment we may find

A

increase in SBP and possible increase or decrease in DBP

decreased pedal pulses

intermittent claudication

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82
Q

what is claudication?

A

pain or cramping in the legs that happens during physical activity that is then relieved by rest

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83
Q

LP is a 63 yo man, brought to hospital after reporting chest tightness, SOB, and palpations. The paramedics started an IV and O2 at 2 L/min via NC. They obtained a 12 lead ecg and gave him 4 low dose ASA and a nitroglycerin tablet. LP is pain free on arrival but still has palpations

  1. what are the possible causes of LPs symptoms?
  2. Is LPs condition stable or unstable?
A
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84
Q

Antipsychotics can cause these CV effects

A

dysrhythmias, orthostatic HTN

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85
Q

Corticosteroids can cause these CV effects

A

hypotension, edema, potassium depletion

86
Q

hormone therapy like birth control can cause these CV effects

A

MI, thromboembolisim, stroke, HTN

87
Q

NSAIDs (non-steroidal antiinflammatory drugs) can have these CV effects

A

MI, stroke, HTN, HF

88
Q

Psychostimulants can have these CV effects

A

tachycardia, angina, MI, HTN, dysrhythimias

89
Q

Tricyclic antidepressants can have these CV effects

A

dysrhythmias, orthostatic hypotension

90
Q

females ten to have ____hearts and their vessels tend to be

A

smaller, narrower

91
Q

______ protects women from heart disease by _______blood vessels, and improving HDL and LDL

A

estrogen, dilating

92
Q

during an assessment a patient reports increased voiding and/or nocturia from which medicaiton

A

duretics

93
Q

teach patients with heart problems to avoid straining during _________

A

shitting

94
Q

CV often disrupt ____
what questions can we ask for clues?

A

sleep
paroxysmal nocturnal dyspnea “do you have shortness of breath during sleep”

do you experience cheyne-stokes during sleep

how many pillows do you use

95
Q

sleep apnea is associated with an increased risk for life threatening _________especially in patients with HF

A

dysrhythmias

96
Q

______, a common finding in CVD, interrupts normal sleep patterns

A

nocturia

97
Q

a focused subjective assessment of LP revealed the following:

Medical hx: HTN, mitral prolapse with mild regurgitation, HF, and type 2 diabetes

meds: lisinopril, metoprolol, aspirin, furosemide

perception: denies any hx of chest pain or CAD. he reports he feels fine until this morning when he woke up with SOB, chest tightness, palpations while walking to the bathroom, he thought he was having a heart attack.

LP denies edema or nocturia

  1. which sub findings most concern you?
  2. how will you conduct a patient-centered assessment?
  3. is this a good time to teach him about nitroglycerin tablets?
  4. what should you include in physical assessment?
A
98
Q

objective assessment:
measure BP bilaterally. readings can vary from 5 to ___ mmHg between arms

A

15

99
Q

Obtain orthostatic (postural) BP and HR while the patient is ______, then sitting with legs ______, and then standing.

SBP should not decrease more than ____ mm Hg from the supine to standing position.

HR should not increase more than ___ beats/min from supine to standing position

A

supine, dangling, 20 mm Hg, 20 beats/min

100
Q

Inspection:
Inspect the skin for color, _____ distribution, and venous pattern.

Check the extremities for ______, dependent rubor, clubbing of nails, variscosities, and lesions such as stasis ulcers

A

hair, edema

101
Q

_________in the legs can be caused by gravity, varicosities, or ______sided HF

A

edema, right

102
Q

______sided HF can cause distention and prominent pulsation of the neck veins referred to as jugular venous distention JVD

A

right

103
Q

what is anasarca?
what does this finding indicate?

A

generalized body edema, severe right sided heart failure

104
Q

Jugular vein distention is a clue for

A

heart failure

105
Q

what are the six P’s when inspecting the extremities?

A

pain, pallor, pulselessness, paresthesia, poikilothermia, paralysis

106
Q

when palpating the arteries rate the force using the following scale

A

0 absent
1+ weak
2+ normal
3+ increased, full, bounding

107
Q

when palpating the pulse, mrs. leonard is not a big fan of

A

only checking someones pulse at their wrist

108
Q

how do we assess for a pulse deficet

A

assess apical and peripheral pulse for 1 minute

109
Q

an artery that is narrowed or has a bulging wall may create turbulent blood flow. This abnormal flow can cause a buzzing or humming called a________
how do we hear this?

A

bruit, bell of stethoscope

110
Q

bluish tinge in tongue, conjunctivae, or inner surface of lips may indicate

A

inadequate o2 saturation of arterial blood because of a pulmonary or cardiac disorder

111
Q

clubbing of the nails may indicate

A

endocarditis, congenital defects, prolonged o2 deficiency

112
Q

pallor, cyanosis, mottling of skin after limb elevation, dependent rubor (reddish blue discoloration), glossy skin may indicate

A

chronic decreased arterial perfusion

113
Q

JVD may indicate

A

increased right atrial pressure, right sided HF

114
Q

bluish tinge in extremities or in nose and ears may indicate

A

decreased blood flow from HF, vasoconstriction, cold environment

115
Q

venous ulcers: necrotic crater-like lesions usually at medial malleolus, slowly healing wounds may indicate

A

poor venous return, varicose veins, incompetent venous valves

116
Q

arterial ulcers: pale ischemic base, well-defined edges usually found on toes, heels indicate

A

arteriosclerosis, diabetes

117
Q

a thready pulse, weak, slowly rising pulse easily obliterated by pressure indicates

A

blood loss, decreased CO, aortic valve disease, peripheral arterial disease

118
Q

a thrill, a vibration of vessel or chest wall indicates

A

aneurysm, aortic regurgitation

119
Q

asymmetry in limb circumference, measurable swelling indicates

A

venous thrombembolisim, lymphedema

120
Q

cold extremities, hands or feet cold to touch indicates

A

decreased CO, severe anemia, peripheral arterial disease

121
Q

delayed capillary refill of nails indicates

A

decreased perfusion, anemia

122
Q

pitting edema of lower extremities or sacral area indicates

A

right sided HF, interruption of venous return to the heart

123
Q

what is a 3rd heart sound S3

what could it indicate

A

extra heart sound, low pitched, heard early of diastole, similar to sound of a gallop

left ventricular failure, volume overload, mitral, aortic, or tricuspid regurgitation, HTN

124
Q

what is a 4th heart sound S4

what could it indicate

A

extra heart sound, low pitched, heard in late diastole, similar to a gallop

forceful atrial contraction from resistance to ventricular filling (eg left ventricular hypertrophy, aortic stenosis, HTN, coronary artery disease)

125
Q

heart murmurs indicate

A

heart valve disorder, abnormal blood flow patterns

126
Q

pericardial friction rub indicates

A

pericarditis

127
Q

a pulse deficit indicates

A

dysrhythmias,

pulse deficit is when the apical heart rate exceeds peripheral pulse rate

128
Q

the S3 heart sound is a low intensity vibration of the ventricular walls usually from decreased compliance of the ______ during filling

A

ventricles

129
Q

the S4 heart sound is a low frequency vibration caused by _____ contraction

A

atrial

130
Q

what would be normal physical assessment findings upon inspection

A

no pallor or cyansis
PMI not visible
no JVD with patient at 45 degree angle

131
Q

what would be normal physical assessment findings upon palpation

A

skin warm
capillary refill <2 sec
PMI palpable in 4th ICS at left MCL
no thrills or heaves
slight palpable pulsations of abdominal aorta in epigastric area
carotid and extremity pulses at 2+ and equal bilaterally
no pedal or sacral edema

132
Q

what would be a normal physical assessment when auscultating

A

s1 and s2 heard
apical-radial pulse equal
no murmurs or extra heart sounds

133
Q

Physical assessment findings of LP are as follows:
BP 100/54, apical pulse rate 154 and irregular, RR 20, Temp 98.2, O2 sat 94% with room air

awake, alert, oriented x3

lungs clear, systolic murmur present

heart monitor shows atrial fibrillation with rapid ventricular response

+1 pedal pulses bilaterally

no peripheral edema, jvd, or heaves noted

  1. which physical assessment findings most concern you?
  2. based on the results of your assessment findings what diagnostic studies should be ordered for LP?
A
134
Q

when cells are injured, they release contents including enzymes and other proteins into circulation. These ______ are useful in diagnosing acute coronary syndrome.

A

biomarkers

135
Q

Interpreting biomarker level results require you to consider the _______elapsed form the onset of symptoms

A

time

136
Q

cardiac-specific _______ is a heart muscle protein released into circulation after injury or infarction

A

troponin

137
Q

troponin is

A

a heart muscle protein released into circulation after injury or infarction

138
Q

normal troponin range is _______, anything above is taken very seriously

A

0-0.4 ng/mL

139
Q

Troponin can be detected up to ____ to ____ days after cardiac event

A

10 to 14

140
Q

______ is the biomarker of choice in diagnosing acute coronary syndrome

A

troponin

141
Q

creatine kinase (CK) enzymes are

A

cardiac enzymes, can show the rise and fall of MI, used to be the standard diagnostic study for MI

142
Q

what does BNP stand for

A

b-type natriuretic peptide

143
Q

what is natriuresis

A

excretion of sodium in urine

144
Q

BNP levels should be <100, anything greater than 100 indicates

A

HF

145
Q

BNP is a neuro________

A

hormone

146
Q

BNP is the marker of choice for distinguishing between cardiac or respiratory cause of

A

dyspnea

147
Q

BNP is a neurohormone that

A

regulates BP and fluid volume
helps diagnose HF, MI, emboli

148
Q

C-reactive protein is made by the _____ during periods of acute inflammation

A

liver

149
Q

Increased C-reactive protein levels are linked with ______ and the first occurrence of a heart event

A

atherosclerosis

150
Q

homocystein is an amino acid made during protein catabolism. High Hcy levels are linked to a higher risk for

A

CVD, PVD, and stroke

151
Q

Serum Lipids:
- total cholesterol
- tryglyceride
- HDL
- LDL

what should these levels be?

A
  • total cholesterol <200
  • triglyceride <150
  • HDL >40
    -LDL <70
152
Q

If c-reactive protein is measured at 3 or higher this indicates

A

CVD

153
Q

if homocysteine is >15 this indicates a

A

high risk for CAD

154
Q

a lipid panel usually measures

A

cholesterol, triglyceride, LDL, HDL

155
Q

triglycerides, the main storage form of lipids, make up about ____ of fatty tissue

A

95%

156
Q

Cholesterol is a structural part of

A

cell membranes and plasma lipoproteins

157
Q

Cholesterol is absorbed from food in gi and then _______ in the ______

A

synthesized, liver

158
Q

blood coagulation studies:
PT/INR

A

study for patiens taking coumadine, a blood thinner

159
Q

blood coagulation studies:
PTT

A

partial prothrobin time
if the patient is on heparin

160
Q

cardiac catheterization what is it?

A

involves insertion of catheter into heart via a vein or artery. evaluates chest pain and obtain info about the heart and major vessels. measures pressures within the heart chambers, contrast medium is injected to help see structures and motion of the heart

161
Q

what is an electrophysiology study

A

invasive study to record intracardiac electrical activity using catheters inserted via the femoral or jugular veins into right side of heart. electrodes record the electrical activity in different heart structures. Can induce and stop dsrhythmias,

162
Q

what is a radiofrequecy ablation for arrhythmias

A

uses radiofrequency energy to destroy heart tissue causing rapid and irregular heart beats. helps restore regular rhythum

163
Q

where is the blood flow altered when a patient has a tricuspid valve problem?
a. vena cava and right atrium
b. left atrium and left ventricle
c. right atrium and right ventricle
d. right ventricle and pulmonary artery

A

c

164
Q

a patient has a severe blockage in his right coronary artery which heart structures would the nurse expect to be affected by this blockage (select all)
a. av node
b. left ventricle
c. coronary sinus
d. right ventricle
e pulmonic valve

A

a,b,d

165
Q

which part of the vascular system provides hemostasis

a. thin capillary vessels
b. endothelial layer of the arteries
c. elastic middle layer of the veins
d. smooth muscle of the arterial wall

A

b

166
Q

which homeostatic mechanism is stimulated to compensate for a rise in blood pressure

a. baroreceptors that inhibit the sym NS, causing vasodilation
b. chemoreceptors, that inhibit sym NS, causing vasodilation
c. baroreceptors that inhibit the parasympathetic NS, causing vasodilation
d. chemoreceptors that stimulate the sym NS, causing an increased HR

A

a

167
Q

which action does the p wave on an ecg represent

A

b. firing of sa node and depolarization of right atria

168
Q

what subjective data would the nurse plan to obtain

A

b,c,d
smoking hx
spiritual preferences
how many pillow used to sleep

169
Q

which heart valve sound is heard best at the LMC at the level of the 5th intercostal space

A

b. mitral

170
Q

which condition is likely to cause a pulse deficeit of 23 beats

A

a. dysrhythmia

171
Q

which finding is expected in the assessment of an 81 year old patient

A

c. difficulty isolating the apical pulse

172
Q

which item would the nurse zero to establish accurate hemodynamic monitoring for a patient

A

a. pressure monitoring system to phlebostatic axis

173
Q

which nursing responsibilities are priorities when caring for a patient returning from catheterization

A

ab
monitoring vital signs
assessing catheter insertion site

174
Q

a normal splitting of S2 is heart best where?

A

pulmonic area.
normally no sound is heard between s1 and s2 but and exception to this is is normal splitting of s2 heard best over the pulmonic area during inspiration.

175
Q

what type of pulse would a nurse expect to hear when a patient is anxious?
rapid, thready, irregular, pulsus alternans

A

rapid

thready is associated with peripherial artery disease or decreased cardiac output, irregular would be seen in dysrhymias,
pulsus alternans is associated with HF

176
Q

what is pulsus alternans

A

characterized by a regular heartbeat in which the strength of the pulse alternates with each beat. In other words, the pulse feels strong with one beat and weak with the next beat, and this pattern repeats consistently. It’s typically observed during a physical examination by a healthcare professional associated with HF

177
Q

which symptom would the nurse expect to find when assessing the CV sx of an 83 year old patient?

a. systolic murmur
b. diminished pedal pulses
c. a narrowed pulse pressure
d. increased systolic bp
e. difficulty in isolating the apical pulse

A

a,b,d,e

178
Q

which assessment finding would the nurse expect when assessing a patient with right sided heart failure
a. peripheral cyanosis
b. splinter hemorrhages
c. pericardial friction rub
d. JVT
e. pitting edema of lower extremities

A

a,d,e

179
Q

the nurse assesses a patient with cardiac problems and finds that one calf is larger than the other. which condition is a possible explanation for this finding
a. lymphedema
b. hypertension
c. varicose veins
d. angina pectoris
e. venous thromboembolisim

A

a,c,e

180
Q

a patient is admitted to the hospital with chest pain. which diagnostic study would the nurse expect to be ordered
a. stress test
b. chest x ray
c. funduscopy
d. electrocardiogram
e. electroencephalogram

A

a,b,d

181
Q

an older adult presents to the ER with recent weight gain, pitting edema to LE, and distended neck veins. which other assessment findings would the nurse expect

a. irregular heart rate
b. lower extremity cyanosis
c. third heart sound upon auscultation
d. displaced point of maximal impulse
e. high pitched scratching sound during s1 or between normal heart sounds

A

b,c,d

182
Q

pitting bilateral edema, weight gain, and JVD are all hallmarks of

A

heart failure

183
Q

lower extremity cyanosis, a third heart sound, and displaced PMI are all symptoms often found in a patient with

A

heart failure

184
Q

irregular heart rate is a hallmark of

A

atrial fibrillation

185
Q

a patient being treated for peripheral artery disease reports erectile dysfunction. which medication classification in a patient’s health record may be contributing to the condition?

A

diuretics, b-adrenergic receptor blockers

186
Q

when providing care for a patient requiring hemodynamic stability monitoring, which clinical manifestation would the nurse associate with the patient being hemodynamically unstable

a. diarrhea
b. absent bowel sounds
c. high body temp
d. reduced urinary output
e. tiredness and exhaustion

A

b,d,e

187
Q

what is the normal range for cardiac output?

A

2.8-4.2 L/min/m2

188
Q

true or false: diuretics and vasodilators decrease preload

A

true,
pg 779

189
Q
A
190
Q

affects of aging:

remember…. in the older adult patient the aorta….

A

widens!

191
Q

affects of aging:

remember in the older patient the heart valves thicken, stiffen, and fail to close properly causing back flow and audible….

A

murmurs!

192
Q

affects of aging:

remember….in the older patient the systolic BP will gradually….

A

elevate as the patient ages

193
Q

affects of aging:

dont forget.. your looking for the PMI but kyphosis may cause….

A

altered chest landmarks for auscultation

194
Q

women who smoke and take oral contraceptives are at increased risk for

A

blood clots

195
Q

You are inspecting a patient and immediately notice anasarca.

what is this and what does it indicate

A

generalized body edema
severe right sided heart failure

196
Q

_____-sided heart failure can cause distention and prominent pulsation of the neck veins referred to as

A

jugular vein distension

197
Q

an ____that is narrowed or has a bulging wall may create turbulent blood flow. This abnormal blood flow can cause a buzzing or humming termed…

A

a bruit

198
Q

S3 may indicate

A

left ventricular failure

199
Q

s4 may indicate

A

left ventricular hypertrophy

200
Q

the PMI (the point of maximal impulse) reflects….

A

the pulsation of the apex of the heart

201
Q

the first heart sound, s1 represents closure of the ___and ____valves

A

tricuspid and mitral

202
Q

the second heart sound, s2 represents the closure of the ____and_____valvese

A

aortic and pulmonic

203
Q

when auscultating the apical area, simultaneously palpate the radial pulse. determine wheather the rhythm is regular or irregular while listening and feeling. if the apical and radial pulses are not equivalent, count the apical pulse while a second person simultanously counts the radial pulse for 1 MINUTE.

A difference between the 2 numbers, called a ________ can indicate dysrhythmias

A

pulse deficit

204
Q

okay the paradoxical splitting is confusing to me but here is what the book says…pg 778

normally, no sound is heard between s1 and s2. an exception to this is a normal splitting of s2, which is heard best at the pulmonic area during INSPIRATION.

Splitting of s2 can be ABNORMAL if it is heard during EXPIRATION or it is constant..

so i guess remember….

A

splitting of s2 is ABNORMAL if it is heard during EXPIRATION

205
Q

severe heart failure can lead to fluid retention and congestion in the veins, which can cause fluid to accumulate in the abdomen,

this is called

A

ascites

206
Q

The S3 sound is a low intensity vibration of the ventricular walls usually from decreased compliance of the ventricles during filling

an s3 sound may be normal in young adults. However, it is pathologic in patients with left-sided heart failure or mitral valve regurgitation.

this sound is also known as

A

ventricullar gallop

207
Q

The s4 sound is a low frequency vibration caused by atrial contraction.

this is also known as

A

atrial gallop

208
Q

preload is

A

the volume in the ventricle at the end of diastole

209
Q

afterload refers to

A

the forces opposing ventricular ejection of blood

these forces include systemic arterial pressure aortic valve resistance and the blood volume and density

210
Q

BNP is the biomarker of choice for distingguishing between _____ or _____ cause of dyspnea

A

cardiac or respiratory

211
Q
A

Med-Surg Spring 2024 (12 decks)

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