Brunner Ch 25: Assessment of Cardiovascular Function Flashcards
(40 cards)
A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what?
A) Systole
B) Diastole
C) Repolarization
D) Ejection fraction
Ans: A
Feedback:
Systole is the action of the chambers of the heart becoming smaller and ejecting blood. This action of the heart is not diastole (relaxations), ejection fraction (the amount of blood expelled), or repolarization (electrical charging).
During a shift assessment, the nurse is identifying the clients 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
Ans: B
Feedback:
The left ventricle is responsible for the apical beat or the point of maximum impulse, which is normally palpated in the left midclavicular line of the chest wall at the fifth intercostal space.
The nurse is calculating a cardiac patients pulse pressure. If the patients blood pressure is 122/76 mm Hg, what is the patients pulse pressure?
A) 46 mm Hg
B) 99 mm Hg
C) 198 mm Hg
D) 76 mm Hg
Ans: A
Feedback:
Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg.
The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. 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 in 24 hours.
b. Because the patient 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.
Ans: C
Feedback:
Troponin I, which is specific to cardiac muscle, is elevated within hours after myocardial injury. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.
The nurse is conducting patient teaching about cholesterol levels. When discussing the patients elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what?
A. Increased LDL and decreased HDL increase my 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 walls.
D. The increased LDL will decrease the amount of cholesterol deposited on the artery walls.
Ans: A
Feedback:
Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.
The physician has placed a central venous pressure (CVP) monitoring line in an acutely ill patient so right ventricular function and venous blood return can be closely monitored. The results show decreased CVP. What does this indicate?
A) Possible hypovolemia
B) Possible myocardial infarction (MI)
C) Left-sided heart failure
D) Aortic valve regurgitation
Ans: A
Feedback:
Hypovolemia may cause a decreased CVP. MI, valve regurgitation and heart failure are less likely causes of decreased CVP.
While auscultating a patients 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 what patient?
A) An older adult
B) A 20-year-old patient
C) A patient who has undergone valve replacement
D) A patient who takes a beta-adrenergic blocker
Ans: B
Feedback:
S3 represents a normal finding in children and adults up to 35 or 40 years of age. In these cases, it is called a physiologic S3. It is an abnormal finding in a patient with an artificial valve, an older adult, or a patient who takes a beta blocker.
The physical therapist notifies the nurse that a patient with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient with CAD may result in what?
A) Development of an atrial-septal defect
B) Myocardial ischemia
C) Formation of a pulmonary embolism
D) Release of potassium ions from cardiac cells
Ans: B
Feedback:
Unlike other arteries, the coronary arteries are perfused during diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Patients, particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not usually result in a pulmonary embolism or create electrolyte imbalances. Atrial-septal defects are congenital.
The nurse is caring for a patient 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
Ans: B
Feedback:
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. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.
The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult?
A) Decreased left ventricular ejection time
B) Decreased connective tissue in the SA and AV nodes and bundle branches
C) Thinning and flaccidity of the cardiac values
D) Widening of the aorta
Ans: D
Feedback:
Changes in cardiac structure and function are clearly observable in the aging heart. Aging results in decreased elasticity and widening of the aorta, thickening and rigidity of the cardiac valves, increased connective tissue in the SA and AV nodes and bundle branches, and an increased left ventricular ejection time (prolonged systole).
A resident of a long-term care facility has complained to the nurse of chest pain. What aspect of the residents pain would be most suggestive of angina 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 his upper body.
Ans: B
Feedback:
Chest pain associated with angina is often precipitated by physical exertion. The other listed aspects of chest pain are more closely associated with noncardiac etiologies.
The critical care nurse is caring for a patient with a central venous pressure (CVP) monitoring system. The nurse notes that the patients CVP is increasing. Of what may this indicate?
A) Psychosocial stress
B) Hypervolemia
C) Dislodgment of the catheter
D) Hypomagnesemia
Ans: B
Feedback:
CVP is a useful hemodynamic parameter to observe when managing an unstable patients 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. Stress, dislodgement of the catheter, and low magnesium levels would not typically result in increased CVP.
The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems?
A) To assess the patients 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
Ans: A
Feedback:
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 patients response to medical interventions, such as fluid administration and vasoactive medications. Pulmonary artery monitoring is preferred for the patient with heart failure over central venous pressure monitoring. Arterial catheters are useful when arterial blood gas measurements and blood samples need to be obtained frequently. Neither intervention is used to clear pulmonary emboli.
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 SA node and then proceeds in what sequence?
A) SA node to bundle of His to AV node to Purkinje fibers
B) SA node to AV node to Purkinje fibers to bundle of His
C) SA node to bundle of His to Purkinje fibers to AV node
D) SA node to AV node to bundle of His to Purkinje fibers
Ans: D
Feedback:
The normal electrophysiological conduction route is SA node to AV node to bundle of HIS to Purkinje fibers.
A patient has had a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. You are aware that the damage occurred where?
A. Endocardium
B. Pericardium
C. Myocardium
D. Visceral pericardium
ANS: C
The myocardium is the layer of the heart responsible for the pumping action.
The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patients stroke volume. The nurse recognizes that afterload is increased when there is what?
A) Arterial vasoconstriction
B) Venous vasoconstriction
C) Arterial vasodilation
D) Venous vasodilation
Ans: A
Feedback:
Arterial vasoconstriction increases the systemic vascular resistance, which increases the afterload. Venous vasoconstriction decreases preload thereby decreasing stroke volume. Venous vasodilation increases preload.
A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform?
A) Instruct the patient to drink 1 liter of water before the test.
B) Administer IV benzodiazepines and opioids.
C) Inform the patient that she will remain on bed rest following the procedure.
D) Inform the patient that an access line will be initiated in her femoral artery.
Ans: C
Feedback:
During the recovery period, the patient must maintain bed rest with the head of the bed elevated to 45 degrees. The patient must be NPO 6 hours preprocedure. The patient is sedated to make him or her comfortable, but will not be heavily sedated, and opioids are not necessary. Also, the patient will have a peripheral IV line initiated preprocedure.
The nurse is caring for a patient admitted with angina who is scheduled for cardiac catheterization. The patient is anxious and asks the reason for this test. What is the best response?
A) Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are.
B) Cardiac catheterization is most commonly done to detect how efficiently a patients heart muscle contracts.
C) Cardiac catheterization is usually done to evaluate cardiovascular response to stress.
D) Cardiac catheterization is most commonly done to evaluate cardiac electrical activity.
Ans: A
Feedback:
Cardiac catheterization is usually used to assess coronary artery patency to determine if revascularization procedures are necessary. A thallium stress test shows myocardial ischemia after stress. An ECG shows the electrical activity of the heart.
The critical care nurse is caring for a patient who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the patients left ventricular function?
A) Central venous pressure (CVP) monitoring
B) Pulmonary artery pressure monitoring (PAPM)
C. Systemic arterial pressure monitoring (SAPM)
D. Arterial blood gases (ABG)
ANS: B
Feedback:
PAPM is used to assess left ventricular function. CVP is used to assess right ventricular function; SAPM is used for continual assessment of BP. ABG are used to assess for acidic and alkalotic levels in the blood.
A critically ill patient is admitted to the ICU. The physician decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize in the plan of care?
A. Fluctuations in core body temperature
B. Signs and symptoms of esophageal varices
C. Signs and symptoms of compartment syndrome
D. Perfusion distal to the insertion site
ANS: D
Feedback:
The radial artery is the usual site selected. However, placement of a catheter into the radial artery can further impede perfusion to an area that has poor circulation. As a result, the tissue distal to the cannulated artery can become ischemic or necrotic. Vigilant assessment is thus necessary. Alterations in temperature and the development of esophageal varices or compartment syndrome are not high risks.
The nurse is caring for an acutely ill patient who has central venous pressure monitoring in place. What intervention should be included in the care plan of a patient with CVP in place?
A. Apply antibiotic ointment to the insertion site twice daily.
B. Change the site dressing whenever it becomes visibly soiled.
C. Perform passive range-of-motion exercises to prevent venous stasis.
D. Aspirate blood from the device once daily to test pH.
Ans: B
Feedback:
Gauze dressings should be changed every 2 days or transparent dressings at least every 7 days and whenever dressings become damp, loosened, or visibly soiled. Passive ROM exercise is not indicated and it is unnecessary and inappropriate to aspirate blood to test it for pH. Antibiotic ointments are contraindicated.
A patient is brought into the ED by family members who tell the nurse the patient grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the patients cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate?
A) Left-sided heart catheterization
B) Cardiac telemetry
C) Transesophageal echocardiography
D) Hardwire continuous ECG monitoring
Ans: D
Feedback:
Two types of continuous ECG monitoring techniques are used in health care settings: hardwire cardiac monitoring, found in EDs, critical care units, and progressive care units; and telemetry, found in general nursing care units or outpatient cardiac rehabilitation programs. Cardiac catheterization and transesophageal echocardiography would not be used in emergent situations to monitor cardiac function.
The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?
A) Whether the patient and involved family members understand the role of genetics in the etiology of the disease
B) Whether the patient and involved family members understand dietary changes and the role of nutrition
C) Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately
D) Whether the patient and involved family members understand the importance of social support and community agencies
Ans: C
Feedback:
During the health history, the nurse needs to determine if the patient and 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. Each of the other listed topics is valid, but the timely and appropriate response to a cardiac emergency is paramount.
The nurse is relating the deficits in a patients synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply.
A) Loop connectivity
B) Excitability
C) Automaticity
D) Conductivity
E) Independence
Ans: B, C, D
Feedback:
Three physiologic characteristics of two types of specialized electrical cells, the nodal cells and the Purkinje cells, provide this synchronization: automaticity, or the ability to initiate an electrical impulse; excitability, or the ability to respond to an electrical impulse; and conductivity, the ability to transmit an electrical impulse from one cell to another. Loop connectivity is a distracter for this question. Independence of the cells has nothing to do with the synchronization described in the scenario.
