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Module 9: Promoting Physiological Health > Circulation > Flashcards

Circulation Flashcards

1
Q

The _, or _, is responsible for the transport of oxygen, fluids, electrolytes, and products of metabolism via the blood to and from tissues.

A

circulatory
cardiovascular system

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2
Q

The _ and _ are closely linked and dependent on one another to deliver oxygen to the tissues of the body.

A

respiratory
cardiovascular systems

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3
Q

The heart is a hollow, cone-shaped organ about the size of a fist. It is located in the mediastinum, between the lungs and underlying the sternum. It is enclosed by a double layer of fibroserous membrane known as the _.

A

pericardium

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4
Q

The parietal, or outermost, pericardium serves to protect the heart and anchor it to surrounding structures. The visceral pericardium adheres to the surface of the heart, forming the heart’s outermost layer, the _. The heart wall contains two additional layers: the _, cardiac muscle cells that form the bulk of the heart and contract with each beat, and the _, which lines the inside of the heart’s chambers and great vessels

A

epicardium
myocardium
endocardium

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5
Q

The heart muscle moves blood to the lungs and peripheral tissues but does not receive oxygen or nourishment from the blood within its chambers. Instead, it is supplied by a network of vessels known as coronary circulation or more commonly as the _.

A

coronary arteries

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6
Q

With each heartbeat, the myocardium goes through a cycle of contraction () and relaxation ()

A

systole
diastole

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7
Q

_ is when the ventricles fill with blood.

A

Diastole

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8
Q

_ is when the heart ejects (propels) the blood into pulmonary and systemic circulation.

A

Systole

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9
Q

_ is a mechanical event that occurs in response to electrical stimulation.

A

Cardiac muscle contraction

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10
Q

Cardiac muscle is unique in that, unlike skeletal muscle, it can generate electrical impulses and contractions independently of the nervous system. This unique property of heart muscle is called _.

A

automaticity

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11
Q

The primary pacemaker of the heart is the _ (SA or sinus) node, located where the superior vena cava enters the right atrium.

A

sinoatrial

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12
Q

From the AV node, the impulse then progresses down through the intraventricular septum to the ventricular conduction pathways: the _, the right and left bundle branches, and the _.

A

bundle of His
Purkinje fibers

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13
Q

These conduction pathways converge and narrow through the _, slightly delaying transmission of the impulse to the ventricles.

A

atrioventricular (AV) node

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14
Q

_ is the amount of blood pumped by the ventricles in 1 minute.

A

Cardiac output (CO)

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15
Q

Cardiac output is calculated by multiplying the _, the amount of blood ejected with each contraction, times the heart rate (HR).

A

stroke volume (SV)

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16
Q

An increased _ increases CO, even if the stroke volume does not change.

A

heart rate

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17
Q

_ is the degree to which muscle fibers in the ventricle are stretched at the end of the relaxation period (diastole).

A

Preload

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18
Q

_ is the natural ability of cardiac muscle fibers to shorten or contract.

A

Contractility

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19
Q

_ is the resistance that the ventricle must overcome during systole to eject blood into circulation.

A

Afterload

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20
Q

_ moves blood from the heart to the tissues, maintaining a constant flow to the capillary beds despite the intermittent pumping action of the heart.

A

Arterial circulation

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21
Q

_ is the force exerted on arterial walls by the blood flowing within the vessel.

A

Blood pressure (BP)

22
Q

_ maintains blood flow to the tissues throughout the cardiac cycle. It is a product of cardiac output times peripheral vascular resistance (PVR), or CO × PVR = MAP.

A

Mean arterial pressure (MAP)

23
Q

In contrast to the high-pressure arterial system, _ is too low to adequately return blood from peripheral tissues to the heart without assistance.

A

venous pressure

24
Q

_ serves as the transport medium within the cardiovascular system, bringing oxygen and nutrients from the environment (via the lungs and gastrointestinal system) to the cells.

A

Blood

25
Q

_ is a major component of red blood cells (erythrocytes), the predominant cell present in blood.

A

Hemoglobin

26
Q

_, the buildup of fatty plaques within the arteries, is the primary contributor to cardiovascular disease (CVD), which is the leading cause of death in North America.

A

Atherosclerosis

27
Q

FACTORS AFFECTING CARDIOVASCULAR FUNCTION

A

Risk Factors:
NONMODIFIABLE RISK FACTORS
MODIFIABLE RISK FACTORS
NONTRADITIONAL RISK FACTORS

28
Q

NONMODIFIABLE RISK FACTORS

A

Heredity
Age
Gender

29
Q

MODIFIABLE RISK FACTORS

A

ELEVATED SERUM LIPID LEVELS HYPERTENSION
CIGARETTE SMOKING
DIABETES
OBESITY
SEDENTARY LIFESTYLE

30
Q

NONTRADITIONAL RISK FACTORS

A

METABOLIC SYNDROME
C-REACTIVE PROTEIN
ELEVATED HOMOCYSTEINE LEVEL

31
Q

_ is a cluster of cardiovascular risk factors that increase the incidence of CVD.

A

Metabolic syndrome (Met-S)

32
Q

Many studies have shown that acute myocardial infarction (AMI) involves an inflammatory process. A useful screening test for this inflammatory process is the _ assay.

A

C-reactive protein (CRP)

33
Q

_ is an amino acid that has been shown to be increased in many people with atherosclerosis.

A

Homocysteine

34
Q

The vessels that supply blood to the heart muscle may become occluded by atherosclerosis or a blood clot, shutting off the blood supply to a portion of the myocardium. When this happens, the tissue becomes necrotic and dies, a condition known as a _ or heart attack.

A

myocardial infarction (MI)

35
Q

_ may develop if the heart is unable to keep up with the body’s need for oxygen and nutrients to the tissues.

A

Heart failure

36
Q

_ is a lack of blood supply due to obstructed circulation.

A

Ischemia

37
Q

_ is by far the most common cause of impaired blood flow to organs and tissues.

A

Atherosclerosis

38
Q

Enzymes such as _ and _ are released into the blood during an MI, as a result of cell membrane damage.

A

creatine kinase (CK)
troponin

39
Q

_ is the study of the forces or pressures involved in blood circulation.

A

Hemodynamics

40
Q

_ is a combination of oral resuscitation (mouth-to-mouth breathing or use of a mask), which supplies oxygen to the lungs, and external cardiac massage (chest compression), which is intended to reestablish cardiac function and blood circulation.

A

Cardiopulmonary resuscitation (CPR)

41
Q

CPR is also referred to as _.

A

basic life support (BLS)

42
Q

The home health nurse has developed a teaching guide for a client with cardiovascular risk factors that focuses on the importance of regular physical activity with gradually increasing activity levels. This teaching guide specifically promotes which topic?
1. Cardiac output and tissue perfusion
2. Renal perfusion and formation of urine
3. Oxygen-carrying capacity of white blood cells
4. Effective breathing and airway clearance

A
  1. Answer: 1. Rationale: Regular physical activity will help promote healthy cardiac functioning and will also promote tissue perfusion. With physical activity the heart muscle becomes more powerful and efficient, and the client has cardiovascular risk factors. Option 2: Improving tissue perfusion may also improve renal perfusion but it is not the primary goal. Option 3: Red, not white, blood cells carry oxygen. Option 4: Effective breathing and airway clearance focus primarily on the respiratory system. Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Planning. Learning Outcome: 51-4.
43
Q

The client’s electrocardiogram (ECG) monitor reflects normal electrical activity through the heart’s conduction system. The nurse knows that the electrical impulse travels in which sequence?
1. Atrioventricular node
2. Bundle branches
3. Sinoatrial node
4. Bundle of His
5. Purkinje fibers
Place the numbers in the correct sequence: ____________

A
  1. Answer: 3, 1, 4, 2, and 5. Rationale: See sequence described on page 1290. Cognitive Level: Remembering. Client Need: Health Promotion and Maintenance. Nursing Process: Assessment. Learning Outcome: 51-1.
44
Q

Which would most likely be included in the evaluation of the client goal of “Demonstrate adequate tissue perfusion”?
1. Symmetrical chest expansion
2. Use of pursed-lip breathing
3. Brisk capillary refill
4. Activity intolerance

A
  1. Answer: 3. Rationale: Capillary refill is an assessment of capillary blood flow and thus tissue perfusion. Symmetrical chest expansion (option 1) is an assessment of respiratory function; pursed-lip breathing (option 2) is a technique used to assist clients with obstructive lung diseases to keep alveoli open during respirations. Activity intolerance (option 4) can occur because of low cardiac output (e.g., heart failure). Activity tolerance would indicate adequate tissue perfusion. Cognitive Level: Applying. Client Need: Physiological Integrity. Nu
45
Q

A client is admitted with acute crushing chest pain that radiates down his left arm. The nurse expects which blood tests to be ordered for this client? Select all that apply.
1. Blood urea nitrogen (BUN)
2. Hemoglobin and hematocrit
3. Creatine kinase (CK)
4. Homocysteine level
5. Troponin

A
  1. Answer: 3 and 5. Rationale: Creatine kinase (CK) and troponin are enzymes that are released into the blood when there is hypoxia and myocardial damage. Option 1 reflects renal function. Option 2 reflects the number of red blood cells. Option 4 reflects level of atherosclerosis, which if increased reflects a risk for myocardial infarction and other cardiovascular diseases. Altered levels 1, 2, and 4 do not cause chest pain. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Planning. Learning Outcome: 51-4.
46
Q

Which client is most likely to experience poor cardiac output?
1. A client who has recently completed exercising and is talking easily with an exercise partner
2. A client who has a stroke volume of 70 mL per beat and a heart rate of 70 beats/min
3. A client with a sustained heart rate of 150 beats/min
4. A client who receives a positive inotropic medication

A
  1. Answer: 3. Rationale: Very rapid heart rates do not allow adequate time for the ventricles to fill, causing cardiac output to fall. Option 1 is a normal response to exercise and does not reflect poor cardiac output. It could reflect poor cardiac output if the client was experiencing difficulty in breathing. Option 2 is a normal cardiac output of 4,900 mL/min. The formula is SV × HR = CO, which is about 5 L/min. Option 4 is incorrect because positive inotropic drugs (e.g., digoxin) increase contractility of the cardiac muscle and thus increase stroke volume, which increases cardiac output. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 51-1.
47
Q

The nurse is assigned to three clients with the following diagnoses: myocardial infarction (MI), heart failure (HF), and anemia. In planning for their nursing care, the nurse knows that all three clients will have which sign/symptom?
1. Pain
2. Distended neck veins
3. Shortness of breath
4. Nausea

A
  1. Answer: 3. Rationale: Because the clients would experience impaired tissue perfusion resulting in respiratory compensation, they are most likely to experience the sign/symptom of shortness of breath. The client with the MI will experience cardiac impairment resulting in decreased cardiac output as well as severe chest pain resulting in increased oxygen demand with decreased availability. Clients with heart failure will have decreased pumping ability of the cardiac muscle resulting in pulmonary congestion and decreased cardiac output. Clients with anemia have fewer RBCs to carry the oxygen to the tissues, resulting in hypoxia. Options 1 and 4 would be signs for the client with the MI. Option 2 is seen in heart failure. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Planning. Learning Outcome: 51-3.
48
Q

Which set of assessment data best validates that the nurse should initiate cardiopulmonary resuscitation on a comatose client?
1. Cool, pale skin; unconsciousness; absence of radial pulse
2. Cyanosis, slow pulse, dilated pupils
3. Absent pulses, flushed skin, pinpoint pupils
4. Apnea, absence of carotid or femoral pulses, dilated pupils

A
  1. Answer: 4. Rationale: The three cardinal signs of cardiac arrest are apnea, absence of a carotid or femoral pulse, and dilated pupils. Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation. Learning Outcome: 51-5.
49
Q

Which diagnoses would be most appropriate for clients with cardiovascular disease? Select all that apply.
1. Ineffective Peripheral Tissue Perfusion
2. Acute Confusion
3. Decreased Cardiac Output
4. Sleep Pattern Disturbance
5. Activity Intolerance

A
  1. Answer: 1, 3, and 5. Rationale: Option 1: An example of Ineffective Tissue Perfusion is a decrease in arterial circulation in the legs related to atherosclerosis. Option 3: Examples of Decreased Cardiac Output are clients with MI, heart failure, or tachycardia. Option 5: Not enough blood is being pumped by the heart to meet the demands of the body. Activity Intolerance is when the client doesn’t have physiological energy for ADLs. Common reasons can be anemias and heart failure. Options 2 and 4: Acute Confusion and Sleep Pattern Disturbance are not directly related to cardiovascular disease. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Diagnosing. Learning Outcome: 51-4.
50
Q

The surgeon ordered sequential compression devices (SCDs) to be applied postoperatively. The client asks why the SCDs are needed. Which is the best response by the nurse when teaching the client about the purpose of SCDs?
1. They promote arterial circulation.
2. They promote venous return from the legs.
3. They decrease afterload.
4. They decrease postoperative pain.

A
  1. Answer: 2. Rationale: SCDs promote venous return from the legs to the heart. They inflate and deflate plastic sleeves wrapped around the legs to promote venous flow. The sequential inflation and deflation counteract blood stasis in the lower extremities. Option 1: Arterial flow is from the heart to the general circulation. Option 3: Afterload is related to the ventricles’ ability to eject blood forward. These devices affect peripheral circulation. Option 4: There is no relationship between pain and the purpose of the devices. Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation. Learning Outcome: 51-6.
51
Q

A client with severe mitral stenosis is having surgery tomorrow. While teaching the client, the nurse shows the client a diagram of the heart. Identify with an “X” which valve the client will have replaced.

A

Module 9: Promoting Physiological Health (7 decks)

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