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1

distinguish the different valves of the heart and its anatomical location and physiological function during the cardiac cycle

4 valves within the heart that keep the blood moving forward and prevent backflow.

* 2 atrioventricular (AV) valves.
- right AV valve," tricuspid valve" because it has 3 flaps
- left AV valve (bicuspid) called mitral valve.

*the remaining 2 valves,
- semilunar valves
- pulmonary semilunar valve

2

what is the difference between an artery and a vein

*artery: carry blood away from the heart.
*veins: carry blood towards the heart

the pattern as follows:
artery---) arteriole----) capillary ---) venule---)vein

3

distinguish the difference between the "lubb" and "dubb" sounds of the cardiac cycle

* the first sound, lubb- (long duration and low pitch) is heard when the AV valves close

* the second sound, dubb-(short duration, sharp sound) is heard when the semilunar valves close

4

what happens during contraction, atrial depolarization, atriel repolarization, ventricular depolaration and ventricular repolarization

(1) heart wall completely relaxed, no change in electrical activity, ECG remains constant
(2) P wave occurs when the AV node and atrial walls depolarize
(3) atrial walls completely depolarized, no change recorded in ECG
(4) QRS complex occurs as the atria repolarize and the ventricular walls depolarize
(5) atrial walls completely repolarized, ventricular walls completely depolarized, no change in ECG
(6) T wave appears on the ECG when ventricular walls repolarize
(7) once ventricles are completely repolarized = back at baseline of the ECG essentially back to beginning

5

what are the harmful effects of continuous runs of premature ventricular contractions (PVC's)

ventricular tachycardia
rate greater than 100
rhythm is regular or slightly irregular

6

why would a patient take coumadin for diagnoses of atrial fibrillation? what are the therapeutic levels for this medication, nurse teaching and side effects?

the goal of therapy is to prevent atrial thrombi from developing and embolizing, such as in the lungs or periphery

the goal of anticoagualtion is to maintain an INR between 2 and 3
-patients with atrial fibrillation are to be prescibed Coumadin and long-term antidysrhythemic medication therapy a

7

Which serum enzyme is used to diagnose a heart attack and the degree of it?

Troponin (Elevated 4-8 hours after a heart attack * peaks

8

B-type BNP indicates what

heart failure

9

A patient reports being diagnosed with a murmur. Which phenomenon can be used to explain what might be the cause of this occurrence?

ineffective closure of the valves

10

The nurse is caring for an older woman with cardiac disease. How does the older cardiac patient differ from the younger cardiac patient?

Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity

11

In evaluating risk factors for cardiovascular disease, which of the following does the nurse identify as a modifiable risk factor?

Hyperlipidemia

12

The nurse is caring for a patient with a new pacemaker. Nursing care for this patient would include what?

Monitoring the heart rate and rhythm by apical pulse and ECG patterns

13

A patient was admitted yesterday for a myocardial infarction. Which of the following statements is true regarding treatment for a patient with myocardial infarction?

The patient with an acute myocardial infarction will be on bed rest with commode privileges for 24 to 48 hours.

14

Cardiac Cycle

-1 cardiac cycle= 1 heartbeat = .8 seconds-Ventricles fill during diastole, then relax-Ventricles contract and eject blood into pulmonary and systemic circulation

15

What test evaluates balance? The client stands with eyes closing, minimal swaying is normal.

Romberg's Test

16

What is MONA used to treat?; Remember O BATMAN

Myocardial Infarction Morphine, Oxygen, Nitrates, Aspirin
O oxygen
B Beta blockers
A Aspirin
T Thrombolytics (Heparin)
M Morphine
A ACE inhibitors- specially with HF and a low ejection fraction
N Nitratess

17

What does the ABCD mnemonic for A-Fib stand for?

A- Anticoagulan
B- Beta blocker
C- Cardioversion ( if BB or calcium channel blocker not helping)
D- Digoxin

18

Impulse Pattern

SA node → AV node → bundle of His → right
and left bundle branches of AV bundle → Purkinje
fibers

19

Heart failure is managed with

digoxin,
vasodilators,
ACE inhibitors,
beta blockers,
and angiotensin II receptor blockers.
Nesiritide is the first of the drug class
called human BNPs. It reduces pulmonary
capillary pressure, improves breathing,
and causes vasodilation with increase in
stroke volume and cardiac output.

20

what laboratory values are the most important to follow up
for patients who are on anticoagulant therapy.

Prothrombin time, International
Normalized Ratio, and partial thromboplastin
time reflect blood clotting

21

Angina pain is caused by

the temporary
lack of oxygen and blood supply to the
heart.

22

Myocardial infarction

A myocardial infarction results from the
occlusion of a major coronary artery or
one of its branches. This leads to ischemia.

12-lead ECG, chest radiograph, cardiac
fluoroscopy, myocardial imaging, echocardiogram,
PET scan, or multigated
acquisition scanning (MUGA).

Prevention of further tissue damage, interventions
to promote tissue perfusion

Monitor vital signs, administer oxygen,
monitor pain, administer medications as
ordered

23

Which of the following is/are true statements regarding angina pectoris? (Select all that apply.)

- indicates a lack of oxygen and blood supply to the heart.
- only occurs at rest.
- may resemble heartburn or indigestion.
- usually relieved by nitroglycerin.
- may appear as jaw pain.

24

During cardiac catheterization,

There is a potential for bleeding or injury to nerves, so
pulses and sensation distal to the site of insertion
must be checked.

25

In third-degree heart block,

the impulses to stimulate heart muscle contraction
are not being transmitted through the AV
junction. The rate is very slow and symptoms
of hypotension and angina are likely.

26

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. Which would be a correct interpretation based on these characteristics?

Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively.

27

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse?
1.Call a code.
2.Call the health care provider.
3.Check the client's status and lead placement.
4.Press the recorder button on the electrocardiogram console. 3.

Check the client's status and lead placement.

Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment.

28

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item?

.Blood pressure and oxygen saturation

Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders, states of hypoxemia, or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine, nicotine, or alcohol.

29

The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse immediately would assess which item based on priority?

Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver

The nurse who is caring for the client after insertion of an automatic internal cardioverter-defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker. Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above which it will fire, and the number of shocks it is programmed to deliver. The remaining options are also nursing interventions but are not the priority.

30

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm?

Sinus tachycardia

Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.