CH 35: Review Heart Structure/Function Flashcards
pages 768-773
A 65-year-old male patient with a history of hypertension presents to the emergency department with complaints of chest pain and shortness of breath. An echocardiogram reveals left ventricular hypertrophy. The nurse understands that which of the following is the best explanation for the patient’s findings?
A. The left ventricular myocardium has thickened due to increased workload from systemic hypertension.
B. The right ventricular myocardium has thickened to accommodate increased pulmonary pressures.
C. The interventricular septum has shifted, decreasing left ventricular function.
D. The left atrium has enlarged due to increased venous return from the lungs.
A. The left ventricular myocardium has thickened due to increased workload from systemic hypertension.
Rationale: The left ventricle has a thicker wall than the right ventricle because it must generate sufficient force to pump blood into systemic circulation. In patients with hypertension, the heart must work harder against increased systemic vascular resistance, leading to left ventricular hypertrophy (LVH). This thickening increases oxygen demand and can contribute to heart failure. The right ventricle is typically affected in conditions such as pulmonary hypertension, not systemic hypertension.
A patient in the intensive care unit (ICU) develops pericardial effusion with signs of cardiac tamponade. Which physiological mechanism best explains why cardiac output is decreased in this condition?
A. Increased pericardial fluid compresses the heart, impairing ventricular filling.
B. Decreased myocardial oxygenation leads to myocardial infarction.
C. Pericardial inflammation directly weakens the myocardial contraction.
D. Increased pulmonary congestion decreases systemic circulation.
A. Increased pericardial fluid compresses the heart, impairing ventricular filling.
Rationale: Cardiac tamponade occurs when excess pericardial fluid (beyond the normal 10-15 mL) accumulates in the pericardial space, compressing the heart and preventing adequate ventricular filling. This reduces stroke volume and cardiac output, leading to hypotension, jugular venous distension, and muffled heart sounds (Beck’s triad).
The nurse is assessing a patient’s cardiovascular status. Which chamber of the heart is responsible for pumping oxygenated blood into systemic circulation?
A. Right atrium
B. Right ventricle
C. Left atrium
D. Left ventricle
D. Left ventricle
Rationale: The left ventricle pumps oxygenated blood into the aorta, which distributes it to the systemic circulation. The right atrium receives deoxygenated blood from the body, the right ventricle pumps blood to the lungs, and the left atrium receives oxygenated blood from the lungs.
A patient is diagnosed with pericarditis after experiencing sharp chest pain that worsens with inspiration. Which statement by the nurse best explains the role of the pericardium?
A. “The pericardium allows the heart to expand freely during contraction.”
B. “The pericardium prevents friction between the heart and surrounding structures.”
C. “The pericardium enhances myocardial contraction for effective pumping.”
D. “The pericardium reduces the need for coronary circulation.”
B. “The pericardium prevents friction between the heart and surrounding structures.”
Rationale: The pericardium consists of two layers and contains pericardial fluid to reduce friction between the heart and surrounding structures. Inflammation of the pericardium (pericarditis) can cause chest pain, pericardial effusion, and potential tamponade.
A patient with left ventricular failure is at risk for which complication due to increased pressure in the left atrium?
A. Pulmonary embolism
B. Systemic hypertension
C. Pulmonary congestion and edema
D. Right ventricular hypertrophy
C. Pulmonary congestion and edema
Rationale: When the left ventricle fails, blood backs up into the left atrium and then into the pulmonary circulation, leading to pulmonary congestion and edema. This results in symptoms such as dyspnea, orthopnea, and crackles upon auscultation.
Which of the following statements about the myocardial layer of the heart are correct? (SATA)
A. It is the thickest layer of the heart.
B. It lines the inner chambers of the heart.
C. It is composed mainly of connective tissue.
D. It is responsible for the heart’s pumping action.
A. It is the thickest layer of the heart.
D. It is responsible for the heart’s pumping action.
Rationale: The myocardium is the thickest layer of the heart and is composed of muscle tissue responsible for contraction and blood circulation. The endocardium lines the inner chambers, and the pericardium is composed of connective tissue.
Which chamber of the heart has the thinnest myocardial wall?
A. Right ventricle
B. Right atrium
C. Left ventricle
D. Left atrium
B. Right atrium
Rationale: The right atrium has the thinnest wall because it only needs to generate minimal force to move blood into the right ventricle. In contrast, the left ventricle has the thickest wall to pump blood into systemic circulation.
A patient with right ventricular failure develops peripheral edema. The nurse understands this occurs due to which physiological mechanism?
A. Increased pulmonary congestion
B. Increased systemic venous pressure
C. Decreased myocardial contractility
D. Left ventricular hypertrophy
B. Increased systemic venous pressure
Rationale: Right ventricular failure causes blood to back up into the systemic circulation, leading to increased venous pressure, fluid leakage, and peripheral edema.
A nurse is reviewing a patient’s echocardiogram that shows normal ventricular wall thickness but an abnormal septum. Which structure is likely affected?
A. Endocardium
B. Pericardium
C. Interventricular septum
D. Myocardium
C. Interventricular septum
Rationale: The interventricular septum divides the right and left ventricles. Any abnormality in this structure, such as a ventricular septal defect, can disrupt normal circulation.
A patient with constrictive pericarditis presents with jugular venous distension (JVD) and hypotension. What is the primary cause of these symptoms?
A. Restricted cardiac filling due to pericardial thickening
B. Right atrial hypertrophy
C. Increased right ventricular afterload
D. Left ventricular dysfunction
A. Restricted cardiac filling due to pericardial thickening
Rationale: In constrictive pericarditis, the thickened pericardium restricts diastolic filling, leading to decreased preload, low cardiac output, and systemic venous congestion (JVD).
Which of the following are functions of the pericardial fluid? (SATA)
A. Enhances myocardial contraction
B. Maintains endocardial integrity
C. Prevents friction during heartbeats
D. Lubricates the pericardial space
C. Prevents friction during heartbeats
D. Lubricates the pericardial space
Rationale: Pericardial fluid (10-15 mL) lubricates the heart and reduces friction between the pericardial layers. It does not enhance contraction or maintain endocardial integrity.
A 72-year-old patient is admitted with worsening fatigue, shortness of breath, and a systolic murmur best heard at the second intercostal space, right sternal border. The echocardiogram shows left ventricular hypertrophy and a thickened, calcified aortic valve. What pathophysiological process is causing the patient’s symptoms?
A. Blood regurgitating into the left atrium
B. Blood regurgitating into the left ventricle
C. Increased preload in the right atrium
D. Increased afterload in the left ventricle
D. Increased afterload in the left ventricle
Rationale: The aortic valve prevents blood from flowing back into the left ventricle. Aortic stenosis causes left ventricular outflow obstruction, leading to increased afterload, left ventricular hypertrophy, and reduced cardiac output. This results in fatigue, dyspnea, and systolic murmur.
A nurse is caring for a patient with ruptured chordae tendineae secondary to a myocardial infarction. Which complication should the nurse monitor for?
A. Aortic stenosis
B. Pulmonic valve regurgitation
C. Acute mitral regurgitation
D. Tricuspid valve stenosis
C. Acute mitral regurgitation
Rationale: The chordae tendineae prevent eversion of the mitral and tricuspid valves. Rupture of the chordae tendineae causes immediate mitral regurgitation, allowing blood to flow backward from the left ventricle into the left atrium during systole, leading to acute pulmonary congestion and heart failure.
During ventricular contraction, what prevents the mitral and tricuspid valve leaflets from inverting into the atria?
A. Semilunar valves
B. Atrial contraction
C. Chordae tendineae and papillary muscles
D. Ventricular dilation
C. Chordae tendineae and papillary muscles
Rationale: The chordae tendineae and papillary muscles anchor the mitral and tricuspid valves, preventing them from prolapsing into the atria during ventricular systole. This ensures unidirectional blood flow.
A 60-year-old patient presents with dyspnea and jugular venous distension. The echocardiogram reveals severe tricuspid regurgitation. What is the most likely consequence of this condition?
A. Pulmonary edema
B. Systemic venous congestion
C. Left ventricular hypertrophy
D. Decreased right atrial pressure
B. Systemic venous congestion
Rationale: The tricuspid valve prevents backflow of blood from the right ventricle into the right atrium. Severe regurgitation leads to volume overload in the right atrium and systemic venous congestion, resulting in jugular venous distension, hepatomegaly, and peripheral edema.
Which of the following valves is most susceptible to stenosis due to rheumatic heart disease?
A. Aortic valve
B. Tricuspid valve
C. Pulmonic valve
D. Mitral valve
D. Mitral valve
Rationale: Rheumatic heart disease commonly affects the mitral valve, leading to fibrosis, thickening, and stenosis. This results in impaired left atrial emptying, increased pulmonary pressure, and eventual right-sided heart failure.
A patient in the ICU is diagnosed with severe aortic regurgitation. Which of the following hemodynamic changes is expected?
A. Decreased left ventricular preload
B. Increased right ventricular afterload
C. Increased left ventricular volume overload
D. Decreased systemic blood pressure
C. Increased left ventricular volume overload
Rationale: In aortic regurgitation, the aortic valve fails to close properly, allowing blood to flow back into the left ventricle during diastole. This causes left ventricular volume overload, leading to dilation, hypertrophy, and reduced cardiac output over time.
A 58-year-old male presents to the emergency department with crushing substernal chest pain radiating to his left arm. ECG shows ST-elevation in leads V1-V4. Which coronary artery is most likely occluded?
A. Right coronary artery
B. Left circumflex artery
C. Left anterior descending artery
D. Posterior descending artery
C. Left anterior descending artery
Rationale: The left anterior descending (LAD) artery supplies the anterior wall of the left ventricle and the interventricular septum. An occlusion in this artery causes an anterior wall myocardial infarction (MI), which appears as ST-elevation in V1-V4 on an ECG.
A patient is admitted with an inferior wall myocardial infarction (MI). The nurse notes bradycardia and hypotension. Which artery is most likely involved?
A. Left anterior descending artery
B. Left circumflex artery
C. Diagonal artery
D. Right coronary artery
D. Right coronary artery
Rationale: The right coronary artery (RCA) supplies the right atrium, right ventricle, SA node, AV node, and part of the posterior left ventricle. An inferior MI (ST-elevation in leads II, III, aVF) can cause bradycardia and hypotension due to SA or AV node ischemia.
Which statement about coronary artery blood flow is correct?
A. The coronary arteries receive blood during systole.
B. The coronary arteries receive blood during diastole.
C. The coronary sinus empties into the left atrium.
D. The left circumflex artery supplies the interventricular septum.
B. The coronary arteries receive blood during diastole.
Rationale: The coronary arteries receive blood primarily during diastole, when the myocardium relaxes, allowing better perfusion. The coronary sinus empties into the right atrium, not the left. The left anterior descending artery (not the circumflex) supplies the interventricular septum.
A nurse is caring for a patient with a right coronary artery (RCA) occlusion. Which complications are most likely to occur? (SATA)
A. AV node block
B. Anterior wall myocardial infarction
C. Pulmonary hypertension
D. Right ventricular infarction
A. AV node block
D. Right ventricular infarction
Rationale: The RCA supplies blood to the right ventricle, right atrium, SA node, AV node, and part of the left ventricle. A blockage can result in right ventricular infarction and AV node dysfunction, leading to heart block or bradycardia.
A 70-year-old patient with chronic coronary artery disease is undergoing a stress test. The physician explains that myocardial ischemia occurs when coronary artery blood supply is insufficient. What phase of the cardiac cycle is most affected by decreased coronary perfusion?
A. Isovolumetric contraction
B. Ventricular systole
C. Atrial systole
D. Ventricular diastole
D. Ventricular diastole
Rationale: Coronary artery perfusion occurs primarily during ventricular diastole. If diastole is shortened (e.g., in tachycardia), the myocardium receives less oxygenated blood, increasing ischemia risk.
A 55-year-old male with a history of hypertension and hyperlipidemia presents with chest pain and new-onset heart block. The ECG shows ST-elevation in leads II, III, and aVF. Which artery is most likely involved?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
C. Right coronary artery
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior wall MI, which is most commonly caused by right coronary artery (RCA) occlusion. Since the AV node is supplied by the RCA in 90% of people, heart block is a common complication.
A nurse is monitoring a patient with a left circumflex artery occlusion. Which area of the heart is most at risk for ischemia?
A. Anterior left ventricle
B. Interventricular septum
C. Lateral and posterior left ventricle
D. Right atrium
C. Lateral and posterior left ventricle
Rationale: The left circumflex artery (LCX) supplies the left atrium, lateral left ventricle, and posterior left ventricle. A blockage in the LCX can lead to lateral or posterior myocardial infarction, commonly presenting with ST-elevation in leads I, aVL, V5, and V6.
Which vessel is responsible for draining most of the venous blood from the heart?
A. Coronary sinus
B. Superior vena cava
C. Inferior vena cava
D. Right atrium
A. Coronary sinus
Rationale: The coronary sinus collects deoxygenated blood from the coronary veins and drains it into the right atrium. It plays a crucial role in venous return from the myocardium.
A patient undergoing cardiac catheterization is found to have 90% stenosis of the left main coronary artery. Which two arteries are affected by this blockage?
A. Left anterior descending and right coronary arteries
B. Left circumflex and right coronary arteries
C. Left anterior descending and left circumflex arteries
D. Right coronary and posterior descending arteries
C. Left anterior descending and left circumflex arteries
Rationale: The left main coronary artery divides into the left anterior descending (LAD) and left circumflex (LCX) arteries. A severe blockage in the left main artery is dangerous because it affects both major branches, leading to extensive myocardial ischemia.
A patient arrives at the emergency department with complaints of dizziness and syncope. The ECG shows sinus bradycardia with a heart rate of 42 bpm. Which structure is most likely responsible for this patient’s rhythm?
A. AV node
B. SA node
C. Purkinje fibers
D. Bundle of His
B. SA node
Rationale: The SA node is the heart’s natural pacemaker, typically generating 60-100 impulses per minute. Sinus bradycardia suggests that the SA node is firing at a slower rate than normal. If the SA node fails, the AV node (40-60 bpm) or Purkinje fibers (20-40 bpm) may take over.
A patient with third-degree AV block is found to have a heart rate of 35 bpm. Which part of the conduction system is now serving as the pacemaker?
A. SA node
B. AV node
C. Purkinje fibers
D. Internodal pathways
C. Purkinje fibers
Rationale: In third-degree (complete) AV block, the atrial impulses fail to reach the ventricles, causing the Purkinje fibers to become the dominant pacemaker. Since the Purkinje fibers fire at 20-40 bpm, this results in severe bradycardia, often requiring pacemaker placement.
A nurse is analyzing an ECG strip and notices progressive lengthening of the PR interval until a QRS complex is dropped. Which part of the conduction system is malfunctioning?
A. SA node
B. AV node
C. Purkinje fibers
D. Right bundle branch
B. AV node
Rationale: This describes second-degree AV block Type I (Wenckebach), which results from a conduction delay at the AV node. The PR interval progressively lengthens until a ventricular beat is dropped.
Which of the following statements about the absolute refractory period are true? (SATA)
A. The heart muscle cannot respond to any new stimulus.
B. The ventricles are in a state of depolarization.
C. It prevents tetany and allows for proper cardiac filling.
D. It occurs just before ventricular contraction.
A. The heart muscle cannot respond to any new stimulus.
C. It prevents tetany and allows for proper cardiac filling.
Rationale: The absolute refractory period is when the heart muscle is completely unresponsive to new electrical stimuli, ensuring that the heart does not enter tetany and can function as an effective pump. This period prevents premature ventricular contractions (PVCs) from causing life-threatening arrhythmias.
A 72-year-old patient presents with syncope and a wide QRS complex rhythm at 30 bpm. The nurse suspects that which area of the conduction system is initiating the patient’s heartbeat?
A. SA node
B. AV node
C. Right bundle branch
D. Purkinje fibers
D. Purkinje fibers
Rationale: A heart rate of 30 bpm suggests the Purkinje fibers are acting as the pacemaker. This often occurs in third-degree heart block, where the AV node fails to transmit impulses to the ventricles. The wide QRS complex is a hallmark of ventricular-origin beats.
A patient with atrial fibrillation is prescribed a beta-blocker. The nurse explains that this medication helps control heart rate by affecting which part of the conduction system?
A. Bundle of His
B. Purkinje fibers
C. AV node
D. Left bundle branch
C. AV node
Rationale: Beta-blockers (e.g., metoprolol) slow conduction through the AV node, reducing ventricular response rate in conditions like atrial fibrillation. This helps prevent rapid and irregular ventricular contractions.
A patient with an anterior wall myocardial infarction (MI) is at risk for developing left bundle branch block. What is the primary concern with this condition?
A. Impaired ventricular conduction and heart failure
B. Increased risk of atrial fibrillation
C. Decreased SA node firing
D. AV node dysfunction leading to bradycardia
A. Impaired ventricular conduction and heart failure
Rationale: The left bundle branch is responsible for conducting impulses to the left ventricle. Anterior wall MIs can damage this conduction pathway, leading to left bundle branch block (LBBB), causing ventricular dyssynchrony and decreased cardiac output, which can contribute to heart failure.
Which part of the conduction system transmits electrical impulses the fastest, ensuring synchronized ventricular contraction?
A. SA node
B. AV node
C. Bundle of His
D. Purkinje fibers
D. Purkinje fibers
Rationale: The Purkinje fibers have the fastest conduction velocity, delivering impulses quickly to the ventricular myocardium. This ensures simultaneous right and left ventricular contraction, which is critical for effective cardiac output.
A patient with a long QT interval on ECG is at risk for which potentially fatal arrhythmia?
A. Atrial flutter
B. Ventricular fibrillation
C. Torsades de Pointes
D. Junctional rhythm
C. Torsades de Pointes
Rationale: Torsades de Pointes is a life-threatening polymorphic ventricular tachycardia associated with prolonged QT intervals. This can result from electrolyte imbalances (low magnesium, low potassium), certain medications (antipsychotics, antiarrhythmics), or congenital long QT syndrome.
A nurse is analyzing an ECG and notes a prolonged PR interval of 0.28 seconds. Which condition is most likely causing this finding?
A. Atrial fibrillation
B. First-degree AV block
C. Ventricular tachycardia
D. Hyperkalemia
B. First-degree AV block
Rationale: A normal PR interval is 0.12–0.20 seconds. A PR interval > 0.20 seconds suggests a first-degree AV block, which indicates delayed conduction through the AV node. This can be caused by beta-blockers, calcium channel blockers, aging, or structural heart disease.
A nurse is reviewing an ECG strip and notices tall, peaked T waves. Which of the following conditions could be responsible for this finding? (SATA)
A. Hypocalcemia
B. Hyperkalemia
C. Hypokalemia
D. Acute kidney injury
B. Hyperkalemia
D. Acute kidney injury
Rationale: Tall, peaked T waves are a hallmark of hyperkalemia, which commonly occurs in acute kidney injury due to reduced potassium excretion. In contrast, hypokalemia is associated with a U wave rather than a peaked T wave.
A patient with hypokalemia is found to have an irregular pulse and ECG changes. Which of the following ECG findings would the nurse expect?
A. Shortened PR interval and prolonged QRS
B. Peaked T waves and widened QRS
C. Prolonged PR interval and ST elevation
D. U waves and flattened T waves
D. U waves and flattened T waves
Rationale: Hypokalemia is associated with flattened T waves and prominent U waves, which represent delayed repolarization of the Purkinje fibers. Severe hypokalemia can lead to ventricular dysrhythmias and cardiac instability.
A patient with a QT interval of 0.52 seconds is at risk for developing which life-threatening arrhythmia?
A. Sinus bradycardia
B. Atrial flutter
C. Torsades de Pointes
D. Ventricular fibrillation
C. Torsades de Pointes
Rationale: A prolonged QT interval (> 0.44 seconds in men, > 0.46 seconds in women) increases the risk of Torsades de Pointes, a type of polymorphic ventricular tachycardia. This arrhythmia is associated with electrolyte imbalances (hypokalemia, hypomagnesemia) and certain medications (antiarrhythmics, antipsychotics, antibiotics).
A nurse observes ST segment elevation in leads II, III, and aVF on a patient’s ECG. This finding suggests which condition?
A. Anterior wall myocardial infarction
B. Inferior wall myocardial infarction
C. Pericarditis
D. Left bundle branch block
B. Inferior wall myocardial infarction
Rationale: ST segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction (MI), which is typically caused by an occlusion of the right coronary artery. Anterior wall MIs show changes in leads V1-V4, and pericarditis typically causes diffuse ST elevation in multiple leads.
A patient with atrial fibrillation is at risk for developing which of the following complications?
A. Stroke
B. Pulmonary hypertension
C. Left ventricular hypertrophy
D. Coronary artery disease
A. Stroke
Rationale: Atrial fibrillation leads to blood stasis in the atria, increasing the risk of thrombus formation. If a clot dislodges, it can travel to the brain, causing a stroke. Patients with atrial fibrillation are often prescribed anticoagulants (e.g., warfarin, apixaban) to reduce this risk.
A nurse is evaluating a patient’s ECG and notes a complete absence of P waves with an irregularly irregular rhythm. Which condition is most likely responsible for this finding?
A. Sinus tachycardia
B. Atrial flutter
C. Atrial fibrillation
D. Ventricular tachycardia
C. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by absent P waves and an irregularly irregular rhythm, indicating chaotic electrical activity in the atria. Unlike atrial flutter, which has sawtooth P waves, atrial fibrillation results in a completely disorganized atrial rhythm.
A patient in the ICU has a heart rate (HR) of 120 bpm and a stroke volume (SV) of 40 mL. What is their cardiac output (CO), and how would the nurse interpret this finding?
A. 3.2 L/min, which is low
B. 4.8 L/min, which is normal
C. 6.0 L/min, which is elevated
D. 8.2 L/min, which is dangerously high
A. 3.2 L/min, which is low
The normal CO range is 4–8 L/min. However, this patient has a high heart rate and low stroke volume, which may indicate compensatory tachycardia due to decreased stroke volume, possibly from hypovolemia, heart failure, or shock.
Which of the following conditions would most likely cause a decreased cardiac output (CO)?
A. Early stages of septic shock
B. Increased preload and contractility
C. Myocardial infarction (MI)
D. Hyperthyroidism
C. Myocardial infarction (MI)
Rationale: A myocardial infarction (MI) damages the myocardium, reducing its ability to contract effectively, leading to decreased stroke volume (SV) and cardiac output (CO).
A nurse is caring for a patient in cardiogenic shock after an acute left ventricular infarction. Which hemodynamic change is expected?
A. Increased cardiac output
B. Decreased cardiac output
C. Increased stroke volume
D. Decreased systemic vascular resistance
B. Decreased cardiac output
Rationale: In cardiogenic shock, the damaged myocardium leads to severely decreased stroke volume and cardiac output, impairing perfusion.
* Systemic vascular resistance (SVR) increases as a compensatory mechanism.
* CO does not increase because the heart is too weak to pump effectively.
Which two physiological mechanisms help maintain cardiac output during decreased stroke volume? (SATA)
A. Increased heart rate (HR)
B. Activation of the sympathetic nervous system (SNS)
C. Decreased preload
D. Decreased contractility
A. Increased heart rate (HR)
B. Activation of the sympathetic nervous system (SNS)
Rationale: When stroke volume (SV) decreases, the body compensates by:
* Increasing heart rate (HR) to maintain cardiac output (CO = HR × SV).
* Activating the sympathetic nervous system (SNS), which releases epinephrine and norepinephrine, increasing HR and contractility.
Decreased preload and contractility would further reduce CO rather than compensate for it.
A nurse is monitoring a patient with severe bradycardia (HR 35 bpm). Which statement best explains how this can affect cardiac output?
A. Cardiac output decreases because there are fewer cardiac cycles per minute
B. Cardiac output remains unchanged because stroke volume increases
C. Cardiac output increases to compensate for the slow heart rate
D. Stroke volume decreases, increasing cardiac output
A. Cardiac output decreases because there are fewer cardiac cycles per minute
Rationale: Bradycardia reduces CO because there are fewer contractions per minute, leading to less blood ejected per minute. While stroke volume may slightly increase, it typically does not compensate enough to maintain a normal CO.
A patient with uncontrolled hypertension is at risk for which cardiac adaptation due to increased afterload?
A. Left atrial enlargement
B. Increased stroke volume
C. Ventricular dilation
D. Ventricular hypertrophy
D. Ventricular hypertrophy
Rationale: In hypertension, increased arterial blood pressure increases afterload, making it harder for the left ventricle to pump blood. Over time, this causes ventricular hypertrophy—thickening of the ventricular wall without an increase in chamber size or cardiac output.
A patient with aortic stenosis has dyspnea on exertion, fatigue, and chest pain. Which hemodynamic factor is most affected in this condition?
A. Afterload
B. Preload
C. Contractility
D. Stroke volume
A. Afterload
Rationale: Aortic stenosis increases afterload by creating obstruction at the aortic valve, making it harder for the left ventricle to eject blood. This increases myocardial workload, reduces cardiac output, and leads to myocardial ischemia (chest pain).
A nurse is caring for a trauma patient with significant blood loss. Which hemodynamic change is expected?
A. Increased preload
B. Decreased preload
C. Increased afterload
D. Decreased heart rate
B. Decreased preload
Rationale: Preload is the volume of blood in the ventricles at the end of diastole. Hypovolemia from blood loss reduces venous return, causing decreased preload, which lowers stroke volume and cardiac output.
Which conditions increase preload? (SATA)
A. Hypervolemia
B. Aortic valve disease
C. Hypertension
D. Pulmonary embolism
E. Hypovolemia
A. Hypervolemia
B. Aortic valve disease
C. Hypertension
Rationale:
* Hypervolemia (excess fluid) increases venous return, raising preload.
* Aortic valve disease (regurgitation or stenosis) increases volume retention in the ventricles.
* Hypertension increases systemic vascular resistance, causing ventricular stretching over time.
Which compensatory mechanism occurs when contractility increases due to sympathetic nervous system activation?
A. Decreased preload
B. Decreased cardiac output
C. Increased stroke volume
D. Increased afterload
C. Increased stroke volume
Rationale: Sympathetic nervous system activation releases epinephrine and norepinephrine, which increase contractility, causing greater ventricular emptying and increased stroke volume.
A nurse is monitoring a patient receiving a beta-blocker for hypertension. How would this medication affect cardiac output?
A. Increases heart rate, increasing cardiac output
B. Increases contractility, improving stroke volume
C. Decreases afterload, increasing ventricular emptying
D. Decreases heart rate, reducing cardiac output
D. Decreases heart rate, reducing cardiac output
Rationale: Beta-blockers decrease sympathetic stimulation, leading to reduced heart rate and contractility, which lowers cardiac output.
A patient in septic shock initially presents with tachycardia, warm skin, and bounding pulses. How is cardiac output affected in this phase?
A. Decreased due to hypoperfusion
B. Increased due to decreased afterload
C. Decreased due to increased afterload
D. Increased due to sympathetic nervous system activation
D. Increased due to sympathetic nervous system activation
Rationale: In early septic shock, vasodilation decreases systemic vascular resistance (SVR) and afterload, while sympathetic activation increases heart rate and contractility, leading to increased cardiac output.
Which two conditions cause an increase in afterload? (SATA)
A. Pulmonary hypertension
B. Aortic stenosis
C. Hypovolemia
D. Sepsis
E. Bradycardia
A. Pulmonary hypertension
B. Aortic stenosis
Rationale:
* Pulmonary hypertension increases right ventricular afterload.
* Aortic stenosis increases left ventricular afterload due to narrowing of the aortic valve.
A nurse is caring for a patient with heart failure who has low cardiac output. Which of the following would increase preload and worsen the condition?
A. Diuretics
B. Nitrates
C. Low sodium diet
D. IV fluid bolus
D. IV fluid bolus
Rationale: An IV fluid bolus increases blood volume, which raises preload, potentially worsening fluid overload in heart failure.
A patient with heart failure is prescribed a vasodilator. How does this medication improve cardiac function?
A. Increases preload to enhance ventricular filling
B. Decreases afterload, reducing myocardial workload
C. Increases contractility to improve cardiac output
D. Increases systemic vascular resistance to maintain perfusion
B. Decreases afterload, reducing myocardial workload
Rationale: Vasodilators reduce afterload, making it easier for the left ventricle to pump blood forward, thereby improving cardiac output and reducing myocardial oxygen demand.
A nurse is assessing a patient with a HR of 160 bpm. How will this affect stroke volume and cardiac output?
A. Stroke volume decreases, cardiac output may decrease
B. Stroke volume and cardiac output increase
C. Stroke volume increases, cardiac output decreases
D. Stroke volume and cardiac output remain unchanged
A. Stroke volume decreases, cardiac output may decrease
Rationale: At high heart rates (>150 bpm), diastolic filling time is reduced, leading to decreased stroke volume. If HR is too fast, cardiac output may decrease due to inadequate ventricular filling.
A nurse is monitoring a patient in the ICU with pulmonary hypertension. How will this condition impact the right ventricle?
A. Decreased afterload, increasing cardiac output
B. Increased stroke volume, decreasing preload
C. Decreased workload, reducing myocardial oxygen demand
D. Increased afterload, leading to right ventricular hypertrophy
D. Increased afterload, leading to right ventricular hypertrophy
Rationale: In pulmonary hypertension, the right ventricle must pump against increased pulmonary arterial pressure, leading to right ventricular hypertrophy and possible right-sided heart failure over time.
Which of the following best describes cardiac reserve?
A. The heart’s ability to maintain preload and afterload
B. The difference between maximum and resting cardiac output
C. The total amount of blood the heart can eject in one contraction
D. The percentage of blood ejected from the ventricles per heartbeat
B. The difference between maximum and resting cardiac output
Rationale: Cardiac reserve is the heart’s ability to increase cardiac output (CO) in response to demands such as exercise, stress, or hypovolemia. It is measured as the difference between resting CO and maximum CO.
A patient with heart failure is unable to tolerate exercise without experiencing severe fatigue and dyspnea. Which physiological factor is most likely impaired?
A. Preload
B. Stroke volume
C. Systemic vascular resistance
D. Cardiac reserve
D. Cardiac reserve
Rationale: Patients with heart failure have a reduced cardiac reserve, meaning their heart cannot effectively increase cardiac output during exertion. This leads to fatigue, dyspnea, and exercise intolerance.
A nurse is assessing a patient with hypovolemic shock. How does the body attempt to compensate using cardiac reserve?
A. Increasing parasympathetic nervous system activity
B. Increasing heart rate and contractility via the sympathetic nervous system
C. Decreasing myocardial oxygen demand to preserve energy
D. Reducing venous return to maintain blood pressure
B. Increasing heart rate and contractility via the sympathetic nervous system
Rationale: In hypovolemia, the body activates the sympathetic nervous system, which increases heart rate and contractility to temporarily sustain cardiac output. However, if volume loss continues, cardiac reserve becomes depleted, leading to decompensation.
Which of the following statements is true about the vascular system?
A. The pulmonary arteries carry oxygenated blood from the heart to the lungs.
B. Blood flows from the left side of the heart into arteries, arterioles, capillaries, venules, and veins.
C. Veins carry oxygenated blood to the heart, except for the pulmonary veins.
D. Arterioles are small branches of veins that carry blood to capillaries.
B. Blood flows from the left side of the heart into arteries, arterioles, capillaries, venules, and veins.
Rationale: Blood flows from the left side of the heart into arteries, arterioles, capillaries, venules, and veins, eventually returning to the right side of the heart. This is the basic pattern of systemic circulation.
A nurse is caring for a patient with pulmonary hypertension. Which of the following best describes the primary blood vessels involved in this condition?
A. Pulmonary arteries and veins
B. Arteries and arterioles in the systemic circulation
C. Veins and venules of the systemic circulation
D. Capillaries and arterioles of the systemic circulation
A. Pulmonary arteries and veins
Rationale: Pulmonary hypertension primarily involves the pulmonary arteries, where increased pressure can lead to right ventricular strain. The condition is characterized by elevated pressure in the pulmonary arteries that carry blood to the lungs.
Which of the following is the primary function of capillaries in the circulatory system?
A. Transport oxygenated blood from the heart to the body
B. Transport deoxygenated blood to the heart
C. Facilitate nutrient and gas exchange between blood and tissues
D. Carry blood away from the heart at high pressure
C. Facilitate nutrient and gas exchange between blood and tissues
Rationale: Capillaries are the smallest blood vessels where nutrient, gas, and waste exchange occurs between blood and tissues. Their thin walls allow for efficient diffusion.
A patient presents with severe hypovolemic shock and a decreased venous return. Which of the following vascular changes is most likely to occur?
A. Dilation of venules and veins
B. Constriction of arterioles and venules
C. Relaxation of arterial smooth muscle
D. Constriction of venules and veins
D. Constriction of venules and veins
Rationale: In hypovolemic shock, the body responds by constricting venules and veins to attempt to preserve circulating blood volume and increase venous return to the heart, maintaining perfusion to vital organs.
Which of the following is a key characteristic of arteries that distinguishes them from veins?
A. Arteries have thinner walls than veins.
B. Arteries carry oxygenated blood away from the heart, except the pulmonary artery.
C. Arteries have valves to prevent backflow.
D. Arteries are part of the systemic circulation only.
B. Arteries carry oxygenated blood away from the heart, except the pulmonary artery.
Rationale: Arteries carry oxygenated blood away from the heart, with the exception of the pulmonary artery. The pulmonary artery carries deoxygenated blood to the lungs. Arteries also have thicker walls than veins due to higher pressure.
A nurse is assessing a patient with chronic venous insufficiency. The nurse notes that the patient’s veins are dilated and their skin has a dark, pigmented appearance. Which of the following is most likely causing these symptoms?
A. Increased pressure in the veins leading to fluid leakage
B. Decreased perfusion of the arteries to the lower limbs
C. Incompetent valves in the veins causing blood pooling
D. Arterial constriction resulting in reduced oxygen supply
C. Incompetent valves in the veins causing blood pooling
Rationale: Chronic venous insufficiency occurs when valves in the veins become incompetent, leading to blood pooling in the veins, causing venous dilation and skin pigmentation due to fluid leakage and stasis.
Which of the following best describes the elastic tissue found in large arteries such as the aorta?
A. It increases vascular resistance by constricting the vessel.
B. It cushions the impact of pressure from ventricular contraction and propels blood forward.
C. It provides structural integrity and allows for recoil after ventricular contraction.
D. It promotes clot formation by triggering the coagulation cascade.
C. It provides structural integrity and allows for recoil after ventricular contraction.
Rationale: Elastic tissue in large arteries like the aorta helps to cushion the impact of ventricular contraction and provides recoil, which propels blood forward into the circulation. This elasticity ensures smooth blood flow during systole and diastole.
Which of the following is the primary function of arterioles in the circulatory system?
A. To control arterial blood pressure and blood flow distribution
B. To return deoxygenated blood to the heart
C. To prevent backflow of blood into the heart
D. To supply oxygen to the tissues through capillaries
A. To control arterial blood pressure and blood flow distribution
Rationale: Arterioles play a key role in controlling arterial blood pressure and the distribution of blood flow to various tissues. They are more muscular than large arteries and can dilate or constrict based on local conditions.
Which of the following describes the response of arterioles to low oxygen levels or high carbon dioxide levels?
A. Arterioles constrict to increase blood pressure.
B. Arterioles dilate to improve oxygen delivery to tissues.
C. Arterioles dilate to increase blood flow and improve oxygen delivery.
D. Arterioles constrict to reduce blood flow and prevent waste buildup.
C. Arterioles dilate to increase blood flow and improve oxygen delivery.
Rationale: In response to low O2 levels and high CO2 levels, arterioles dilate to increase blood flow and improve the delivery of oxygen to tissues that need it most.
A nurse is caring for a patient with hypertension. Which of the following mechanisms is most likely contributing to the increased blood pressure in this patient?
A. Decreased elasticity in the arteries leading to reduced recoil
B. Constriction of arterioles increasing vascular resistance
C. Increased elasticity of the large arteries allowing for better recoil
D. Decreased smooth muscle tone in the arterioles allowing for dilation
B. Constriction of arterioles increasing vascular resistance
Rationale: Constriction of arterioles increases vascular resistance, contributing to higher blood pressure. This is a key factor in the pathophysiology of hypertension.
What is the role of the endothelium in the arterial system?
A. It controls blood flow by constricting the vessel.
B. It forms a fibrin clot when the surface is disrupted.
C. It regulates the oxygenation levels in the blood.
D. It promotes blood flow and inhibits coagulation under normal conditions.
D. It promotes blood flow and inhibits coagulation under normal conditions.
Rationale: The endothelium plays an important role in maintaining hemostasis, promoting blood flow, and inhibiting blood coagulation under normal conditions. When disrupted, such as in atherosclerotic plaque rupture, the coagulation cascade is triggered.
A patient is diagnosed with a ruptured atherosclerotic plaque. Which of the following will most likely occur as a result of the endothelial disruption?
A. Formation of a fibrin clot due to activation of the coagulation cascade
B. Vasodilation of arterioles to increase blood flow
C. Decreased blood flow to the heart due to arterial constriction
D. Increased elasticity in the arterial walls to accommodate higher pressure
A. Formation of a fibrin clot due to activation of the coagulation cascade
Rationale: When the endothelium is disrupted (e.g., due to a ruptured atherosclerotic plaque), the coagulation cascade is activated, resulting in the formation of a fibrin clot.
Which of the following best describes the composition of the walls of large arteries such as the aorta?
A. Primarily smooth muscle with a small amount of elastic tissue
B. Thick walls composed mainly of elastic tissue with some smooth muscle
C. Thin walls composed mainly of smooth muscle
D. Thin walls with an equal distribution of elastic tissue and smooth muscle
B. Thick walls composed mainly of elastic tissue with some smooth muscle
Rationale: Large arteries like the aorta have thick walls composed mainly of elastic tissue. This helps to cushion the pressure from ventricular contraction and aids in the propulsion of blood forward.
Which of the following blood vessels has the most smooth muscle relative to other components of the arterial system?
A. Aorta
B. Pulmonary artery
C. Large veins
D. Arterioles
D. Arterioles
Rationale: Arterioles have the most smooth muscle relative to their size and play a crucial role in regulating arterial blood pressure and blood flow distribution.
Which of the following is not a characteristic of large arteries such as the aorta?
A. Contain elastic tissue to cushion pressure from ventricular contraction
B. Contain smooth muscle to regulate blood flow
C. Have thin walls due to low pressure
D. Propels blood forward into the circulation due to recoil
C. Have thin walls due to low pressure
Rationale: Large arteries such as the aorta have thick walls made mainly of elastic tissue, not thin walls. These thick walls help cushion the pressure from ventricular contraction and provide recoil to propel blood forward.
Which of the following is the primary function of capillaries in the circulatory system?
A. To return deoxygenated blood to the heart
B. To facilitate the exchange of cellular nutrients and metabolic waste products
C. To regulate arterial blood pressure
D. To propel blood forward into the venules
B. To facilitate the exchange of cellular nutrients and metabolic waste products
Rationale: Capillaries are specialized for the exchange of nutrients, gases, and metabolic waste between the blood and tissues due to their thin endothelial walls.
Which of the following describes the structural characteristic of capillaries that allows for nutrient exchange?
A. Thin endothelial walls with no elastic or muscle tissue
B. Thick muscular walls that regulate blood flow
C. Elastic tissue that cushions blood flow
D. Smooth muscle lining that constricts to push blood through
A. Thin endothelial walls with no elastic or muscle tissue
Rationale: Capillaries have thin endothelial walls without elastic or muscle tissue, which allows for efficient exchange of nutrients and metabolic waste products.
Capillaries connect which two types of blood vessels?
A. Arteries and veins
B. Arterioles and veins
C. Arterioles and venules
D. Arteries and venules
C. Arterioles and venules
Rationale: Capillaries serve as the connecting vessels between arterioles and venules, facilitating the exchange of substances between the blood and tissues.
Which of the following is true regarding veins?
A. They are low-pressure, high-volume vessels that return blood to the heart.
B. They are high-pressure vessels that distribute blood from the heart to tissues.
C. Veins have thick muscular walls for maintaining pressure.
D. They carry oxygenated blood except for the pulmonary veins.
A. They are low-pressure, high-volume vessels that return blood to the heart.
Rationale: Veins are part of the low-pressure, high-volume system that returns blood to the heart, unlike arteries, which operate under high pressure.
What is the function of semilunar valves in veins?
A. To promote blood flow away from the heart
B. To prevent the backward flow of blood and maintain unidirectional flow
C. To regulate blood pressure within the veins
D. To facilitate nutrient exchange between the blood and tissues
B. To prevent the backward flow of blood and maintain unidirectional flow
Rationale: Semilunar valves in veins prevent backward blood flow and ensure that blood continues toward the heart, despite the low-pressure environment in veins.
Which factor most significantly affects the amount of blood in the venous system?
A. The contractility of the heart
B. The thickness of the arterial walls
C. Skeletal muscle compression and changes in thoracic and abdominal pressures
D. The presence of valves in the arteries
C. Skeletal muscle compression and changes in thoracic and abdominal pressures
Rationale: Skeletal muscle compression and changes in thoracic and abdominal pressures (e.g., during breathing or physical activity) are crucial in helping the venous system move blood toward the heart.
Which of the following veins carries blood from the lower part of the body to the heart?
A. Inferior vena cava
B. Pulmonary vein
C. Superior vena cava
D. Inferior vena cava
A. Inferior vena cava
Rationale: The inferior vena cava returns blood from the lower part of the body to the right atrium of the heart.
What effect does elevated right atrial pressure have on the venous system?
A. It can cause distended neck veins or liver engorgement.
B. It causes reduced venous return to the heart.
C. It increases blood flow to the kidneys.
D. It decreases the volume of blood returning from the lower body.
A. It can cause distended neck veins or liver engorgement.
Rationale: Elevated right atrial pressure increases resistance to blood flow, which can lead to distended neck veins or liver engorgement, as blood is unable to flow properly back to the heart.
The function of venules in the circulatory system is to:
A. Collect blood from capillary beds and channel it to the arteries
B. Return oxygenated blood to the heart
C. Collect blood from capillary beds and channel it to larger veins
D. Regulate blood pressure in the venous system
C. Collect blood from capillary beds and channel it to larger veins
Rationale: Venules collect blood from the capillary beds and channel it into larger veins for return to the heart.
In the venous system, what is the effect of skeletal muscle contraction on blood flow?
A. It decreases blood return to the heart
B. It increases arterial blood pressure
C. It compresses veins and assists in moving blood toward the heart
D. It dilates veins to reduce blood flow resistance
C. It compresses veins and assists in moving blood toward the heart
Rationale: Skeletal muscle contraction helps compress veins, which propels blood toward the heart, increasing venous return.
The superior vena cava returns blood to the heart from which of the following areas?
A. The lower body
B. The head, neck, and arms
C. The lungs
D. The abdomen
B. The head, neck, and arms
Rationale: The superior vena cava returns deoxygenated blood from the head, neck, and arms to the right atrium of the heart.
The presence of semilunar valves in veins helps to:
A. Control blood pressure in arteries
B. Promote the exchange of gases in capillaries
C. Facilitate nutrient and waste exchange in venules
D. Prevent the backward flow of blood in veins
D. Prevent the backward flow of blood in veins
Rationale: Semilunar valves in veins are responsible for maintaining unidirectional blood flow, preventing backflow and ensuring blood moves toward the heart.
Which part of the autonomic nervous system primarily increases heart rate and cardiac output during a stressful situation?
A. Parasympathetic nervous system
B. Sympathetic nervous system
C. Somatic nervous system
D. Central nervous system
B. Sympathetic nervous system
Rationale: The sympathetic nervous system is responsible for the “fight or flight” response. It increases heart rate, cardiac output, and blood pressure in response to stress or physical activity by releasing norepinephrine and stimulating the heart’s beta receptors.
Which of the following describes the function of the parasympathetic nervous system in regulating the cardiovascular system?
A. It increases heart rate and blood pressure during physical activity.
B. It decreases heart rate and promotes relaxation.
C. It stimulates the release of norepinephrine to increase cardiac output.
D. It has no effect on cardiovascular function.
B. It decreases heart rate and promotes relaxation.
Rationale: The parasympathetic nervous system, mainly through the vagus nerve, decreases heart rate and promotes relaxation by releasing acetylcholine, which acts to slow down the heart rate and reduce the force of contraction. This helps in maintaining a resting or “rest and digest” state.
Which part of the autonomic nervous system primarily increases heart rate and cardiac output during a stressful situation?
A. Parasympathetic nervous system
B. Somatic nervous system
C. Central nervous system
D. Sympathetic nervous system
D. Sympathetic nervous system
Rationale: The sympathetic nervous system is responsible for the “fight or flight” response. It increases heart rate, cardiac output, and blood pressure in response to stress or physical activity by releasing norepinephrine and stimulating the heart’s beta receptors.
Which of the following describes the function of the parasympathetic nervous system in regulating the cardiovascular system?
A. It decreases heart rate and promotes relaxation.
B. It increases heart rate and blood pressure during physical activity.
C. It stimulates the release of norepinephrine to increase cardiac output.
D. It has no effect on cardiovascular function.
A. It decreases heart rate and promotes relaxation.
Rationale: The parasympathetic nervous system, mainly through the vagus nerve, decreases heart rate and promotes relaxation by releasing acetylcholine, which acts to slow down the heart rate and reduce the force of contraction. This helps in maintaining a resting or “rest and digest” state.
Which of the following describes the effect of sympathetic nervous system stimulation on the heart?
A. It decreases heart rate and impulse conduction.
B. It increases heart rate, impulse conduction, and force of contraction.
C. It increases heart rate, speed of impulse conduction, and force of contraction.
D. It decreases heart rate and the force of contraction.
C. It increases heart rate, speed of impulse conduction, and force of contraction.
Rationale: Stimulation of the sympathetic nervous system increases heart rate, speed of impulse conduction through the AV node, and force of atrial and ventricular contractions. This effect is mediated through beta-adrenergic receptors that respond to norepinephrine and epinephrine.
Which type of receptor mediates the effects of the sympathetic nervous system on the heart?
A. Alpha-adrenergic receptors
B. Beta-adrenergic receptors
C. Muscarinic receptors
D. Nicotinic receptors
B. Beta-adrenergic receptors
Rationale: The effects of the sympathetic nervous system on the heart, such as increased heart rate and force of contraction, are mediated through beta-adrenergic receptors, which respond to the neurotransmitters norepinephrine and epinephrine.
Which of the following is a primary effect of parasympathetic nervous system stimulation on the heart?
A. Increased heart rate and contractility
B. Increased conduction through the AV node
C. Decreased heart rate and conduction through the AV node
D. Decreased heart rate and slowed impulse conduction through the AV node
D. Decreased heart rate and slowed impulse conduction through the AV node
Rationale: The parasympathetic nervous system, mediated by the vagus nerve, slows the heart rate and decreases impulse conduction through the AV node, promoting a resting state for the heart.
What is the primary neurotransmitter involved in sympathetic stimulation of the heart?
A. Acetylcholine
B. Norepinephrine
C. Dopamine
D. Serotonin
B. Norepinephrine
Rationale: Norepinephrine is the primary neurotransmitter released during sympathetic stimulation of the heart, which binds to beta-adrenergic receptors, resulting in increased heart rate, impulse conduction, and force of contraction.
Which of the following best describes the effect of parasympathetic stimulation on the heart rate?
A. It increases heart rate and contractility.
B. It decreases heart rate by inhibiting the SA node.
C. It decreases heart rate and increases contractility.
D. It has no effect on heart rate.
D. It has no effect on heart rate.
Rationale: Parasympathetic stimulation primarily decreases heart rate by inhibiting the SA node and decreasing the conduction of impulses through the AV node. This is mediated by the vagus nerve and acetylcholine.
What is the effect of stimulation of alpha-1 (α1)-adrenergic receptors in vascular smooth muscle?
A. Vasodilation
B. Vasoconstriction
C. Decreased blood pressure
D. Increased blood flow
B. Vasoconstriction
Rationale: Stimulation of alpha-1 (α1)-adrenergic receptors in vascular smooth muscle results in vasoconstriction, which increases vascular resistance and blood pressure.
Which of the following occurs when stimulation of alpha-1 (α1)-adrenergic receptors is decreased?
A. Vasoconstriction
B. Increased blood pressure
C. Vasodilation
D. Decreased blood flow
C. Vasodilation
Rationale: Decreased stimulation of alpha-1 (α1)-adrenergic receptors causes vasodilation, which lowers vascular resistance and facilitates blood flow.
Which of the following is true regarding the neural control of blood vessels?
A. The sympathetic nervous system increases vasodilation by stimulating alpha-1 receptors.
B. The parasympathetic nervous system regulates vascular smooth muscle contraction.
C. The sympathetic nervous system controls blood vessel tone through alpha-1 adrenergic receptors.
D. The sympathetic nervous system decreases blood flow by inhibiting beta-adrenergic receptors.
C. The sympathetic nervous system controls blood vessel tone through alpha-1 adrenergic receptors.
Rationale: The sympathetic nervous system regulates blood vessel tone through the alpha-1 (α1)-adrenergic receptors, leading to vasoconstriction when stimulated.
What is the result of vasoconstriction mediated by alpha-1 (α1)-adrenergic receptors?
A. Decreased systemic vascular resistance
B. Increased blood flow to the peripheral tissues
C. Decreased blood pressure
D. Increased systemic vascular resistance
D. Increased systemic vascular resistance
Rationale: Vasoconstriction mediated by alpha-1 (α1)-adrenergic receptors leads to increased systemic vascular resistance, which raises blood pressure.
Where are baroreceptors located, which are sensitive to stretch or pressure within the arterial system?
A. In the right atrium
B. At the junction of the left ventricle and aorta
C. In the aortic arch and carotid sinus
D. In the pulmonary arteries
C. In the aortic arch and carotid sinus
Rationale: Baroreceptors are located in the aortic arch and carotid sinus, where they detect stretch or pressure changes in the arterial system.
What is the result of baroreceptor stimulation due to volume overload?
A. Increased sympathetic nervous system activity
B. Decreased parasympathetic nervous system influence
C. Inhibition of sympathetic nervous system and enhancement of parasympathetic influence
D. Increased heart rate and vasoconstriction
C. Inhibition of sympathetic nervous system and enhancement of parasympathetic influence
Rationale: Baroreceptor stimulation from volume overload leads to the inhibition of the sympathetic nervous system and the enhancement of parasympathetic influence, which decreases heart rate and causes peripheral vasodilation.
What happens when there is a decreased arterial pressure in the body regarding baroreceptor activity?
A. Increased sympathetic nervous system activity
B. Enhanced parasympathetic influence
C. Decreased heart rate
D. Peripheral vasodilation
A. Increased sympathetic nervous system activity
Rationale: Decreased arterial pressure results in increased sympathetic nervous system activity to increase heart rate and vascular tone, in contrast to the response to volume overload.
Which of the following best describes the physiological role of baroreceptors?
A. They control the rate of blood flow in the veins.
B. They regulate blood pressure by detecting stretch or pressure changes and adjusting autonomic nervous system activity.
C. They are located only in the heart and monitor cardiac output.
D. They are involved in the inflammatory response to high blood pressure.
B. They regulate blood pressure by detecting stretch or pressure changes and adjusting autonomic nervous system activity.
Rationale: Baroreceptors monitor blood pressure by detecting stretch or pressure changes, sending signals to the vasomotor center to adjust autonomic nervous system activity accordingly.
What is the primary effect of baroreceptor stimulation when blood volume is high?
A. Vasoconstriction and tachycardia
B. Increased sympathetic nervous system response
C. Decreased heart rate and vasodilation
D. Increased blood pressure and decreased cardiac output
C. Decreased heart rate and vasodilation
Rationale: Baroreceptor stimulation due to high blood volume causes decreased heart rate and peripheral vasodilation to lower blood pressure.
In which of the following situations would baroreceptors lead to increased heart rate and vasoconstriction?
A. Volume overload leading to baroreceptor stimulation
B. Decreased arterial pressure causing reduced stretch on baroreceptors
C. Enhanced parasympathetic activity due to baroreceptor inhibition
D. Increased blood volume detected by baroreceptors
B. Decreased arterial pressure causing reduced stretch on baroreceptors
Rationale: Decreased arterial pressure, which reduces stretch on the baroreceptors, results in an increased heart rate and vasoconstriction as the body attempts to raise blood pressure.
Where are chemoreceptors located in the body?
A. In the lungs and diaphragm
B. In the aortic and carotid bodies and the medulla
C. In the heart and atria
D. In the right and left ventricles
B. In the aortic and carotid bodies and the medulla
Rationale: Chemoreceptors are located in the aortic and carotid bodies and the medulla, where they play a role in monitoring respiratory and cardiovascular changes.
Which of the following stimuli causes chemoreceptors to induce changes in respiratory rate and blood pressure?
A. Increased sodium levels
B. Increased arterial oxygen pressure
C. Increased arterial CO2 pressure
D. Decreased body temperature
C. Increased arterial CO2 pressure (hypercapnia)
Rationale: Chemoreceptors respond to increased arterial CO2 pressure (hypercapnia) and, to a lesser degree, decreased plasma pH (acidosis) and decreased arterial O2 pressure (hypoxia), affecting both respiratory rate and blood pressure.
What effect does chemoreceptor stimulation in the medulla have on the cardiovascular system?
A. Decreased blood pressure
B. Decreased heart rate
C. Increased blood pressure
D. Vasodilation
C. Increased blood pressure
Rationale: When chemoreceptors in the medulla are stimulated, they activate the vasomotor center, resulting in increased blood pressure.
Which condition is most likely to stimulate the chemoreceptors to cause changes in blood pressure and respiratory rate?
A. Hypokalemia
B. Hypercapnia (increased CO2)
C. Hypernatremia
D. Hypoxia (decreased O2)
B. Hypercapnia (increased CO2)
Rationale: Hypercapnia (increased CO2) is the most common stimulus for chemoreceptors to trigger changes in both blood pressure and respiratory rate. Although hypoxia and acidosis can also have effects, hypercapnia is a primary trigger.
In which part of the body would chemoreceptors have the least influence on blood pressure regulation?
A. In the left atrium
B. In the carotid bodies
C. In the aortic bodies
D. In the medulla
A. In the left atrium
Rationale: Chemoreceptors in the aortic bodies, carotid bodies, and medulla have direct effects on blood pressure regulation, whereas chemoreceptors in the left atrium are not primarily involved in regulating blood pressure through changes in respiratory rate.
Which of the following best defines diastolic blood pressure (DBP)?
A. The peak pressure exerted against the arteries during heart contraction
B. The residual pressure in the arteries during ventricular relaxation
C. The force created by the movement of blood through large arteries
D. The pressure in the arteries when the heart is at rest
B. The residual pressure in the arteries during ventricular relaxation
Rationale: Diastolic blood pressure (DBP) represents the residual pressure in the arteries during ventricular relaxation (or filling), whereas systolic blood pressure (SBP) is the pressure during ventricular contraction.
Which factor primarily contributes to systemic vascular resistance (SVR) in the body?
A. Cardiac output (CO)
B. Small arteries and arterioles
C. Large veins and venules
D. Heart rate (HR)
B. Small arteries and arterioles
Rationale: Systemic vascular resistance (SVR) is primarily created in small arteries and arterioles. These vessels regulate the resistance to blood flow, impacting blood pressure.
What is the definition of normal blood pressure according to the provided text?
A. SBP less than 140 mm Hg and DBP less than 90 mm Hg
B. SBP less than 120 mm Hg and DBP less than 80 mm Hg
C. SBP less than 100 mm Hg and DBP less than 60 mm Hg
D. SBP greater than 120 mm Hg and DBP greater than 80 mm Hg
B. SBP less than 120 mm Hg and DBP less than 80 mm Hg
Rationale: Normal blood pressure is defined as a systolic blood pressure (SBP) of less than 120 mm Hg and a diastolic blood pressure (DBP) of less than 80 mm Hg.
Which of the following factors has the most direct effect on blood pressure?
A. Cardiac output (CO)
B. Blood volume
C. Heart rate (HR)
D. Arterial compliance
A. Cardiac output (CO)
Rationale: Cardiac output (CO), which is the amount of blood pumped by the heart per minute, and systemic vascular resistance (SVR) are the main factors influencing blood pressure (BP).
Which of the following best describes systolic blood pressure (SBP)?
A. The pressure in the arteries when the heart is relaxed
B. The resistance to blood flow in the arterioles
C. The peak pressure exerted against the arteries during ventricular contraction
D. The residual pressure during ventricular filling
C. The peak pressure exerted against the arteries during ventricular contraction
Rationale: Systolic blood pressure (SBP) is the peak pressure exerted on the arterial walls during ventricular contraction.
If systemic vascular resistance (SVR) increases, what is the likely effect on blood pressure?
A. Blood pressure decreases
B. Blood pressure remains unchanged
C. Heart rate decreases
D. Blood pressure increases
D. Blood pressure increases
Rationale: An increase in systemic vascular resistance (SVR) increases the resistance to blood flow, which in turn increases blood pressure.
A 56-year-old male is admitted to the ICU with a suspected hypertensive crisis. His BP is measured using a sphygmomanometer. The nurse hears the Korotkoff sounds and notes the first sound at 180 mm Hg and the fifth sound at 120 mm Hg.
What should the nurse report as the patient’s BP?
A. 180/120 mm Hg
B. 120/80 mm Hg
C. 180/120 mm Hg with an auscultatory gap
D. 180/120 mm Hg with a pulse deficit
A. 180/120 mm Hg
Rationale: The first Korotkoff sound represents the systolic BP (SBP) and the fifth Korotkoff sound represents the diastolic BP (DBP).
Which of the following is true regarding the measurement of BP using an invasive method?
A. It requires catheter insertion into an artery and a transducer to measure pressure directly.
B. It uses a sphygmomanometer and stethoscope to measure BP.
C. It is less accurate than noninvasive BP measurement.
D. It is primarily used for routine blood pressure screening.
A. It requires catheter insertion into an artery and a transducer to measure pressure directly.
Rationale: Invasive arterial BP monitoring involves catheter insertion and a transducer to measure pressure directly.
A patient in the ICU requires invasive BP monitoring. The nurse is preparing to insert a catheter into the radial artery. What should the nurse prioritize before inserting the catheter?
A. Assessing the patient’s pulse in the radial artery.
B. Ensuring the patient is in a supine position.
C. Preparing the sphygmomanometer and stethoscope.
D. Applying an automated BP cuff on the upper arm.
A. Assessing the patient’s pulse in the radial artery.
Rationale: Before invasive BP monitoring, the nurse should assess the pulse to ensure the artery is patent for catheter insertion.
What is the correct method for measuring BP when the systolic pressure is unknown?
A. Inflate the cuff to 40 mm Hg above the estimated SBP.
B. Palpate the brachial pulse and inflate the cuff until the pulse ceases.
C. Inflate the cuff to 20 mm Hg below the expected SBP.
D. Auscultate for Korotkoff sounds to determine the SBP.
B. Palpate the brachial pulse and inflate the cuff until the pulse ceases.
Rationale: If the SBP is unknown, palpating the brachial pulse and inflating the cuff until the pulse ceases provides an estimate for SBP.
Which of the following are important factors for accurate noninvasive BP measurement? (Select all that apply.)
A. Using the correct size cuff.
B. Positioning the arm at heart level.
C. Inflating the cuff to 40 mm Hg above the DBP.
D. Avoiding the use of automated BP devices for critically ill patients.
E. Ensuring the patient is seated quietly for at least 5 minutes before measurement.
A. Using the correct size cuff.
B. Positioning the arm at heart level.
E. Ensuring the patient is seated quietly for at least 5 minutes before measurement.
Rationale: Correct cuff size, arm positioning at heart level, and a quiet rest period are essential for accurate BP readings.
What does an auscultatory gap refer to in BP measurement?
A. A miscalculation in cuff inflation during BP measurement.
B. A continuous sound during the deflation of the cuff.
C. A discrepancy between invasive and noninvasive BP readings.
D. A loss of sound between the systolic and diastolic pressures.
D. A loss of sound between the systolic and diastolic pressures.
Rationale: An auscultatory gap occurs when the Korotkoff sounds disappear between the SBP and DBP, which can lead to inaccurate readings.
A nurse is using a Doppler ultrasonic flowmeter to measure BP in a patient who has peripheral vascular disease. What should the nurse do to ensure an accurate reading?
A. Inflate the cuff 20 to 30 mm Hg above the expected SBP.
B. Use an automated oscillometric BP device.
C. Listen for the Korotkoff sounds at the brachial artery.
D. Position the Doppler transducer over the femoral artery.
A. Inflate the cuff 20 to 30 mm Hg above the expected SBP.
Rationale: The Doppler ultrasonic flowmeter requires cuff inflation to 20 to 30 mm Hg above the expected SBP to ensure the return of the pulse sounds.
What is the primary purpose of using a sphygmomanometer and stethoscope to measure BP?
A. To obtain invasive BP measurements.
B. To measure pulse rate and oxygen saturation.
C. To assess for Korotkoff sounds in the brachial artery.
D. To obtain noninvasive, indirect BP measurements.
D. To obtain noninvasive, indirect BP measurements.
Rationale: The sphygmomanometer and stethoscope are used to measure BP noninvasively by detecting Korotkoff sounds in the brachial artery.
A 72-year-old patient with hypertension is receiving noninvasive BP monitoring. The nurse auscultates for Korotkoff sounds and notices an auscultatory gap. How should the nurse proceed with BP measurement?
A. Ignore the auscultatory gap and record the first and fifth sounds.
B. Discontinue the measurement and call the physician for an invasive BP procedure.
C. Inflate the cuff 20 to 30 mm Hg above the point where the sounds were first heard.
D. Inflate the cuff to 40 mm Hg above the SBP and repeat the measurement.
C. Inflate the cuff 20 to 30 mm Hg above the point where the sounds were first heard.
Rationale: The auscultatory gap should be accounted for by inflating the cuff above the point where the sounds were first heard to ensure accurate BP measurement.
Which factors can lead to inaccurate BP readings? (Select all that apply.)
A. Using an improperly sized cuff.
B. Positioning the arm above the heart level.
C. Rapid cuff deflation.
D. The patient being in a seated position for less than 5 minutes.
E. The stethoscope not placed properly over the artery.
all of the choices are correct
Rationale: Any of these factors can contribute to inaccuracies in BP measurement, leading to erroneous readings.
A nurse is caring for a patient in the ICU who requires continuous invasive BP monitoring. Which of the following should the nurse monitor to ensure accurate readings?
A. The accuracy of automated oscillometric measurements.
B. The positioning of the catheter and transducer.
C. The presence of an auscultatory gap.
D. The placement of the stethoscope during measurement.
B. The positioning of the catheter and transducer.
Rationale: For continuous invasive BP monitoring, the nurse must ensure that the catheter and transducer are positioned correctly to obtain accurate readings.
A nurse is preparing to measure BP using an automated oscillometric device. What should the nurse consider to ensure accuracy?
A. Avoid placing the cuff over clothing.
B. Inflate the cuff to 40 mm Hg above the SBP.
C. Ensure the patient is lying flat during the measurement.
D. Use the device for critically ill patients only.
A. Avoid placing the cuff over clothing.
Rationale: Placing the cuff over clothing can result in inaccurate readings, so the cuff should be placed directly on the skin.
A nurse is measuring a patient’s BP using a sphygmomanometer. The nurse hears a tapping sound at 150 mm Hg and a muffled sound at 110 mm Hg. What should the nurse record as the BP?
A. 150/110 mm Hg
B. 150/70 mm Hg
C. 150/100 mm Hg
D. 150/90 mm Hg
A. 150/110 mm Hg
Rationale: The tapping sound corresponds to the systolic pressure, and the muffled sound corresponds to the diastolic pressure.
What does the fifth phase of Korotkoff sounds represent?
A. Systolic BP.
B. Diastolic BP.
C. The disappearance of sounds.
D. The return of blood flow.
B. Diastolic BP.
Rationale: The fifth phase of Korotkoff sounds represents the disappearance of sounds, which indicates the diastolic BP.
Which of the following can affect the accuracy of BP readings when using a sphygmomanometer? (Select all that apply.)
A. The patient talking during the measurement.
B. The arm being positioned at heart level.
C. The cuff being too tight.
D. The nurse listening for Korotkoff sounds accurately.
E. The cuff size being appropriate for the patient’s arm.
A. The patient talking during the measurement.
C. The cuff being too tight.
D. The nurse listening for Korotkoff sounds accurately.
E. The cuff size being appropriate for the patient’s arm.
Rationale: Talking, a tight cuff, and incorrect sound interpretation can lead to inaccurate readings, while correct positioning and cuff size ensure accuracy.
A 65-year-old patient with diabetes is using a Doppler ultrasonic flowmeter to assess their BP. The nurse inflates the cuff until the sounds disappear and then inflates the cuff another 20 mm Hg. When the sounds return, the nurse records the SBP at 140 mm Hg. What is the next step?
A. Record the DBP as the point when the sound disappears.
B. Deflate the cuff to 100 mm Hg and measure the BP again.
C. Document the BP as 140/90 mm Hg.
D. Repeat the measurement at least twice for accuracy.
D. Repeat the measurement at least twice for accuracy.
Rationale: To ensure accuracy, the BP measurement should be repeated and averaged, especially when using a Doppler ultrasonic flowmeter.
A patient presents with a BP of 140/90 mm Hg. What is the pulse pressure for this patient?
A. 50 mm Hg
B. 40 mm Hg
C. 30 mm Hg
D. 20 mm Hg
A. 50 mm Hg
Rationale: Pulse pressure is the difference between systolic and diastolic BP. In this case, 140 - 90 = 50 mm Hg.
A 70-year-old patient with a history of atherosclerosis presents with a BP of 160/90 mm Hg. The nurse notes an increased pulse pressure. What is the most likely cause of this increased pulse pressure in this patient?
A. Heart failure
B. Hypovolemia
C. Atherosclerosis of the larger arteries
D. Anemia
C. Atherosclerosis of the larger arteries
Rationale: Atherosclerosis can cause increased pulse pressure due to the stiffening of the large arteries, leading to higher systolic BP.
A patient with a BP of 90/60 mm Hg is admitted to the hospital with signs of shock. What is the patient’s mean arterial pressure (MAP)?
A. 60 mm Hg
B. 65 mm Hg
C. 70 mm Hg
D. 75 mm Hg
B. 65 mm Hg
Rationale: MAP is calculated as DBP + (SBP - DBP)/3. In this case, MAP = 60 + (90 - 60)/3 = 60 + 30/3 = 65 mm Hg.
Which of the following factors can lead to a decreased pulse pressure? (Select all that apply.)
A. Heart failure
B. Hypovolemia
C. Atherosclerosis
D. Exercise
E. High SBP
A. Heart failure
B. Hypovolemia
Rationale: Decreased pulse pressure may occur in conditions like heart failure or hypovolemia, as these conditions reduce the difference between SBP and DBP.
Why is the mean arterial pressure (MAP) not simply the average of the SBP and DBP?
A. Systole lasts longer than diastole, so the MAP gives more weight to SBP.
B. Diastole lasts longer than systole, so the MAP gives more weight to DBP.
C. The SBP and DBP are not accurate representations of the actual pressure.
D. MAP calculations are based on the length of the cardiac cycle.
B. Diastole lasts longer than systole, so the MAP gives more weight to DBP.
Rationale: MAP takes into account the fact that diastole is longer than systole, so it is not a simple average of SBP and DBP.
A 55-year-old patient with a BP of 110/50 mm Hg is being assessed for organ perfusion. What is the patient’s mean arterial pressure (MAP), and is it adequate for perfusion?
A. MAP is 65 mm Hg, and it is adequate for perfusion.
B. MAP is 60 mm Hg, and it is adequate for perfusion.
C. MAP is 70 mm Hg, and it is inadequate for perfusion.
D. MAP is 60 mm Hg, and it is inadequate for perfusion.
A. MAP is 65 mm Hg, and it is adequate for perfusion.
Rationale: MAP = DBP + (SBP - DBP)/3, so MAP = 50 + (110 - 50)/3 = 50 + 60/3 = 65 mm Hg. A MAP greater than 60 mm Hg is usually adequate for organ perfusion.
A nurse is monitoring a critically ill patient. The patient’s BP is recorded as 80/40 mm Hg. What is the most likely result of prolonged low MAP in this patient?
A. Improved tissue perfusion
B. Ischemia of vital organs
C. Increased cardiac output
D. Improved blood flow to the brain
B. Ischemia of vital organs
Rationale: A MAP below 60 mm Hg for a prolonged period can lead to ischemia of vital organs due to inadequate perfusion.
Which of the following changes in the cardiovascular system is most commonly observed in older adults?
A. Decreased collagen in the heart
B. Decreased sensitivity to β-adrenergic agonist drugs
C. Decreased arterial sensitivity to vasopressin
D. Increased number of pacemaker cells in the SA node
B. Decreased sensitivity to β-adrenergic agonist drugs
Rationale: As people age, the number and function of β-adrenergic receptors in the heart decrease, leading to a reduced cardiovascular response to physical and emotional stress and less sensitivity to β-adrenergic drugs.
A 72-year-old patient presents with symptoms of dizziness and lightheadedness upon standing. The nurse assesses the patient and finds that their blood pressure drops significantly upon standing. What is the most likely cause of this symptom in an older adult?
A. Orthostatic hypotension
B. Acute myocardial infarction
C. Postprandial hypotension
D. Dehydration
A. Orthostatic hypotension
Rationale: In older adults, the sympathetic nerve pathway’s blunted response to changes in position can lead to orthostatic hypotension, which causes a drop in blood pressure when standing, resulting in dizziness or lightheadedness.
Which cardiovascular change in older adults can lead to an increased pulse pressure?
A. Decreased collagen in the heart
B. Increased sensitivity to vasopressin
C. Arterial thickening and loss of elasticity
D. Increased β-adrenergic receptor activity
C. Arterial thickening and loss of elasticity
Rationale: As arteries thicken and lose elasticity with aging, systolic blood pressure (SBP) tends to rise while diastolic blood pressure (DBP) remains the same or decreases, leading to an increased pulse pressure.
An older adult is diagnosed with aortic stenosis. What heart sounds would the nurse expect to hear during auscultation?
A. Systolic murmur with a whooshing sound
B. Diastolic murmur with a whooshing sound
C. Systolic click with a high-pitched sound
D. Continuous murmur with a rumbling sound
A. Systolic murmur with a whooshing sound
Rationale: Aortic stenosis causes narrowing of the aortic valve orifice, which leads to turbulent blood flow during systole, producing a systolic murmur that is often described as a whooshing sound.
Which of the following are likely to be observed in the cardiovascular system of an older adult? (Select all that apply.)
A. Stiffening of the heart valves
B. Decreased number of pacemaker cells
C. Increased responsiveness to vasopressin
D. Increased number of β-adrenergic receptors
E. Thickening and loss of elasticity in arteries
A. Stiffening of the heart valves
B. Decreased number of pacemaker cells
E. Thickening and loss of elasticity in arteries
Rationale: Age-related changes include stiffening of the heart valves, a decrease in pacemaker cells in the SA node, and thickening and loss of elasticity in arteries. These changes contribute to cardiovascular issues such as heart murmurs, dysrhythmias, and elevated blood pressure.
A 75-year-old patient reports feeling lightheaded after meals. Their blood pressure is measured before and after eating, showing a 20 mm Hg drop in systolic blood pressure. What condition does this suggest?
A. Acute myocardial infarction
B. Orthostatic hypotension
C. Postprandial hypotension
D. Chronic hypertension
C. Postprandial hypotension
Rationale: Postprandial hypotension is a condition common in older adults where a significant drop in blood pressure occurs within 75 minutes after eating. It can lead to symptoms like dizziness and increase the risk of falls.
What effect does aging have on the cardiovascular response to exercise in older adults?
A. Increased cardiac output during exercise
B. Increased systolic blood pressure with a normal diastolic BP
C. No change in cardiac output during exercise
D. Decreased cardiac output during exercise
D. Decreased cardiac output during exercise
Rationale: In older adults, due to changes in heart muscle function, the cardiovascular response to exercise is blunted, and the increase in cardiac output (CO) is much smaller compared to younger adults.
An older patient presents with a history of coronary artery disease (CAD) and reports feeling more fatigued with less physical activity than in previous years. The nurse notes decreased stretch and contractility of the heart. What changes are contributing to these symptoms?
A. Decreased collagen in the heart and increased elasticity
B. Decreased collagen and decreased elastin in the heart
C. Increased number of pacemaker cells and increased elasticity
D. Increased heart valve rigidity and decreased collagen
B. Decreased collagen and decreased elastin in the heart
Rationale: Aging results in increased collagen and decreased elastin in the heart muscle, which affects its ability to stretch and contract efficiently, leading to reduced cardiac output and symptoms like fatigue with less activity.
Which of the following are risk factors for cardiovascular disease (CVD) in older adults? (Select all that apply.)
A. Age
B. Physical inactivity
C. Healthy diet
D. Smoking
E. Low cholesterol levels
A. Age
B. Physical inactivity
D. Smoking
Rationale: Age is a major risk factor for CVD, and physical inactivity and smoking are significant contributors to cardiovascular disease in older adults. A healthy diet and low cholesterol levels are protective factors.
Which of the following findings on an ECG is most commonly seen in older adults?
A. Shortened PR interval
B. Increased QT interval
C. Decreased heart rate
D. Increased pacemaker cell activity
B. Increased QT interval
Rationale: The number of pacemaker cells in the SA node and conduction cells in the heart decreases with age, which often results in prolonged conduction times, such as an increased QT interval on the ECG.
A 68-year-old patient presents with swelling in the lower legs and feet. They report prolonged standing and difficulty walking. What is the most likely cause of the edema?
A. Venous insufficiency due to weakened leg vein valves
B. Acute renal failure due to weakened leg vein valves
C. Left-sided heart failure due to weakened leg vein valves
D. Hyperthyroidism due to weakened leg vein valves
A. Venous insufficiency due to weakened leg vein valves
Rationale: In older adults, the valves in the large veins of the legs become less effective, leading to venous insufficiency and the accumulation of fluid in the lower extremities, causing edema.
What is the primary cause of coronary artery disease (CAD) in older adults?
A. Diabetes mellitus
B. Atherosclerosis
C. Hypertension
D. Physical inactivity
B. Atherosclerosis
Rationale: Atherosclerosis, the buildup of plaque in the arteries, is the most common cause of CAD, and it is a primary contributor to cardiovascular disease in older adults.
Which factors increase the risk of falls in older adults with cardiovascular issues? (Select all that apply.)
A. Orthostatic hypotension
B. Postprandial hypotension
C. Increased β-adrenergic receptor activity
D. Decreased heart rate variability
E. Blunted heart rate response to positional changes
A. Orthostatic hypotension
B. Postprandial hypotension
D. Decreased heart rate variability
E. Blunted heart rate response to positional changes
Rationale: Orthostatic hypotension, postprandial hypotension, decreased heart rate variability, and blunted heart rate response to positional changes can all increase the risk of falls in older adults with cardiovascular issues.
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
c. Right atrium and right ventricle
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 that apply)
a. AV node
b. Left ventricle
c. Coronary sinus
d. Right ventricle
e. Pulmonic valve
a. AV node
b. Left ventricle
d. Right ventricle
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
b. Endothelial layer of the arteries
Which homeostatic mechanism is stimulated to compensate for a rise in blood pressure?
a. Baroreceptors that inhibit the sympathetic nervous system, causing vasodilation
b. Chemoreceptors that inhibit the sympathetic nervous system, causing vasodilation
c. Baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation
d. Chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate
a. Baroreceptors that inhibit the sympathetic nervous system, causing vasodilation
Which action does the P wave on an ECG represent?
a. Firing of the SA node and repolarizing the atria
b. Firing of the SA node and depolarizing the atria
c. Conduction through the AV node and depolarizing the atria
d. Conduction through the AV node and spreading to the bundle of His
b. Firing of the SA node and depolarizing the atria
Which condition is likely to cause a pulse deficit of 23 beats?
a. Dysrhythmia
b. Heart murmur
c. Gallop rhythm
d. Pericardial friction rub
a. Dysrhythmia
Which finding is expected in the assessment of an 81-year-old patient?
a. Narrowed pulse pressure
b. Diminished carotid artery pulses
c. Difficulty isolating the apical pulse
d. Increased heart rate in response to stress
c. Difficulty isolating the apical pulse
An older adult patient who has just arrived in the emergency department has a pulse deficit of 46 beats. Which intervention would the nurse anticipate for this patient?
a. Cardiac catheterization
b. Hourly blood pressure checks
c. Electrocardiographic monitoring
d. Emergent synchronized cardioversion
c. Electrocardiographic monitoring
Rationale: Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It indicates that there may be a cardiac dysrhythmia that would best be detected with ECG monitoring. Frequent BP monitoring, cardiac catheterization, and emergent cardioversion are used for diagnosis and/or treatment of cardiovascular disorders but would not be as helpful in determining the immediate reason for the pulse deficit.
How would the nurse document a loud humming sound auscultated over the patient‘s abdominal aorta?
a. Thrill
b. Bruit
c. Murmur
d. Normal finding
b. Bruit
Rationale: A bruit is the sound created by turbulent blood flow in an artery. Auscultating a bruit in an artery is not normal and indicates pathology. Thrills are palpable vibrations felt when there is turbulent blood flow through the heart or in a blood vessel. A murmur is the sound caused by turbulent blood flow through the heart.
Which parameter will the nurse use to evaluate changes in a patient‘s right ventricular afterload?
a. Central venous pressure (CVP)
b. Systemic vascular resistance (SVR)
c. Pulmonary vascular resistance (PVR)
d. Pulmonary artery wedge pressure (PAWP)
c. Pulmonary vascular resistance (PVR)
Rationale: PVR is a measure of right ventricular afterload, which is elevated in conditions such as pulmonary hypertension The other parameters do not directly assess for right ventricular afterload.
A patient requires arterial pressure monitoring. Which action would the nurse plan to take?
a. Balance and calibrate the monitoring equipment every 2 hours.
b. Position the zero-reference stopcock line level with the phlebostatic axis.
c. Disconnect the low pressure alarm to avoid disturbing the patient‘s sleep.
d. Ensure that the patient is supine with the head of the bed flat for all readings.
b. Position the zero-reference stopcock line level with the phlebostatic axis.
Rationale: For accurate measurement of pressures, the zero-reference level would be at the phlebostatic axis. There is no need to rebalance and recalibrate monitoring equipment every 2 hours. Accurate hemodynamic readings are possible with the patient‘s head raised to 45 degrees or in the prone position. Alarms should be activated; if the pressure in the line falls (e.g., when the line is disconnected), the low-pressure alarm sounds immediately and notifies staff to promptly correct the problem.
