Chapter 35 Extra Flashcards
During a wellness screening the nurse is assessing healthy individuals after exercise. The nurse observes both increased pulse and blood pressure values when compared to resting values. The nurse interprets these changes based on the understanding of which of the following?
A) these changes demonstrate cardiovascular pathology
B) these changes reflect the effects of acetylcholine on the cardiovascular system
C) these changes reflect the hearts ability to increase cardiac output based on demand for blood
D) these changes represent increased automaticity in pacemaker cells in the heart
C) These changes reflect the hearts ability to increase cardiac output based on demand for blood
The nurse is preparing to administer a drug with a therapeutic effect of decreasing cardiac afterload. It would be most important for the nurse to monitor which of the following parameters? A) Cardiac rhythm B) Urinary output C) Heart sounds D) Blood pressure
D) Blood pressure
A client’s heart rate and rhythm are sinus bradycardia at 45 beats/min. Alteration of function in which of the cardiac conduction system structures can cause this rate and rhythm?
A) sinoatrial (SA) node
B) bachmann’s bundle
C) bundle of his
D) purine fibers
A) sinoatrial (SA) node (60-100 BPM)
A client’s heart disease has resulted in a reduced stroke volume. What physiologic response would be expected to maintain normal cardiac output?
Heart rate would increase (CO=HR x SV)
The client is being given a drug that blocks the action of the sympathetic division of the autonomic nervous system. For which of the following cardiovascular clinical manifestations should the nurse remain alert?
A) increased heart rate, increased blood pressure
B) increased heart rate, decreased blood pressure
C) decreased heart rate, increased blood pressure
D) decreased heart rate, decreased blood pressure
D) decreased heart rate, decreased blood pressure
sympathetic system=increased vasodilation and increased blood pressure
The ______________ is the middle layer of the heart that consists of striated muscle fibers.
Myocardium
What is the patients cardiac output if the heart rate is 70 beats per min and the stroke volume is 50 mL?
3.5 L
CO= HR x SV
________________ (part of the cardiac cycle) begins with closure of the mitral and tricuspid valves.
Systole
The tendency to be self-initiating in the conductivity-contractility-relaxation cycle if no external stimulation is provided is called ___________.
Automaticity
A client has had a recent MI. Why is damage to the myocardium problematic for this client?
A) damage to the area causes plaque to build up on the heart valves
B) damage to this layer can decrease the contractile force of the heart
C) damage to this layer can lead to excessive cortisol and endorphin release
D) damage to this area causes striated heart muscle fibers to release damaging high-density lipoproteins
B) damage to this layer can decrease the contractile force of the heart
(The myocardium is the layer responsible for the contractile force of the hear)
A client with mitral valve disease has presented to the clinic for further evaluation of the mitral valve. Which chamber of the heart will be affected if the mitral valve is narrowed?
A) right atrium
B) left atrium
C) right ventricle
D) left ventricle
B) left atrium
(The mitral valve separates the left atrium from the left ventricle. Narrowing of this valve results in a damming of blood in the left atrium
What is the minimum mean arterial pressure (MAP) necessary to ensure adequate blood flow through the coronary arteries?
A) 80 mm Hg
B) 70 mm Hg
C) 60 mm Hg
D) 50 mm Hg
C) 60 mm Hg
What is the function of the property of automaticity in heart muscle?
A) to initiate an impulse in response to a stimulus
B) to transmit electrical impulses that are received
C) to respond to a stimulus only after re polarization
D) to spontaneously and repetively institute an impulse
D) to spontaneously and repetitively initiate an impulse
Automaticity refers to the ability of cardiac cells to spontaneously and repetitively initiate an impulse. The initiation of an impulse in response to a stimulus refers to excitability. The transmission of electrical impulses that are received refers to the property of conductivity, and the response to a stimulus only after repolarization refers to refractoriness.
A client brought to the emergency room following a myocardial infarction is found to be hypotensive. What effect from the baroreceptor stimulation on this clients heart rate would be expected?
A) the heart rate would increase
B) the heart rate would decrease
C) there would be no effect on heart rate
D) the heart rate would vacillate between accelerations and deceleration
A) the heart rate would increase
When a client experiences hypotension, baroreceptor in the aortic arch sense a pressure decrease in the vessels. The parasympathetic system responds by lessening the inhibitory effect on the SA node, and this results in an increase in heart rate.
A client’s heart disease has resulted in a reduced stroke volume. What physiologic response would be expected to maintain normal cardiac output?
A) mean arterial pressure would increase
B) mean arterial pressure would decrease
C) heart rate would increase
D) heart rate would decrease
C) heart rate would increase
Which conditions would lead to an increase in stroke volume?
A) increased preload, increased afterload
B) increased preload, decreased afterload
C) decreased preload, increased afterload
D) decreased preload, decreased afterload
B) increased preload, decreased afterload
An increased preload increases contractility; decreased afterload reduces the amount of resistance to ejection of blood from the left ventricle. Both changes together increase stroke volume of the left ventricle
What effect on blood pressure should the nurse expect when the client is given a drug that causes vasoconstriction?
A) increased diastolic blood pressure
B) decreased diastolic blood pressure
C) increased systolic blood pressure
D) decreased systolic blood pressure
A) increased diastolic blood pressure
Diastolic pressure is determined by the amount of vasoconstriction in the periphery. An increase in peripheral vascular resistance increases diastolic pressure.
The client is being given a drug that blocks the action of the sympathetic division of the autonomic nervous system. For which of the following cardiovascular clinical manifestations should the nurse remain alert?
A) increased heart rate, increased blood pressure
B) increased heart rate, decreased blood pressure
C) decreased heart rate, increased blood pressure
D) decreased heart rate, decreased blood pressure
C) decreased heart rate, increased blood pressure
The sympathetic nervous system directly stimulates the ventricles, increasing heart rate; it also causes vasoconstriction, increasing blood pressure. Agents that block sympathetic impulses decrease heart rate and blood pressure.
Beta blockers therapy is commonly used for those experiencing an acute myocardial infarction. Beta blocker therapy have several theoretical benefits such as: (select all that applying)
A) decreased preload B) increase afterload C) reduce myocardial oxygen demand D) reduce heart rate E) decrease contractility F) limit catecholamine stimulation of the heart G) anti-arrhythmic properties
A, C, D, E, F, and G
Which of the following factors tend to increase cardiac output? Select all that apply)
A) gradually increasing heart rates up to 150/ min
B) presence of atrial kick
C) increased preload
D) decreased afterload
A) gradually increasing the heart rates up to 150/min
D) decreased afterload
Acidosis impairs intercellular chemical reactions, potentially leading to cellular death.
A) true
B) false
True
Cardiac ischemia can cause: (select all that apply)
A) a decrease in contractility
B) decrease in energy production
C) increased intercellular acidity
D) days rhythmical
A, B, C, D
Pressure within the ventricle must overcome the arterial diastolic pressure before the semilunar valves open and blood is ejected.
A) true
B) false
True
A typical stroke volume for a healthy adult is:
A) 15-35 mL
B) 35-50 mL
C) 50-80 mL
D) 80-100 mL
C) 50-80 mL
Increased preload usually corresponds to increased contractility (force of contraction)
A) true
B) false
A) true
Patients with heart disease will most likely hemodynamics lily tolerate heart rates below 50 BPM and above 150 BPM.
A) true
B) false
A) true
What marker is NOT cardiac specific but is the earliest marker detected?
Myoglobin
What lab value is assessed in patients receiving heparin?
Partial thromboplastin time (PTT)
What lab values are monitored to assess anticoagulant status in Warfarin therapy?
Prothrombin time (PT) and international normalized ratio (INR)
CK-MB is the most specific for MI. When does the peak level occur after the onset of chest pain?
24 hours
Which serum markers are not found in healthy patients?
Troponins T and I
What happens to T-waves in hyperkalemia?
T-wave is elevated
Hypomagnesemia can cause what rhythm disturbance?
Torsades de Pointes
Why does the erythrocyte (RBC) count rise in patients with heart disease?
To compensate for decreased available oxygen
An elevation of which electrolyte causes a shortened QT interval, AV block, digitalis hypersensitivity, and cardiac arrest?
Hypercalcemia
Which electrolyte values reflect fluid balance?
Serum sodium values
What is the minimum mean arterial pressure (MAP) necessary to ensure adequate blood flow through the coronary arteries?
60 mm Hg
What is the function of the property of automaticity in heart muscle?
To spontaneously and repetitively initiate an impulse
What part of the cardiac cycle begins with closure of the mitral and tricuspid valves?
Systole
A patient brought to the emergency room following a myocardial infarction is found to be hypotensive. What effect from baroreceptor stimulation on this client’s heart rate would be expected?
The heart rate would increase
Which diagnostic assessment is the most invasive, yet is the most definitive in the diagnosis of heart disease?
Cardiac catheterization
What does a beta blocker block?
Beta blockers block the beta 1 adrenergic receptors in the heart
The nurse is preparing to administer a drug with a therapeutic effect of decreasing cardiac afterload. It would be most important for the nurse to monitor which parameter?
Blood pressure
Diltiazem is a calcium channel blocker (dysrhythmic) that may be used to convert what dysrhythmia to NSR?
Atrial fibrillation
What medication has short period of asystole after administration?
Adenocard
Hypokalemia can increase the risks of toxicity of what drug?
Digoxin
So that blood may flow from the right ventricle to the pulmonary artery, all of the following conditions must be met EXCEPT that
A) The atrioventricular valves must be closed
B) The pulmonic valve must be open
C) Right ventricular pressure must be less than pulmonary arterial pressure
D) Right ventricular pressure must rise with systole
C) Right ventricular pressure must be less than pulmonary arterial pressure
