FUNDA LECTURIO Flashcards
Before administering a diuretic to a client, what should the nurse assess?
Blood pressure
What essential laboratory parameter should the nurse evaluate before administering fast-acting insulin
Blood sugar
What should the nurse anticipate when digoxin is given to a client with low serum potassium?
An increased risk of toxicity from the medication
What is a possible side effect of a rapid infusion of vancomycin?
Flushing
What should the nurse ask the client about to properly evaluate the risk of drug interactions?
Over-the-counter medications or herbal supplements taken, Current medications prescribed by the health care provider, Vitamins and minerals taken without prescription, Nutritional and medication allergies
What precautions should the nurse educate their client about when they prescribed a central acting antihistamine drug like diphenhydramine?
Do not mix diphenhydramine with other central nervous system depressants like alcohol
What is the best source of information when a question arises regarding the potential interaction of a medication?
A pharmacist
What should the nurse do when a client has an allergy or contraindication to a drug that a health care provider has prescribed?
Hold the medication and contact the health care provider
What is the primary reason for evaluating the effectiveness of a drug after administration?
It confirms if the drug is achieving its intended action
What blood test would the nurse expect a health care provider to order for a client’s partial pressure of oxygen (PaO2) levels?
Arterial blood gases (ABG)
Supplemental oxygen is considered a medical treatment. What should the nurse understand about administering supplemental oxygen to a client?
It is a drug and must be ordered by a health care provider
What are signs of significant respiratory problems?
Tachypnea, Wheezing stridor and moaning, Flaring of nostrils with breathing, Pursed-lip breathing
What would the nurse expect when applying a pulse oximeter(SaO2) to a client with Raynaud’s disease?
Poor perfusion in fingers and toes will not give an accurate SaO2 reading
What is less invasive and indirect measure to monitor a client’s ratio of oxyhemoglobin to deoxyhemoglobin level?
Pulse oximetry (SaO2)
What does the pulse oximetry, or SaO2 represent?
The percentage of oxygen saturation of hemoglobin
What type of oxygen delivery system would likely be needed by a client with chronic obstructive pulmonary disease and stable respiratory patterns and rate?
The client needs a low flow system, such as a nasal cannula
What are the examples of high flow supplemental oxygen?
Mechanical ventilations, Continuous positive airway pressure(CPAP), Nebulizer, Bilevel positive airway pressure (BIPAP)
What is the difference between low flow and high flow supplemental oxygen?
Low flow systems provide oxygen at flow rates that are lower than client’s inspiratory demands
Which statements regarding the proper handling and storage of portable oxygen tanks are true?
Oxygen in a cylinder is stored under pressure and if damaged it can become a missile and shoot off at a high speed, Oxygen tanks should always be stored in a stand or cart, Portable oxygen tanks should never be left freestanding
The flow meter is an instrument connected to the wall that is intended for delivering and measuring the amount of oxygen being administered. What do the numbers on the flow meter indicate?
Liters per minute
What is the average percentage of oxygen in breathable room air (FiO2)?
21%
If a client will receive high flow oxygen for more than 24 hours, what should the nurse consider an appropriate nursing intervention to help tolerate the oxygen?
Humidify the oxygen
What are the indicated flow rates in liters per minute(LPM) when using nasal prongs?
1-6 LPM
Which actions are appropriate for the nurse to take when applying a nasal cannula to a client?
Wrap the tubing with fabric or foam tape to help alleviate uncomfortable friction behind the ears, Check the cannula size is not too big or too small for the client’s nose, Turn the cannula so the prongs are curved downward into the client’s nose
Every increase of 1L/min oxygen equates to about what percentage increase in fraction of inspired oxygen (FiO2)?
4%
How many liters per minute of oxygen can be delivered when applying a simple face mask to a client?
5-10 LPM
Why are the partial rebreather oxygen masks not able to deliver 100% oxygen concentration?
They lack a one-way valve to prevent expired air from returning to the client
What features of a non-rebreather mask should the nurse understand when considering oxygenating clients with a non-rebreather mask?
Prolonged periods of over oxygenating at 15 liters per minute can be harmful, They can be used for clients who severely hypoxic but can ventilate well, They can be set between 10 and 15 liters per minute, Flow must be sufficient to keep the reservoir bag from deflating upon inspiration
Unlike simple masks what feature do reservoir masks have to prevent the client from inhaling expired air?
One-way valves
Which type of oxygen administration methods can deliver 100% oxygen?
Ventilator, Tightfitting non-rebreather masks
Partial rebreather and non-rebreather reservoir masks are indicated in which types of clients?
People with serious respiratory conditions in need of higher concentrations of oxygen
What are examples of low flow oxygen delivery methods?
Nasal cannulas, Reservoir masks, Simple face masks
What is another term for a Venturi mask?
Air entertainment mask
What is the medical term for surgically created opening in the neck where a tube is inserted to deliver air?
Tracheostomy
What is common non-invasive ventilation method used to treat clients with chronic obstructive pulmonary disease and acute respiratory distress syndrome exacerbations?
Bilevel positive airway pressure (BiPAP)
What is a common non-invasive ventilation method used to treat clients with obstructive sleep apnea and acute pulmonary edema?
Continuous positive airway pressure (CPAP)
What is a popular method of adult respiratory management in both the emergency department (ED) and the intensive care unit that is increasingly used in pediatric units?
Non-invasive ventilation
What is functional residual capacity(FRC)?
Increased volume of air present in the lungs at the end of passive expiration to reduce alveolar collapse
What are the usual settings for continuous positive airway pressure?
5, 7.5, and 10 cm of H2O
What is the purpose of continuous positive airway pressure?
Deliver continuous positive pressure to reduce alveolar collapse
With which interdisciplinary team member should the nurse collaborate regarding a client’s bilevel positive airway pressure machine?
Respiratory therapy staff
What are the potential client risks when setting the inspiratory pressure > 20-25 cm H2O?
Aspiration, Decreased diaphragmatic excursion, Gastric distention
What is usually the expiratory pressure setting for bilevel positive airway pressure?
4-6 cm H2O
What does the acronym BiPAP stand for?
Bilevel positive airway pressure
What physician led intervention should the nurse anticipate if a client is not responding to bilevel positive airway pressure within the first 20-40 mins?
Perform endotracheal intubation
What are the benefits to non-invasive positive pressure ventilation?
Less need for invasive endotracheal intubation, Greater improvements in the first hour after treatment, Shorter length of stay in the hospital, A lower mortality rate
Why are Venturi masks especially helpful for clients with chronic obstructive pulmonary disease?
They offer precise O2 measurement
Which chamber of the heart pumps blood through the pulmonary circuit?
Right ventricle
Which chamber of the heart pumps blood through the systemic circuit?
Left ventricle
Which chamber of the heart receives blood returning from the systemic circuit?
Right atrium
Which chamber of the heart receives blood returned from the pulmonary circuit?
Left atrium
Which part of the heart receives oxygen-poor blood from the tissues?
Right side
Which part of the heart receives oxygenated blood from the lungs?
Left side
What is the most superficial layer of the heart?
Fibrous Pericardium
What is the function of the superior vena cava?
Returns blood from body regions above the diaphragm into the right atrium
What is the function of the inferior vena cava?
Returns blood from body regions below the diaphragm into the right atrium
What is the function of the coronary sinus?
Returns blood from coronary veins into the right atrium
What is the tricuspid valve’s main function?
Atrioventricular valve that separates the right atrium and right ventricle
What is the bicuspid valve’s main function?
Atrioventricular valve that separates the left atrium and the left ventricle
What is the aortic valve’s main function?
Semilunar valve that separates the left ventricle and the aorta
What is the pulmonary valve’s main function?
Semilunar valve that separates the right ventricle and the pulmonary trunk
What is contained within the myocardium?
Circular or spiral bundles of contractile cardiac muscle cells
What is the purpose of chordae tendineae?
To anchor the cusps of the atrioventricular valves to papillary muscles to promote stabilization of the valve as the heart pumps blood
Which structure returns blood below the diaphragm?
Inferior vena cava
Which characteristics are associated with the pulmonary circuit?
Transport of oxygenated blood, Short low-pressure circulation, Transport of deoxygenated blood
Which characteristics are associated with the coronary circulation?
It creates a functional blood supply to the heart, It has the shortest circulation in the body, It is delivered when the heart is relaxed
Which is the term used to describe the part of the heart that is encircled by the left and right coronary arteries?
Coronary sulcus
Which are the different types of myocytes?
Pacemaker and Contractile cells
Which characteristics are associated with cardiac muscles?
Interconnected, Striated, Branched
What holds cardiac cells together and prevents them from separating during contraction?
Desmosomes
How are cardiac muscles different from skeletal muscles?
Cardiac muscles have more mitochondria, Cardiac muscles are more adaptable to other fuels, Cardiac muscles need oxygen to function
Which part of the brain is responsible for sending signals to the heart?
Medulla oblongata
What part of the heart can be found in the inferior portion of the interatrial septum?
Atrioventricular node
What does cardioacceleratory center stimulate in the heart by sending signals through the sympathetic trunk?
Atrioventricular and Sinoatrial nodes
What nerve helps parasympathetic signals to decrease the heart rate?
Vagus nerve
What is the term for the process that opens fast voltage gated Na+ channels and allows Na+ to enter cardiac muscle cells?
Depolarization
What represents the depolarization of the SA node and atria on a ECG?
P wave
What represents the beginning of atrial excitation to the beginning of ventricular excitation on an ECG?
P-R interval
What represents depolarization of the ventricles on an ECG?
QRS complex
What represents the beginning of ventricular depolarization through ventricular repolarization on an ECG?
Q-T interval
What represents the time between ventricular depolarization and ventricular repolarization on an ECG?
S-T segment
What represents ventricular repolarization on an ECG?
T wave
The nurse places their stethoscope on the far left side of the client’s chest, below the client’s axilla and close to the client’s nipple. The student nurse knows that the nurse will be able to hear the opening and closing of which valve the best in this location?
Mitral
What is the definition of a cardiac output?
the volume of blood pumped by each ventricle in 1 minute
What is the formula for calculating cardiac output?
CO = heart rate x stroke volume
What 3 main factors affect stroke volume?
Preload, Contractility, and afterload
What is the definition of a cardiac preload?
The degree to which cardiac muscle cells are stretched just before they contract
How is contractility defined?
The contractile strength at the given muscle length independent of muscle stretch and end-diastolic volume
What is the definition of a afterload?
The pressure that the ventricles must overcome to eject blood
Which events occur during isovolumetric relaxation?
Aortic valved is closed, Dicrotic notch occurs, Mitral valve is closed
Which mechanical events are part of the diastolic phase of a heartbeat?
Isovolumetric relaxation, Mitral and tricuspid valves are open, Rapid inflow of blood to ventricles
What factor that affects the stroke volume is increased by hypertension?
Afterload
What is a common manifestation of right-sided heart failure?
Peripheral congestion
What is a common manifestation of left sided heart failure?
Pulmonary congestion
What congenital heart defect is defined by part of a vessel being narrowed therefore increasing the workload of the left ventricle?
Coarctation of the aorta
What progressive condition results in cardiac output so low that the blood circulation cannot meet the tissue requirements?
Congestive heart failure
How does age affect a client’s heart rate?
As age increases the heart rate decreases
How does body temperature affect heart rate?
As body temperature increases heart rate increases
What are the 2 main ions that directly affect normal heart function?
Calcium and potassium
When the sympathetic nervous is activated, what happens with the parasympathetic nervous system?
It is inhibited
When norepinephrine is released, what receptors does it bind to in order to affect the heart rate?
Beta 1-adregenic receptors on the heart
How many valves are in the heart?
2 atrioventricular valves and 2 semilunar valves
What are the types of circulation?
Pulmonary, Systemic, Coronary
What is best description of the function of blood vessels?
To be the delivery system of dynamic structures that begins and ends at the heart and work with the lymphatic system to circulate fluids
What is the function of the veins?
To carry deoxygenated blood toward the heart except for pulmonary circulation and the umbilical vessels of a fetus
What is the function of the arteries?
To carry oxygenated blood away from the heart except for pulmonary circulation and umbilical vessels of a fetus
What is the function of the capillaries?
To have direct contact with tissue cells and directly serve cellular needs
What are the terms for the 3 layers that most vessels have?
Tunica intima, tunica media, and tunica externa
What is an accurate description of the tunica intima?
The innermost layer that is in intimate contact with blood
What is an accurate description of the tunica media?
The middle layer composed mostly of smooth muscle and sheets of elastin
What is best description of the tunica externa?
The outermost layer of the vessel wall
What are the three groups of arteries?
Elastic arteries, muscular arteries, and arterioles
Which group of arteries allows for continuous blood flow downstream even between heartbeats?
Elastic arteries
What is another name for arterioles?
Resistance arteries
What is another name for muscular arteries?
Distributing arteries
Which structures are described as continuous, fenestrated, and sinusoidal?
Capillaries
Which type of capillary makes up the blood-brain barrier?
Continuous
Which type f capillary is found only in the liver, bone marrow, spleen and adrenal medulla?
Sinusoidal
How is capillary bed best defined?
An interwoven network of capillaries between arterioles and venules
Which vessels are also called capacitance vessels?
Veins
What prevents the backflow of blood in veins?
Venous valves
What type of anastomoses provides an alternative pathway to ensure continuous systemic blood flow even if one artery is blocked?
Arterial anastomoses
What does the force per unit area exerted on the walls of blood vessels by the blood refer to?
Blood pressure
Which term describes the sources that come from blood viscosity, total blood vessel length, and blood vessel diameter?
resistance
If the blood pressure gradient increases, what impact does it have on blood flow?
It speeds up
If peripheral resistance increases how does that impact blood flow?
It decreases
Which term describes the throbbing of arteries due to the difference in pulse pressures that can be felt under the skin?
Pulse
Which two factors determine arterial blood pressure?
Elasticity of arteries close to the heart and the volume of blood forced into them at any time
What best describes systolic blood pressure?
Pressure exerted in the aorta during ventricular contraction
Which best describes diastolic blood pressure?
The lowest level of aortic pressure when the heart is at rest
Which formula is utilized to calculate mean arterial pressure?
MAP = diastolic pressure + 1/3 x pulse pressure
What is considered the normal pressure measurement for systolic blood pressure?
90-120 mm Hg
What is considered the normal pressure measurement for diastolic blood pressure?
60-80 mm Hg
Which factors are responsible for aiding the return of venous blood?
Respiratory pump, muscular pump, sympathetic venoconstriction
What are the three main factors that regulate blood pressure?
Total peripheral resistance, cardiac output, blood volume
What can decrease blood pressure by antagonizing aldosterone?
Atrial natriuretic peptide
Which structures are involved in neural control of blood pressure via reflex arcs?
Baroreceptors, Cardiovascular center of medulla, chemoreceptors
What is the cardiovascular center composed of?
Parasympathetic and sympathetic neurons, medulla oblongata
Which functions are directly stimulated by arteriolar vasodilation?
reduces peripheral resistance, decreases mean arteriole pressure
Which renal blood pressure mechanism functions independent from hormones?
Direct
What is the difference between primary and secondary hypertension?
Primary hypertension has no underlying cause and secondary hypertension has an identifiable disorder causing the hypertension
What type of shock occurs when blood vessels inadequately fill and blood distribution through the body is impaired?
Circulatory shock
Which factors listed can influence blood pressure?
Weight, stress, changes in physical exertion, changes in posture
What is usually a hint of poor nutrition and a warning sign of Addison’s disease?
Chronic hypotension
Which hormone directly causes increased NaCl absorption in the kidney in response to low blood pressure?
Aldosterone
What type of shock is a result of extreme vasodilation and decreased peripheral resistance?
Vasogenic shock
What happens in the brain when the pH decreases or carbon dioxide concentrations increase?
Marked vasodilation
Which parts of the body are involved in the systemic circulation?
Aorta, superior vena cava, inferior vena cava
Which tunics are contained in blood vessels?
tunica media, intima, externa
Where is the velocity of blood flow fastest?
Aorta
What type of pressure is inconsequential?
Interstitial fluid colloid osmotic pressure
What system returns interstitial fluid to the blood?
Lymphatic system
The QRS complex reflects which event?
Ventricular depolarization
The T wave corresponds to which of the following?
Ventricular repolarization
The P wave corresponds to which of the following?
Atrial depolarization
Which of the following is true of the U wave?
Commonly seen in hypokalemia
Which of the following describes the electrical conduction pathway of the heart?
SA node –> atrium –>AV node –> His-Purkinje system –> ventricles
Which of the following is the normal pacemaker of the heart?
The SA node