Quiz # 2 study guide Flashcards
distinguish the different valves of the heart and its anatomical location and physiological function during the cardiac cycle
4 valves within the heart that keep the blood moving forward and prevent backflow.
- 2 atrioventricular (AV) valves.
- right AV valve,” tricuspid valve” because it has 3 flaps
- left AV valve (bicuspid) called mitral valve.
- the remaining 2 valves,
- semilunar valves
- pulmonary semilunar valve
what is the difference between an artery and a vein
- artery: carry blood away from the heart.
- veins: carry blood towards the heart
the pattern as follows:
artery—) arteriole—-) capillary —) venule—)vein
distinguish the difference between the “lubb” and “dubb” sounds of the cardiac cycle
- the first sound, lubb- (long duration and low pitch) is heard when the AV valves close
- the second sound, dubb-(short duration, sharp sound) is heard when the semilunar valves close
what happens during contraction, atrial depolarization, atriel repolarization, ventricular depolaration and ventricular repolarization
(1) heart wall completely relaxed, no change in electrical activity, ECG remains constant
(2) P wave occurs when the AV node and atrial walls depolarize
(3) atrial walls completely depolarized, no change recorded in ECG
(4) QRS complex occurs as the atria repolarize and the ventricular walls depolarize
(5) atrial walls completely repolarized, ventricular walls completely depolarized, no change in ECG
(6) T wave appears on the ECG when ventricular walls repolarize
(7) once ventricles are completely repolarized = back at baseline of the ECG essentially back to beginning
what are the harmful effects of continuous runs of premature ventricular contractions (PVC’s)
ventricular tachycardia
rate greater than 100
rhythm is regular or slightly irregular
why would a patient take coumadin for diagnoses of atrial fibrillation? what are the therapeutic levels for this medication, nurse teaching and side effects?
the goal of therapy is to prevent atrial thrombi from developing and embolizing, such as in the lungs or periphery
the goal of anticoagualtion is to maintain an INR between 2 and 3
-patients with atrial fibrillation are to be prescibed Coumadin and long-term antidysrhythemic medication therapy a
Which serum enzyme is used to diagnose a heart attack and the degree of it?
Troponin (Elevated 4-8 hours after a heart attack * peaks
B-type BNP indicates what
heart failure
A patient reports being diagnosed with a murmur. Which phenomenon can be used to explain what might be the cause of this occurrence?
ineffective closure of the valves
The nurse is caring for an older woman with cardiac disease. How does the older cardiac patient differ from the younger cardiac patient?
Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity
In evaluating risk factors for cardiovascular disease, which of the following does the nurse identify as a modifiable risk factor?
Hyperlipidemia
The nurse is caring for a patient with a new pacemaker. Nursing care for this patient would include what?
Monitoring the heart rate and rhythm by apical pulse and ECG patterns
A patient was admitted yesterday for a myocardial infarction. Which of the following statements is true regarding treatment for a patient with myocardial infarction?
The patient with an acute myocardial infarction will be on bed rest with commode privileges for 24 to 48 hours.
Cardiac Cycle
-1 cardiac cycle= 1 heartbeat = .8 seconds-Ventricles fill during diastole, then relax-Ventricles contract and eject blood into pulmonary and systemic circulation
What test evaluates balance? The client stands with eyes closing, minimal swaying is normal.
Romberg’s Test
What is MONA used to treat?; Remember O BATMAN
Myocardial Infarction Morphine, Oxygen, Nitrates, Aspirin O oxygen B Beta blockers A Aspirin T Thrombolytics (Heparin) M Morphine A ACE inhibitors- specially with HF and a low ejection fraction N Nitratess
What does the ABCD mnemonic for A-Fib stand for?
A- Anticoagulan
B- Beta blocker
C- Cardioversion ( if BB or calcium channel blocker not helping)
D- Digoxin
Impulse Pattern
SA node → AV node → bundle of His → right
and left bundle branches of AV bundle → Purkinje
fibers
Heart failure is managed with
digoxin, vasodilators, ACE inhibitors, beta blockers, and angiotensin II receptor blockers. Nesiritide is the first of the drug class called human BNPs. It reduces pulmonary capillary pressure, improves breathing, and causes vasodilation with increase in stroke volume and cardiac output.
what laboratory values are the most important to follow up
for patients who are on anticoagulant therapy.
Prothrombin time, International
Normalized Ratio, and partial thromboplastin
time reflect blood clotting
Angina pain is caused by
the temporary
lack of oxygen and blood supply to the
heart.
Myocardial infarction
A myocardial infarction results from the
occlusion of a major coronary artery or
one of its branches. This leads to ischemia.
12-lead ECG, chest radiograph, cardiac
fluoroscopy, myocardial imaging, echocardiogram,
PET scan, or multigated
acquisition scanning (MUGA).
Prevention of further tissue damage, interventions
to promote tissue perfusion
Monitor vital signs, administer oxygen,
monitor pain, administer medications as
ordered
Which of the following is/are true statements regarding angina pectoris? (Select all that apply.)
- indicates a lack of oxygen and blood supply to the heart.
- only occurs at rest.
- may resemble heartburn or indigestion.
- usually relieved by nitroglycerin.
- may appear as jaw pain.
During cardiac catheterization,
There is a potential for bleeding or injury to nerves, so
pulses and sensation distal to the site of insertion
must be checked.
In third-degree heart block,
the impulses to stimulate heart muscle contraction
are not being transmitted through the AV
junction. The rate is very slow and symptoms
of hypotension and angina are likely.
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. Which would be a correct interpretation based on these characteristics?
Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively.
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse?
- Call a code.
- Call the health care provider.
- Check the client’s status and lead placement.
- Press the recorder button on the electrocardiogram console. 3.
Check the client’s status and lead placement.
Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment.
A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item?
.Blood pressure and oxygen saturation
Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders, states of hypoxemia, or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine, nicotine, or alcohol.
The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse immediately would assess which item based on priority?
Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver
The nurse who is caring for the client after insertion of an automatic internal cardioverter-defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker. Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above which it will fire, and the number of shocks it is programmed to deliver. The remaining options are also nursing interventions but are not the priority.
A client’s electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm?
Sinus tachycardia
Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.
A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse best describe this type of anginal pain?
Variant angina
Variant angina, or Prinzmetal’s angina, is prolonged and severe and occurs at the same time each day, most often at rest. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction.
The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a ventricular rate of 150 beats/min. The nurse should next assess the client for which finding?
Hypotension
an electric shock to your chest; restores your regular heartbeat
cardioversion
part of the blood vessel is blocked
occlusion
the arteries are thicker and not as stretchy
arteriosclerosis
chest pain and chocking sensations that are relieved by nitroglycerin
angina pectoris
bulging of an artery, like a tire with a bulge
aneurysm
removing the plaque from the inner part of arteries
endarterectomy
the arteries are filling up with plaque and beginning to close
artherosclerosis
a condition that causes the blood to stop going to the arteries around the heart
coronary artery disease
an abnormal heartbeat
dysrhythmia
a blood clot or foreign matter travels into the bloodstream
embolus
the heart cannot pump correctly
heart failure
you do not have enough oxygen in your blood
hypoxemia
cramps and weakness in your legs caused by decreased blood flow to your muscles
intermittent claudication
a body part or organ is not getting enough blood, thus causin pain
ischemia
the heat is damaged by the lack of blood
myocardial infarction
fluid is collecting in the lining around the lungs
pleural effusion
you have too many red blood cells in your blood
polycythemia
your heart is not pumping effectively, causing fluid to settle in the lungs
pulmonary edema
during discharge teach, pt concerned about why risk of heart dz is elevated simply bcuz she has hx of DM
what is best explanation to give to pt
elevated bld glucose levels contribute to arterial damage
which psychosocial behaviors are more likely to be associated with increased cardiovascular symptoms
pessimistic and generally one who generally expresses negativity
pt cardiac monitor shows a regular rhythem with rate of 65 beats/min, P waves precede each QRS complex, QRS compexes are symmetrical and regularly spaced, and a normal T wave shows repolarization. what is nurse interpretation of monitor display
monitor indicates normal sinus rhythem
for which dysrhythmia would a pacemaker mostly likely be necessary
third degree heart block
pt had percutaneous transluminal coronary angioplasty with stent placement
what type of medication is pt will be on for at least 3 months
anticoagulant
which instructions would nurse give to pt for self administration of nitrate medications
apply patches in the morning and remove at bedtime
prevents the development of tolerance. Nitroglycerin tablets should always be carried in a pocket or purse for immediate availability. A burning sensation under the tongue is expected during activation of the tablet. Up to three tablets should be taken to determine if pain relief is adequate.
for a pt with MI what symptom is most important
pain
is the target of immediate therapy, because
pain is a signal of ischemia. Diaphoresis is
secondary to pain or possibly hypotension.
Palpitations could occur, but are not a typical
complaint. Shortness of breath is related to the
body’s attempt to increase oxygen to the tissues.
what is the best method to help pt comply with dietary restrictions associated with atherosclerotic heart disease
teach how to read nutritional labels on food products
pt with hx of heart failure tells home health nurse, “every night i sleep in this recliner chair I feel better if I sleep with my head up
what will nurse assess first
check for dependent edema in the lower extemities
pt arrives in ER with severe dyspnea, agitation cyanosis, audible wheezes and a cough with blood tinges sputem
what is priority nursing action
administer O2
which sign/sx inidcates to the nurse that a pt with endocarditis is experiencing a serious and common complicaton of the dz
sudden SOB
