Study Guide Chapter 31 Assessment of Cardiovascular System

Question 1

Which arteries are the major providers of coronary circulation? (select all that apply)

a. Left marginal artery
b. Right marginal artery
c. Left circumflex artery
d. Right coronary artery
e. Posterior descending artery
f. Left anterior descending artery

Answer 1

c. Left circumflex artery
d. Right coronary artery
f. Left anterior descending artery
Rational: The left circumflex and left anterior descending arteries branch from the left coronary artery. The left coronary artery and right coronary artery arise from the aorta to supply the atria, ventricles, and interventricular septum

Question 2

Number the sequence the path of the action potential along the conduction system of the heart.

Answer 2

1) Sinoatrial node (SA)
2) Right and left atrial cells
3) Internodal pathways
4) Atrioventricular node (AV)
5) Bundle of His
6) Right and left bundle branches
7) Purkinje fibers
8) Ventricular cells

Question 3

Cardiac activity: Measured from the beginning of P wave to beginning of QRS complex
Wave forms of the ECG:

Answer 3

Wave forms of the ECG: PR interval

Question 4

Cardiac activity: Repolarization of the ventricles

Wave forms of the ECG:

Answer 4

Wave forms of the ECG: T wave

Question 5

Cardiac activity: 0.12 to 0.20 seconds

Wave forms of the ECG:

Answer 5

Wave forms of the ECG: PR interval

Question 6

Cardiac activity: 0.16 seconds

Wave forms of the ECG:

Answer 6

Wave forms of the ECG: T wave

Question 7

Cardiac activity: Time of depolarization and repolarization of ventricles
Wave forms of the ECG:

Answer 7

Wave forms of the ECG: QT interval

Question 8

Cardiac activity: <0.12 seconds

Wave forms of the ECG:

Answer 8

Wave forms of the ECG: QRS interval

Question 9

Cardiac activity: Depolarization from the AV node throughout ventricles
Wave forms of the ECG:

Answer 9

Wave forms of the ECG: QRS interval

Question 10

Cardiac activity: 0.06 to 0.12 seconds

Wave forms of the ECG:

Answer 10

Wave forms of the ECG: P wave

Question 11

Situation: Valsalva maneuver
Stroke volume factor:
Cardiac output:

Answer 11

Stroke volume factor: Preload is decreased

Cardiac output: Decreased

Question 12

Situation: Venous dilation
Stroke volume factor:
Cardiac output:

Answer 12

Stroke volume factor: Preload is decreased

Cardiac output: Decreased

Question 13

Situation: Hypertension
Stroke volume factor:
Cardiac output:

Answer 13

Stroke volume factor: Afterload is increased

Cardiac output: Decreased

Question 14

Situation: Administration of epinephrine
Stroke volume factor:
Cardiac output:

Answer 14

Stroke volume factor: Contractility is increased

Cardiac output: Increased

Question 15

Situation: Obstruction of pulmonary artery
Stroke volume factor:
Cardiac output:

Answer 15

Stroke volume factor: Preload is decreased

Cardiac output: Decreased

Question 16

Situation: Hemorrhage
Stroke volume factor:
Cardiac output:

Answer 16

Stroke volume factor: Preload is decreased

Cardiac output: Decreased

Question 17

Which effects result from sympathetic nervous system stimulation of B-adrenergic receptors (select all that apply)

a. Vasoconstriction
b. Increased heart rate
c. Decreased heart rate
d. Increased rate of impulse conduction
e. Decrease rate of impulse conduction
f. Increased force of cardiac contraction

Answer 17

b. Increased heart rate
d. Increased rate of impulse conduction
f. Increased force of cardiac contraction
Rational: The sympathetic nervous system increased the heart rate, the speed of impulse conduction through the atrioventricular (AV) node, and the force of atrial and ventricular contractions via the B-adrenergic receptors

Question 18

Age-related physiologic changes that occur in the older adult that result in the following cardiovascular problems.
Cardiovascular problem: Widened pulse pressure
Physiological change:

Answer 18

Physiological change: Loss of vascular elasticity and distensibility, increased sensitivity to antidiuretic hormone

Question 19

Age-related physiologic changes that occur in the older adult that result in the following cardiovascular problems.
Cardiovascular problem: Decreased cardiac reserve
Physiological change:

Answer 19

Physiological change: Increased collagen and decreased elastin

Question 20

Age-related physiologic changes that occur in the older adult that result in the following cardiovascular problems.
Cardiovascular problem: Increased cardiac dysrhythmias
Physiological change:

Answer 20

Physiological change: Decreased in sinoatrial (SA) node cells, conduction cells in the internodal tracts, the bundle of His, and bundle branches

Question 21

Age-related physiologic changes that occur in the older adult that result in the following cardiovascular problems.
Cardiovascular problem: Decreased response to sympathetic stimulation
Physiological change:

Answer 21

Physiological change: Decreased number and function of B-adrenergic receptors

Question 22

Age-related physiologic changes that occur in the older adult that result in the following cardiovascular problems.
Cardiovascular problem: Aortic or mitral valve murmurs
Physiological change:

Answer 22

Physiological change: Valvular lipid accumulation, collagen degeneration and fibrosis

Question 23

What is a significant finding in the health history of a patient during an assessment of the cardiovascular system?

a. Metastatic cancer
b. Calcium supplementation
c. Frequent viral pharyngitis
d. Frequent use of recreational drugs

Answer 23

d. Frequent use of recreational drugs

Rational: Recreational or abused drugs, especially stimulants such as cocaine and methamphetamine, are a growing cause of cardiac dysrhythmias and problems associated with tachycardia. IV injection of abused drugs is a risk factor for inflammatory and infectious conditions of the heart. Although calcium is involved in the contraction of muscles, calcium supplementation is not a significant factor in heart disease, nor is metastatic cancer. Streptococcal, but not viral, pharyngitis is a risk factor for rheumatic heart disease

Question 24

When palpating the patient’s popliteal pulse, the nurse feels a vibration at the site. This finding is recorded as a:

a) thready, weak pulse
b) bruit at the artery site
c) bounding pulse volume
d) thrill of the popliteal artery

Answer 24

d) thrill of the popliteal artery

Rational: A palpable vibration of a blood vessel is called a thrill and usually indicates a narrowed or bulging vessel wall. A weak, thready pulse has little pressure and is difficult to palpate. A bruit is an abnormal buzzing or humming sound that may be auscultated over pathologic vessels, and a bounding pulse is an extra full, hard pulse that may occur with atherosclerosis or hypervolemia.

Question 25

Indicate whether the following are characteristic of the first heart sound (S1) or the second heart sound (S2)

a. Soft lub sound:
b. Sharp dub sound:
c. Indicates beginning of systole:
d. Indicates the onset of diastole:
e. Loudest at pulmonic and aortic areas:
f. Loudest at tricuspid and mitral areas:

Answer 25

a. Soft lub sound: S1
b. Sharp dub sound: S2
c. Indicates beginning of systole: S1
d. Indicates the onset of diastole: S2
e. Loudest at pulmonic and aortic areas: S2
f. Loudest at tricuspid and mitral areas: S1

Question 26

What can be auscultated in a patient with cardiac valve problems (select all that apply)

a. Arterial bruit
b. Heart murmurs
c. Pulsus alternans
d. Third heart sound (S3)
e. Pericardial friction rub
f. Fourth heart sound (S4)

Answer 26

b. Heart murmurs
d. Third heart sound (S3)
f. Fourth heart sound (S4)

Rational: The heart murmurs are produced by turbulent blood flow across diseased heart valves, S3 is heard with mitral valve regurgitation, and S4 is heard with aortic stenosis. Arterial bruits are from turbulent peripheral blood flow. Pulsus alternans, seen in heart failure, is a variation in the strength of each pulse when palpated. Pericardial friction rub is the sound heard with pericarditis

Question 27

The nursing student is seeking assistance in hearing the patient’s abnormal heart sounds. What should the nurse tell the student to do for a more effective assessment?

Answer 27

Use the bell of the stethoscope with the patient leaning forward
Rational: The bell of the stethoscope will enable better hearing of the low-pitched extra heart sounds. Having the patient lean forward best enables hearing the aortic and pulmonic areas; having the patient on the left side will enhance the mitral area sounds; both of these positions bring the heart closer to the chest wall. Having the patient supine or prone will NOT improve the auscultation

Question 28

Which finding is associated with a blue tinge around the lips and conjunctiva?

a. Finger clubbing
b. Central cyanosis
c. Peripheral cyanosis
d. Delayed capillary filling time

Answer 28

b. Central cyanosis

Rational: Central cyanosis is evident with a blue tinge in the lips, conjunctiva, or tongue. Finger clubbing results from endocarditis, congenital defects, or prolonged O2 deficiency. Peripheral cyanosis is evident with blue-tinged extremities or in the nose and ears. Decreased capillary refill may be seen in reduced capillary perfusion or anemia

Question 29

A patient is scheduled for exercise nuclear imaging stress testing. The nurse explains to the patient that this test involves?

a. IV administration of a radioisotope at the maximum heart rate during exercise to identify the heart’s response to physical stress
b. Placement of electrodes inside the right-sided heart chambers through a vein to record the electrical activity of the heart directly
c. Exercising on a treadmill or stationary bicycle with continuous ECG monitoring to detect ischemic changes in the heart during exercise
d. Placement of a small transudcer in four positions on the chest to record the direction and flow of blood through the heart by the reflection of sound waves

Answer 29

a. IV administration of a radioisotope at the maximum heart rate during exercise to identify the heart’s response to physical stress

Rational: In an exercise nuclear imaging scan, a radioisotope is injected at the maximum heart rate on a bicycle or treadmill and used to evaluate blood flow in different parts of the heart. Insertion of electrodes into the heart chambers via the venous system to record intracardiac electrical activity is an electrophysiology study. Simply monitoring ECG activity during exercise is an exercise stress test, and an echocardiogram uses transducers to bounce sounds waves off of the heart

Question 30

The nurse caring for a patient immediately following a transesophageal echocardiogram (TEE) should consider which action the highest priority?

a. Monitor the ECG
b. Monitor pulse oximetry
c. Assess vital signs (BP, HR, RR, temperature)
d. Maintain NPO status until gag reflex has returned

Answer 30

d. Maintain NPO status until gag reflex has returned

Rational: All actions will be done but order to perform a transesophageal echocardiogram (TEE). The throat must be numbed. Until sensation returns, as evidenced by the gag reflex, the patient is at risk of aspiration, so this action has the highest priority (priority related to airway-ABCs)

Question 31

Which method is used to evaluate the ECG responses to normal activity over a period of 1 or 2 days?

Answer 31

Holter monitoring

Rational: Holter monitoring involves placed electrodes on the chest attached to a recorder that will record ECG rhythm for 24 to 48 hours while the patient engages in normal activities of daily living (ADLs). The recording is later analyzed for cardiac dysrhythmias. Serial ECGs are frequent but not continuous ECGs. The 6-minute walk test measures the distance walked in 6 minutes to determine response to treatment and functional capacity for ADLs. An event monitor or loop recorder is used to record infrequent rhythm disturbances when the patient activates the recording with symptom occurrence

Question 32

When caring for a patient after a cardiac catheterization with coronary angiography, which finding would be of most concern to the nurse?

a. Swelling at the catheter insertion site
b. Development of raised wheals on the patient’s trunk
c. Absence of pulses distal to the catheter insertion site
d. Patient pain at the insertion site at 4 on a scale of 0 to 10

Answer 32

c. Absence of pulses distal to the catheter insertion site

Rational: An absence of pulses distal to the catheter insertion site indicates that clotting is occluding blood flow to the extremity and is an emergency that requires immediate medical attention. Some swelling and pain at the site are expected, but the site is also monitored for bleeding, and a pressure dressing or compression device may be applied. Hives may occur as a result of iodine sensitivity and will require treatment but the priority is the lack of pulses.

Question 33

A female patient has a total cholesterol level of 232 mg/dL (6.0 mmol/L) and a high-density lipoprotein (HDL) of 65 mg/dL (1.68 mmol/dL). A male patient has a total cholesterole level of 200 mg/dL (5.172 mmol/L) and an HDL of 32 mg/dL (0.83 mmol/L). Based on these findings, which patient has the highest cardiac risk?

a. The man, because his HDL is lower
b. The woman, because her HDL is higher
c. The woman, because her cholesterol is higher
d. The man, because his cholesterol to HDL ratio is higher

Answer 33

d. The man, because his cholesterol to HDL ratio is higher

Rational: A risk assessment for coronary artery disease (CAD) is determined by comparing the total cholesterol to high density lipoprotein (HDL), and a ratio can be calculated by dividing the total cholesterol level by the HDL level. The ratio provides more information than either value alone, and an increased ratio indicates an increased risk. The female patient has a ratio of 3.56, which is average risk, compared with the male patient’s ratio of 6.56, which is increased risk

Question 34

Increases in which blood studies are diagnostic for acute coronary syndrome (ACS) (Select all that apply)

a. Copetin
b. Creatine kinase (CK-MM)
c. Cardiac troponin T (cTnT)
d. B-type natriuretic peptide (BNP)
e. High sensitivity C-reactive protein (hs-CRP)
f. Lipoprotein-associated phospholipase A2 (Lp-PLAa2)

Answer 34

a. Copetin
c. Cardiac troponin T (cTnT)

Rational: Copeptin is detected immediately with ACS and increased levels of cardiac troponin T (cTnT) is detected within hours. Increased CK-MM is most commonly associated with skeletal muscle injury. Increased b-type natriuretic peptide (BNP) is a marker for heart failure. Increased C-reactive protein (CRP) occurs with acute inflammation as in atherosclerosis. Increased lipoprotein-associated phospholipase A2 (Lp-PLA2) indicates increased risk for CAD