Unit 6 Flashcards
Chapter 25- patho
nurse is teaching a client the correct technique for taking an arterial pulse. The nurse explains that the pulsations are:
A. Turbulence of the blood flow
B. Korotkoff sounds
C. Blood flow in the veins
D. Pressure pulses
D. Pressure points
Considering how hydrostatic forces affect the capillaries, which of the following would increase capillary hydrostatic pressure most?
Increase in venous pressure
Decrease in arterial pressure
Decrease in gravity when standing
Increase in small-artery pressure
A. Increase in venous
Which of the following is true regarding pulmonary circulation?
A. It consists of the left side of the heart, the aorta, and its branches.
B. The system functions with an increased arterial pressure to circulate through the distal parts of the body.
C. It is the larger of the two circulatory systems.
D. It is a low-pressure system that allows for improved gas exchange.
D. It is a low pressure system
nurse is caring for a client with right heart failure caused by pulmonary hypertension. Which hemodynamic parameter is most appropriate for the nurse to monitor?
A. Systemic vascular resistance (SVR)
B. Central venous pressure (CVP)
C. Blood pressure
D. Pulmonary arterial pressure (PAP)
D. Pulmonary arterial pressure
client has had an acute myocardial infarction (MI). The brother of the client has a history of angina. The client asks how he will know if his brother’s pain is angina or if the brother is actually having an MI. Which statement is correct?
A. Chest pain with angina only occurs at rest; MI pain occurs during a stressful time.
B. Pain is more severe and lasts longer with angina than with an MI.
C. Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.
D. Chest pain with angina only occurs during the day; Ml pain is more likely at night.
C. Nitro
Which factor represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?
A. Preload
B. Cardiac contractility
C, heart rate
D, after load
A. Preload
The nurse is caring for a client with severe aortic stenosis. What affect to cardiac afterload will the nurse note?
• Less pressure recorded on the cardiac output due to poor leaflet contactivity
• Pulse rate will decrease due to less blood being ejected from the heart
• Greatly elevated systolic pressure when measured with hemodynamic setting
• Blood pressure will be below normal due to the narrowing of the valve outlet
C. Greatly elevated systolic pressure
Which related circulatory complication can result from surgical treatment for metastatic breast cancer?
• Hypotension upon standing
• Tachycardia when at rest
• Lymphedema in the affected arm
Irregular heart rate
C. Lymphedema in the affected arm
Which neurotransmitter is associated with the parasympathetic nervous system?
• Acetylcholine
• Norepinephrine
• Epinephrine
Dopamine
A. Acetylcholine
When a client experiences the Cushing reflex, what occurs with the body?
• An increase in arterial pressure to levels above the intracranial pressure -
• The toes fan outward in response to stimulation being applied to the bottom of the foot.
• The pupils contract in response to light exposure.
• The systemic blood pressure decreases to restore equal amounts of oxygen throughout the body.
A. And increase in arterial pressure
While intubated for surgery, a client has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?
• Decreased heart rate as a result of parasympathetic innervation of the heart
Decreased vascular perfusion due to parasympathetic stimulation
• Decreased heart rate as a result of impaires acetyicholine reuptake
Decreased heart rate, contractility, and afterload
A. Decreased heart rate as a result of parasympathetic innervation of the heart
Select the correct sequence of blood return to the heart.
A. Capillaries, venules, veins, left atrium
B. Capillaries, arterioles, veins, left atrium
C. Capillaries, venules, veins, right atrium
D. Capillaries, arterioles, arteries, right atrium
C. Capillaries, venues, veins, RA
The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?
• Repolarization of the ventricles
Depolarization of the ventricular conduction system
Repolarization of the atrium
Depolarization of the sinoatrial node
A. Repolorization of the ventricles
Which statements are true regarding the capillary system? Select all that apply.
A. Flow into the system is controlled by colloidal osmotic pressure.
B. Normal function requires that all fluid that leaves the capillary beds be reabsorbed.
C. Flow out of the system is controlled by hydrostatic pressure.
D. Fluid leaves the capillary beds via lymphatic channels.
E. Albumin plays a significant role in maintaining the function of this system.
ACE
Which client is most likely to be experiencing vasodilation?
A. A 32-year-old man who takes a selective serotonin reuptake inhibitor for treatment of depression
B. A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system
C. A 30-year-old woman who takes antihistamines to treat her seasonal allergies
D. A 9-year-old boy who has been given an injection of epinephrine to preclude an anaphylactic reaction to a bee sting
B. Angiotensin is a potent vasoconstrictor, and medications that block this induce vasodilation. Epinephrine is also a vasoconstrictor. Histamine is a medications are likely to induce vasoconstriction. Serotonin is a vasoconstrictor, so medications that block its reuptake and increase free levels : vasoconstriction.
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?
A. Axially
B. Turbulent
C. Laminar
D. Crosswise
C. Laminar
A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which assessment should the nurse complete?
A. Palpate the pericardium for a heave or thrill.
B. Monitor the blood pressure.
C. Auscultate for an extra heart sound due to incomplete semilunar valve closure.
D. Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves.
D. When closed, the AV valves prevent backflow of blood from the ventricles to the atria during systole. The AV valves are supported by the papillary muscles, which project from the wall of the ventricles. Contraction of the papillary muscles at the onset of systole ensures closure by producing tension on the leaflets of the AV valves before the full force of ventricular contraction pushes against them.
Which blood vessels function without 3 muscle layers
A. Capillaries
B, arteries
C. Arterioles
D, veins
A. Capillary
Which organ has larger capillary pores to allow the exchange of gases, nutrients, and/or waste products?
A. Kidney
B. Brain
C. Blood brain barrier
D. Liver
D. Liver
A client’s echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:
A. Tricuspid valve
B. Aortic valve
C, bicuspid valve
D, pulmonic valve
C. Bicuspid valve
Chapter 26
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:
A. Pulmonary embolism
B. Arterial insufficiency
C, polyarteritus
D. Vasculitis
A. Pulmonary embolism
The nurse is discussing risk factors for hypertension with a client. Which factors are nonmodifiable risk factors for development of hypertension? Select all that apply.
A. Obesity
B. Advanced age
C, ethnicity
D. Low dietary potassium
E, excess salt consumption
BC
A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color.
What is a potential diagnosis for this client?
A. Raynaud disease
B. DVT
C. Frostbite r/t hypothermia
D. Atherosclerotic occlusive disease
A. Raynauds
Which individual is at greatest risk for developing a venous thrombosis resulting from venous stasis?
A. Client in the terminal stage of cancer
B. Pregnant woman
C. Client on bed rest
D. Dehydrated client
C. Client on bed rest
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
A. HTN
B. Family history of heart disease
C. Being male
D, 55 years of age
A. Hypertension
When will the nurse plan to assess a client’s blood pressure to confirm the possible diagnosis of orthostatic hypotension?
• Within a half-hour after the heaviest meal of the day
In the morning before arising from bed
In the evening just before sleep
• Midmorning right after taking a short walk
B. In the morning h before arisi g from bed, then stand and do it again
The health care provider is reviewing the results of a client’s magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as:
A. Saccular aneurysm
B. Suitor aneurysm
C. Berry aneurysm
D. Dissecting aneurysm
C. Berry aneurysm. (Fusiform one a gradual progressive dilation of vessel)
Which are the primary treatment options for a client with DVt
Sitting
Elastic support
Elevation of the legs with flexion at the knees
Application of heat
Bed rest
Elastic support, application of heat and bed rest
Rationale:
The objectives of treatment of venous thrombosis are to prevent the formation of additional thrombi, prevent extension and embolization of existing thrombi, and minimize venous valve damage. A 15- to 20-degree elevation of the legs prevents stasis. It is important that the entire lower extremity or extremities be carefully extended to avoid acute flexion of the knee or hip. Heat often is applied to the leg to relieve venospasm and to aid in the resolution of the inflammatory process. Bed rest usually is maintained until local tenderness and swelling have subsided. Gradual ambulation with elastic support is then permitted. Standing and sitting increase venous pressure and are to be avoided. Elastic support is needed for 3 to 6 months to permit recanalization and collateralization and to prevent venous insufficiency.
A client is diagnosed with orthostatic hypotension. The nurse knows that which drugs can predispose the client to orthostasis? Select all that apply.
A. Bronchodilators
B, diuretics
C. Anti hypertensive
D, antibiotics
E. Psychotropic
BC and E
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.
A. Obesity
B. High salt
C. Female
D. Poor performance in school
E. Inactive lifestyle
AB E
An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?
A. Hypotension
B. Dry mouth
C. Constipation
D, restlessness
A. Hypotension
Which of the following are characteristic signs of acute arterial embolism?
•Paralysis, warmth, and paranoia
Pallor, pulselessness, and pain
Pain, increased blood pressure, and warmth
Purpura, muscle weakness, and shortness of breath
B. Pallor, pulselessness and pain
The presentation of acute arterial embolism is often described as that of the seven Ps: pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.
The physician’s order states, “Calculate the pulse pressure of the client’s B/P.” The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:
A. 228
B. 64
C. 41
D. 73
B. 64 (difference between systolic and diastolic)
A 65-year-old male client is diagnosed with systolic hypertension. The nurse educates the client about how the aging process and development of stiff, large arteries can result in which physiologic occurence? Select all that apply.
Unstable blood pressure
Increased diastolic pressure
Widened pulse pressure
Decreased diastolic pressure
Increased systolic pressure
CDE Rationale:
The stiffening of the large arteries results in increased systolic pressure. Diastolic pressure may decrease or remain unchanged. The pulse pressure widens as systolic pressure rises. Stiffening of the arteries does not produce unstable blood pressure
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:
100/60
140/90
100/90
140/60
140/90
Which client is at greatest risk for orthostatic hypotension?
• A 66-year-old postoperative client on bed rest
• A 42-year-old male client with history of pulmonary embolism
•A 20-year-old pregnant client at 36 weeks’ gestation
•A 70-year-old female client who has taken the same antihypertensive medication for 10 years
A. Bed rest
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important int for the nurse to implement would be:
A. Ice to dvt hourly
B. Bed rest
C. Apply sequential pneumatic compression to lower extremities
D. Massage legs to maintain blood flow
C. Sequential pressure
The nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that which activity is most likely the cause of the varicosities?
A. Rapid wt loss
B. Weak bone structure
C. Prolonged sitting
D. Heavy lifting
D. Heavy lifting
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.
• Blood pressure 90/60 and proteinuria in the second trimester
• Blood pressure 140/90 and glucose in the urine during the 36th week of pregnancy
•Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy
• Blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy
BP 160/100
Rationale:
Preeclampsia eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing
after 20 weeks of gestation.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:
Late hypertensive crisis
Chest pain radiating to the right arm
Tearing or ripping-type pain in the chest or back
Tonic-clonic seizures
Tearing or ripping
Rationale:
A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated.
Chapter 27
The diagnosis is hypovolemic shock. The nurse knows that causes of hypovolemic shock include which of the following? Select all that apply.
A. Excessive vasoconstriction
B. 15% blood volume loss
C. MI
D, severe dehydration
E. Severe burns
BDE
The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states the blood is shunted to which part of the body?
• Left lung to the right lung
•Right side of the heart to the left side of the heart
• Right lung to the left lung
• Left side of the heart to the right side of the heart
D. Left to right
Rationale:Defects that result in a left-to-right shunt are categorized as acyanotic disorders since they do not compromise oxygenation of blood in the pulmonary circul
The nurse is caring for a client with chronic heart failure. Which drug category may be pescribed for acute heart failure to improve heart performance by decreasing preload?
A. Beta-adrenergic receptor blocking agents like atenolol
B. Cardiac glycosides like digitalis
C. Vasodilator drugs like nitroprusside
D. ACE inhibitors like captopril
C. Vasodilators
The nurse is preparing to auscultate for a mitral valve stenosis murmur. Where is the best location to place the stethoscope?
A. At the carotid arteries
B. Over the aorta
C. At the apex of the heart
D. Over the sternum
C. At the apex of the heart
The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.
A. Ensuring adequate oxygenation with continuous oxygen administration
B. Assisting the client to return to previous lifestyle
C. Preventing clotting disorders
D. Myocardial infarction prevention
D. Prevevting MI
A preventive measure to decrease the risk of developing rheumatic heart disease includes:
• prompt diagnosis of streptococcal infections with a throat culture. scheduling regular hearing examinations.
• yearly electrocardiography after the age of 50.
• blood specimen assessed for rheumatoid factor.
A. Throat culture
Which serum biomarker is highly specific for myocardial tissue?
C-reactive protein
Creatine kinase
Troponin
White blood cells
Troponin
What is the most common identifiable cause of secondary cardiomyopathy?
Heart transplant
Alcohol abuse
Genetic abnormalities
Heart failure
Alcohol abuse
Exudate in the pericardial cavity is a characteristic of which cardiac condition?
Acute pericarditis
Pericardial effusion
Constrictive pericarditis
Cardiac tamponade
Pericardial effusion
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client’s output is:
60ml
40
20
80
20ml/hour
A 75-year-old client is being evaluated for heart failure. Which questions will the nurse ask to confirm common signs and symptoms observed in older adults experiencing heart failure? Select all that apply.
• “Are you eating more than usual?”
Do you have swelling in your ankles?”
“Are you feeling depressed?”
Do you get up often during the night to urinate?”
“Do you easily get tired?”
BCDE
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A 62-year-old female client presents to the emergency department and is diagnosed with acute heart failure syndrome. Which assessment finding would the nurse expect?
A. Slowed breathing and dehydration.
B. Increased urination and dry skin.
C. Productive cough with frothy sputum.
D. Shortness of breath and bradycardia.
C. Productive cough
Rationale:
The signs and symptoms of acute heart failure syndromes include shortness of breath and other respiratory manifestations (i.e., exertional dyspnea, orthopnea), fatigue and limited exercise tolerance, fluid retention and edema, cachexia and malnutrition, and cyanosis. Acute pulmonary edema is the most dramatic symptom of AHFS. The client would have an increased heart rate as a result of the exertional process.
When an acute event occurs and the circulatory system can no longer provide the body with adequate perfusion of its tissues and organs, cellular hypoxia occurs and the body goes into shock. What are the causes of shock in the human body? Select all that apply.
■ Hypervolemia
• Maldistribution of blood flow
Excessive vasoconstriction
Hypovolemia
Obstruction of blood flow
B. Maldistribution of blood flow,
D. Hypovolemia
E. Obstruction of blood flow
In distributive shock, there are abnormalities in vascular resistance. Which type of shock display the same pattern?
• Neurogenic
Septic
_ Hypovolemic
_ Anaphylactic
Cardiogenic
Neurogenic, septic and anaphylactic
Rationale:
In distributive shock, the capacity of the vascular compartment is greatly enlarged so that a normal blood volume becomes insufficient. In neurogenic shock, loss of sympathetic (adrenergic) control of blood vessels is lost and extreme vasodilation occurs. In anaphylactic shock, a severe allergic reaction, massive release of histamine induces extreme vasodilation. In septic shock, a response to severe infection, there is vascular dilation. Cardiogenic shock is a loss of ventricular contractility. Hypovolemic shock is a loss of blood volume.
A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection.
A. Actinobacillus actinomycetemcomitans
B. Staphylococcus aureus
C. Kingella kingae
D. Eikenellla corrodens
B. Staph
A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause.
A. Backward failure
B. Diastolic dysfunction
C. Systolic dysfunction
D. Frontward failure
B. Diastolic dysfunction Rationale:
The conditions that cause diastolic dysfunction are those that impede expansion of the ventricles (i.e., pericarditis), those that increase ventricular wall thickness and reduce chamber size (i.e., myocardial hypertrophy), and those that delay diastolic relaxation (i.e., aging).
A child is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are most accurate? Select all that apply.
• Physical activity must be discouraged.
Inotropic agents such as digoxin may be used in children.
The etiology of heart failure is similar in children and adults.
Symptoms include tachypnea and tachycardia.
Congenital defects are a risk factor.
BDE
Rationale:
The etiology of heart failure in children is different from that in older adults. Causes in children include congenital abnormalities and genetic cardiomopathy. Signs and symptoms include fatigue, effort intolerance, cough, anorexia, abdominal pain, and impaired growth, as well as tachypnea and tachycardia. Surgery can correct some underlying defects.
Drugs such as digoxin and diuretics are used when medical management is required. Clients should be as active as their cardiac function supports.
