Week 1 Chapter 21 Assessment of Cardiovascular

Question 1

Three layers of heart

Answer 1

Endocardium
Myocardium
Epicardium

Question 2

Four chambers

Answer 2

Right atrium, right ventricle , left atrium , left ventricle

Question 3

Cardiac Action Potential

Repolarization

Refractory periods

Answer 3

: return of cell to resting state caused
by reentry of potassium into cell while sodium exits

Refractory periods

o Effective refractory period: phase in which cells
are incapable of depolarizing
o Relative refractory period: phase in which cells
require stronger-than-normal stimulus to
depolarize

Question 4

Cardiac Cycle

Answer 4

Each cycle has three major sequential events:
o Diastole
o Atrial systole
o Ventricular systole

Question 5

Cardiac Output #1

Answer 5

Ejection fraction: percent of end diastolic volume
ejected with each heart beat (left ventricle)
Cardiac output (CO): amount of blood pumped by
ventricle in liters per minute
CO = SV × HR

Question 6

Stroke volume (SV):

Answer 6

amount of blood ejected with

each heartbeat

Question 7

o Preload:

Answer 7

degree of stretch of cardiac muscle

fibers at end of diastole

Question 8

Afterload:

Answer 8

resistance to ejection of blood from

ventricle

Question 9

Contractility:

Answer 9

ability of cardiac muscle to shorten

in response to electrical impulse

Question 10

Influencing Factors

Answer 10

Control of heart rate
o Autonomic nervous system, baroreceptors
Control of stroke volume
o Preload: Frank–Starling Law
o Afterload: affected by systemic vascular
resistance, pulmonary vascular resistance

Question 11

Contractility

Answer 11

Contractility increased by catecholamines, SNS,
certain medications
 Increased contractility results in increased stroke
volume
 Decreased by hypoxemia, acidosis, certain
medications

Question 12

Stroke volume is

Answer 12

the amount of blood

ejected with each heartbeat.

Question 13

Cardiac output is

Answer 13

the
amount of blood pumped by the ventricle in liters per
minute.

Question 14

Preload is

Answer 14

is the degree of stretch of the cardiac

muscle fibers at the end of diastole.

Question 15

Contractility is

Answer 15

the
ability of the cardiac muscle to shorten in response to
an electrical impulse

Question 16

Assessment of the Cardiovascular System

Answer 16

 Health history
 Demographic information
 Family/genetic history
 Cultural/social factors
 Risk factors
o Modifiable
o Nonmodifiable

Question 17

Health History

Answer 17

Common symptoms
o Chest pain/discomfort
o Pain/discomfort in other areas of the upper body
o SOB/dyspnea
o Peripheral edema, weight gain, abdominal
distention
o Palpitations
o Unusual fatigue, dizziness, syncope, change in
LOC

Question 18

Past Health, Family, and Social History

Answer 18

Medications
Nutrition
Elimination
Activity, exercise
Sleep, rest
Self-perception/self-concept
Roles and relationships
Sexuality and reproduction
Coping and stress tolerance

Question 19

Physical Assessment of the Cardiovascular

System

Answer 19

General appearance
Skin and extremities
Pulse pressure
Blood pressure; orthostatic changes
Arterial pulses
Jugular venous pulsations
Heart inspection, palpation, auscultation
Assessment of other systems

Question 20

Laboratory Tests

Answer 20

Cardiac biomarkers
Blood chemistry, hematology, coagulation
Lipid profile
Brain (B-type) natriuretic peptide
C-reactive protein
Homocysteine
Refer to Table 21-4

Question 21

Electrocardiography

Answer 21

12-lead ECG
Continuous monitoring
o Hardwire
o Telemetry
o Lead systems
o Ambulatory monitoring

Question 22

Cardiac Stress Testing

Answer 22

Exercise stress test
o Patient walks on treadmill with intensity
progressing according to protocols
o ECG, V/S, symptoms monitored
o Terminated when target HR is achieved
Pharmacologic stress testing
o Vasodilating agents given to mimic exercise

Question 23

Diagnostic Tests

Answer 23

Radionuclide imaging:
o Myocardial perfusion imaging
o Positron emission tomography
o Test of ventricular function, wall motion
o Computed tomography
o Magnetic resonance angiography

Question 24

Echocardiography

Answer 24

Noninvasive ultrasound test that is used to:
o Measure the ejection fraction
o Examine the size, shape, and motion of cardiac
structures
Transthoracic
Transesophageal

Question 25

Cardiac Catheterization

Answer 25

Invasive procedure used to diagnose structural and
functional diseases of the heart and great vessels
Right heart catheterization
o Pulmonary artery pressure and oxygen
saturations may be obtained; biopsy of
myocardial tissue may be obtained
Left heart catheterization
o Involves use of contrast agent

Question 26

Nursing Interventions

Answer 26

Observe cath site for bleeding, hematoma
Assess peripheral pulses
Evaluate temperature, color, and capillary refill of
affected extremity
Screen for arrhythmias
Maintain bed rest 2 to 6 hours
Instruct patient to report chest pain, bleeding
Monitor for contrast-induced nephropathy
Ensure patient safety

Question 27

Hemodynamic Monitoring

Answer 27

Central venous pressure
Pulmonary artery pressure
Intra-arterial B/P monitoring
Minimally invasive cardiac output monitoring devices