Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
C H A P T E R
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Nursing Assessment:
128 Chapter 32 Nursing Assessment: Cardiovascular System
2. Identify the structures in the following illustrations by placing the correct term from the list below in the corresponding answer blank at the bottom of the page (some terms will be used more than once).
a b
c
d
e f
g h
i j k l m n
o p
q
r
s
t u
w
v x y z
a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
e. _____________________________________
f. _____________________________________
g. _____________________________________
h. _____________________________________
i. _____________________________________
j. _____________________________________
k. _____________________________________
l. _____________________________________
m. _____________________________________
n. _____________________________________
o. _____________________________________
p. _____________________________________
q. _____________________________________
r. _____________________________________
s. _____________________________________
t. _____________________________________
u. _____________________________________
v. _____________________________________
w. _____________________________________
x. _____________________________________
y. _____________________________________
z. _____________________________________
Terms
Left anterior descending artery Aorta
Circumflex artery Coronary sinus Great cardiac vein Left atrium
Left coronary artery Left marginal artery Left ventricle Middle cardiac vein
Posterior descending artery Posterior vein
Pulmonary trunk Right atrium
Right coronary artery Right marginal artery Right ventricle Small cardiac vein Superior vena cava
Chapter 32 Nursing Assessment: Cardiovascular System 129 3. 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
4. Number in sequence the path of the action potential along the conduction system of the heart.
_______ a. Atrioventricular (AV) node _______ b. Purkinje fibers
_______ c. Internodal pathways _______ d. Bundle of His _______ e. Ventricular cells _______ f. Sinoatrial (SA) node _______ g. Right and left atrial cells _______ h. Right and left bundle branches
5. On the following illustration, locate and letter the following normal electrocardiographic (ECG) pattern deflections and indicate where to locate and measure the intervals. (Use Table 36-2 to assist with this exercise.)
P
PR interval Q
QRS interval QT interval R
S T U
e
d b
g
f
h i c a
a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
e. _____________________________________
f. _____________________________________
g. _____________________________________
h. _____________________________________
i. _____________________________________
130 Chapter 32 Nursing Assessment: Cardiovascular System
6. Match the cardiac activity and time frames characteristic of the waveforms of the electrocardiogram (answers may be used more than once).
a. Measured from beginning of P wave to beginning of QRS complex b. Repolarization of the ventricles
c. 0.12 to 0.20 sec d. 0.16 sec
e. Time of depolarization and repolarization of ventricles f. <0.12 sec
g. Depolarization from the AV node throughout ventricles h. 0.06 to 0.12 sec
1. P wave 2. PR interval 3. QRS interval 4. T wave 5. QT interval
7. Indicate what factor of stroke volume (i.e., preload, afterload, or contractility) is primarily affected (i.e., increased or decreased) by the following situations and whether cardiac output (CO) is increased or decreased by the factor.
Situation Stroke Volume Factor Cardiac Output
Valsalva maneuver Venous dilation Hypertension
Administration of epinephrine Obstruction of pulmonary artery Hemorrhage
8. 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. Decreased rate of impulse conduction f. Increased force of cardiac contraction
9. What are the age-related physiologic changes that occur in the older adult that result in the following cardiovascular problems?
Cardiovascular Problem Physiologic Change Widened pulse pressure
Decreased cardiac reserve Increased cardiac dysrhythmias
Decreased response to sympathetic stimulation Aortic or mitral valve murmurs
Chapter 32 Nursing Assessment: Cardiovascular System 131 10. What is a significant finding in the health history of a patient during an assessment of the cardiovascular system?
a. Metastatic cancer
b. Frequent viral pharyngitis c. Calcium supplementation
d. Frequent use of recreational drugs
11. Identify one specific finding identified by the nurse during assessment of each of the patient’s functional health patterns that indicates a risk factor for cardiovascular disease or a patient response to an actual cardiovascular problem.
Functional Health Pattern Risk Factor for or Response to Cardiovascular Problem Health perception–health management
Nutritional-metabolic Elimination
Activity-exercise Sleep-rest
Cognitive-perceptual Self-perception–self-concept Role-relationship
Sexuality-reproductive Coping–stress tolerance Value-belief
12. When palpating the patient’s popliteal pulse, the nurse feels a vibration at the site. How should the nurse record this finding?
a. Thready, weak pulse b. Bruit at the artery site c. Bounding pulse volume d. Thrill of the popliteal artery
132 Chapter 32 Nursing Assessment: Cardiovascular System
14. Indicate whether the following are characteristic of the first heart sound (S1) or the second heart sound (S2).
_______ a. Soft lub sound _______ b. Sharp dup 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
15. What can be auscultated in a patient with cardiac valve problems (select all that apply)?
a. Arterial bruit b. Pulsus alternans c. Cardiac murmurs d. Third heart sound (S3) e. Pericardial friction rub f. Fourth heart sound (S4)
16. 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?
a. Use the diaphragm of the stethoscope with the patient prone b. Use the diaphragm of the stethoscope with the patient supine c. Use the bell of the stethoscope with the patient leaning forward d. Use the bell of the stethoscope with the patient on the right side a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
e. _____________________________________
f. _____________________________________
13. Locate the following points or locations that are inspected and palpated on the chest wall.
b. ____________
a. ____________
c. ________________
d. __________
e. __________
f. __________
Angle of Louis Aortic area Erb’s point
Mitral area (apex) and point of maximal impulse (PMI) Pulmonic area
Tricuspid area
Chapter 32 Nursing Assessment: Cardiovascular System 133 17. 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
18. 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 during exercise.
d. placement of a small transducer in four positions on the chest to record the direction and flow of blood through the heart by the reflection of sound waves.
19. Priority Decision: 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
20. Which method is used to evaluate the ECG responses to normal activity over a period of 1 or 2 days?
a. Serial ECGs b. Holter monitoring c. 6-minute walk test
d. Event monitor or loop recorder
21. 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 as 4 on a scale of 0 to 10
22. 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/L). A male patient has a total cholesterol level of 200 mg/dL and an HDL of 32 mg/dL. 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
23. Increases in which factors are predictors of an increased risk for coronary artery disease or evidence of myocardial injury (select all that apply)?
a. Creatine kinase (CK)-MM b. Cardiac troponin T (cTnT) c. B-type natriuretic peptide (BNP) d. High-sensitivity C-reactive protein e. Lipoprotein-associated phospholipase A2
C H A P T E R
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1. In the regulation of normal blood pressure (BP), indicate whether the following mechanisms elevate BP by
increasing cardiac output (CO), increasing systemic vascular resistance (SVR), or increasing both, and identify how these mechanisms cause the increases indicated.
Increasing Cardiac Output
Increasing Systemic Vascular Resistance
Mechanisms Causing Increases
β1-Adrenergic stimulation α1-Adrenergic stimulation α2-Adrenergic stimulation Endothelin release Angiotensin II Aldosterone release Antidiuretic hormone (ADH) release
2. A patient is given an α1-adrenergic agonist and experiences a reflex bradycardia. What normal mechanism of BP control is stimulated in this situation?
3. A patient uses a mixed β-adrenergic blocking drug for treatment of migraine headaches. What effect might this drug have on BP and why?
4. What are nonmodifiable risk factors for primary hypertension (select all that apply)?
a. Age d. Ethnicity
b. Obesity e. Genetic link
c. Gender
5. How is secondary hypertension differentiated from primary hypertension?
a. Has a more gradual onset than primary hypertension
b. Does not cause the target organ damage that occurs with primary hypertension
c. Has a specific cause, such as renal disease, that often can be treated by medicine or surgery d. Is caused by age-related changes in BP regulatory mechanisms in people over 65 years of age 6. What is the patient with primary hypertension likely to report?
a. No symptoms c. Dyspnea on exertion
b. Cardiac palpitations d. Dizziness and vertigo