Deck 25: Assessment of Cardiovascular Function

Question 1

A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what?

A) Systole
B) Diastole
C) Repolarization
D) Ejection fraction

Answer 1

Systole

Question 2

During a shift assessment, the nurse is identifying the clients point of maximum impulse (PMI). Where will the nurse best palpate the PMI?

A) Left midclavicular line of the chest at the level of the nipple
B) Left midclavicular line of the chest at the fifth intercostal space
C) Midline between the xiphoid process and the left nipple
D) Two to three centimeters to the left of the sternum

Answer 2

Left midclavicular line of the chest at the fifth intercostal space

Question 3

The nurse is calculating a cardiac patients pulse pressure. If the patients blood pressure is $122 / 76 \mathrm{~mm}$ $\mathrm{Hg}$ , what is the patients pulse pressure?

A) $\quad 46 \mathrm{~mm} \mathrm{Hg}$
B) $\quad 99 \mathrm{~mm} \mathrm{Hg}$
C) $\quad 198 \mathrm{~mm} \mathrm{Hg}$
D) $\quad 76 \mathrm{~mm} \mathrm{Hg}$

Answer 3

$\quad 46 \mathrm{~mm} \mathrm{Hg}$

Question 4

The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding?

A) This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours.
B) Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury.
C) This is an accurate indicator of myocardial injury.
D) This result indicates muscle injury, but does not specify the source.

Question 5

The nurse is conducting patient teaching about cholesterol levels. When discussing the patients elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what?

A) Increased LDL and decreased HDL increase my risk of coronary artery disease.
B) Increased LDL has the potential to decrease my risk of heart disease.
C) The decreased HDL level will increase the amount of cholesterol moved away from the artery walls.
D) The increased LDL will decrease the amount of cholesterol deposited on the artery walls.

Question 6

The physician has placed a central venous pressure (CVP) monitoring line in an acutely ill patient so right ventricular function and venous blood return can be closely monitored. The results show decreased CVP. What does this indicate?

A) Possible hypovolemia
B) Possible myocardial infarction (MI)
C) Left-sided heart failure
D) Aortic valve regurgitation

Question 7

While auscultating a patients heart sounds, the nurse hears an extra heart sound immediately after the second heart sound $\left(\mathrm{S}_{2}\right)$ . An audible $\mathrm{S}_{3}$ would be considered an expected finding in what patient?

A) An older adult
B) A 20-year-old patient
C) A patient who has undergone valve replacement
D) A patient who takes a beta-adrenergic blocker

Question 8

The physical therapist notifies the nurse that a patient with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient with CAD may result in what?

A) Development of an atrial-septal defect
B) Myocardial ischemia
C) Formation of a pulmonary embolism
D) Release of potassium ions from cardiac cells

Question 9

The nurse is caring for a patient who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output?

A) A change in position from standing to sitting
B) A heart rate of $54 \mathrm{bpm}$
C) A pulse oximetry reading of $94 \%$
D) An increase in preload related to ambulation

Question 10

The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult?

A) Decreased left ventricular ejection time
B) Decreased connective tissue in the SA and AV nodes and bundle branches
C) Thinning and flaccidity of the cardiac values
D) Widening of the aorta

Question 11

A resident of a long-term care facility has complained to the nurse of chest pain. What aspect of the residents pain would be most suggestive of angina as the cause?

A) The pain is worse when the resident inhales deeply.
B) The pain occurs immediately following physical exertion.
C) The pain is worse when the resident coughs.
D) The pain is most severe when the resident moves his upper body.

Question 12

The critical care nurse is caring for a patient with a central venous pressure (CVP) monitoring system. The nurse notes that the patients CVP is increasing. Of what may this indicate?

A) Psychosocial stress
B) Hypervolemia
C) Dislodgment of the catheter
D) Hypomagnesemia

Question 13

The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems?

A) To assess the patients response to fluid and drug administration
B) To obtain specimens for arterial blood gas measurements
C) To dislodge pulmonary emboli
D) To diagnose the etiology of chronic obstructive pulmonary disease

Question 14

The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence?

A) SA node to bundle of His to AV node to Purkinje fibers
B) SA node to AV node to Purkinje fibers to bundle of His
C) SA node to bundle of His to Purkinje fibers to AV node
D) SA node to AV node to bundle of His to Purkinje fibers

Question 15

A patient has had a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. You are aware that the damage occurred where?

A) Endocardium
B) Pericardium
C) Myocardium
D) Visceral pericardium

Question 16

The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patients stroke volume. The nurse recognizes that afterload is increased when there is what?

A) Arterial vasoconstriction
B) Venous vasoconstriction
C) Arterial vasodilation
D) Venous vasodilation

Question 17

A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform?

A) Instruct the patient to drink 1 liter of water before the test.
B) Administer IV benzodiazepines and opioids.
C) Inform the patient that she will remain on bed rest following the procedure.
D) Inform the patient that an access line will be initiated in her femoral artery.

Question 18

The nurse is caring for a patient admitted with angina who is scheduled for cardiac catheterization. The patient is anxious and asks the reason for this test. What is the best response?

A) Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are.
B) Cardiac catheterization is most commonly done to detect how efficiently a patients heart muscle contracts.
C) Cardiac catheterization is usually done to evaluate cardiovascular response to stress.
D) Cardiac catheterization is most commonly done to evaluate cardiac electrical activity.

Question 19

The critical care nurse is caring for a patient who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the patients left ventricular function?

A) Central venous pressure (CVP) monitoring
B) Pulmonary artery pressure monitoring (PAPM)
C) Systemic arterial pressure monitoring (SAPM)
D) Arterial blood gases (ABG)

Question 20

A critically ill patient is admitted to the ICU. The physician decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize in the plan of care?

A) Fluctuations in core body temperature
B) Signs and symptoms of esophageal varices
C) Signs and symptoms of compartment syndrome
D) Perfusion distal to the insertion site

Question 21

The nurse is caring for an acutely ill patient who has central venous pressure monitoring in place. What intervention should be included in the care plan of a patient with CVP in place?

A) Apply antibiotic ointment to the insertion site twice daily.
B) Change the site dressing whenever it becomes visibly soiled.
C) Perform passive range-of-motion exercises to prevent venous stasis.
D) Aspirate blood from the device once daily to test $\mathrm{pH}$ .

Question 22

A patient is brought into the ED by family members who tell the nurse the patient grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the patients cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate?

A) Left-sided heart catheterization
B) Cardiac telemetry
C) Transesophageal echocardiography
D) Hardwire continuous ECG monitoring

Question 23

The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?

A) Whether the patient and involved family members understand the role of genetics in the etiology of the disease
B) Whether the patient and involved family members understand dietary changes and the role of nutrition
C) Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately
D) Whether the patient and involved family members understand the importance of social support and community agencies

Question 24

The nurse is relating the deficits in a patients synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply.

A) Loop connectivity
B) Excitability
C) Automaticity
D) Conductivity
E) Independence

Question 25

The nurses assessment of an older adult client reveals the following data: Lying BP $144 / 82 \mathrm{~mm} \mathrm{Hg}$ ; sitting BP 121/69 mm Hg; standing BP $98 / 56 \mathrm{~mm} \mathrm{Hg}$ . The nurse should consequently identify what nursing diagnosis in the patients plan of care?

A) Risk for ineffective breathing pattern related to hypotension
B) Risk for falls related to orthostatic hypotension
C) Risk for ineffective role performance related to hypotension
D) Risk for imbalanced fluid balance related to hemodynamic variability

Question 26

A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult patient who has been experienced vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis?

A) Pleurisy
B) Heart failure
C) Valve dysfunction
D) Cardiomyopathy

Question 27

A lipid profile has been ordered for a patient who has been experiencing cardiac symptoms. When should a lipid profile be drawn in order to maximize the accuracy of results?

A) As close to the end of the day as possible
B) After a meal high in fat
C) After a 12-hour fast
D) Thirty minutes after a normal meal

Question 28

When hemodynamic monitoring is ordered for a patient, a catheter is inserted into the appropriate blood
Vessel or heart chamber. When assessing a patient who has such a device in place, the nurse should check which of the following components? Select all that apply.

A) A transducer
B) A flush system
C) A leveler
D) A pressure bag
E) An oscillator

Question 29

The critical care nurse is caring for a patient who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located?

A) SA node
B) AV node
C) Bundle of His
D) Purkinje cells

Question 30

The nurse is doing discharge teaching with a patient who has coronary artery disease. The patient asks why he has to take an aspirin every day if he doesnt have any pain. What would be the nurses best response?

A) Taking an aspirin every day is an easy way to help restore the normal function of your heart.
B) An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks.
C) Taking an aspirin every day is a simple way to make your blood penetrate your heart more freely.
D) An aspirin a day eventually helps your blood carry more oxygen that it would otherwise.

Question 31

The physician has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a patient. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis?

A) Immunosuppression
B) Inflammation
C) Infection
D) Hemostasis

Question 32

The patient has a homocysteine level ordered. What aspects of this test should inform the nurses care? Select all that apply.

A) A 12-hour fast is necessary before drawing the blood sample.
B) Recent inactivity can depress homocysteine levels.
C) Genetic factors can elevate homocysteine levels.
D) A diet low in folic acid elevates homocysteine levels.
E)An ECG should be performed immediately before drawing a sample.

Question 33

A patient with a complex cardiac history is scheduled for transthoracic echocardiography. What should the nurse teach the patient in anticipation of this diagnostic procedure?

A) The test is noninvasive, and nothing will be inserted into the patients body.
B) The patients pain will be managed aggressively during the procedure.
C) The test will provide a detailed profile of the hearts electrical activity.
D) The patient will remain on bed rest for 1 to 2 hours after the test.

Question 34

A critical care nurse is caring for a patient with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply.

A) Pneumothorax
B) Infection
C) Atelectasis
D) Bronchospasm
E) Air embolism

Question 35

The nurse is caring for a patient who has central venous pressure (CVP) monitoring in place. The nurses most recent assessment reveals that CVP is $7 \mathrm{~mm} \mathrm{Hg}$ . What is the nurses most appropriate action?

A) Arrange for continuous cardiac monitoring and reposition the patient.
B) Remove the CVP catheter and apply an occlusive dressing.
C) Assess the patient for fluid overload and inform the physician.
D) Raise the head of the patients bed and have the patient perform deep breathing exercise, if possible.

Question 36

A critical care nurse is caring for a patient with a pulmonary artery catheter in place. What does this catheter measure that is particularly important in critically ill patients?

A) Pulmonary artery systolic pressure
B) Right ventricular afterload
C) Pulmonary artery pressure
D) Left ventricular preload

Question 37

A patients declining cardiac status has been attributed to decreased cardiac action potential. Interventions will be aimed at restoring what aspect of cardiac physiology?

A) The cycle of depolarization and repolarization
B) The time it takes from the firing of the SA node to the contraction of the ventricles
C) The time between the contraction of the atria and the contraction of the ventricles
D) The cycle of the firing of the AV node and the contraction of the myocardium

Question 38

A patient has been scheduled for cardiovascular computed tomography (CT) with contrast. To prepare the patient for this test, what action should the nurse perform?

A) Keep the patient NPO for at least 6 hours prior to the test.
B) Establish peripheral IV access.
C) Limit the patients activity for 2 hours before the test.
D) Teach the patient to perform incentive spirometry.

Question 39

The student nurse is preparing a teaching plan for a patient being discharged status post MI. What should the student include in the teaching plan? (Mark all that apply.)

A) Need for careful monitoring for cardiac symptoms
B) Need for carefully regulated exercise
C) Need for dietary modifications
D) Need for early resumption of prediagnosis activity
E) Need for increased fluid intake

Question 40

The nurse is caring for a patient who is undergoing an exercise stress test. Prior to reaching the target heart rate, the patient develops chest pain. What is the nurses most appropriate response?

A) Administer sublingual nitroglycerin to allow the patient to finish the test.
B) Initiate cardiopulmonary resuscitation.
C) Administer analgesia and slow the test.
D) Stop the test and monitor the patient closely.