NURSING 160: EXAM THREE PREP | TOP SCORES
MADE SIMPLE | TRUSTED TEST SOLUTIONS!
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What is the term used to describe the exchange of blood, gases, and fluids between the
vessels, tissues, and organ systems? Answer: Perfusion.
What is the primary purpose of the cardiovascular system? Answer: Primary purpose is to
pump blood and distribute it to all areas of the body.
When problems exist with the cardiovascular system it can lead to death.
How does the cardiovascular system function? Answer: It promotes the perfusion of blood
through the body, carries cellular wastes to excretory organs, and promotes the return of
blood to the heart for oxygenation.
What is the first thing the nurse should do when a patient comes in with possible perfusion
issues? Answer: An ASSESSMENT!
What kind of questions should the nurse make sure to ask the patient in regards to possible
perfusion problems? Answer: 1. Health History:
- History of present illness: What is their chief complaint and is it urgent or not? For
example, chest pain is ALWAYS urgent.
- Past medical history: Any comorbidities, such as diabetes or PVD? Have they had any
childhood infections that could have damaged the heart?
- Family history of perfusion problems?
- Functional health patterns: how is their nutrition? How well do they sleep? How active are
they? Any problems with sexuality or stress? What are their personal habits?
- ADL's: Any DOE? Are they sedentary or active? Do they have any edema or fatigue? When
did it start? How long has it been going on? What brings it on and what relieves it?
- Height and weight: Elevated BMI can be an indicator or precursor to CVD.
- Medications
In regards to functional health patterns, what are some signs and symptoms that could be
indicative of possible CVD? Answer: 1. Nutrition
1
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,- weight loss or gain: more than 2 pounds in a day or 5 pounds in a week? (Even a measly 5
pounds can increase the demands on cardiac function).
- special diets: for example, if they do have perfusion issues they should be restricting
sodium and eating low fat.
2. Sleep
- sleep apnea: causes snoring and fatigue and is often associated with cardiovascular
problems due to a perfusion source. Ex, they may be snoring because of an airway
obstruction that is decreasing their perfusion.
- dyspnea
- fatigue
- orthopnea
3. Sexual Acitivity
- difficulty or frequency: if it's not being perfused then it won't work.
- fertility issues
4. Activity
- sedentary or active?
- activity intolerance is a BIG indicator of perfusion issues! Are they SOB or experiencing
DOE?
5. Personal Habits
- caffeine use
- alcohol use
- tobacco use
- illicit drug use: patient may not tell you but if they are their vessels are usually already
sclerotic and they may have cellulitis.
6. Stress
- increased coping response -->increases HR and BP
What are some non-modifiable (cannot be changed) risk factors related to perfusion
issues? Answer: 1. Age
2. Family history (genetics)
2
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,3. Gender
4. Race
What are some modifiable risk factors related to perfusion issues? Answer: 1. Smoking
2. Obesity
3. Dyslipidemia
4. Stress
5. Sedentary lifestyle
6. Modifiable medications: DM, HTN, Metabolic Syndrome (improvement of the control of
the diseases can help decrease the possibility of damage to the vessels)
What kind of medications is it important to ask the patient about when assessing whether
or not a perfusion issue is present? Answer: ALL OF THEM!
1. Current list of medications.
2. Any OTC medications such as: decongestants (these are stimulants and can affect BP,
ex: Claritin), cold meds, nasal sprays, vitamins, and laxatives.
3. Any CAM such as: garlic, fish oil (oils change the metabolic rate of other pills), omega
fatty acids, and even curcumin/curry (these have a strong systemic anti-inflammatory
effect).
What are some notable signs and symptoms related to perfusion issues? Answer: 1.
CHEST PAIN/DISCOMFORT IS ALWAYS AN EMERGENCY AND REQUIRES IMMEDIATE
ASSESSMENT! This occurs because there is decreased blood flow occurring from the
coronary arteries to the heart tissues which causes pain.
2. Vital Signs.
3. SOB/Dyspnea/DOE.
4. Edema or weight gain.
5. Palpitations (the sensation of rapid HR to the point where the patient is aware of it = not
normal).
6. Fatigue or weakness.
7. Dizziness or syncope/fainting.
3
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, 8. Auscultate heart sounds: S1 and S2 (S1 is best heard at the fifth intercostal space to the
left of the sternum at the apex and S2 is heard best at the base of the heart, the area
between the apex and the sternum). Remember: S1 at apex, S2 at the base.
What should the nurse ask the patient about any pain they may be experiencing related to a
possible perfusion issue? Answer: Pain Assessment = PQRST.
P = Provocation/Palliation:
What where you doing when the pain started? What caused it? What makes it better?
Worse? What seems to trigger it? Stress? Position? Certain activities?
What relieves it? Medications, massage, heat/cold, changing position, being active,
resting?
What aggravates it? Movement, bending, lying down, walking, standing?
Q = Quality/Quantity:
What does it feel like? Use words to describe the pain such as sharp, dull, stabbing,
burning, crushing, throbbing, nauseating, shooting, twisting or stretching.
R = Region/Radiation:
Where is the pain located? Does the pain radiate? Where? Does it feel like it travels/moves
around? Did it start elsewhere and is now localized to one spot?
S = Severity Scale:
How severe is the pain on a scale of 0 to 10, with zero being no pain and 10 being the worst
pain ever? Does it interfere with activities? How bad is it at its worst? Does it force you to sit
down, lie down, slow down? How long does an episode last?
T = Timing
When/at what time did the pain start? How long did it last? How often does it occur:
hourly? daily? weekly? monthly? Is it sudden or gradual? What were you doing when you
first experienced it? When do you usually experience it: daytime? night? early morning? Are
you ever awakened by it? Does it lead to anything else? Is it accompanied by other signs
and symptoms? Does it ever occur before, during or after meals? Does it occur seasonally?
4
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MADE SIMPLE | TRUSTED TEST SOLUTIONS!
QUALITY CONTENT YOU CAN RELY ON!
What is the term used to describe the exchange of blood, gases, and fluids between the
vessels, tissues, and organ systems? Answer: Perfusion.
What is the primary purpose of the cardiovascular system? Answer: Primary purpose is to
pump blood and distribute it to all areas of the body.
When problems exist with the cardiovascular system it can lead to death.
How does the cardiovascular system function? Answer: It promotes the perfusion of blood
through the body, carries cellular wastes to excretory organs, and promotes the return of
blood to the heart for oxygenation.
What is the first thing the nurse should do when a patient comes in with possible perfusion
issues? Answer: An ASSESSMENT!
What kind of questions should the nurse make sure to ask the patient in regards to possible
perfusion problems? Answer: 1. Health History:
- History of present illness: What is their chief complaint and is it urgent or not? For
example, chest pain is ALWAYS urgent.
- Past medical history: Any comorbidities, such as diabetes or PVD? Have they had any
childhood infections that could have damaged the heart?
- Family history of perfusion problems?
- Functional health patterns: how is their nutrition? How well do they sleep? How active are
they? Any problems with sexuality or stress? What are their personal habits?
- ADL's: Any DOE? Are they sedentary or active? Do they have any edema or fatigue? When
did it start? How long has it been going on? What brings it on and what relieves it?
- Height and weight: Elevated BMI can be an indicator or precursor to CVD.
- Medications
In regards to functional health patterns, what are some signs and symptoms that could be
indicative of possible CVD? Answer: 1. Nutrition
1
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,- weight loss or gain: more than 2 pounds in a day or 5 pounds in a week? (Even a measly 5
pounds can increase the demands on cardiac function).
- special diets: for example, if they do have perfusion issues they should be restricting
sodium and eating low fat.
2. Sleep
- sleep apnea: causes snoring and fatigue and is often associated with cardiovascular
problems due to a perfusion source. Ex, they may be snoring because of an airway
obstruction that is decreasing their perfusion.
- dyspnea
- fatigue
- orthopnea
3. Sexual Acitivity
- difficulty or frequency: if it's not being perfused then it won't work.
- fertility issues
4. Activity
- sedentary or active?
- activity intolerance is a BIG indicator of perfusion issues! Are they SOB or experiencing
DOE?
5. Personal Habits
- caffeine use
- alcohol use
- tobacco use
- illicit drug use: patient may not tell you but if they are their vessels are usually already
sclerotic and they may have cellulitis.
6. Stress
- increased coping response -->increases HR and BP
What are some non-modifiable (cannot be changed) risk factors related to perfusion
issues? Answer: 1. Age
2. Family history (genetics)
2
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,3. Gender
4. Race
What are some modifiable risk factors related to perfusion issues? Answer: 1. Smoking
2. Obesity
3. Dyslipidemia
4. Stress
5. Sedentary lifestyle
6. Modifiable medications: DM, HTN, Metabolic Syndrome (improvement of the control of
the diseases can help decrease the possibility of damage to the vessels)
What kind of medications is it important to ask the patient about when assessing whether
or not a perfusion issue is present? Answer: ALL OF THEM!
1. Current list of medications.
2. Any OTC medications such as: decongestants (these are stimulants and can affect BP,
ex: Claritin), cold meds, nasal sprays, vitamins, and laxatives.
3. Any CAM such as: garlic, fish oil (oils change the metabolic rate of other pills), omega
fatty acids, and even curcumin/curry (these have a strong systemic anti-inflammatory
effect).
What are some notable signs and symptoms related to perfusion issues? Answer: 1.
CHEST PAIN/DISCOMFORT IS ALWAYS AN EMERGENCY AND REQUIRES IMMEDIATE
ASSESSMENT! This occurs because there is decreased blood flow occurring from the
coronary arteries to the heart tissues which causes pain.
2. Vital Signs.
3. SOB/Dyspnea/DOE.
4. Edema or weight gain.
5. Palpitations (the sensation of rapid HR to the point where the patient is aware of it = not
normal).
6. Fatigue or weakness.
7. Dizziness or syncope/fainting.
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
, 8. Auscultate heart sounds: S1 and S2 (S1 is best heard at the fifth intercostal space to the
left of the sternum at the apex and S2 is heard best at the base of the heart, the area
between the apex and the sternum). Remember: S1 at apex, S2 at the base.
What should the nurse ask the patient about any pain they may be experiencing related to a
possible perfusion issue? Answer: Pain Assessment = PQRST.
P = Provocation/Palliation:
What where you doing when the pain started? What caused it? What makes it better?
Worse? What seems to trigger it? Stress? Position? Certain activities?
What relieves it? Medications, massage, heat/cold, changing position, being active,
resting?
What aggravates it? Movement, bending, lying down, walking, standing?
Q = Quality/Quantity:
What does it feel like? Use words to describe the pain such as sharp, dull, stabbing,
burning, crushing, throbbing, nauseating, shooting, twisting or stretching.
R = Region/Radiation:
Where is the pain located? Does the pain radiate? Where? Does it feel like it travels/moves
around? Did it start elsewhere and is now localized to one spot?
S = Severity Scale:
How severe is the pain on a scale of 0 to 10, with zero being no pain and 10 being the worst
pain ever? Does it interfere with activities? How bad is it at its worst? Does it force you to sit
down, lie down, slow down? How long does an episode last?
T = Timing
When/at what time did the pain start? How long did it last? How often does it occur:
hourly? daily? weekly? monthly? Is it sudden or gradual? What were you doing when you
first experienced it? When do you usually experience it: daytime? night? early morning? Are
you ever awakened by it? Does it lead to anything else? Is it accompanied by other signs
and symptoms? Does it ever occur before, during or after meals? Does it occur seasonally?
4
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