MEDICAL SURGICAL NURSING 1 T T T
CARE OF CLIENTS WITH CARDIOVASCULAR DISORDERS
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SITUATION: Basic knowledge about the physiology of the cardiovascular system will greatly help the nurse to
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provide appropriate assessment and interventions. The key component of physical assessment includes a health
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history, physical examination, and monitoring of variety of laboratory and diagnostic test results.
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1. The pumping action of the heart is accomplished by the rhythmic contraction and relaxation of its muscular wall.
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What change occurs during systole?
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a. The chambers of the heart become smaller as the blood is ejected
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b. The heart chambers fill with blood in preparation for subsequent ejection.
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c. The heart chamber of the heart becomes bigger as it receives blood
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d. The myocardium becomes thinner as it blood enter the chamber.
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ANSWER: A
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Rationale: As the blood coming from the systemic circulation enters the inferior and superior vena cava, the atrium
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will receive the blood which makes the myocardium thin and enlarged. This occurs during diastole when the heart
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relaxes as the chamber of the heart is filled with blood. During systole or contraction, the heart become smaller as the
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blood is ejected to the circulation.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
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2. Cardiac conduction system generates and transmits electrical impulses that stimulate contraction of the
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myocardium. Impulses come from two specialized electrical cells. What are the physiologic characteristics of the
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electrical cell?
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a. Automaticity, excitability, potentiality T T
c. Conductivity, potentiality, refractivity
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b. Automaticity, conductivity, refractivity T T
d. Automaticity, conductivity, excitability
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ANSWER: D
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The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by its
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automaticity, conductivity, and excitability.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
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3. Automaticity refers to: T T
a. Ability to transmit an electrical impulse from one cell to another
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b. Ability to respond to electrical impulse
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c. Ability to initiate an electrical impulse
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d. Ability to automatically respond to electrical impulse
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ANSWER: C
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The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by it its
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Automaticity, conductivity, and excitability. Automaticity refers to the ability to initiate an electrical impulse. Option A
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refers to conductivity of the cell. Option B refers to excitability. Option D doesn’t refer to any of the three physiologic
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characteristic of the electrical cell.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
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4. Cardiac output must be responsive to changes in the metabolic demand. You know that cardiac output can be
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determined by:
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a. Measuring the amount of blood ejected per heartbeat and multiplying it to the client’s heart rate.
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b. Summing up the stroke volume with the client’s heart rate
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c. Getting the heart rate of the client and the client’s stroke volume and BP
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d. Getting the BP of the client multiply to the client’s heart rate
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ANSWER: A
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Rationale: Cardiac output refers to the amount of blood pumped by each ventricle during a given period. CO is
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computed by multiplying the stroke volume by the heart rate. Stroke volume refers to the amount of blood ejected
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per heartbeat.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
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5. Heart rate is stimulated by the following except:
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a. Increased level of the catecholamine T T T T
c. The vagus nerve
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b. Excess thyroid hormone T T
d. The sympathetic system
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ANSWER: C
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Rationale: The increase level of epinephrine and norepinephrine increases the contractility of the heart by stimulating
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the sympathetic nervous system. Excess thyroid hormone like in patients with hyperthyroidism, where metabolic
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demand is increased, you can observe an increase in the heart rate. Vagus nerve, which is the longest nerve, will
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cause bradycardia when stimulated which can be a serious problem especially to patients with cardiac diseases.
T T T T T T T T T T T T T T T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787
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6. One student nurse asks you how to determine the stroke volume of the heart. You will answer the question,
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knowingly that stroke volume is determined by:
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a. The degree of cardiac muscle strength
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b. The intrinsic contractility of the cardiac muscle
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c. The pressure gradient against which the muscle ejects blood during contraction
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d. All of the above factors
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ANSWER: D
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,Rationale: Stroke volume is primarily affected by three factors- preload, afterload and contractility. Option A refers to
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Tcontractility, option B is refers to preload, option C refers to afterload.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787
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7. You know that there are factors that may bring changes in the cardiac structure associated with aging which
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Tincludes all of the following except: T T T T T
a. Elongation of the aorta T T T
c. Increased sensitivity to baroreceptors
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b. Endocardial fibrosis T
d. Increased size of left atrium
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TANSWER: C T
Rationale: The above changes are structural changes that occur as part of the aging process. Instead of increase in
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Tbaroreceptors sensitivity, the change that occurs is decrease in its sensitivity. Baroreceptors work under negative
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Tfeedback mechanism. When BP is elevated, it transmits impulses to the medulla to lower down the HR and BP and the
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Topposite.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
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8. How are you going to assess a client with postural hypotension? Arrange the following in order of execution.
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i. Position the client supine and flat T T T T T
ii. Do not remove the BP cuff between position changes but check to see if the BP is still correctly placed
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iii. Supine measurements should be measured before checking the upright position
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iv. Assess BP changes with client sitting on the edge of the bed with feet dangling and standing
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v. Record HR and BP T T T
a. i, ii, iii, iv, v
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b. i, iii, ii, iv, v
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c. i, iii, ii, v, iv
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d. ii, i, iii, iv, v
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TANSWER: B T
Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the
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Tpatient assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. The proper
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Torder in checking the BP changes should start by positioning the patient first and then measure first the BP in supine
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Tposition before an upright position but never remove the BP cuff to avoid any changes related to misplacing or
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Tadjusting the cuff. Lastly document the HR and BP.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.799
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9. You assess a patient for postural hypotension and recognize the following are normal postural responses except:
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a. An unchanged systolic pressure
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c. An increase of 10 mm Hg in the reading
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b. A heart rate of 5-20 bpm above the resting rate
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d. An increase of 5 mm Hg in diastolic pressure
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TANSWER: C T
Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the
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Tpatient assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. Option C is
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Tincorrect. For us to say that it is normal postural response, it should be a slight decrease of up to 10 mm Hg and not
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Tan increase.
T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.799.
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10. You check the client’s chart and see on the assessment data that the client’s pulse strength is “left radial+2.”
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TBased on 0-4 rating scale, this means:
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a. Diminished pulse and cannot be obliterated T T T T T
b. Pulse is weak, thready, difficult to palpate and obliterated with pressure
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c. Full pulse, easy to palpate, weak and thread
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d. Strong and bounding pulse, may be abnormal
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TANSWER: A T
Rationale: Pulse is weak, thready, and difficult to palpate only if pressure is applied. 0: pulse not palpable or absent.
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+1 Pulse is weak, thready, difficult to palpate and obliterated with pressure. +2 diminished pulse and cannot be
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Tobliterated. +3 Full pulse, easy to palpate. +4 Strong and bounding pulse may be abnormal.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.800
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11. A nurse is explaining the anatomy and physiology of the heart to a group of adults participating in a wellness
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Tprogram. When a participant asks for an explanation of the purpose of the superior vena cava, the nurse provides
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Twhich of the following information?
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a. Returns blood from the body area above the diaphragm
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b. Returns blood from the body below the diaphragm T T T T T T T
c. Drains blood from the heart T T T T
d. Receives freshly oxygenated blood from the lungs through the pulmonary veins
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TANSWER: B T
The superior vena cava returns blood from the body area above the diaphragm, the inferior vena cava returns blood
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Tfrom the body below the diaphragm, and the coronary sinus drains blood from the heart. The left atrium receives
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Tfreshly oxygenated blood from the lungs through the pulmonary veins.
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SITUATION: Cardiovascular disease is the leading cause of death and showed in later studies that many of the
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Tpopulation, men and women of all racial and ethnic groups are seriously affected by these cardiac conditions.
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12. When do coronary arteries primarily receive blood flow?
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a. During inspiration T
b. During diastole T
c. During expiration T
d. During systole T
,ANSWER: B T
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to
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coronary arteries is supplied during diastole. This is the relaxation of the muscle, the heart chambers fill with blood in
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preparation for the subsequent ejection. Breathing patterns are irrelevant to blood flow.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
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Edition, Vol. 1. Page 647
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13. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
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a. Plaques obstruct the vein
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c. Blood clots form outside the vessel wall
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b. Plaques obstruct the artery
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d. Hardened vessels dilate to allow blood to flow through
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, ANSWER: B T
Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atheresclerosis is a direct result of
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plaque formation in the artery. Hardened vessels cannot dilate properly and therefore constrict blood flow.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 713
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14. A murmur is heard at the second left intercostals space along the left sternal border. Which valve area is this?
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a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid
ANSWER:
T
C
T
Abnormalities of the pulmonic valve are auscultated at the second left intercostals space along the left sternal border.
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Option A – aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum.
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Option B – mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line.
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Option D – tricuspid valve abnormalities are heard at the third and fourth intercostals spaces along the sternal border.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T T
Edition, Vol. 1. Page 664
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15. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein
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distention?
T
a. High fowler’s T
b. Raised 10 degrees T T
c. Raised 30 degrees T T
d. Supine position T
ANSWER: C
T T
Jugular venous pressure is measure with a centimeter ruler to obtain the vertical distance between the sternal angle
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and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees.
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Option A – in high fowler’s position, the veins would be barely discernible above the clavicle.
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Option B and D – increased pressure can’t be seen when the client is supine or when the head of the bed is raised 10
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degrees because the point that marks the pressure level is above the jaw, therefore not visible.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 664
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16. After teaching a group of adults about modifiable risk factors for coronary artery disease (CAD), the community
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health nurse knows that the group needs additional teaching if which finding is identified as one of these factors?
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a. Cigarette smoking T
b. Family history T
c. Hypercholesterolemia
d. Hypertension
ANSWER: B
T T
Family history is a risk factor for CAD, but it is a non-modifiable risk factor. Cigarette smoking, elevated cholesterol
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levels (hypercholesterolemia), and hypertension are modifiable risk factors for CAD.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 656
T T T T T
17. A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by the
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nurse best explains the procedure to the client?
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a. "PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter."
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b. "PTCA involves cutting away blockages with a special catheter."
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c. "PTCA involves passing a catheter through the coronary arteries to find blocked arteries."
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d. "PTCA involves inserting grafts to divert blood from blocked coronary arteries."
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ANSWER: A
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PTCA is best described as insertion of a balloon-tipped catheter into the coronary artery to compress a plaque,
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thereby opening a stenosed or blocked artery.
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Option B - this is a description of an atherectomy.
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Option C - this only describes a cardiac catheterization.
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Option D - Inserting grafts to divert blood from blocked arteries describes coronary artery bypass graft surgery.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T T
Edition, Vol. 1. Page 733-735
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18. As initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3 mg given
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sublingually. This drug’s principal effects are produced by:
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a. Antispasmodic effects on the pericardium T T T T
c. Vasodilation of peripheral vasculature
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b. Causing an increased myocardial oxygen T T T T
d. Improved conductivity in the myocardium
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ANSWER: C
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Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand.
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Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the
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heart.
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Option A and D - nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.
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Option B - nitroglycerin decreases myocardial oxygen demand.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 721
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19. A client is experiencing an acute myocardial infarction (MI) and I.V. morphine is prescribed. Morphine is given
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because it:
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CARE OF CLIENTS WITH CARDIOVASCULAR DISORDERS
T T T T T
SITUATION: Basic knowledge about the physiology of the cardiovascular system will greatly help the nurse to
T T T T T T T T T T T T T T T
provide appropriate assessment and interventions. The key component of physical assessment includes a health
T T T T T T T T T T T T T T
history, physical examination, and monitoring of variety of laboratory and diagnostic test results.
T T T T T T T T T T T T T
1. The pumping action of the heart is accomplished by the rhythmic contraction and relaxation of its muscular wall.
T T T T T T T T T T T T T T T T T
What change occurs during systole?
T T T T T
a. The chambers of the heart become smaller as the blood is ejected
T T T T T T T T T T T
b. The heart chambers fill with blood in preparation for subsequent ejection.
T T T T T T T T T T
c. The heart chamber of the heart becomes bigger as it receives blood
T T T T T T T T T T T
d. The myocardium becomes thinner as it blood enter the chamber.
T T T T T T T T T
ANSWER: A
T T
Rationale: As the blood coming from the systemic circulation enters the inferior and superior vena cava, the atrium
T T T T T T T T T T T T T T T T T
will receive the blood which makes the myocardium thin and enlarged. This occurs during diastole when the heart
T T T T T T T T T T T T T T T T T T
relaxes as the chamber of the heart is filled with blood. During systole or contraction, the heart become smaller as the
T T T T T T T T T T T T T T T T T T T T T
blood is ejected to the circulation.
T T T T T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
T T T T T T T T
2. Cardiac conduction system generates and transmits electrical impulses that stimulate contraction of the
T T T T T T T T T T T T
myocardium. Impulses come from two specialized electrical cells. What are the physiologic characteristics of the
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electrical cell?
T T
a. Automaticity, excitability, potentiality T T
c. Conductivity, potentiality, refractivity
T T T
b. Automaticity, conductivity, refractivity T T
d. Automaticity, conductivity, excitability
T T T
ANSWER: D
T T
The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by its
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automaticity, conductivity, and excitability.
T T T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
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3. Automaticity refers to: T T
a. Ability to transmit an electrical impulse from one cell to another
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b. Ability to respond to electrical impulse
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c. Ability to initiate an electrical impulse
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d. Ability to automatically respond to electrical impulse
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ANSWER: C
T T
The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by it its
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Automaticity, conductivity, and excitability. Automaticity refers to the ability to initiate an electrical impulse. Option A
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refers to conductivity of the cell. Option B refers to excitability. Option D doesn’t refer to any of the three physiologic
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characteristic of the electrical cell.
T T T T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
T T T T T T T T
4. Cardiac output must be responsive to changes in the metabolic demand. You know that cardiac output can be
T T T T T T T T T T T T T T T T T
determined by:
T T
a. Measuring the amount of blood ejected per heartbeat and multiplying it to the client’s heart rate.
T T T T T T T T T T T T T T T
b. Summing up the stroke volume with the client’s heart rate
T T T T T T T T T
c. Getting the heart rate of the client and the client’s stroke volume and BP
T T T T T T T T T T T T T
d. Getting the BP of the client multiply to the client’s heart rate
T T T T T T T T T T T
ANSWER: A
T T
Rationale: Cardiac output refers to the amount of blood pumped by each ventricle during a given period. CO is
T T T T T T T T T T T T T T T T T T
computed by multiplying the stroke volume by the heart rate. Stroke volume refers to the amount of blood ejected
T T T T T T T T T T T T T T T T T T T
per heartbeat.
T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
T T T T T T T T
5. Heart rate is stimulated by the following except:
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a. Increased level of the catecholamine T T T T
c. The vagus nerve
T T T
b. Excess thyroid hormone T T
d. The sympathetic system
T T T
ANSWER: C
T T
Rationale: The increase level of epinephrine and norepinephrine increases the contractility of the heart by stimulating
T T T T T T T T T T T T T T T
the sympathetic nervous system. Excess thyroid hormone like in patients with hyperthyroidism, where metabolic
T T T T T T T T T T T T T T
demand is increased, you can observe an increase in the heart rate. Vagus nerve, which is the longest nerve, will
T T T T T T T T T T T T T T T T T T T T
cause bradycardia when stimulated which can be a serious problem especially to patients with cardiac diseases.
T T T T T T T T T T T T T T T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787
T T T T T T T T
6. One student nurse asks you how to determine the stroke volume of the heart. You will answer the question,
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knowingly that stroke volume is determined by:
T T T T T T T
a. The degree of cardiac muscle strength
T T T T T
b. The intrinsic contractility of the cardiac muscle
T T T T T T
c. The pressure gradient against which the muscle ejects blood during contraction
T T T T T T T T T T
d. All of the above factors
T T T T
ANSWER: D
T T
,Rationale: Stroke volume is primarily affected by three factors- preload, afterload and contractility. Option A refers to
T T T T T T T T T T T T T T T T
Tcontractility, option B is refers to preload, option C refers to afterload.
T T T T T T T T T T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787
T T T T T T T T
7. You know that there are factors that may bring changes in the cardiac structure associated with aging which
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Tincludes all of the following except: T T T T T
a. Elongation of the aorta T T T
c. Increased sensitivity to baroreceptors
T T T T
b. Endocardial fibrosis T
d. Increased size of left atrium
T T T T T
TANSWER: C T
Rationale: The above changes are structural changes that occur as part of the aging process. Instead of increase in
T T T T T T T T T T T T T T T T T T
Tbaroreceptors sensitivity, the change that occurs is decrease in its sensitivity. Baroreceptors work under negative
T T T T T T T T T T T T T T
Tfeedback mechanism. When BP is elevated, it transmits impulses to the medulla to lower down the HR and BP and the
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Topposite.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
T T T T T T T T
8. How are you going to assess a client with postural hypotension? Arrange the following in order of execution.
T T T T T T T T T T T T T T T T T
i. Position the client supine and flat T T T T T
ii. Do not remove the BP cuff between position changes but check to see if the BP is still correctly placed
T T T T T T T T T T T T T T T T T T T
iii. Supine measurements should be measured before checking the upright position
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iv. Assess BP changes with client sitting on the edge of the bed with feet dangling and standing
T T T T T T T T T T T T T T T T
v. Record HR and BP T T T
a. i, ii, iii, iv, v
T T T T
b. i, iii, ii, iv, v
T T T T
c. i, iii, ii, v, iv
T T T T
d. ii, i, iii, iv, v
T T T T
TANSWER: B T
Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the
T T T T T T T T T T T T T
Tpatient assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. The proper
T T T T T T T T T T T T T T T
Torder in checking the BP changes should start by positioning the patient first and then measure first the BP in supine
T T T T T T T T T T T T T T T T T T T T
Tposition before an upright position but never remove the BP cuff to avoid any changes related to misplacing or
T T T T T T T T T T T T T T T T T T
Tadjusting the cuff. Lastly document the HR and BP.
T T T T T T T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.799
T T T T T T T T
9. You assess a patient for postural hypotension and recognize the following are normal postural responses except:
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a. An unchanged systolic pressure
T T T
c. An increase of 10 mm Hg in the reading
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b. A heart rate of 5-20 bpm above the resting rate
T T T T T T T T T
d. An increase of 5 mm Hg in diastolic pressure
T T T T T T T T T
TANSWER: C T
Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the
T T T T T T T T T T T T T
Tpatient assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. Option C is
T T T T T T T T T T T T T T T T
Tincorrect. For us to say that it is normal postural response, it should be a slight decrease of up to 10 mm Hg and not
T T T T T T T T T T T T T T T T T T T T T T T T
Tan increase.
T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.799.
T T T T T T T T
10. You check the client’s chart and see on the assessment data that the client’s pulse strength is “left radial+2.”
T T T T T T T T T T T T T T T T T T
TBased on 0-4 rating scale, this means:
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a. Diminished pulse and cannot be obliterated T T T T T
b. Pulse is weak, thready, difficult to palpate and obliterated with pressure
T T T T T T T T T T
c. Full pulse, easy to palpate, weak and thread
T T T T T T T
d. Strong and bounding pulse, may be abnormal
T T T T T T
TANSWER: A T
Rationale: Pulse is weak, thready, and difficult to palpate only if pressure is applied. 0: pulse not palpable or absent.
T T T T T T T T T T T T T T T T T T T
+1 Pulse is weak, thready, difficult to palpate and obliterated with pressure. +2 diminished pulse and cannot be
T T T T T T T T T T T T T T T T T
Tobliterated. +3 Full pulse, easy to palpate. +4 Strong and bounding pulse may be abnormal.
T T T T T T T T T T T T T T
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.800
T T T T T T T T
11. A nurse is explaining the anatomy and physiology of the heart to a group of adults participating in a wellness
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Tprogram. When a participant asks for an explanation of the purpose of the superior vena cava, the nurse provides
T T T T T T T T T T T T T T T T T T
Twhich of the following information?
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a. Returns blood from the body area above the diaphragm
T T T T T T T T
b. Returns blood from the body below the diaphragm T T T T T T T
c. Drains blood from the heart T T T T
d. Receives freshly oxygenated blood from the lungs through the pulmonary veins
T T T T T T T T T T
TANSWER: B T
The superior vena cava returns blood from the body area above the diaphragm, the inferior vena cava returns blood
T T T T T T T T T T T T T T T T T T
Tfrom the body below the diaphragm, and the coronary sinus drains blood from the heart. The left atrium receives
T T T T T T T T T T T T T T T T T T
Tfreshly oxygenated blood from the lungs through the pulmonary veins.
T T T T T T T T T
SITUATION: Cardiovascular disease is the leading cause of death and showed in later studies that many of the
T T T T T T T T T T T T T T T T T
Tpopulation, men and women of all racial and ethnic groups are seriously affected by these cardiac conditions.
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12. When do coronary arteries primarily receive blood flow?
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a. During inspiration T
b. During diastole T
c. During expiration T
d. During systole T
,ANSWER: B T
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to
T T T T T T T T T T T T T T T T T T
coronary arteries is supplied during diastole. This is the relaxation of the muscle, the heart chambers fill with blood in
T T T T T T T T T T T T T T T T T T T T
preparation for the subsequent ejection. Breathing patterns are irrelevant to blood flow.
T T T T T T T T T T T T
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 647
T T T T T
13. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
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a. Plaques obstruct the vein
T T T
c. Blood clots form outside the vessel wall
T T T T T T T
b. Plaques obstruct the artery
T T T
d. Hardened vessels dilate to allow blood to flow through
T T T T T T T T T
, ANSWER: B T
Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atheresclerosis is a direct result of
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plaque formation in the artery. Hardened vessels cannot dilate properly and therefore constrict blood flow.
T T T T T T T T T T T T T T T
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 713
T T T T T
14. A murmur is heard at the second left intercostals space along the left sternal border. Which valve area is this?
T T T T T T T T T T T T T T T T T T T
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid
ANSWER:
T
C
T
Abnormalities of the pulmonic valve are auscultated at the second left intercostals space along the left sternal border.
T T T T T T T T T T T T T T T T T
Option A – aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum.
T T T T T T T T T T T T T T T T T T T
Option B – mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line.
T T T T T T T T T T T T T T T T
Option D – tricuspid valve abnormalities are heard at the third and fourth intercostals spaces along the sternal border.
T T T T T T T T T T T T T T T T T T
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T T
Edition, Vol. 1. Page 664
T T T T T
15. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein
T T T T T T T T T T T T T T T T T T T T
distention?
T
a. High fowler’s T
b. Raised 10 degrees T T
c. Raised 30 degrees T T
d. Supine position T
ANSWER: C
T T
Jugular venous pressure is measure with a centimeter ruler to obtain the vertical distance between the sternal angle
T T T T T T T T T T T T T T T T T
and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees.
T T T T T T T T T T T T T T T T T T
Option A – in high fowler’s position, the veins would be barely discernible above the clavicle.
T T T T T T T T T T T T T T T
Option B and D – increased pressure can’t be seen when the client is supine or when the head of the bed is raised 10
T T T T T T T T T T T T T T T T T T T T T T T T
degrees because the point that marks the pressure level is above the jaw, therefore not visible.
T T T T T T T T T T T T T T T T
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 664
T T T T T
16. After teaching a group of adults about modifiable risk factors for coronary artery disease (CAD), the community
T T T T T T T T T T T T T T T T
health nurse knows that the group needs additional teaching if which finding is identified as one of these factors?
T T T T T T T T T T T T T T T T T T T
a. Cigarette smoking T
b. Family history T
c. Hypercholesterolemia
d. Hypertension
ANSWER: B
T T
Family history is a risk factor for CAD, but it is a non-modifiable risk factor. Cigarette smoking, elevated cholesterol
T T T T T T T T T T T T T T T T T T
levels (hypercholesterolemia), and hypertension are modifiable risk factors for CAD.
T T T T T T T T T T
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 656
T T T T T
17. A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by the
T T T T T T T T T T T T T T
nurse best explains the procedure to the client?
T T T T T T T T
a. "PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter."
T T T T T T T T T T T T T T T T
b. "PTCA involves cutting away blockages with a special catheter."
T T T T T T T T
c. "PTCA involves passing a catheter through the coronary arteries to find blocked arteries."
T T T T T T T T T T T T
d. "PTCA involves inserting grafts to divert blood from blocked coronary arteries."
T T T T T T T T T T
ANSWER: A
T T
PTCA is best described as insertion of a balloon-tipped catheter into the coronary artery to compress a plaque,
T T T T T T T T T T T T T T T T T
thereby opening a stenosed or blocked artery.
T T T T T T T
Option B - this is a description of an atherectomy.
T T T T T T T T T
Option C - this only describes a cardiac catheterization.
T T T T T T T T T
Option D - Inserting grafts to divert blood from blocked arteries describes coronary artery bypass graft surgery.
T T T T T T T T T T T T T T T T
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T T
Edition, Vol. 1. Page 733-735
T T T T T
18. As initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3 mg given
T T T T T T T T T T T T T T T T
sublingually. This drug’s principal effects are produced by:
T T T T T T T T
a. Antispasmodic effects on the pericardium T T T T
c. Vasodilation of peripheral vasculature
T T T T
b. Causing an increased myocardial oxygen T T T T
d. Improved conductivity in the myocardium
T T T T T
ANSWER: C
T T
Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand.
T T T T T T T T T T
Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the
T T T T T T T T T T T T T T T T T T
heart.
T
Option A and D - nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.
T T T T T T T T T T T T T T T T T T
Option B - nitroglycerin decreases myocardial oxygen demand.
T T T T T T T T
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th
T T T T T T T T T T T T T T
Edition, Vol. 1. Page 721
T T T T T
19. A client is experiencing an acute myocardial infarction (MI) and I.V. morphine is prescribed. Morphine is given
T T T T T T T T T T T T T T T T
because it:
T T
