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, MEDICAL SURGICAL NURSING 1
CARE OF CLIENTS WITH CARDIOVASCULAR DISORDERS
SITUATION: Basic knowledge about the physiology of the cardiovascular system will greatly help the nurse to
provide appropriate assessment and interventions. The key component of physical assessment includes a health
history, physical examination, and monitoring of variety of laboratory and diagnostic test results.
1. The pumping action of the heart is accomplished by the rhythmic contraction and relaxation of its muscular wall.
What change occurs during systole?
a. The chambers of the heart become smaller as the blood is ejected
b. The heart chambers fill with blood in preparation for subsequent ejection.
c. The heart chamber of the heart becomes bigger as it receives blood
d. The myocardium becomes thinner as it blood enter the chamber.
ANSWER: A
Rationale: As the blood coming from the systemic circulation enters the inferior and superior vena cava, the atrium
will receive the blood which makes the myocardium thin and enlarged. This occurs during diastole when the heart
relaxes as the chamber of the heart is filled with blood. During systole or contraction, the heart become smaller as the
blood is ejected to the circulation.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
2. Cardiac conduction system generates and transmits electrical impulses that stimulate contraction of the
myocardium. Impulses come from two specialized electrical cells. What are the physiologic characteristics of the
electrical cell?
a. Automaticity, excitability, potentiality
c. Conductivity, potentiality, refractivity
b. Automaticity, conductivity, refractivity
d. Automaticity, conductivity, excitability
ANSWER: D
The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by its
automaticity, conductivity, and excitability.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
3. Automaticity refers to:
a. Ability to transmit an electrical impulse from one cell to another
,b. Ability to respond to electrical impulse
c. Ability to initiate an electrical impulse
d. Ability to automatically respond to electrical impulse
ANSWER: C
The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by it its
Automaticity, conductivity, and excitability. Automaticity refers to the ability to initiate an electrical impulse. Option A
refers to conductivity of the cell. Option B refers to excitability. Option D doesn’t refer to any of the three physiologic
characteristic of the electrical cell.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
4. Cardiac output must be responsive to changes in the metabolic demand. You know that cardiac output can be
determined by:
a. Measuring the amount of blood ejected per heartbeat and multiplying it to the client’s heart rate.
b. Summing up the stroke volume with the client’s heart rate
c. Getting the heart rate of the client and the client’s stroke volume and BP
d. Getting the BP of the client multiply to the client’s heart rate
ANSWER: A
Rationale: Cardiac output refers to the amount of blood pumped by each ventricle during a given period. CO is
computed by multiplying the stroke volume by the heart rate. Stroke volume refers to the amount of blood ejected
per heartbeat.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
5. Heart rate is stimulated by the following except:
a. Increased level of the catecholamine
c. The vagus nerve
b. Excess thyroid hormone
d. The sympathetic system
ANSWER: C
Rationale: The increase level of epinephrine and norepinephrine increases the contractility of the heart by stimulating
the sympathetic nervous system. Excess thyroid hormone like in patients with hyperthyroidism, where metabolic
demand is increased, you can observe an increase in the heart rate. Vagus nerve, which is the longest nerve, will
, cause bradycardia when stimulated which can be a serious problem especially to patients with cardiac diseases.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787
6. One student nurse asks you how to determine the stroke volume of the heart. You will answer the question,
knowingly that stroke volume is determined by:
a. The degree of cardiac muscle strength
b. The intrinsic contractility of the cardiac muscle
c. The pressure gradient against which the muscle ejects blood during contraction
d. All of the above factors
ANSWER: D