MEDICAL SURGICAL NURSING 1 LL LL LL
CARE OF CLIENTS WITH CARDIOVASCULAR DISORDERS
LL LL LL LL LL
SITUATION: Basic knowledge about the physiology of the cardiovascular system will greatly help the nurse to pro
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
vide appropriate assessment and interventions. The key component of physical assessment includes a health history
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
, physical examination, and monitoring of variety of laboratory and diagnostic test results.
LL LL LL LL LL LL LL LL LL LL LL LL
1. The pumping action of the heart is accomplished by the rhythmic contraction and relaxation of its muscular wal
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
l. What change occurs during systole?
LL LL LL LL LL
a. The chambers of the heart become smaller as the blood is ejected
LL LL LL LL LL LL LL LL LL LL LL
b. The heart chambers fill with blood in preparation for subsequent ejection.
LL LL LL LL LL LL LL LL LL LL
c. The heart chamber of the heart becomes bigger as it receives blood
LL LL LL LL LL LL LL LL LL LL LL
d. The myocardium becomes thinner as it blood enter the chamber.
LL LL LL LL LL LL LL LL LL
LLANSWER: A LL
Rationale: As the blood coming from the systemic circulation enters the inferior and superior vena cava, the atrium
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
will receive the blood which makes the myocardium thin and enlarged. This occurs during diastole when the heart r
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
elaxes as the chamber of the heart is filled with blood. During systole or contraction, the heart become smaller as th
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
e blood is ejected to the circulation.
LL LL LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
LL LL LL LL LL LL LL LL
2. Cardiac conduction system generates and transmits electrical impulses that stimulate contraction of the my
LL LL LL LL LL LL LL LL LL LL LL LL LL
ocardium. Impulses come from two specialized electrical cells. What are the physiologic characteristics of the e
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
lectrical cell? LL
a. Automaticity, excitability, potentiality LL LL
c. Conductivity, potentiality, refractivity
LL LL LL
b. Automaticity, conductivity, refractivity LL LL
d. Automaticity, conductivity, excitability ANSW
LL LL LL LL
ER: D LL
The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by it
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
s automaticity, conductivity, and excitability.
LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
LL LL LL LL LL LL LL LL
3. Automaticity refers to: LL LL
a. Ability to transmit an electrical impulse from one cell to another
LL LL LL LL LL LL LL LL LL LL
b. Ability to respond to electrical impulse
LL LL LL LL LL
c. Ability to initiate an electrical impulse
LL LL LL LL LL
d. Ability to automatically respond to electrical impulse
LL LL LL LL LL LL
LLANSWER: C LL
The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by it i
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ts Automaticity, conductivity, and excitability. Automaticity refers to the ability to initiate an electrical impulse. Opti
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
on A refers to conductivity of the cell. Option B refers to excitability. Option D doesn’t refer to any of the three phy
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
siologic characteristic of the electrical cell.
LL LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
LL LL LL LL LL LL LL LL
4. Cardiac output must be responsive to changes in the metabolic demand. You know that cardiac output can b
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
e determined by:
LL LL
a. Measuring the amount of blood ejected per heartbeat and multiplying it to the client’s heart rate.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
b. Summing up the stroke volume with the client’s heart rate LL LL LL LL LL LL LL LL LL
c. Getting the heart rate of the client and the client’s stroke volume and BP
LL LL LL LL LL LL LL LL LL LL LL LL LL
d. Getting the BP of the client multiply to the client’s heart rat
LL LL LL LL LL LL LL LL LL LL LL
e ANSWER: A
LL LL
Rationale: Cardiac output refers to the amount of blood pumped by each ventricle during a given period. CO is co
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
mputed by multiplying the stroke volume by the heart rate. Stroke volume refers to the amount of blood ejected pe
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
r heartbeat.
LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
LL LL LL LL LL LL LL LL
5. Heart rate is stimulated by the following except:
LL LL LL LL LL LL LL
a. Increased level of the catecholamine LL LL LL LL
c. The vagus nerve
LL LL LL
b. Excess thyroid hormone LL LL
d. The sympathetic system ANSWE
LL LL LL LL
R: C LL
Rationale: The increase level of epinephrine and norepinephrine increases the contractility of the heart by stimulating
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL L
Lthe sympathetic nervous system. Excess thyroid hormone like in patients with hyperthyroidism, where metabolic de
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
mand is increased, you can observe an increase in the heart rate. Vagus nerve, which is the longest nerve, will cau
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
se bradycardia when stimulated which can be a serious problem especially to patients with cardiac diseases.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787
LL LL LL LL LL LL LL LL
6. One student nurse asks you how to determine the stroke volume of the heart. You will answer the questio
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
n, knowingly that stroke volume is determined by:
LL LL LL LL LL LL LL
a. The degree of cardiac muscle strength
LL LL LL LL LL
b. The intrinsic contractility of the cardiac muscle
LL LL LL LL LL LL
c. The pressure gradient against which the muscle ejects blood during contraction
LL LL LL LL LL LL LL LL LL LL
d. All of the above factors
LL LL LL LL L
LANSWER: D LL
,Rationale: Stroke volume is primarily affected by three factors-
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preload, afterload and contractility. Option A refers to contractility, option B is refers to preload, option C refers to a
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
fterload.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787
LL LL LL LL LL LL LL LL
7. You know that there are factors that may bring changes in the cardiac structure associated with aging whic
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
h includes all of the following except:
LL LL LL LL LL LL
a. Elongation of the aorta LL LL LL
c. Increased sensitivity to baroreceptors
LL LL LL LL
b. Endocardial fibrosis LL
d. Increased size of left atrium ANS
LL LL LL LL LL LL
WER: C LL
Rationale: The above changes are structural changes that occur as part of the aging process. Instead of increase in
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL L
Lbaroreceptors sensitivity, the change that occurs is decrease in its sensitivity. Baroreceptors work under negative fe
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
edback mechanism. When BP is elevated, it transmits impulses to the medulla to lower down the HR and BP and the
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
opposite.
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 LL LL LL LL LL
ii. Do not remove the BP cuff between position changes but check to see if the BP is still correctly placed
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
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 LL LL LL
a. i, ii, iii, iv, vLL LL LL LL
b. i, iii, ii, iv, vLL LL LL LL
c. i, iii, ii, v, ivLL LL LL LL
d. ii, i, iii, iv, v LL LL LL LL L
LANSWER: B LL
Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the pati
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ent assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. The proper ord
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
er in checking the BP changes should start by positioning the patient first and then measure first the BP in supine p
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
osition before an upright position but never remove the BP cuff to avoid any changes related to misplacing or adjus
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ting the cuff. Lastly document the HR and BP.
LL LL LL LL LL LL LL LL
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
LL LL LL
c. An increase of 10 mm Hg in the reading
LL LL LL LL LL LL LL LL LL
b. A heart rate of 5-20 bpm above the resting rate
LL LL LL LL LL LL LL LL LL
d. An increase of 5 mm Hg in diastolic pressur
LL LL LL LL LL LL LL LL LL
e ANSWER: C
LL LL
Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the pati
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ent assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. Option C is inc
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
orrect. For us to say that it is normal postural response, it should be a slight decrease of up to 10 mm Hg and not
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
an increase.
LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.799.
LL LL LL LL LL LL LL LL
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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” Based on 0-4 rating scale, this means:
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a. Diminished pulse and cannot be obliterated LL LL LL LL LL
b. Pulse is weak, thready, difficult to palpate and obliterated with pressure
LL LL LL LL LL LL LL LL LL LL
c. Full pulse, easy to palpate, weak and thread
LL LL LL LL LL LL LL
d. Strong and bounding pulse, may be abnormal LL LL LL LL LL LL
LLANSWER: A LL
Rationale: Pulse is weak, thready, and difficult to palpate only if pressure is applied. 0: pulse not palpable or absent.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
+1 Pulse is weak, thready, difficult to palpate and obliterated with pressure. +2 diminished pulse and cannot be obl
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
iterated. +3 Full pulse, easy to palpate. +4 Strong and bounding pulse may be abnormal.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.800
LL LL LL LL LL LL LL LL
11. A nurse is explaining the anatomy and physiology of the heart to a group of adults participating in a wellne
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ss program. When a participant asks for an explanation of the purpose of the superior vena cava, the nurse prov
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ides which of the following information?
LL LL LL LL LL
a. Returns blood from the body area above the diaphragmLL LL LL LL LL LL LL LL
b. Returns blood from the body below the diaphragm LL LL LL LL LL LL LL
c. Drains blood from the heart LL LL LL LL
d. Receives freshly oxygenated blood from the lungs through the pulmonary veins
LL LL LL LL LL LL LL LL LL LL
LLANSWER: B LL
The superior vena cava returns blood from the body area above the diaphragm, the inferior vena cava returns bloo
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d from the body below the diaphragm, and the coronary sinus drains blood from the heart. The left atrium receive
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s freshly 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 pop
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ulation, 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?
LL LL LL LL LL LL LL
a. During inspiration LL
b. During diastole LL
c. During expiration LL
d. During systole LL
,ANSWER: B LL
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coro
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
nary arteries is supplied during diastole. This is the relaxation of the muscle, the heart chambers fill with blood in pr
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
eparation 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-
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Surgical Nursing. 10th 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
LL LL LL
c. Blood clots form outside the vessel wall
LL LL LL LL LL LL LL
b. Plaques obstruct the artery
LL LL LL
d. Hardened vessels dilate to allow blood to flow through
LL LL LL LL LL LL LL LL LL
, ANSWER: B LL
Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atheresclerosis is a direct result o
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f 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-
LL LL LL LL LL LL LL LL LL LL LL LL
Surgical Nursing. 10th 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?
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid L
LANSWER: LL
C
Abnormalities of the pulmonic valve are auscultated at the second left intercostals space along the left sternal border.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL L
LOption 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.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Option D – LL LL
tricuspid valve abnormalities are heard at the third and fourth intercostals spaces along the sternal border. Referenc
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e: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
LL LL LL LL LL LL LL LL LL LL LL LL
Surgical Nursing. 10th Edition, Vol. 1. Page 664
LL LL LL LL LL LL LL
15. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vei
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
n distention?
LL
a. High fowler’s LL
b. Raised 10 degrees LL LL
c. Raised 30 degrees LL LL
d. Supine position LL
ANSWER: C
LL LL
Jugular venous pressure is measure with a centimeter ruler to obtain the vertical distance between the sternal angl
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
e 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.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Option B and D – LL LL LL LL
increased pressure can’t be seen when the client is supine or when the head of the bed is raised 10 degrees becaus
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
e the point that marks the pressure level is above the jaw, therefore not visible.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
LL LL LL LL LL LL LL LL LL LL LL LL
Surgical Nursing. 10th 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 communit
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y health nurse knows that the group needs additional teaching if which finding is identified as one of these factor
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
s?
a. Cigarette smoking LL
b. Family history LL
c. Hypercholesterolemia
d. Hypertension
ANSWER: B
LL LL
Family history is a risk factor for CAD, but it is a non-
LL LL LL LL LL LL LL LL LL LL LL LL
modifiable risk factor. Cigarette smoking, elevated cholesterol levels (hypercholesterolemia), and hypertension are
LL LL LL LL LL LL LL LL LL LL LL LL
modifiable risk factors for CAD. LL LL LL LL
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
LL LL LL LL LL LL LL LL LL LL LL LL
Surgical Nursing. 10th Edition, Vol. 1. Page 656
LL LL LL LL LL LL LL
17. A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by th
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
e nurse best explains the procedure to the client?
LL LL LL LL LL LL LL LL
a. "PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter."
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
b. "PTCA involves cutting away blockages with a special catheter."
LL LL LL LL LL LL LL LL
c. "PTCA involves passing a catheter through the coronary arteries to find blocked arteries."
LL LL LL LL LL LL LL LL LL LL LL LL
d. "PTCA involves inserting grafts to divert blood from blocked coronary arteries.
LL LL LL LL LL LL LL LL LL LL
" ANSWER: A
LL LL
PTCA is best described as insertion of a balloon-
LL LL LL LL LL LL LL LL
tipped catheter into the coronary artery to compress a plaque, thereby opening a stenosed or blocked artery.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Option B - LL LL
this is a description of an atherectomy. Option C -
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this only describes a cardiac catheterization.
LL LL LL LL LL LL
Option D - LL LL
Inserting grafts to divert blood from blocked arteries describes coronary artery bypass graft surgery. Reference:
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Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
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Surgical Nursing. 10th 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 give
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
n sublingually. This drug’s principal effects are produced by:
LL LL LL LL LL LL LL LL
a. Antispasmodic effects on the pericardium LL LL LL LL
c. Vasodilation of peripheral vasculature
LL LL LL LL
b. Causing an increased myocardial oxygen LL LL LL LL
d. Improved conductivity in the myocardium A
LL LL LL LL LL LL
NSWER: C LL
Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodi
LL LL LL LL LL LL LL LL LL LL LL
lation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Option A and D - LL LL LL LL
nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium. Option B -
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
nitroglycerin decreases myocardial oxygen demand.
LL LL LL LL LL
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
LL LL LL LL LL LL LL LL LL LL LL LL
Surgical Nursing. 10th Edition, Vol. 1. Page 721
LL LL LL LL LL LL LL
19. A client is experiencing an acute myocardial infarction (MI) and I.V. morphine is prescribed. Morphine is give
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
CARE OF CLIENTS WITH CARDIOVASCULAR DISORDERS
LL LL LL LL LL
SITUATION: Basic knowledge about the physiology of the cardiovascular system will greatly help the nurse to pro
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
vide appropriate assessment and interventions. The key component of physical assessment includes a health history
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
, physical examination, and monitoring of variety of laboratory and diagnostic test results.
LL LL LL LL LL LL LL LL LL LL LL LL
1. The pumping action of the heart is accomplished by the rhythmic contraction and relaxation of its muscular wal
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
l. What change occurs during systole?
LL LL LL LL LL
a. The chambers of the heart become smaller as the blood is ejected
LL LL LL LL LL LL LL LL LL LL LL
b. The heart chambers fill with blood in preparation for subsequent ejection.
LL LL LL LL LL LL LL LL LL LL
c. The heart chamber of the heart becomes bigger as it receives blood
LL LL LL LL LL LL LL LL LL LL LL
d. The myocardium becomes thinner as it blood enter the chamber.
LL LL LL LL LL LL LL LL LL
LLANSWER: A LL
Rationale: As the blood coming from the systemic circulation enters the inferior and superior vena cava, the atrium
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
will receive the blood which makes the myocardium thin and enlarged. This occurs during diastole when the heart r
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
elaxes as the chamber of the heart is filled with blood. During systole or contraction, the heart become smaller as th
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
e blood is ejected to the circulation.
LL LL LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
LL LL LL LL LL LL LL LL
2. Cardiac conduction system generates and transmits electrical impulses that stimulate contraction of the my
LL LL LL LL LL LL LL LL LL LL LL LL LL
ocardium. Impulses come from two specialized electrical cells. What are the physiologic characteristics of the e
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
lectrical cell? LL
a. Automaticity, excitability, potentiality LL LL
c. Conductivity, potentiality, refractivity
LL LL LL
b. Automaticity, conductivity, refractivity LL LL
d. Automaticity, conductivity, excitability ANSW
LL LL LL LL
ER: D LL
The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by it
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
s automaticity, conductivity, and excitability.
LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
LL LL LL LL LL LL LL LL
3. Automaticity refers to: LL LL
a. Ability to transmit an electrical impulse from one cell to another
LL LL LL LL LL LL LL LL LL LL
b. Ability to respond to electrical impulse
LL LL LL LL LL
c. Ability to initiate an electrical impulse
LL LL LL LL LL
d. Ability to automatically respond to electrical impulse
LL LL LL LL LL LL
LLANSWER: C LL
The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized by it i
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ts Automaticity, conductivity, and excitability. Automaticity refers to the ability to initiate an electrical impulse. Opti
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
on A refers to conductivity of the cell. Option B refers to excitability. Option D doesn’t refer to any of the three phy
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
siologic characteristic of the electrical cell.
LL LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
LL LL LL LL LL LL LL LL
4. Cardiac output must be responsive to changes in the metabolic demand. You know that cardiac output can b
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
e determined by:
LL LL
a. Measuring the amount of blood ejected per heartbeat and multiplying it to the client’s heart rate.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
b. Summing up the stroke volume with the client’s heart rate LL LL LL LL LL LL LL LL LL
c. Getting the heart rate of the client and the client’s stroke volume and BP
LL LL LL LL LL LL LL LL LL LL LL LL LL
d. Getting the BP of the client multiply to the client’s heart rat
LL LL LL LL LL LL LL LL LL LL LL
e ANSWER: A
LL LL
Rationale: Cardiac output refers to the amount of blood pumped by each ventricle during a given period. CO is co
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
mputed by multiplying the stroke volume by the heart rate. Stroke volume refers to the amount of blood ejected pe
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
r heartbeat.
LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786
LL LL LL LL LL LL LL LL
5. Heart rate is stimulated by the following except:
LL LL LL LL LL LL LL
a. Increased level of the catecholamine LL LL LL LL
c. The vagus nerve
LL LL LL
b. Excess thyroid hormone LL LL
d. The sympathetic system ANSWE
LL LL LL LL
R: C LL
Rationale: The increase level of epinephrine and norepinephrine increases the contractility of the heart by stimulating
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL L
Lthe sympathetic nervous system. Excess thyroid hormone like in patients with hyperthyroidism, where metabolic de
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
mand is increased, you can observe an increase in the heart rate. Vagus nerve, which is the longest nerve, will cau
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
se bradycardia when stimulated which can be a serious problem especially to patients with cardiac diseases.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787
LL LL LL LL LL LL LL LL
6. One student nurse asks you how to determine the stroke volume of the heart. You will answer the questio
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
n, knowingly that stroke volume is determined by:
LL LL LL LL LL LL LL
a. The degree of cardiac muscle strength
LL LL LL LL LL
b. The intrinsic contractility of the cardiac muscle
LL LL LL LL LL LL
c. The pressure gradient against which the muscle ejects blood during contraction
LL LL LL LL LL LL LL LL LL LL
d. All of the above factors
LL LL LL LL L
LANSWER: D LL
,Rationale: Stroke volume is primarily affected by three factors-
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preload, afterload and contractility. Option A refers to contractility, option B is refers to preload, option C refers to a
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fterload.
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 whic
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h includes all of the following except:
LL LL LL LL LL LL
a. Elongation of the aorta LL LL LL
c. Increased sensitivity to baroreceptors
LL LL LL LL
b. Endocardial fibrosis LL
d. Increased size of left atrium ANS
LL LL LL LL LL LL
WER: C LL
Rationale: The above changes are structural changes that occur as part of the aging process. Instead of increase in
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Lbaroreceptors sensitivity, the change that occurs is decrease in its sensitivity. Baroreceptors work under negative fe
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edback mechanism. When BP is elevated, it transmits impulses to the medulla to lower down the HR and BP and the
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opposite.
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 LL LL LL LL LL
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 LL LL LL
a. i, ii, iii, iv, vLL LL LL LL
b. i, iii, ii, iv, vLL LL LL LL
c. i, iii, ii, v, ivLL LL LL LL
d. ii, i, iii, iv, v LL LL LL LL L
LANSWER: B LL
Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the pati
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ent assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. The proper ord
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er in checking the BP changes should start by positioning the patient first and then measure first the BP in supine p
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osition before an upright position but never remove the BP cuff to avoid any changes related to misplacing or adjus
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ting the cuff. Lastly document the HR and BP.
LL LL LL LL LL LL LL LL
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
LL LL LL
c. An increase of 10 mm Hg in the reading
LL LL LL LL LL LL LL LL LL
b. A heart rate of 5-20 bpm above the resting rate
LL LL LL LL LL LL LL LL LL
d. An increase of 5 mm Hg in diastolic pressur
LL LL LL LL LL LL LL LL LL
e ANSWER: C
LL LL
Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the pati
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ent assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. Option C is inc
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orrect. 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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an increase.
LL
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.799.
LL LL LL LL LL LL LL LL
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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” Based on 0-4 rating scale, this means:
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a. Diminished pulse and cannot be obliterated LL LL LL LL LL
b. Pulse is weak, thready, difficult to palpate and obliterated with pressure
LL LL LL LL LL LL LL LL LL LL
c. Full pulse, easy to palpate, weak and thread
LL LL LL LL LL LL LL
d. Strong and bounding pulse, may be abnormal LL LL LL LL LL LL
LLANSWER: A LL
Rationale: Pulse is weak, thready, and difficult to palpate only if pressure is applied. 0: pulse not palpable or absent.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
+1 Pulse is weak, thready, difficult to palpate and obliterated with pressure. +2 diminished pulse and cannot be obl
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iterated. +3 Full pulse, easy to palpate. +4 Strong and bounding pulse may be abnormal.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL
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 wellne
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ss program. When a participant asks for an explanation of the purpose of the superior vena cava, the nurse prov
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
ides which of the following information?
LL LL LL LL LL
a. Returns blood from the body area above the diaphragmLL LL LL LL LL LL LL LL
b. Returns blood from the body below the diaphragm LL LL LL LL LL LL LL
c. Drains blood from the heart LL LL LL LL
d. Receives freshly oxygenated blood from the lungs through the pulmonary veins
LL LL LL LL LL LL LL LL LL LL
LLANSWER: B LL
The superior vena cava returns blood from the body area above the diaphragm, the inferior vena cava returns bloo
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d from the body below the diaphragm, and the coronary sinus drains blood from the heart. The left atrium receive
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s freshly 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 pop
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ulation, 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?
LL LL LL LL LL LL LL
a. During inspiration LL
b. During diastole LL
c. During expiration LL
d. During systole LL
,ANSWER: B LL
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coro
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
nary arteries is supplied during diastole. This is the relaxation of the muscle, the heart chambers fill with blood in pr
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eparation 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-
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Surgical Nursing. 10th 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
LL LL LL
c. Blood clots form outside the vessel wall
LL LL LL LL LL LL LL
b. Plaques obstruct the artery
LL LL LL
d. Hardened vessels dilate to allow blood to flow through
LL LL LL LL LL LL LL LL LL
, ANSWER: B LL
Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atheresclerosis is a direct result o
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f 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-
LL LL LL LL LL LL LL LL LL LL LL LL
Surgical Nursing. 10th 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?
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid L
LANSWER: LL
C
Abnormalities of the pulmonic valve are auscultated at the second left intercostals space along the left sternal border.
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LOption 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.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Option D – LL LL
tricuspid valve abnormalities are heard at the third and fourth intercostals spaces along the sternal border. Referenc
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e: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
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Surgical Nursing. 10th 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 vei
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
n distention?
LL
a. High fowler’s LL
b. Raised 10 degrees LL LL
c. Raised 30 degrees LL LL
d. Supine position LL
ANSWER: C
LL LL
Jugular venous pressure is measure with a centimeter ruler to obtain the vertical distance between the sternal angl
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e 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.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Option B and D – LL LL LL LL
increased pressure can’t be seen when the client is supine or when the head of the bed is raised 10 degrees becaus
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
e 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-
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Surgical Nursing. 10th 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 communit
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y health nurse knows that the group needs additional teaching if which finding is identified as one of these factor
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s?
a. Cigarette smoking LL
b. Family history LL
c. Hypercholesterolemia
d. Hypertension
ANSWER: B
LL LL
Family history is a risk factor for CAD, but it is a non-
LL LL LL LL LL LL LL LL LL LL LL LL
modifiable risk factor. Cigarette smoking, elevated cholesterol levels (hypercholesterolemia), and hypertension are
LL LL LL LL LL LL LL LL LL LL LL LL
modifiable risk factors for CAD. LL LL LL LL
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
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Surgical Nursing. 10th Edition, Vol. 1. Page 656
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17. A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by th
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e nurse best explains the procedure to the client?
LL LL LL LL LL LL LL LL
a. "PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter."
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
b. "PTCA involves cutting away blockages with a special catheter."
LL LL LL LL LL LL LL LL
c. "PTCA involves passing a catheter through the coronary arteries to find blocked arteries."
LL LL LL LL LL LL LL LL LL LL LL LL
d. "PTCA involves inserting grafts to divert blood from blocked coronary arteries.
LL LL LL LL LL LL LL LL LL LL
" ANSWER: A
LL LL
PTCA is best described as insertion of a balloon-
LL LL LL LL LL LL LL LL
tipped catheter into the coronary artery to compress a plaque, thereby opening a stenosed or blocked artery.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Option B - LL LL
this is a description of an atherectomy. Option C -
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this only describes a cardiac catheterization.
LL LL LL LL LL LL
Option D - LL LL
Inserting grafts to divert blood from blocked arteries describes coronary artery bypass graft surgery. Reference:
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Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
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Surgical Nursing. 10th 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 give
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n sublingually. This drug’s principal effects are produced by:
LL LL LL LL LL LL LL LL
a. Antispasmodic effects on the pericardium LL LL LL LL
c. Vasodilation of peripheral vasculature
LL LL LL LL
b. Causing an increased myocardial oxygen LL LL LL LL
d. Improved conductivity in the myocardium A
LL LL LL LL LL LL
NSWER: C LL
Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodi
LL LL LL LL LL LL LL LL LL LL LL
lation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart.
LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL
Option A and D - LL LL LL LL
nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium. Option B -
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nitroglycerin decreases myocardial oxygen demand.
LL LL LL LL LL
Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-
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Surgical Nursing. 10th 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 give
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