QUESTIONS

ANSWER

REFERNCE AND RATIONALE

1. The nurse who is caring for a patient with

pericarditis understands that there is
inflammation involving the:
a. Thin fibrous sac ensacing the heart
b. Inner lining of the heart and valves
c. Hearts muscle fibers
d. Exterior layer of the heart

-its cover the heart muscle.

2. The coronary arteries arise from the:

a. Aorta near the origin of the left
ventricle
b. Pulmonary artery at the apex of the
right ventricle
c. Pulmonary vein near the left atrium
d. Superior vena cava at the origin of the
right atrium

-their bronchos supply arterial blood of the heart

3. The pacemaker for the entire myocardium

is the:
a. Atrioventiculare junction
b. Bundle of His
c. Purkinje fibers
d. Sinoatrial node

-compose of nodal cells

Part I.
Multiple Choice

4. The intrinsic pacemaker rate of ventricular

myocardial cell is:
a. More than 80 bpm
b. 60 to 80 bpm
c. 40 to 60 bpm
d. Fewer than 40 bpm

-the av node generally takes over the pacemaker

function of the heart at its inherently lower rate

5. An example of a beta-blocker that is

administered to decrease automaticity is:
a. Cardezem
b. Cordarone
c. Lopressor
d. Rythmol

-block AV conduction

6. So that blood may flow from the right

ventricle to the pulmonary artery, which of
the following conditions is not required?
a. The atrioventicular valves must be
closed
b. The pulmonic valve must be open
c. Right ventricular pressure must be less
than pulmonary arterial pressure
d. Right ventricular pressure must rise
with systole

-its not required to the following condition of

pulmonic artery.

7. Heart rare is stimulated by all of the

following except:
a. Excess thyroid hormone.
b. Increased levels of circulating

-can slow the cardiac rate where as symptomatic

impulse increase it.

catecholamines.
c. Thesympathetic nervous system.
d. The vagus nerve.
8. Stroke volume of the heart is determined
by:
a. The degree of cardiac muscle strength
(precontraction)
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.

-this composed of primarily determined by three

factor.pre load, after load, and contractility

9. Changes in cardiac structure associated

with aging would include all of the
following except:
a. Elongation of the aorta.
b. Endocardial fibrosis.
c. Increased sensitivity to baroreceptors.
d. The increased size of the left atrium.

10.A nonmodifiable risk factor for

atherosclerosis is.
a. Strees
b. Obesity
c. Possotive family history
d. Hyperlipidemia

-genetics factors: occurs in families

11.The difference between the systolic and

diastolic pressure is called the.
a. Pulse pressure
b. Auscultory gap
c. Pulse deficit
d. Korotkoff sound

-it is a reflection of stroke volume, ejection

velocity, and systematic vascular resistance.

12.The nurse assessing a patient for postural

hypotension recognize that the following is
a positive sign.
a. A heart rate of 5-20 bpm above the
resting
b. An unchanged systolic pressure
c. An increase of 10 mm hg reading
d. An increase of 5 mm hg in diastolic
pressure

-to offset reduced stroke volume and maintain

cardiac out put.

13.If the sphygmomanometer cuff is too small

for the patient, the blood pressure reading
will probably be.
a. Falsely elevated
b. Falsely decrease
c. An accurate reading
d. Significantly different wit the each
reading

-because if the patient is big arm there is elevated

reading.

14.The first heart sound is generated by.

a. Closure of the aortic valve

-tricuspid and mitral valve closure the first heart

sound. The word lub is used to replicate its

b. Closure of the atrioventricular valves

opening of the atrioventricular valves
c. Opening of the pulmonic valve

sounds.

15.Exercise stress testing is a noninvasive

procedure that can be used to assess ceratin
aspects of cardiac. function . after test, the
patient is instructed to.
a. Rest for a tine
b. Avoid stimulants
c. Avoids extreme temperature change
d. Do all of the above

-this are procedure to make the patient avoid

after exercise.

16.Postcatherization nursing measure for a

patient who has had a cardiac catherization
include.
a. Assessing the peripheral pulses in the
affected extremity
b. Checking te insertion site for hematoma
formation
c. Evaluating temperature and color in the
affected extremity
d. All of the above

-the nursing responsibilities after cardiac

chatrerization include all of this.

SHORT ANSWER
1. List the five categories of cardiovascular
disease (CVD). __________,
____________,___________,__________
and ___________

-hypertension
-coronary artery
-heart failure
-stroke
-conventional cardiovascular

-this are most common disease of cardiovascular

disease. And may be cause of death.

2. Distinguish between the functions of the

atrioventricular and the semilunar
valves.____________________________.

-antrioventicular-secondary pacemaker of the

heart located in the right atrial wall near the
tricuspid valve.

-they are connected to the papillary muscles by

the chordae tendineae, which lie in the right
ventricle. Tricuspid valves will not always consist
of three leaflets and may also occur with two or
four leaflets; the number may change during life.

-semilunar valve-are closed during diastole.at this

point, the pressure In the pulmonary artery &
aorta decreases,causing blood toflow back toward
the semilunar valves,

-this action fills the cusps with blood and close

the valves.the semilunar valves are forced open
during ventricular systole as blood is ejected from
the right and left ventricles into the pulmonary
artery aorta.

3. Briefly explain depolarization as it relates

to cardiac physiology.________________

-electrical activation of the cell caused by the

influx of sodium into the cell while potassium
exists the cell.

-once depolarization is complete the exchanges of

ions roverts to its resting state, this period is
known as repolarization.the repeated cycle of
depolarization is called the cardiac action
potential.

4. List the three factors that determine stroke

volume.__________________________

-preload

-amount of cardiac muscle fiber tension or stretch

at the end of diastole.
-force the ventricles must overcome to eject their

-after load

-contractility

blood volume.
-inherent capability of cardiac muscle fibers to
shorten.

5. an adult heart rate of 76 bpm with an

average stroke volume of 70 ml per
beat.___________________________
6. Describe starling s law of the
heart.______________________________

-as the volume of blood returning to the heart

increase, muscle fiber stretch also increase
preload, resulting in stronger contraction and a
greater stroke volume, this relationship, called
the frank-starling law of the heart, is maintained
until the physiologic limit of the muscle is
reached.

-the starlings law of the heart is based on the fact

that, within limits the greater the initial length or
stretch of the cardiac muscle cell, the greater the
degree of shortening that occurs.

7. List at four physiologic effects on the

cardiovascular system that are associated
with aging
process._______________,____________,
_________ and _____________
8. List three major cardiovascular risk
factor_________, __________ and ______

-cardiovascular structure
-structural changes
-functional changes
-history and physical findings

-medical surgical of nursing

-chapter 26

-cardio vascular disease

-cerebro vascular accident

- medical surgical of nursing

-chapter 26

9. If coronary artery disease is present, the

American heart association recommends
the following laboratory measurements.
LDL,___________; blood
pressure,________;serume glucose,

-<160 if no coronary artery disease and <2 risk

factor <130 id no CAD and 2 or more risk factor
<100 if CAD present
-120/80
-3.3-6.05 mml/L

-medical surgical of nursing

-page 2220

_________; and body mass index of

_____________.
10.To assess the apical pulse, the would find
the following location; _______________

-fifth intercostals space to the left sternum

-Medical surgical of nursing

-chapter 26
-Page 700

11.The two most specific enzymes

traditionally used to analyze an acute MI
are ____________and ___________; two
new biomarkers,___________and
__________, are early indicators of a MI.

12.List several purposes of cardiac

catherization.______________________

-The purpose of cardiac catheterization is to find www.webmd.com

out if you have disease in your coronary arteries
(atherosclerosis). If you have atherosclerosis, this
test can pinpoint the size and location of fat and
calcium deposits (plaque) that are narrowing your
coronary arteries. Results from cardiac
catheterization help determine whether treatment
with bypass surgery or percutaneous coronary
intervention (PCI), such as angioplasty, may be
effective.

13.Describe selective
angiography._______________________

-cardiac catherization is usually performed with

angiography, a technique in which a contrast
agent is injected into the vascular system to out
line the eart and blood vessel. When a specific
heart chanber or blood vessel is singled out for
study. The procedure is known as selective

-medical surgical nursing

-chapter 26
-page 713

angiography.
14.Discuss the implication of a low central
nervous pressure reading.______________
15.Identify four of seven possible
complications pulmonary artery
monitoring.______________,
___________,_________________and
_____________.

MATCHING TYPE
Column 1
1.______seperates the right and left atria

2.______is located at the juncture of the superior

venacava and the right atrium

3.______supports of the heart in the mediastinum

4.______sits between the right ventricle and the

pulmonary artery
5.______distirbutes venous blood to the lungs
6.______is embedded in the right atrial wall near
the tricuspid valve

D
B
F

-the aortic regulates valves blood flow from the

heart into the aorta.
-the SA node in a normal resting adult heart has
inherent firing rate 60-100 impulse per minute.
but rate changes in response to the metabolic
demands of the body
-the pulmonary artery is supply the arterial blood
to the heart.
-semilunar valve located between the right
ventricle and the pulmonary artery
-semilunar valve located between the right
ventricle and the pulmonary artery.
-ejection the blood to the lungs.
-compose of three cusps or leaflets.

Column 2
a. parietal pericardium
b. pulmonary artery
c. biscuspid valve
d. pulmonic valve
e.. sinatrial node
f. atrioventricular node
Column 1
1.______a principle blood lipid
2.______a risk factor that cause pulmonary
damage
3.______the functional lesion of atherosclerosis
4.______biochemical substance, soluble in fat,
that accumulate within the blood vessel
5.______a risk factor that is endocrine in origin
6.______ a risk factor associated with a type A
personality
7.______a risk factor related weight gain
8.______a recommended dietary restriction that
is a risk factor for heart disease
9.______a symptom of a myocardial ischemia

10._____myocardial manifestation of coronary

artery disease

I
C

-it cause increase the blood sugar level

-because the lower respiratory disorder

D
D

-it may be cause of high cholesterol level

-many fat that block the blood vessel

K
G

-if you are stress your endocrine increase level

-its because smoking more dangerous habit for
daily life style
-being the obesity most common for heart disease
-the fat is block the artery

B
J
C

-because that occurs when the heart muscle is not

getting enough oxygen reach blood for a short
period
-the fat is block the artery

11._____a lifestyle habit that is considered a

modifiable risk factor for heart disease

-regular activity less prone to CHD than

sedentary.

Column 2
a. atheroma
b. obesity
c. chest pain
d. cholesterol
e. inactivity
f. lipids
g. smoking
h. dysrhythmias
i. diabetes
j. fat
k. stress

Part II
DISCUSSION AND ANALYSIS
1.describe the most common signs and symptom
of coronary vascular disease

-Dyspnea also called shortness of breath

Fatigue tiredness in humans
Chest pain
Angina is severe chest pain
Myocardial infarction is a complication of
coronary disease. It is sometimes classified as a
symptom

-MEDICAL SURGICAL NURSING

-CHAPTER 26

2. for each the following structures, describe the

age related structural and functional changes in
the cardiac system

-Age related changes of the cardiac system

Atria - structural changes.. Increase size of left
atrium Thickening of the endocardium.
Functional changes.. Increase atrial irritability
Left ventricle structural changes.. endocardial
fibrosis Myocardial thickening (hypertrophy)
Infiltration of fat into myocardium.
Functional changes.. left ventricle stiff and less
compliant. Progressive decline in cardiac out put..
risk for ventricular dysrhythmias prolonged
systole.
Valves structural changes.. thickening and
rigidity of AV valves.. calcification of aortic
valve.
Functional changes.. abnormal blood flow across
valves during cardiac cycle.
Conduction system structural changes
connective of aortic valve Connective tissue
collects in SA Node , AV node, and Bundle
branches. Decrease number of sa node cells,
decrease number of av,bundle of his and right and
left bundle branches cells.
Decrease to beta-adrenergic stimulation.

--MEDICAL SURGICAL NURSING

-CHAPTER 26

Functional changes.. slower SA node rate of

impulse discharge. Slowed conduction across AV
node and ventricular conduction system.
Sympathetic nervous system - structural changes..
decrease response to beta-adrenergic stimulation.
Functional changes.. decrease adaptive response
to exercise: contractility and heart rate slower to
respond to exercise demands. Heart rate takes
more time to return to baseline
Aorta and arteries - structural changes.. stiffening
of vasculature. Decrease elasticity and widening
of aorta elongation of aorta, displacing the
branchiocephalic artery upward.
Functional changes.. Left Ventricular
hypertrophy
Baroreceptors response Structural changes..
decrease sensitivity of baroreceptors in the
carotid artery and aorta to transient episodes of
hypertension and hypotension.
Functional changes.. baroreceptors unable to
regulate heart rate and vascular tone, causing
slow response to postural changes in body

3. compare and contrast the character, duration,

aggravating factor, and precipitating events of
cardiac and noncardiac chest pain
4. draft a detailed assessment guide that the nurse
would ues to evaluate various symptom
associated with chest pain, shortness of breath,
palpitations, fatigue, and syncope
5. describe the classic type A personality and
explain what is meant by cardiac reactivity

position.
-The risks are alternately flex and extended so
that the chest is cupped or clapped in a painless
manner

-Type A Behavior:
Over the years, the type of extra stress that most
Type A people experience takes a toll on ones
health and lifestyle. The following are some of
the negative effects that are common among
those exhibiting TAB:

6. describe the various characteristics of heart

murmurs

-To help this dislodge mucus adhering to the

bronchioles and bronchi

-stress.about.com

Hyptertension: High blood pressure is

common among Type A personalities, and
has been documented by research to be as
much as 84% more of a risk among those with
Type A characteristics..
Heart Disease: Some experts predict that, for
those exhibiting TAB, heart disease by age 65
is a virtual certainty.

-Murmurs are audible successive sounds with

-Google.com

7. describe the etiology and significance of

gallop sounds

distinct duration, as opposed to normal heart

sounds, which are short transitory events. Cardiac
murmurs result from turbulence created in
laminar blood flow. When the flow velocity of
fluid within a pipe exceeds a certain value,
turbulence develops and energy is dissipated,
which generates audible vibrations. Turbulence
may also arise when fluid passes through a small
hole in a plate that partially occludes a pipe, when
the pipe diameter changes abruptly, or when a jet
of fluid strikes a surface. A critical level of
turbulence must be achieved to produce a sound
that is clinically evident. The characteristics of
the murmur depend upon the velocity of blood
flow and the surrounding structures that are
caused to vibrate. Blood velocity and blood
density variations can also produce turbulence
within the heart and arteries.

8. discuss the value of telemetry to cardiac

assessment

-Telemetry- in addition to hardwire cardiac

monitoring, the ECg can be continously observed
by telemetry, the transmission of radiowaves
from a battery operated transmitter to a central
bank of monitors. The primary benefit of using
telemetry is that the system is wireless, which
allows patients to ambulate while one or two
ECG leads are monitored. The patient has

-MEDICAL SURGICAL NURSING

-page 162

electrodes placed on the chest with a lead cable

that connects to the transmitter.thge transmitter
can be placed in a disposable pouch and worn
around the neck or simply secured to the patients
clothing. Most transmitter batteries are changed
every 24 to 48 hours

EXAMINING ASSOCIATIONS
1.the pulmonary artery ; lungs:: aorta:_________
2. epicardium : outer layer of cells lining the
heart::___________: the heart muscle itself.
3. apical are of the heart : fifth intercostals space:
erbs point:_______________
4. the first heart sound : closure of the mitral and
tricuspid valves :: the second heart sound :
closure of___________
5. murmurs: malfunctioning valves : friction
rubs:____________

-heart(aorta area)
-pericardium
-third intercostals space
-pulmonic and aortic valves.

-inflamed pericardial

-second intercostals space to the right sternum.

-though fibrous tissue that attaches to the great
vessel
-in this area to auscultate the left of the sternum
from to the heart
-the aortic component of S2 is heard the loudest
over the aortic and pulmonic area.
-a harsh. Gratting sound that can heard in both
systole and diastole, it caused by abrasion of the
imfalmed pericardial surfaces from pericardities.

INTERPRETING DATA
Pericarditis
Duration of pain:________________________
Precipitating events:_____________________
And aggravating factors:__________________
alleviating factors:_______________________

-Intermittent
-sudden onset
-pain increase with inspiration, swallowing,
coughing, and rotation of trunk.
-sitting upright, analgesia, anti-inflammatory
medications

-MEDICAL SURGICAL NURSING

-CHAPTER 26
-table 26-2
-page 692

-5-15 minutes
-angina: physical exertion. Emotion. Upset.
Eating large meal. Or exposure to extreme in
temperature.
-angina rest, nitroglycerin, oxygen

-MEDICAL SURGICAL NURSING

-CHAPTER 26
-table 26-2
-page 692

Angina pectoris
Duration of pain:_________________________
Precipitating events:______________________
And aggravating factors:___________________
Alleviating factors:_______________________

CLINICAL SITUATION
CASE STUDY: cardiac assessment for chest
pain
Mr. Anderson is a 45 yr old executive with a
major oil firm. Lately he has experienced
frequent episodes of chest pressure that are
relieved with rest. He has requested a complete
physical examination. the nurse conducts an
initial cardiac assessments.
1. The nurse immediately inspects the patients
skin. She observes a bluish tinge round the
patients lips. She knows that this is an indication
of.
a. central cyanosis
b. pallor
c. peripheral cyanosis
d. xanthelasma

-increased amount of unoxygenated hemoglobin

and exposure to cold, anxiety

2. the nurse takes a baseline blood pressure

measurement after the patient has rested for 10

-if the patient rested up to 10 minutes the bp of

the patient is down to the last blood pressure.

minutes in a supine position, the reading that

reflects a reduced pulse pressure is.
a. 140/90 mm hg
b. 140/100 mm hg
c.140/110 mm hg
d. 140/120 mm hg
3. five minutes after the initial blood pressure
measurement is taken, the nurse assesses
additional readings with the patient in a sitting
and then is a standing position. The reading
indicative of an abnormal postural response
would be.
a. lying, 140/110; sitting, 130/110; standing,
135/106 mm hg
b. lying, 140/110; sitting, 135/112; standing,
130/115 mm hg
c. lying, 140/110;sitting, 135/100; standing
120/90 mm hg
d. lying, 140/110; sitting,. 130/108;
standing,125/108 mm hg

-to perform the autonomic insufficiency as

demonstrated of this procedure

4. the nurse returns mr. Anderson to the supine

position and measures for jugular vein distention.
The finding that would initially indicate an
abnormal increase ion the volume of the venous
system would be obvious distention of the veins
with the patient at what angle.

-it indicate an abnormal increase in the volume of

the venous system

a. 15 degrees
b. 25 degrees
c. 35 degrees
d. 45 degrees

5. the nurse auscultates the apex of the heart by

placing a stethoscope over.
a. erbs point
b. the fifth intercostals space
c. the pulmonic area
d. the tricuspid area

-in the fifth intercostals is to locate the heart.