NUR 239 Exam 3 - Questions with Verified Answers Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space,
... [Show More] midclavicular line. The client asks, "What does that mean?" The nurse will base her answer on which of the following physiologic principles? "You have a heart valve that is diseased." A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to "watch" for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which of the following physiological principles? As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture. A client has entered hypovolemic shock after massive blood loss in a car accident. Many of the client's peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon? Blood pressure is no longer able to overcome vessel wall tension. Which of the following statements about vascular compliance is accurate? Veins can act as a reservoir for storing large quantities of blood. In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis? Endocarditis Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences? Backflow from the left ventricle to the left atrium Heart muscle differs from skeletal muscle tissue by being able to generate: Action potentials When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which of the following statements are accurate? Select all that apply. A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. When there is an AV block, impulses from the atria and ventricles beat independently of each other so, the heart rhythm is usually chaotic and not regular. If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? Slowing of heart rate to below 60 beats/minute When explaining a new diagnosis of complete heart block to a client/family, the nurse should include which of the following statements? "One consequence of this type of block is a very slow heart rate that limits circulation to the brain." A male client with a history of angina has presented to the emergency department with uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle? Ventricular repolarization During ventricular systole, closure of the atrioventricular (AV) valves coincides with: Isovolumetric contraction A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client: "This means your heart is not pumping as much blood out of the heart with each beat." A client with a history of heart failure has been referred for an echocardiogram. Results of this diagnostic test reveal the following findings: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction? 50% Preload represents the volume work of the heart and is largely determined by: Venous blood return A client with a diagnosis of secondary hypertension has begun to experience signs and symptoms that are consistent with decreased cardiac output. Which of the following determinants of cardiac output is hypertension most likely to affect directly? Afterload Hypoxia is said to have a negative inotropic effect on the heart, which means: There will be interference in the generation of ATP, which is needed for muscle contraction. A large increase in heart rate can cause: Decreased stroke volume Which of the following statements about calcium channel-blocking (CCB) drugs is accurate? CCB drugs work on β-adrenergic receptors to close the channels, so vasodilation occurs. Following a hypertensive crisis, a client's family asks, "Why are the client's eyes so bloodshot?" The nurse responds that high arterial pressure: Damages more fragile blood vessels like those in the eyes to the point of rupture A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect? Smooth muscle relaxation of vessels Following a kitchen accident with a knife, the client's cut has experienced a decrease in the amount of bleeding and has developed a clot. The nurse knows this is primarily a result of humoral control of blood flow with the release of: Serotonin A client has had a myocardial infarction (MI) that damaged the right atrium, which has interfered with the SA node. The compensatory mechanism, the AV node, becomes the pacemaker of the heart and beats how many times/minute? 45 to 50 beats/minute A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is: "You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." The parasympathetic nervous system causes a slowing of the heart rate by increasing: Cardioinhibitory center A client asks, "Why do I have clogged arteries but my neighbor has higher 'bad cholesterol' levels and yet he is just fine?" The health care provider bases the reply on which of the following physiological principles about lipoprotein? "You more than likely have small, dense type of 'bad cholesterol' (LDL)." Which of the following would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL? High-calorie diet Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease? C-reactive protein The most important complication of atherosclerosis that may cause occlusion of small heart vessels is: Thrombosis In addition to direct invasion of the vascular wall by an infectious agent, this pathogenic mechanism is a common cause of vasculitis? Immune-mediated inflammation Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is: Calf pain A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo: Percutaneous transluminal angioplasty and stent placement A health care provider was asked by a client, "Why do my hands turn blue when I drive my car in the winter without gloves?" Which of the following is the best response? "Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen." Because of its location, the presence of an abdominal aortic aneurysm may first be manifested as: A pulsating mass While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes? Peripheral vascular resistance A client asks why his blood pressure pills seem to make him go to the bathroom to urinate frequently when they are not water pills (diuretics). Which of the following physiologic processes explains the long-term regulation of blood pressure most accurately? Renal monitoring and adjustment of extracellular fluid volume A client consistently has an elevated systolic BP greater than 150 mm Hg but a diastolic pressure in the 80s. The health care provider should be assessing for which of the following complications? Crackles in bilateral lung bases caused by left-sided heart failure Which of the following is a nonmodifiable risk factor for the development of primary hypertension? African American raceA 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the client's following statements indicates a need for further health promotion teaching? "I'm resolving to eat organic foods from now on and to drink a lot more water." A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the client's increased blood pressure? Activation of the renin-angiotensin-aldosterone mechanism A client with persistent, primary hypertension remains apathetic about his high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement? "You may not sense any problems, but it really increases your risk of heart disease and stroke." A client's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this agent achieve its therapeutic effect? By decreasing vascular volume by increasing sodium and water excretion A 29-year-old woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia-eclampsia in her second trimester. What should her care provider teach her about this change in her health status? "We don't really understand why some women get high blood pressure when they're pregnant." Which of the following children may be considered high risk for developing hypertension? Select all that apply. Diagnosed with coarctation of the aorta as an infant Recent scan showing a pheochromocytoma Takes cyclosporine daily since a kidney transplant An elderly client newly diagnosed with systolic hypertension asks her health care provider why this happens. The most accurate response would be: "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." Which of the following clients should most likely be assessed for orthostatic hypotension? An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom [Show Less]