NURS6550 Final Exam (2 Versions) / NURS 6550 Final Exam (2 Versions) (Latest)| Walden University
1. The Valsalva maneuver and the squat-to-stand
... [Show More] maneuver are likely to increase the sound of a cardiac murmur associated with which of these conditions?
a. Hypertrophic cardiomyopathy
2. Which of the following conditions may result in lower extremity edema?
Nephrotic syndrome
Decompensated congestive heart failure
Cirrhosis
Renal failure
Deep venous thrombosis
Late-stage pregnancy
All of the above
3. Art Bakke is a 46-year-old male who is being treated for an acute myocardial infarction. He has now developed significant dyspnea at rest and, per physical exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-valve regurgitation.
Question: Which of the following physical findings would support this diagnostic hypothesis?
A palpable diastolic murmur maximal in the second intercostal space (ICS) at the left sternal border
A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the left sternal border
A holosystolic systolic murmur heard maximally in the fifth ICS at the midclavicular line
4. emodynamics and the Frank-Starling law
Cardiac output (CO) is the total volume of blood pumped by the ventricle per minute.
Stroke volume (SV) is the amount of blood pumped from the left ventricle per single contraction (systole). This is also referred to as the ejection fraction on an echocardiogram.
Therefore, CO = SV x HR (heart rate).
Example: An average healthy adult having a SV of 70 mL and a HR of 80 bpm would have CO of 5.6 L/min. This means that almost the entire blood volume is circulated every minute.
Although in general an increase of heart rate increases cardiac output, when the heart rate increases significantly (>160 bpm), there is less time for the ventricles to fill with blood (decreased diastolic filling time). This results in decreased stroke volume and, therefore, decreased cardiac output.
Stroke volume is affected by preload and afterload.
Preload is the amount of blood in the ventricles just prior to ventricular contraction (i.e., end-diastolic volume) and correlates with the degree to which the cardiac muscle (i.e., the sarcomere, the contractile unit of the myocardium) is stretched. Increasing preload increases stroke volume in a healthy heart, but only up to a maximum stretch. [Show Less]