Nokea
The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence?
- A. SA node to bundle of His to AV node to Purkinje fibers
- B. SA node to AV node to Purkinje fibers to bundle of His
- C. SA node to bundle of His to Purkinje fibers to AV node
- D. SA node to AV node to bundle of His to Purkinje fibers
Correct Answer: D
Rationale: The normal electrophysiological conduction route is SA node to AV node to bundle of His to Purkinje fibers.
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A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult patient who has been experienced vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis?
- A. Pleurisy
- B. Heart failure
- C. Valve dysfunction
- D. Cardiomyopathy
Correct Answer: B
Rationale: The level of BNP in the blood increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF. It is not specific to cardiomyopathy, pleurisy, or valve dysfunction.
A critically ill patient is admitted to the ICU. The physician decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize in the plan of care?
- A. Fluctuations in core body temperature
- B. Signs and symptoms of esophageal varices
- C. Signs and symptoms of compartment syndrome
- D. Perfusion distal to the insertion site
Correct Answer: D
Rationale: The radial artery is the usual site selected. However, placement of a catheter into the radial artery can further impede perfusion to an area that has poor circulation. As a result, the tissue distal to the cannulated artery can become ischemic or necrotic. Vigilant assessment is thus necessary. Alterations in temperature and the development of esophageal varices or compartment syndrome are not high risks.
The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult?
- A. Decreased left ventricular ejection time
- B. Decreased connective tissue in the SA and AV nodes and bundle branches
- C. Thinning and flaccidity of the cardiac valves
- D. Widening of the aorta
Correct Answer: D
Rationale: Changes in cardiac structure and function are clearly observable in the aging heart. Aging results in decreased elasticity and widening of the aorta, thickening and rigidity of the cardiac valves, increased connective tissue in the SA and AV nodes and bundle branches, and an increased left ventricular ejection time (prolonged systole).
A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform?
- A. Instruct the patient to drink 1 liter of water before the test
- B. Administer IV benzodiazepines and opioids
- C. Inform the patient that she will remain on bed rest following the procedure
- D. Inform the patient that an access line will be initiated in her femoral artery
Correct Answer: C
Rationale: During the recovery period, the patient must maintain bed rest with the head of the bed elevated to 45 degrees. The patient must be NPO 6 hours preprocedure. The patient is sedated to make him or her comfortable, but will not be heavily sedated, and opioids are not necessary. Also, the patient will have a peripheral IV line initiated preprocedure.
During a shift assessment, the nurse is identifying the clients point of maximum impulse (PMI). Where will the nurse best palpate the PMI?
- A. Left midclavicular line of the chest at the level of the nipple
- B. Left midclavicular line of the chest at the fifth intercostal space
- C. Midline between the xiphoid process and the left nipple
- D. Two to three centimeters to the left of the sternum
Correct Answer: B
Rationale: The left ventricle is responsible for the apical beat or the point of maximum impulse, which is normally palpated in the left midclavicular line of the chest wall at the fifth intercostal space.