Nokea
The nurse is caring for a client with a damaged tricuspid valve. The nurse knows that the tricuspid valve is held in place by which of the following?
- A. Chordae tendineae
- B. Atrioventricular tendons
- C. Semilunar tendineae
- D. Papillary tendons
Correct Answer: A
Rationale: Attached to the mitral and tricuspid valves are cordlike structures known as chordae tendineae, which in turn attach to papillary muscles, two major muscular projections from the ventricles. Neither atrioventricular tendons, semilunar tendineae, nor papillary tendons hold the tricuspid valve in place.
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The nurse is assessing a client who has dyspnea and considering the process of gas exchange. Which structural characteristic of capillaries best enables gas exchange at the cellular level?
- A. Capillaries are one cell-layer thick.
- B. Capillaries form a complex network
- C. Capillaries transport blood back to the heart.
- D. Capillaries are elastic structures.
Correct Answer: A
Rationale: Capillaries are one cell-layer thick and in direct contact with the cells of all tissues. This allows ease of gas exchange. Capillaries do form a complex network; however, it is the one cell structure that facilitates gas exchange. Venules and veins transport blood back to the heart. Arteries are elastic.
The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a comorbidity of multiple sclerosis, so the nurse knows the stress test will be drug induced. What drug will be used to dilate the coronary arteries?
- A. Thallium
- B. Lorazepam
- C. Diazepam
- D. Dobutamine
Correct Answer: D
Rationale: Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. The other drugs would not dilate the coronary arteries.
The nurse instructor is teaching a group of nursing students about adventitious heart sounds. The instructor explains that auscultation of the heart requires familiarization with normal and abnormal heart sounds. What would the instructor tell these students a ventricular gallop indicates in an adult?
- A. Heart failure
- B. Hypertensive heart disease
- C. Normal functioning
- D. Pericarditis
Correct Answer: A
Rationale: A sound that follows S1 and S2 is called an S3 heart sound or a ventricular gallop. An S3, normal in children, often is an indication of heart failure in an adult. An extra sound before S1 is an S4 heart sound, or atrial gallop. An S4 sound often is associated with hypertensive heart disease. A friction rub may cause a rough, grating, or scratchy sound that is an indication of pericarditis or inflammation of the pericardium.
The following clients are in need of exercise electrocardiography. Which client would the nurse indicate as most appropriate for a drug-induced stress test?
- A. A 48-year-old policemen with history of knee replacement 4 years ago
- B. A 68-year-old housewife with history of osteoporosis
- C. A 72-year-old retired janitor obtaining a cardiac baseline
- D. A 55-year-old recovering from a fall and broken femur
Correct Answer: D
Rationale: An exercise electrocardiography or stress test monitors the electrical activity of the heart while the client walks on a treadmill. If a client has a sedentary lifestyle or physical disability, cardiac medications may be administered to stress the heart similar to activity. Even though the client is middle aged at 55 years old, the client is recovering from a broken femur thus would be unable to have vigorous exercise. None of the other clients have a history which precludes them from exercise electrocardiography.
In which client does the nurse consider the presence of an S3 heart sound to be normal?
- A. In a client who is in elementary school
- B. In a client who is an older adult
- C. In a client with an indwelling pacemaker
- D. In a client who is diagnosed with heart failure
Correct Answer: A
Rationale: A heart sound that follows S1 and S2 is called an S3 heart sound, or a ventricular gallop. Although an abnormal finding for many clients, this finding is considered normal in many pediatric clients, including a school-age client. In adults, the presence of S3 may signify heart failure, so this is not considered normal. Additionally, S3 is not considered normal for older adult clients nor for a client who has an indwelling pacemaker.