Chapter 33: Cardiovascular System Introduction Linton: Medical-Surgical Nursing, 7th Edition

Chapter 33: Cardiovascular System Introduction
Linton: Medical-Surgical Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse performs an apical-radial pulse evaluation, with the result of 100/88. What is the
pulse deficit?
a. 12
b. 24
c. 76
d. 88
ANS: A
To detect an apical-radial pulse deficit, the rates should be counted simultaneously and
compared for differences. If a difference exists between the apical rate and the radial rate, then
a pulse deficit is present. For example, in atrial fibrillation, a pulse deficit exists.
DIF: Cognitive Level: Analysis REF: p. 603 OBJ: 3

TOP: Vital Sign Assessment: Pulse Deficit
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. What is increased in hypertension that in turn causes an increase in the work of the heart?
a. Preload
b. Stroke volume
c. Contractility
d. Afterload
ANS: D
An increase blood pressure creates an increase in afterload because the heart must work harder
to push the blood out of the left ventricle into the circulating volume.
DIF: Cognitive Level: Comprehension REF: p. 597 OBJ: 4

TOP: Hypertension Effect on Afterload KEY: Nursing Process Step: Implementation
3. Which heart sound should the nurse record as normal?

a. Ventricular gallop in a 20-year-old patient
b. Atrial gallop in a 25-year-old patient
c. Friction rub in a 45-year-old patient
d. Medium diastolic murmur in a 50-year-old patient
ANS: A
Ventricular gallops are considered normal in individuals younger than 30 years of age. All
other options are pathologic abnormalities.
DIF: Cognitive Level: Application REF: p. 604 OBJ: 3

TOP: Heart Sound Assessment KEY: Nursing Process Step: Assessment
4. A patient asks what a transesophageal echocardiogram (TEE) is and what it is expected to do?
What is the best explanation by the nurse?
a. Measures conductivity
b. Records the force of contraction
c. Evaluates the efficiency of the valves
d. Checks the volume of the preload
ANS: C
TEE evaluates the efficiency of the valves.

TOP: TEE KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
5. A nurse records the finding of a normal sinus rhythm (NSR) when the P, Q, R, S, and T are all
present in the electrocardiographic complex. What additional information should the nurse
document?
a. Rate of 82 seconds
b. PR interval of 0.36 second
c. QRS complex of 0.16 second
d. Inverted T
ANS: A
NSR requires the presence of P, Q, R, S, and T waves, in that order, and all pointing in the
same direction, with a rate of 60 to 100 seconds. Normal intervals are a PR interval of 0.12 to
0.20 seconds and a QRS complex less than 0.10 second.

TOP: Normal Sinus Rhythm KEY: Nursing Process Step: Assessment
6. A nurse should anticipate that a patient taking Vasotec, an angiotensin-converting enzyme

(ACE) inhibitor, should have which positive outcome to this drug?
a. Increased fluid retention
b. Decreased blood pressure
c. Decreased urine output
d. Increased appetite
ANS: B
ACE inhibitors suppress the excretion of angiotensin, which lowers the blood pressure,
reduces fluid retention, and leads to increased urine output.

TOP: ACE Inhibitors KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
7. A 29-year-old patient is to receive cardioversion for a dysrhythmia. What should the nurse
instruct the patient to expect?
a. Administration of a short-acting sedative
b. Digoxin dose to be taken as scheduled
c. Procedure to be completely safe
d. Pacemaker spikes to be carefully monitored
ANS: A
A cardioversion has risks, such as ventricular fibrillation. Emergency equipment should be
available. The digoxin dose is held before a cardioversion, and the patient is given a short-
acting sedative such as Versed or Valium, which will require recovery. The electrocardiogram
R wave is synchronized via the computer, and no pacemaker is involved.

TOP: Cardioversion KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
8. A 68-year-old patient is scheduled for open heart surgery in the morning and is crying. What
is the most appropriate response by the nurse?
a. “Everything will go great! Dr. C. is the best!”
b. “I know how you feel, so do not cry.”
c. “Tell me what concerns you the most.”
d. “I will call the physician for a sedative. You are too upset.”
ANS: C
Therapeutic implementations identify and acknowledge feelings. Do not assume that you
know how the patient feels and do not give false assurances.

TOP: Open Heart Surgery KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
9. A nurse explains that cardiac rehabilitation lasts from the end of acute care to the return to
home and beyond. What does this service include?
a. One-on-one individualized care
b. Focus on the patient rather than the family
c. Telemetry-monitored exercise
d. Rejection from the program for noncompliance
ANS: C
Cardiac rehabilitation programs are supervised by a team of experts who arrange for
telemetry-supervised exercise and other modalities, such as diet and medical protocol
management. The focus is on the family, as well as the patient. Although some patients reject
the program, they are rarely rejected by the rehabilitation center.

TOP: Cardiac Rehabilitation KEY: Nursing Process Step: Assessment
10. On auscultation, a nurse detects a heart murmur. What should the nurse know that a heart
murmur indicates?
a. Valves that do not close correctly
b. Pericardium that is inflamed
c. Decrease in pacemaker cells
d. Loud ventricular gallop
ANS: A
Heart murmurs indicate turbulent blood flow and can be caused by valves that are stiff and do
not shut correctly; consequently, blood flows back into the chamber.

TOP: Heart Murmur KEY: Nursing Process Step: Assessment
11. A physician has ordered continuous pulse oximetry. What should the nurse explain to the
patient about this procedure?
a. Involves a single prick
b. Measures the amount of oxygen in the blood
c. Is applied to the wrist
d. Identifies damaged cells in the myocardium
ANS: B
Pulse oximetry measures arterial oxygen saturation noninvasively by attaching a clip to a
digit, an ear, or a nose.

TOP: Pulse Oximetry KEY: Nursing Process Step: Implementation
12. A stress test is scheduled for a 41-year-old patient. What action should the nurse implement to
prepare the patient for the examination?
a. Have the patient sign a consent form.
b. Give the patient a special heart diet.
c. Prepare the patient for sedation.
d. Remove all metal objects.
ANS: A
A stress test is a noninvasive test that consists of a patient walking on a treadmill while an
electrocardiogram records the activity. A consent form is required.

TOP: Stress Test KEY: Nursing Process Step: Implementation
13. What action should a nurse expect to implement when a patient returns from a cardiac
catheterization?
a. Ambulate the patient in the hall.
b. Check the puncture site.
c. Monitor the gag reflex.
d. Remove the gel from all sites on the skin.
ANS: B
Cardiac catheterizations are invasive procedures during which a catheter is threaded through
an artery. Postprocedure care requires bed rest and monitoring the puncture site.

TOP: Cardiac Catheterization KEY: Nursing Process Step: Implementation
14. A nurse assesses an inverted T wave on the ECG of a patient who had an acute MI two days
earlier. How should the nurse interpret this finding?
a. Normal recovery
b. New MI
c. Abnormal waveform
d. Congestive heart failure
ANS: C
The abnormal waveform of the inverted T wave is an indicator that tissue death has occurred
in part of the cardiac wall. The cardiac wall now has no ability to conduct or to contract and
sends that message to the ECG via the inverted T. The tissue will take 6 weeks to regenerate.
DIF: Cognitive Level: Analysis REF: p. 614 OBJ: 4

TOP: Significance of Inverted T Wave KEY: Nursing Process Step: Evaluation
15. Laboratory tests are performed to identify damage to the heart muscle. Which test is elevated
the earliest with heart damage?
a. Creatine phosphokinase-MB (CPK-MB)
b. Lactate dehydrogenase (LDH)
c. Lipid profile
d. Troponin
ANS: D
Troponin is elevated within 3 to 6 hours and is often measured in the emergency department.
CPK-MB is elevated in 12 to 24 hours. Three serial samples are drawn. The LDH increases
with heart damage within 3 to 6 days. The lipid profile is not elevated with heart damage.
DIF: Cognitive Level: Knowledge REF: p. 618 OBJ: 1

TOP: Cardiac Enzymes KEY: Nursing Process Step: Implementation
16. A patient is scheduled for a heart catheterization. What action should the nurse implement in
preparation for this examination?
a. Ask the patient about allergies to seafood or iodine.
b. Remove all metal objects.
c. Give the patient a special heart diet.
d. Test arterial blood gases (ABGs).
ANS: A
The dye injected during the cardiac catheterization is iodine based. An allergy to seafood is
correlated with a reaction to this dye as well.

TOP: Cardiac Catheterization KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control
17. A patient has had atropine sulfate that has been administered intravenously to treat a
dysrhythmia. What should the nurse assess this patient for after administration?
a. Weight gain
b. Tachycardia
c. Muscle twitching
d. Incontinence of urine
ANS: B
Atropine increases the heart rate. The nurse should watch for tachycardia, which increases the
workload of the heart. This medication causes urinary retention.

TOP: Drugs for Dysrhythmias KEY: Nursing Process Step: Assessment
18. A dopamine infusion is being administered to a patient with shock. For what should the nurse
be alert?
a. Sharp spike in blood pressure
b. Tremor of the hands
c. Increasing urinary output
d. Hyperirritability of the patient
ANS: A
Dopamine has a direct effect by elevating the blood pressure. The criterion is to titrate to the
target blood pressure. Urinary output should also be monitored for a decreased amount
because a heightened blood pressure may slow urine filtration and reduce urine output.

TOP: Dopamine KEY: Nursing Process Step: Assessment
19. A patient with atrial fibrillation is prescribed amiodarone for the dysrhythmia. Which potential
adverse reaction should the nurse report?
a. Ataxia
b. Decreasing pulse rate
c. Decreasing blood pressure
d. Increase in cardiac output
ANS: A
The drug amiodarone is meant to quiet atrial activity and modify rapid pulse rate, high blood
pressure, and decreased cardiac output caused by the dysrhythmia. The drug interferes with
the thyroid and causes an ataxic gait and trembling of hands as adverse effects.

TOP: Atrial Fibrillation with Amiodarone
20. A medication, simvastatin (Zocor), is administered to lower a patient’s cholesterol level.

Follow-up lipid levels are reviewed by the nurse. Which level indicates the desired therapeutic
range?
a. High-density lipoprotein (HDL), 29 mg/dL; low-density lipoprotein (LDL), 160
mg/dL
b. HDL, 38 mg/dL; LDL, 120 mg/dL
c. HDL, 56 mg/dL; LDL, 106 mg/dL
d. HDL, 42 mg/dL; LDL, 98 mg/dL
ANS: D
The reading that has both an HDL level above 40 mg/dL and an LDL level below 100 mg/dL
is in the therapeutic target range.

TOP: Drug Therapy KEY: Nursing Process Step: Implementation
21. A diuretic medication, furosemide (Lasix), is being administered for congestive heart failure.
Which assessment is not an anticipated consequence of the therapy?
a. Increased urinary output
b. Weight loss
c. Thirst
d. Muscle weakness
ANS: D
Increased urinary output, weight loss, and thirst are all anticipated consequences of the
therapy. Muscle weakness is a sign of hypokalemia.

TOP: Diuretic Therapy KEY: Nursing Process Step: Assessment
22. A patient is receiving digoxin 0.25 mg/day. What should the nurse do prior to administering
this medication?
a. Count an apical pulse for 15 seconds.
b. Hold the dose if the apical rate is 57 beats/min.
c. Give the dose if the apical rate is 59 beats/min.
d. Double the dose if the rate is 62 beats/min.
ANS: B
The dose should be held if the apical rate is less than 60 beats/min for 1 minute.

23. A 46-year-old patient is receiving propranolol (Inderal), a nonselective beta-adrenergic

blocker, for a heart condition. What patient teaching is most appropriate?
a. Sit or lie down when taking the drug.
b. Limit caffeine intake.
c. Double the dose if symptoms occur.
d. Never stop taking the drug abruptly.
ANS: D
Beta-blockers should never be stopped abruptly because they can cause angina or MI. Patients
are gradually weaned off these medications.

24. Which assessment should be immediately addressed in a patient on lidocaine?
a. Slowed ventricular rate
b. Occasional PVCs
c. Increase in temperature to 102 F
d. Nausea and vomiting
ANS: C
A temperature that goes up drastically indicates an adverse reaction to lidocaine, malignant
hyperthermia. The slowed ventricular rate, even with occasional PVCs, is an expected
outcome of lidocaine infusion. Nausea and vomiting are adverse effects.

TOP: Drug Therapy KEY: Nursing Process Step: Assessment
25. A nurse records a “1” for the pulse quality of the pedal pulse. What interpretation is correct
regarding the pulse?
a. Absent
b. Normal
c. Thready
d. Forceful
ANS: C
A “1” in a pulse evaluation indicates a thready pulse that is easily obliterated by pressure.

TOP: Pulse Quality KEY: Nursing Process Step: Assessment
26. A patient with an irregular sinoatrial (SA) node conduction has a permanent pacemaker with
the code AAIOO and is now going home. The patient asks, “What happens when my real SA
node fires on its own?” How should the nurse respond regarding what the pacemaker should
do?
a. Not fire
b. Fire only the ventricles
c. Change the rate of firing
d. Fire both the atria and the ventricles.
ANS: A
The code is A (chamber-paced) atria, A (sense impulse) atria only, I (inhibit) inhibit firing
from the pacemaker, O (rate modification) no rate modification, and O (multichamber) no
other chambers to be stimulated by the pacemaker. If the SA fires on its own, the pacemaker
does nothing until it fails to sense an impulse.

TOP: Permanent Pacemaker Care KEY: Nursing Process Step: Implementation
27. What is a normal age-related change in older adults that makes them susceptible to
cardiovascular disease?
a. Increase in cardiac output
b. Increase in stroke volume
c. Stiff peripheral vessels
d. Oxygen capacity improvement
ANS: C
As adults age, their peripheral vessels become stiff, their oxygen capacity and stroke volume
are reduced, and their aorta thickens and calcifies.

TOP: Changes in Older Adults KEY: Nursing Process Step: Assessment
28. A nurse assesses a patient’s capillary refill time as less than 3 seconds. What does this
assessment indicate?
a. Hypertension
b. Tissue perfusion
c. Fluid volume excess
d. Increased blood viscosity
ANS: B
Capillary refill is determined by compressing the nail bed until it blanches. With a normal
capillary refill, color returns to the blanched skin within 3 seconds.

TOP: Capillary Refill KEY: Nursing Process Step: Implementation
29. A nurse performs Homans maneuver by flexing the knee and sharply dorsiflexing the foot.
What response indicates a positive Homans sign?
a. Cramping of the toes
b. Resisting dorsiflexion
c. Pain in the calf area
d. Blanching of the sole
ANS: C
A positive Homans sign indicates the possible presence of a DTV because of the pain
produced in the calf of the leg when the foot is dorsiflexed.

TOP: Homans Sign KEY: Nursing Process Step: Assessment
30. Which technique should the nurse implement when performing the Allen test on a patient to
evaluate the adequacy of circulation in the radial artery?
a. Asks the patient to relax the hand by the side
b. Compresses only the ulnar artery to blanch the hand
c. Releases pressure on both arteries at the same time
d. Observes whether the color is returning to the hand, which indicates perfusion
ANS: D
The Allen test is performed to evaluate circulation in the hand, both in the radial and the ulnar
arteries. The patient is asked to make a fist. The nurse compresses both the ulnar and the radial
artery to blanch the hand. The patient is asked to open the hand as the nurse releases pressure
on one or the other of the arteries. Color returning to the hand confirms perfusion.

TOP: Allen Test KEY: Nursing Process Step: Assessment
31. A nurse records that a patient has a 3+ edema to the right foot. How deep did the nurse’s
thumb depress the edematous area?
a. More than 1 inch
b. To 1 inch
c. To inch
d. Less than inch
ANS: B
Edema is measured by the depth of the depression of the thumb: 1 = less than inch, 2 = to
inch, 3 = to 1 inch, and 4 = more than 1 inch.

TOP: Assessing for Edema KEY: Nursing Process Step: Assessment
32. A nurse is caring for a patient who has had an angiogram. What should the nurse make a point
of care to assess and document on this patient?
a. Fluid intake
b. Peripheral pulses in the affected leg
c. Inquiring about an allergy to iodine
d. Decreased blood pressure
ANS: B
Checking and recording the presence and strength of the pulses in the affected leg ensure that
the injection site has not occluded the vessel and that vascular spasm has not impaired
circulation. An inquiry about an iodine allergy is made before the procedure.

TOP: Postangiogram Care KEY: Nursing Process Step: Implementation
33. A nurse is educating a patient regarding a stress test on a treadmill. Teaching includes that this
test is a noninvasive procedure. What additional information is appropriate for the nurse to
include?
a. Is monitored continuously by blood pressure and an electrocardiogram
b. Will last about 1 hour
c. Is meant to stimulate claudication and dyspnea
d. Will require a period of bed rest afterward
ANS: A
The examination requires the patient to walk at a rate of approximately 1.5 miles per hour.
The exercise is continually monitored and is terminated if the patient experiences pain or
dyspnea.
TOP: Treadmill Stress Test KEY: Nursing Process Step: Implementation
34. A patient inquires how something as simple as walking could help his venous vascular
disorder. What is the best response by the nurse when explaining the benefits of walking?
a. Improves the strength of the vascular walls
b. Boosts venous circulation through leg muscle activity
c. Increases cardiac output
d. Clears plaques from the veins
ANS: B
Walking is helpful because the muscle action of the legs that massage the valves of the veins
boosts circulation.

TOP: Benefits of Walking KEY: Nursing Process Step: Implementation
35. What is contraindicated for a patient performing Buerger-Allen exercises?

a. Lying on the stomach
b. Raising legs for 2 minutes until they blanch
c. Lowering the legs until the color returns
d. Keeping legs flat for 5 minutes and then repeat the exercise
ANS: A
Buerger-Allen exercises promote emptying of the blood vessels by gravity. Initially, lying on
the back and elevating the legs will result in pallor, and then lowering the legs will allow color
to return.

TOP: Buerger-Allen Exercises KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
36. A nurse cautions a patient with peripheral vascular disease (PVD) that continued smoking
causes detrimental vasoconstriction for up to ____ after only one cigarette.
a. 10 minutes
b. 20 minutes
c. 30 minutes
d. 1 hour
ANS: D
Smoking restricts circulation by vasoconstriction and lasts up to 1 hour after a cigarette; it also
causes vasospasm.

TOP: Smoking Cessation KEY: Nursing Process Step: Implementation
37. A nurse is performing an intake examination on a patient with peripheral vascular disease
(PVD). Which lifestyle information identified by the patient aggravates vascular disease?
a. Riding a bicycle to work
b. Drinking red wine every day
c. Being employed as an air traffic controller
d. Eating chocolate candy every day
ANS: C
Employment as an air controller is a stressful occupation. Stress increases vasoconstriction
and increases vascular resistance. Wine and chocolate actually have beneficial effects on
circulation, as does bicycle riding.

TOP: Stress and PVD KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
38. Vascular disease disorders often require the use of elastic stockings. Which action should the
nurse implement when caring for a patient with elastic stockings?
a. Apply the stockings and roll down the cuff.
b. Remove the stockings for skin inspection two times a day.
c. Remove the stockings when the patient is ambulating.
d. Inspect the skin for pressure or irritation daily.
ANS: B
Elastic stockings improve blood flow. They should be applied early in the morning. They
should be removed twice daily for 20 to 30 minutes, and the skin integrity of the feet should
be examined.

TOP: Vascular Disease and Elastic Stockings
KEY: Nursing Process Step: Implementation
39. Which instruction is most appropriate for a patient with arterial insufficiency?
a. Frequently allow the legs to dangle dependently.
b. Rub the legs vigorously.
c. Stand often to keep blood flow in the legs.
d. Walk barefoot.
ANS: A
Dangling legs can use gravity to help with arterial circulation. Vigorous rubbing of the legs is
contraindicated, and prolonged standing strains the vascular system. The patient should never
walk barefoot.

TOP: Home Instruction for the Patient with a Vascular Disorder
40. A nurse is preparing to administer low-molecular-weight heparin (LMWH). What is a major

advantage related to the administration of LMWH?
a. It can be given orally.
b. It is provided fixed doses.
c. It is given only after partial thromboplastin time (PTT) laboratory work.
d. It provides an immediate effect.
ANS: B
LMWH can be given as a fixed dose without waiting for the results of the PTT. It is only
given subcutaneously and does not have an immediate effect. PTT is not done to monitor
LMWH.

TOP: Anticoagulant Drug Therapy KEY: Nursing Process Step: Implementation
41. Which statement made by a patient indicates to the nurse that a teaching plan for the use of
warfarin was not effective?
a. “I don’t take aspirin anymore.”
b. “I read that grapefruit interferes with warfarin.”
c. “I’m drinking too much tea. My urine looks like tea.”
d. “I wear my medical alert bracelet all the time.”
ANS: C
Anticoagulants, such as warfarin (Coumadin), can cause bleeding. A sign of bleeding may be
bruising, tea- or cola-colored urine, or dark-colored stool.

TOP: Anticoagulant Therapy KEY: Nursing Process Step: Evaluation
42. What medication obtained in a patient’s history will lessen the effects of warfarin
(Coumadin)?
a. Iron supplement for anemia
b. Simvastatin (Zocor) for the control of cholesterol
c. Furosemide (Lasix) for fluid retention
d. Yaz (drospirenone/estradiol) as an oral contraceptive
ANS: D
Oral contraceptives lessen the effects of warfarin (Coumadin).

TOP: Drug Therapy KEY: Nursing Process Step: Assessment
MULTIPLE RESPONSE
1. Which factors affect stroke volume? (Select all that apply.)

a. Contractility
b. Climate
c. Age
d. Preload
e. Afterload
ANS: A, D, E
Stroke volume is dependent on contractility, preload, and afterload. Age may affect all three,
but the stroke volume, regardless of age, is dependent on these three factors.
TOP: Stroke Volume KEY: Nursing Process Step: Implementation
2. Which age-related changes in the heart should a nurse take into consideration? (Select all that
apply.)
a. Decrease in contractility
b. Thickened valves
c. Stiffened valves
d. Decreased SA node cells
e. Increased nerve fibers in ventricles
ANS: A, B, C, D
Aging thickens and stiffens the valves and reduces the cells in the SA node. Age decreases the
nerve fibers in the ventricles.

TOP: Age-Related Cardiac Changes KEY: Nursing Process Step: Planning
3. Why do older persons adapt more slowly to changes in the peripheral vascular system? (Select
all that apply.)
a. Slowing heart rate
b. Decreasing cardiac output
c. Increasing stroke volume
d. Stiffening of blood vessels
e. Thickening of aorta
ANS: A, B, D, E
Age-related changes include a slowing of the heart rate, a decrease in both cardiac output and
stroke volume, and a stiffening and thickening of blood vessels.

TOP: Age-Related Changes to the Cardiovascular System
4. A nurse suspects a circulatory disorder in one leg. Which assessments should the nurse
include when comparing both legs? (Select all that apply.)
a. Color
b. Warmth
c. Muscle strength
d. Pulse quality
e. Hair loss on extremity
ANS: A, B, D, E
Muscle strength is not a circulatory assessment. Color, warmth, pulse quality, and loss of
superficial hair are indicators of decreased arterial perfusion.

TOP: Circulatory Assessment KEY: Nursing Process Step: Assessment
COMPLETION
1. At rest, the cardiac cells in the myocardium are electrically polarized, with the inside of the
cell being more ______ than the outside of the cell.
ANS:
negative
When the heart is at rest, the inside of the cell is negatively charged.

TOP: Polarization of Myocardium KEY: Nursing Process Step: Assessment
2. A nurse explains that the lining of a vessel that allows for smooth blood flow and also reduced
resistance in the vessel is the ______ of the vessel.
ANS:
intima
The interior lining of a blood vessel is referred to as the intima.

TOP: Intima KEY: Nursing Process Step: Implementation
3. A nurse explains that when a patient history reveals a recent episode of vomiting and diarrhea,
the nurse anticipates that this fluid loss will cause ______ and increased blood viscosity.
ANS:
hemoconcentration
Hemoconcentration occurs when fluid is lost through dehydration, which makes the blood
more viscous and shows an inaccurately high value of hemoglobin.

TOP: Hemoconcentration KEY: Nursing Process Step: Intervention
4. A nurse uses a picture to demonstrate the conduction pathway through the chambers of the
heart. ______ (Arrange the following options in the correct sequence. Do not separate
answers with a space or punctuation. Example: ABCD.)
a. The atria contract.
b. Conduction occurs through the bundle branches.
c. The AV node fires.
d. The Purkinje fibers conduct.
e. The SA node fires.
f. The ventricles contract.
ANS:
EACBDF
The conduction pathway begins in the SA node, travels down the atrial wall, depolarizing the
atria, to the AV node, bundle branches, and Purkinje fibers, contracting the ventricles.

TOP: Conduction Pathway for Cardiac Contraction

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Chapter 33: Cardiovascular System Introduction

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DIF: Cognitive Level: Analysis REF: p. 603 OBJ: 3

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3. Which heart sound should the nurse record as normal?

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6. A nurse should anticipate that a patient taking Vasotec, an angiotensin-converting enzyme

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20. A medication, simvastatin (Zocor), is administered to lower a patient’s cholesterol level.

DIF: Cognitive Level: Knowledge REF: p. 624 OBJ: 5

DIF: Cognitive Level: Comprehension REF: p. 630 OBJ: 5

DIF: Cognitive Level: Application REF: p. 621 OBJ: 5

23. A 46-year-old patient is receiving propranolol (Inderal), a nonselective beta-adrenergic

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35. What is contraindicated for a patient performing Buerger-Allen exercises?

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40. A nurse is preparing to administer low-molecular-weight heparin (LMWH). What is a major

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1. Which factors affect stroke volume? (Select all that apply.)

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The interior lining of a blood vessel is referred to as the intima.

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