RN Cardiovascular Hematologic and Lymphatic Systems
EAQ
Which complication would the nurse consider in a client who just had a total hip
replacement and is experiencing restlessness and changes in mentation?
- Bladder spasms
- Polycythemia vera
- Hypovolemic shock
- Pulmonary hypertension - ANSWER: These signs occur with hypovolemic shock
because less blood is being circulated to vital centers in the brain. A large loss of
blood may occur during and after orthopedic surgery. Urinary retention, not bladder
spasms, may occur after general anesthesia. Anemia and deep vein thrombosis, not
an increase in the total red blood cells (polycythemia vera), tend to occur after a
total hip replacement. Atelectasis and pneumonia are possible complications of
general anesthesia, but pulmonary hypertension is not a postoperative complication.
Which physiological response occurs first when a client experiences sudden
hypovolemia caused by hemorrhage?
- Peripheral vasoconstriction
- Elevation of serum cortisol level
- Release of immature erythrocytes
- Increased antidiuretic hormone (ADH) - ANSWER: The initial response to
hemorrhage is activation of the sympathetic nervous system, leading to increases in
heart rate and peripheral vasoconstriction, which shunts blood to essential core
organs. The other responses also occur, but more slowly. Cortisol increases as part of
the stress response, leading to fluid retention, but this process occurs more slowly.
Immature red blood cells (erythrocytes) are released from the bone marrow, but this
occurs more slowly than vasoconstriction. An increase in ADH causes fluid retention,
but this occurs more slowly.
Which behavior would the nurse expect a client to exhibit during the initial stage of
grieving after learning that a tumor is malignant and has metastasized to several
organs and that the illness is terminal?
- Crying uncontrollably
- Criticizing medical care
- Refusing to receive visitors
- Asking for a second opinion - ANSWER: Seeking other opinions to disprove the
inevitable is a form of denial employed by individuals who have illnesses with a poor
prognosis. If the client is crying, the client is aware of the magnitude of the situation
and is past the stage of denial. Criticism that is unjust often is characteristic of the
stage of anger. Refusing to receive visitors is most common during the depression
experienced as one moves toward acceptance or during the acceptance stage.
Which physiological process causes temperature elevation after a client has had a
myocardial infarction?
,- Tissue necrosis and inflammation
- Thrombosis followed by thrombolysis
- Sympathetic nervous system stimulation
- Infectious process of myocardial muscle cells - ANSWER: The body's inflammatory
response to myocardial necrosis causes an elevation of temperature as well as
leukocytosis within 24 to 48 hours after the event. Arterial thrombosis that causes
myocardial infarction is followed by thrombolysis, but does not cause elevated
temperature. Sympathetic activation does commonly occur with stress associated
with myocardial infarction but is not the cause of fever. Myocardial infarction is not
associated with an infectious process.
Which waveform on an electrocardiogram (ECG) illustrates atrial depolarization?
-A
-b
-c
- d - ANSWER: Option a reflects the P wave; it represents the electrical impulse
starting at the sinus node and spreading throughout the atria (atrial depolarization).
Waveform b reflects the QRS complex; it represents depolarization of the ventricles.
Option c reflects the T wave; it represents repolarization of the ventricles. Waveform
d reflects the U wave; it is believed to reflect late ventricular repolarization or
repolarization of the Purkinje fibers; it is sometimes identified in clients with
hypokalemia.
Which explanation would the nurse nurse give regarding purpose of early
ambulation to a client who had surgery the previous day?
- Promote healing of the incision
- Decrease the incidence of urinary tract infections
- Allow nursing staff to change the bedding
- Keep blood from pooling in the legs to prevent clots - ANSWER: The muscular
action during ambulation facilitates the return of venous blood to the heart; this
reduces venous stasis and minimizes the risk of postoperative thrombophlebitis.
Protein and vitamin C promote wound healing. Walking is not related to the
prevention of urinary tract infections. Although nursing staff often change the bed
when clients are up ambulating, the purpose of early ambulation is the prevention of
client complications, not making nursing actions more convenient for the staff.
Which type of shock is associated with a ruptured abdominal aneurysm?
- Vasogenic shock
- Neurogenic shock
- Cardiogenic shock
- Hypovolemic shock - ANSWER: When an abdominal aneurysm ruptures,
hypovolemic shock ensues because fluid volume depletion occurs as the heart
continues to pump blood out of the ruptured vessel. Vasogenic shock results from
humoral or toxic substances acting directly on the blood vessels, causing
vasodilation. Neurogenic shock results from decreased neuromuscular tone, causing
decreased vasoconstriction. Cardiogenic shock results from a decrease in cardiac
output.
, Which lymph nodes would the nurse expect to be affected first when a client is
diagnosed with Hodgkin disease?
- Cervical
- Axillary
- Inguinal
- Mediastinal - ANSWER: Painless enlargement of the cervical lymph nodes often is
the first sign of Hodgkin disease, a malignant lymphoma of unknown etiology.
Axillary node enlargement occurs after cervical lymph node enlargement. Inguinal
node enlargement occurs later. Mediastinal node involvement follows as the disease
progresses.
Which is involved in the postprocedure nursing care of a child after left-side cardiac
catheterization?
- Encouraging early ambulation
- Monitoring the insertion site for bleeding
- Comparing blood pressures in the two extremities
- Restricting fluids until the blood pressure has stabilized - ANSWER: Postprocedure
hemorrhage, a life-threatening complication after cardiac catheterization, is possible
because arterial blood is under pressure and the catheter has entered an artery. Rest
will be encouraged; flexion of the insertion site should be avoided to prevent
disturbance of the clot. Comparing blood pressures in the two extremities is
unnecessary; the pulse distal to the catheterization insertion site is monitored. The
blood pressure will not be unstable unless a problem develops; fluid intake should be
encouraged.
Which part of the electrocardiogram (ECG) represents depolarization of the
ventricles?
- P wave
- T wave
- PR interval
- QRS interval - ANSWER: Atrial and ventricular depolarization and repolarization are
represented on the ECG as a series of waves: the P wave followed by the QRS
complex and the T wave. The QRS represents ventricular depolarization. The P wave
occurs with depolarization of the atria. The T wave represents ventricular
repolarization. The PR interval represents depolarization of the atria and of the
atrioventricular node.
In what order does normal cardiac conduction occur through the heart?
1. Atrioventricular (AV) node
2. Sinoatrial node
3. Bundle of His
4. Bundle branches
5. Purkinje fibers - ANSWER: The cardiac cycle begins with an impulse generated
from a small concentrated area of pacemaker cells high in the right atria called the
sinus or sinoatrial node. The impulse quickly reaches the AV node located in the area
called the AV junction, between the atria and the ventricles. Here the impulse is
EAQ
Which complication would the nurse consider in a client who just had a total hip
replacement and is experiencing restlessness and changes in mentation?
- Bladder spasms
- Polycythemia vera
- Hypovolemic shock
- Pulmonary hypertension - ANSWER: These signs occur with hypovolemic shock
because less blood is being circulated to vital centers in the brain. A large loss of
blood may occur during and after orthopedic surgery. Urinary retention, not bladder
spasms, may occur after general anesthesia. Anemia and deep vein thrombosis, not
an increase in the total red blood cells (polycythemia vera), tend to occur after a
total hip replacement. Atelectasis and pneumonia are possible complications of
general anesthesia, but pulmonary hypertension is not a postoperative complication.
Which physiological response occurs first when a client experiences sudden
hypovolemia caused by hemorrhage?
- Peripheral vasoconstriction
- Elevation of serum cortisol level
- Release of immature erythrocytes
- Increased antidiuretic hormone (ADH) - ANSWER: The initial response to
hemorrhage is activation of the sympathetic nervous system, leading to increases in
heart rate and peripheral vasoconstriction, which shunts blood to essential core
organs. The other responses also occur, but more slowly. Cortisol increases as part of
the stress response, leading to fluid retention, but this process occurs more slowly.
Immature red blood cells (erythrocytes) are released from the bone marrow, but this
occurs more slowly than vasoconstriction. An increase in ADH causes fluid retention,
but this occurs more slowly.
Which behavior would the nurse expect a client to exhibit during the initial stage of
grieving after learning that a tumor is malignant and has metastasized to several
organs and that the illness is terminal?
- Crying uncontrollably
- Criticizing medical care
- Refusing to receive visitors
- Asking for a second opinion - ANSWER: Seeking other opinions to disprove the
inevitable is a form of denial employed by individuals who have illnesses with a poor
prognosis. If the client is crying, the client is aware of the magnitude of the situation
and is past the stage of denial. Criticism that is unjust often is characteristic of the
stage of anger. Refusing to receive visitors is most common during the depression
experienced as one moves toward acceptance or during the acceptance stage.
Which physiological process causes temperature elevation after a client has had a
myocardial infarction?
,- Tissue necrosis and inflammation
- Thrombosis followed by thrombolysis
- Sympathetic nervous system stimulation
- Infectious process of myocardial muscle cells - ANSWER: The body's inflammatory
response to myocardial necrosis causes an elevation of temperature as well as
leukocytosis within 24 to 48 hours after the event. Arterial thrombosis that causes
myocardial infarction is followed by thrombolysis, but does not cause elevated
temperature. Sympathetic activation does commonly occur with stress associated
with myocardial infarction but is not the cause of fever. Myocardial infarction is not
associated with an infectious process.
Which waveform on an electrocardiogram (ECG) illustrates atrial depolarization?
-A
-b
-c
- d - ANSWER: Option a reflects the P wave; it represents the electrical impulse
starting at the sinus node and spreading throughout the atria (atrial depolarization).
Waveform b reflects the QRS complex; it represents depolarization of the ventricles.
Option c reflects the T wave; it represents repolarization of the ventricles. Waveform
d reflects the U wave; it is believed to reflect late ventricular repolarization or
repolarization of the Purkinje fibers; it is sometimes identified in clients with
hypokalemia.
Which explanation would the nurse nurse give regarding purpose of early
ambulation to a client who had surgery the previous day?
- Promote healing of the incision
- Decrease the incidence of urinary tract infections
- Allow nursing staff to change the bedding
- Keep blood from pooling in the legs to prevent clots - ANSWER: The muscular
action during ambulation facilitates the return of venous blood to the heart; this
reduces venous stasis and minimizes the risk of postoperative thrombophlebitis.
Protein and vitamin C promote wound healing. Walking is not related to the
prevention of urinary tract infections. Although nursing staff often change the bed
when clients are up ambulating, the purpose of early ambulation is the prevention of
client complications, not making nursing actions more convenient for the staff.
Which type of shock is associated with a ruptured abdominal aneurysm?
- Vasogenic shock
- Neurogenic shock
- Cardiogenic shock
- Hypovolemic shock - ANSWER: When an abdominal aneurysm ruptures,
hypovolemic shock ensues because fluid volume depletion occurs as the heart
continues to pump blood out of the ruptured vessel. Vasogenic shock results from
humoral or toxic substances acting directly on the blood vessels, causing
vasodilation. Neurogenic shock results from decreased neuromuscular tone, causing
decreased vasoconstriction. Cardiogenic shock results from a decrease in cardiac
output.
, Which lymph nodes would the nurse expect to be affected first when a client is
diagnosed with Hodgkin disease?
- Cervical
- Axillary
- Inguinal
- Mediastinal - ANSWER: Painless enlargement of the cervical lymph nodes often is
the first sign of Hodgkin disease, a malignant lymphoma of unknown etiology.
Axillary node enlargement occurs after cervical lymph node enlargement. Inguinal
node enlargement occurs later. Mediastinal node involvement follows as the disease
progresses.
Which is involved in the postprocedure nursing care of a child after left-side cardiac
catheterization?
- Encouraging early ambulation
- Monitoring the insertion site for bleeding
- Comparing blood pressures in the two extremities
- Restricting fluids until the blood pressure has stabilized - ANSWER: Postprocedure
hemorrhage, a life-threatening complication after cardiac catheterization, is possible
because arterial blood is under pressure and the catheter has entered an artery. Rest
will be encouraged; flexion of the insertion site should be avoided to prevent
disturbance of the clot. Comparing blood pressures in the two extremities is
unnecessary; the pulse distal to the catheterization insertion site is monitored. The
blood pressure will not be unstable unless a problem develops; fluid intake should be
encouraged.
Which part of the electrocardiogram (ECG) represents depolarization of the
ventricles?
- P wave
- T wave
- PR interval
- QRS interval - ANSWER: Atrial and ventricular depolarization and repolarization are
represented on the ECG as a series of waves: the P wave followed by the QRS
complex and the T wave. The QRS represents ventricular depolarization. The P wave
occurs with depolarization of the atria. The T wave represents ventricular
repolarization. The PR interval represents depolarization of the atria and of the
atrioventricular node.
In what order does normal cardiac conduction occur through the heart?
1. Atrioventricular (AV) node
2. Sinoatrial node
3. Bundle of His
4. Bundle branches
5. Purkinje fibers - ANSWER: The cardiac cycle begins with an impulse generated
from a small concentrated area of pacemaker cells high in the right atria called the
sinus or sinoatrial node. The impulse quickly reaches the AV node located in the area
called the AV junction, between the atria and the ventricles. Here the impulse is
