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NURS 3365 Circulatory System Disorders Answers & Rationale Assignment 5,6 7
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NURS 3365 Circulatory System Disorders Answers & Rationale Assignment 5,6 7
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answers ASSIGNMENT #5(Circulatory
System
Disorders)
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1. A patient has intermittent claudication and a history of atherosclerosis. What other
findings are most likely?
a. pitting edema of the ankles. Wrong—edema is associated with venous issues, not arterial
(everything in stem of question points to arterial: intermittent claudication = PAD, atherosclerosis =
arterial prob.)
b. jugular vein distention. Wrong—associated with RHF in which there is back up of venous blood
into jugular veins.
c. cool feet with diminished pulses. Correct—atherosclerosis blocks arterial flow to distal areas;
intermittent claudication means basically “limping because of ischemic pain,” so you link this with
PAD & diminished flow to feet.
d. S&S of increased preload. Wrong—increased volume is not a part of this scenario.
2. A patient is diagnosed with venous insufficiency. What treatment is most likely and why?
a. a clot-busting medication, because it is used to dissolve arterial clots that block off
flow. Wrong—venous insufficiency = venous prob, not arterial (“arterial clots” is in stem of
question)
b. drop the legs lower than the heart so that circulation can bypass DVTs.
Wrong—venous issues = raise feet.
c. complete bedrest, as venous stasis is the best way to prevent thrombosis. Wrong—
blood should never be static! increases risk for thrombus.
d. elevation of feet as often as possible, because it enhances venous return. Correct –
think of venous insufficiency as “insufficient ability to get venous flow back UP to the heart” (often
due to incompetent venous valves) so that blood pools in veins in the feet.
***Questions 3-7 refer to this scenario: A patient with a history of atherosclerosis and HTN is
complaining of chest pain, SOB, and pain radiating to his left arm. He is diagnosed with an MI of
his left ventricular wall.
3. What S&S would be expected and would indicate decreased CO /perfusion?
a. ankle edema and varicose veins. Wrong—atherosclerosis & HTN are arterial dzs; ankle
edema & varicose veins relate to venous issues.
b. decreased urine output and capillary refill of 4 seconds. Correct – an MI will be a
negative inotrope—it will decrease contractility of the heart muscle and thus decrease stroke volume,
which in turn decreases CO (see concept map); decreased CO means less perfusion to the
body!delayed capillary refill as well as diminishment of organ efficiency such as that of the kidneys.
c. BP of 190/90 and capillary refill of 2 seconds. Wrong—capillary refill of 2 sec. is normal.
d. strong, bounding DP & PT pulses. Wrong—with decreased CO, you are more likely to have
decreased, weaker pulses.
4. Lab work done during the MI most likely shows high blood levels of certain substances,
including:
a. troponin. Correct—increase in serum troponin almost always means cardiomyocytes injury/death,
since troponin is a substance usually only found in the heart cells.
b. BNP. Wrong—BNP is increased in HF, not MI.
c. histamine Wrong—histamine MAY be increased because of inflammatory side of MI, but it is more
subtle and not measured as lab work.
d. inotropes. Wrong—the word inotrope means having to do with contractility; it’s not usually a
measurement in terms of labs, etc.
,5. He develops a blood pressure of 80/50. Which statement is most accurate?
a. The patient is in cardiogenic shock and should be given meds to increase SVR
(systemic vascular resistance). Wrong—the first part is correct, but you would never give
medications to increase afterload for a patient whose heart is already struggling (cardiogenic =
heart-related).
b. The patient should be given a negative inotrope, as this will cause vasodilation.
Wrong—inotrope means related to contractility; a negative inotrope means something that
suppresses contractility, not causes vasodilation.
.c. The patient is hypotensive and should be given large volumes of fluid. Wrong—by
increasing preload in this case you will add to the heart’s workload—the heart “says”: ‘here I am sick,
and now I have more fluid coming in—I have to work even harder!’
d. The patient is in cardiogenic shock and should be given a positive inotrope. Correct--
anything that is a positive inotrope will increase the contractility of the heart, thus giving it the strength to eject
more blood and increase the ailing BP.
6. Several days later the patient manifests S&S of heart failure. Given the area of his heart
involved in the MI, which are the most likely S&S?
a. increased preload & ankle edema. Wrong—increased preload (ie, increased blood volume,
AKA fluid volume overload,) is usually present in any type of HF; ankle edema is one of S&S of RHF,
not left (in stem of question it mentions LV MI).
b. decreased afterload & intermittent claudication. Wrong—random answers not applying to
this situation.
c. tricuspid regurgitation & right atrial hypertrophy. Wrong—both of these situations occur
on right side of heart, not the problem area of our scenario (left side.)
d. shortness of breath and lung crackles. Correct – you are given the fact that this was an MI in
the LV, so most likely, as the LV gets too tired to pump blood forward, some of it will go backward—
into the lungs, causing pulmonary edema & related S&S (“Lung crackles” means if you listen to the
lungs with a stethoscope, you can hear the crackling of air going in and out of fluid-filled alveoli). BE
SURE TO KNOW HEART FLOW BOTH FORWARD and BACKWARD.
7. When the patient was suspected of developing the heart failure (HF), lab work was drawn
that specifically corroborated the diagnosis of HF by showing that the ______was elevated.
a. CRP Wrong—likely that a CRP would be elevated, but only indicates that there is inflammation, not
where it is.
b. BNP. Correct – BNP (B-type natriuretic peptide) is secreted by the heart when there is TOO MUCH
preload (ie, fluid volume overload)—BNP circulates to the kidneys & “tells them” they need to
increase urination as a compensatory response for high blood volume, because a “bad” heart cannot
tolerate extra fluid; heart failure should ALWAYS be considered a problem of fluid volume overload
because of the effect of the RAAS (see concept map on page 26 of RRD6).
c. CK Wrong— likely that a CK would be elevated, but only indicates non-specific cell injury (in an MI,
both CK AND troponin would be elevated, but CK by itself would not be diagnostic.)
d. RBC.
8. A 40-year-old man is undergoing a yearly physical. Everything is fine except that the nurse
practitioner hears a murmur. All the following are likely etiologies EXCEPT:
a. pulmonic valve insufficiency.
b. a heart valve that is ischemic from a coronary artery blockage.
c. incompetent venous valves. . Correct – the other answers are appropriate to the scenario; this
is the exception, since it is talking about valves in the veins; vein valves don’t usually have murmurs
that can be heard in this fashion. (Be sure you think about venous valves & heart valves as very
different entities)
d. a stenotic mitral valve.
, 9. A patient with CAD reports that he gets angina only when he walks more than a mile. It
always goes away when he rests or takes a NTG. Which statement best fits this patient?
a. He has unstable angina due to worsening of an atherosclerotic plaque. Wrong—the
consistency and mildness of this patient’s S&S indicates stable, not unstable angina.
b. He has ACS that is stable due to development of collateral circulation over time.
Wrong—ACS (acute coronary syndrome) is used to describe unstable types of CAD status; ACS is an
umbrella term that covers unstable angina and MI.
c. He has stable angina due to development of collateral circulation over time. . Correct
stable angina (a category of CAD that basically means “ischemic heart problems that remain stable”)
is almost always related to SLOW development of obstruction of blood flow (such as slow-developing
plaque), giving the body a chance to develop collateral circulation & thus feed oxygen-deprived tissue
on an ongoing basis.
d. His pain is caused by increased preload from venous congestion. Wrong— a mix of
terms that doesn’t apply here.
10. The patient in the question above is on medications. All the following are likely EXCEPT
that he takes
a. NTG to maximize coronary artery patency.
b. NTG to dilate coronaries.
c. aspirin to prevent inflammation that leads to increased plaque formation.
d. negative inotropic medications Correct—anything that is a negative inotrope will decrease
contractility of the heart muscle, decreasing stroke volume, and thus decreasing cardiac output.
11. A patient in atrial fibrillation has an increased likelihood of
a. no cardiac output and dying immediately. Wrong—this answer would be correct if the
question asked about ventricular fibrillation; usually with atrial fibrillation the ventricles are still
working fine.
b. an arterial embolus to the lungs. Wrong—this would be correct if it said “venous” embolus to
the lungs… remember that it would be a venous embolus that flows through the right ventricle and
into the pulmonary artery.
c. a venous embolus to the brain. Wrong— this would be correct if it said “arterial” embolus to
the brain… remember that it would be an arterial embolus that flows through the left ventricle and
into the aorta, then possibly up the carotid to the brain.
d. a thromboembolic event. Correct-- when the atria are quivering, there is no “atrial kick”—no
ejection of a last bit of blood from atria to ventricles; this means some blood can pool in the atria;
pooled blood ! increase risk of thrombus! increased risk of embolus.
12. Lab work done on a heart patient shows a potassium of 5.5 (normal = 3.5 – 5.0). The
patient is at risk for
a. ventricular fibrillation because his heart cells will be more irritable. Correct –
hyperkalemia can lead to more cations (K+) diffusing into myocardial cells; more cations! resetting
of RMP at a more positive charge! “closer” to the depolarization/contraction point of +30mV!
hypopolarization! heart cells more irritable & thus more likely to become irregular.
b. bradycardia because his heart cells will be more sluggish. Wrong—the opposite is true.
c. atrial fibrillation because he will be in heart failure. Wrong—no mention of HF.
d. increased afterload for the left ventricular because of systemic vasoconstriction.
Wrong— systemic vasoconstriction would indeed cause an increased afterload for the LV, but this
scenario would not likely cause systemic vasoconstriction.
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