ATI RN
Physical Exam Cardiovascular System
1. The client on nitroglycerin complains of a headache. How does the nurse explain this?
- A. This is a normal side effect of nitroglycerin.
- B. This is an allergic reaction to nitroglycerin.
- C. This is an indication of overdose.
- D. This is a sign of heart failure.
Correct answer: A
Rationale: The correct answer is A: 'This is a normal side effect of nitroglycerin.' Headaches are a common side effect of nitroglycerin due to vasodilation. Choice B is incorrect because allergic reactions to nitroglycerin typically present with symptoms like rash, itching, or shortness of breath. Choice C is incorrect as an overdose of nitroglycerin would likely present with symptoms beyond just a headache. Choice D is incorrect because headaches related to nitroglycerin are not indicative of heart failure.
2. Identify the three layers of the heart:
- A. Endocardium, Myocardium, Epicardium
- B. Epicardium, Pericardium, Endocardium
- C. Myocardium, Endocardium, Pericardium
- D. Pericardium, Myocardium, Endocardium
Correct answer: A
Rationale: The correct answer is A: Endocardium, Myocardium, Epicardium. The heart consists of three main layers: the endocardium, which lines the inner chambers of the heart; the myocardium, the middle layer responsible for the heart's pumping action; and the epicardium, the outermost layer that protects the heart. Choices B, C, and D are incorrect as they do not list the heart's layers in the correct order or combination.
3. This is a chronic condition where the heart is unable to pump enough blood to meet the body's needs.
- A. Heart failure
- B. Cardiomyopathy
- C. Myocarditis
- D. Pericarditis
Correct answer: A
Rationale: The correct answer is A: Heart failure. Heart failure is a chronic condition characterized by the heart's inability to pump enough blood to meet the body's needs, resulting in symptoms such as fatigue, shortness of breath, and fluid retention. Choice B, Cardiomyopathy, refers to diseases of the heart muscle that can lead to heart failure but is not the specific term for the condition described. Choices C and D, Myocarditis and Pericarditis, respectively, are conditions involving inflammation of the heart muscle or the lining around the heart, which can cause heart failure as a complication but are not the primary condition described in the question.
4. This is a more accurate indicator of tissue perfusion. It represents the cardiac output in terms of liters per minute per square meter of body surface area. Its normal range is 2.4-4 L/min.
- A. Cardiac Index
- B. Stroke volume
- C. Ejection fraction
- D. Cardiac output
Correct answer: A
Rationale: The correct answer is A: Cardiac Index. Cardiac Index is a measure of cardiac output relative to body surface area, providing a more accurate assessment of tissue perfusion. It is calculated by dividing the cardiac output by the body surface area. The normal range for cardiac index is 2.4-4 L/min/m². Choice B, Stroke volume, refers to the amount of blood ejected by the heart in one contraction and is not adjusted for body surface area. Choice C, Ejection fraction, is the percentage of blood pumped out of the heart's ventricles with each contraction, not adjusted for body surface area. Choice D, Cardiac output, is the total volume of blood pumped by the heart per minute, without considering body surface area.
5. What is a life-threatening condition where the heart suddenly stops beating?
- A. Cardiac arrest
- B. Myocardial infarction
- C. Heart failure
- D. Atrial fibrillation
Correct answer: A
Rationale: Cardiac arrest is the correct answer. It is a sudden, unexpected loss of heart function, breathing, and consciousness, typically resulting in death if not treated immediately. Myocardial infarction (choice B) refers to a heart attack caused by a blockage in the coronary arteries. Heart failure (choice C) is a chronic condition where the heart is unable to pump blood efficiently. Atrial fibrillation (choice D) is an irregular and often rapid heart rate that can lead to complications but is not the same as cardiac arrest.
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