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The Chicago Review Press NCLEX-PN
Practice Test and Review
By Linda Waide, Berta Roland
Chicago Review Press IncorporatedCopyright © 2004 Linda Waide and Berta Roland
All rights reserved.
Practice Test 1
Cardiocirculatory and Peripheral Circulatory Systems
The Cardiocirculatory System
The cardiocirculatory system consists of blood, vessels to transport the blood, and a four-chambered muscular pump called the heart. The cardiocirculatory system is responsible for transporting food and oxygen to all the cells and organs of the body.
Blood vessels in the lungs absorb oxygen that is inhaled from the air, and blood vessels in the small intestine absorb food materials from the digestive tract. Blood also provides a means whereby cellular wastes, i.e., carbon dioxide and urea, are transported to the lungs and kidneys, where they are eliminated from the body.
There are three types of blood vessels: arteries, veins, and capillaries.
Arteries are large vessels that carry oxygenated blood away from the heart. In order to withstand the high pressure of the heart's pumping action, arteries are made of connective tissue, elastic fibers, and inner walls of epithelial cells. As the heart forces blood into the arteries, their elastic qualities enable them to expand and contract. Some of the arteries in the body are very large compared to their smaller branches, called arterioles. The walls of arterioles are much thinner than the walls of the larger arteries. The thin walls of arterioles allow them to carry blood to the smallest of vessels, which are known as capillaries.
The walls of capillaries are very thin (just one epithelial cell thick). Because they are so small (microscopic), they are capable of allowing oxygen and nutrients to pass out of the bloodstream and into the tissue fluid (interstitial fluid) that surrounds all body cells. Once nutrients and oxygen are inside the cells, the nutrients are burned (catabolized) and needed energy is released within the cells. At the same time that oxygen and nutrients are passing into the interstitial fluid, the waste products of catabolism, namely, carbon dioxide and water, pass out of the cells and into the thin-walled capillaries. These waste products flow back to the heart via small veins known as venules, which branch to form larger vessels known as veins.
Veins do not have to withstand the pressures that arteries do. Therefore, vein walls are thinner than arterial walls, and veins are less elastic and have less connective tissue than arteries. Compared to arteries, blood pressure in the veins is low. To keep blood flowing toward the heart, veins have small valves on their inner walls that prevent blood from flowing backward. In addition to these valves, muscular action also helps to "milk" blood flow along in the veins.
The four chambers of the heart actually form two pumps. The right side of the heart pumps blood from the heart into the lungs, where it gives off carbon dioxide and picks up oxygen; the left side of the heart pumps the oxygenated blood from the lungs into the body.
Pulmonary circulation consists of the flow of blood through the vessels from the heart to the lungs and then back to the heart again.
When blood goes into the heart, the top two chambers (the right and left atria) relax and deoxygenated blood flows from the veins into the right atrium. This is known as venous return. At the same time, oxygenated blood coming from the lungs flows into the left atrium. At this point the blood-filled atria contract and the blood pushes open the heart valves (the bicuspid and tricuspid valves). This allows oxygenated blood from the left atrium to pass into the left ventricle, and deoxygenated blood from the right atrium to pass into the right ventricle.
When blood leaves the heart, the right and left ventricles contract and deoxygenated blood in the right ventricle flows into the lung (via the pulmonary artery), where it will give off its carbon dioxide and pick up oxygen, and oxygenated blood in the left ventricle flows out of the heart (via the coronary arteries and aorta), where it begins its travels into the body.
Diseases/disorders of the Cardiocirculatory System Include
Acquired Inflammatory Heart Disease
Endocarditis Other names for endocarditis are infective or bacterial endocarditis. The infection affects the endocardium, heart valves, or cardiac processes and is characterized by bacteria or fungi creating vegetative growths on the heart valves and on the endocardial lining of the heart chambers. These growths may also be located on the endothelium of a blood vessel, where they may embolize to organs such as the spleen, kidneys, central nervous system, and lungs. An organism commonly associated with endocarditis is Streptococcus viridans.
Myocarditis Myocarditis is associated with diffuse inflammation of the cardiac muscle (the myocardium). This condition is caused by viral infections, bacterial infections, immune reactions, radiation therapy, chemical poisons, parasitic infestations, and helminthic infestations.
Pericarditis Pericarditis is the inflammation of the pericardium (the membranous fibroserous sac that encloses the heart and the bases of the great vessels). Common causes include infections with bacteria, viruses, or fungi; also neoplasms, radiation to the chest, and postcardiac injury.
Rheumatic Fever/Heart Disease Rheumatic fever is a consequence of infection with a group of beta-hemolytic streptococcal bacteria. Rheumatic heart disease refers to the sequelae, or aftereffects, of rheumatic fever, and may include: Myocarditis, pericarditis, endocarditis, and eventually, valvular disease.
Cardiac Arrhythmias/Dysrhythmias Cardiac arrhythmias/dysrhythmias are faulty electrical conductions that change the rate and rhythm of the heart. Types of arrhythmias include: Sinus arrhythmia, sinus tachycardia, sinus bradycardia, sinoatrial arrest/block, premature atrial contraction, ventricular tachycardia, and ventricular fibrillation.
Cardiac Tamponade Cardiac tamponade is a sequela of pericarditis or injuries to the heart or great blood vessels that cause an accumulation of blood in the pericardial sac. The classic signs of cardiac tamponade are increased venous pressure with neck vein distention, reduced arterial blood pressure, muffled heart sounds, and pulsus paradoxus (an abnormal inspiratory drop in systemic blood pressure greater than 15 mm Hg.)
Cardiogenic Shock Cardiogenic shock occurs when cardiac output diminishes and severe tissue ischemia takes place. Cardiogenic shock is associated with left-sided heart failure and is seen in approximately 15% of clients experiencing a myocardial infarction (MI).
Hypovolemic Shock Hypovolemic shock is best described as lack of tissue perfusion due to insufficient blood volume. Untreated, this condition may cause irreversible cerebral and renal damage, cardiac arrest, and death. Typical causes of this condition are gastrointestinal bleeding and accidental or surgical trauma, severe burns, or ascites resulting in significant blood loss..
Ventricular Aneurysm An aneurysm is an abnormal ballooning or dilatation of a blood vessel (usually an artery) due to either a congenital defect or weakness in the vessel wall. A ventricular aneurysm is a ballooning or out-pouching of the left ventricle. Untreated, this condition may lead to arrhythmias, systemic embolization, and heart failure, including sudden death.
Congential Acyanotic Defects
Atrial Septal Defect (ASD) An atrial septal defect is a congenital heart defect that allows blood to flow through an opening between the right and left atria.
Coarctation of the Aorta This is a localized malformation that results in the narrowing of the aorta. Untreated, it may lead to left-sided heart failure and possibly cerebral hemorrhage and aortic rupture.
Patent Ductus Arteriosus (PDA) In PDA, the lumen of the ductus remains open following birth, allowing blood to flow from the aorta to the pulmonary artery and causing recirculation of arterial blood through the lungs. Respiratory distress and signs of heart failure are the two most common symptoms.
Ventral Septal Defect (VSD) This is the most common congenital heart disorder. The defect (a septum between the left and right ventricles of the heart) allows blood to be shunted between the ventricles, and may cause left atria and right ventricle hypertrophy. Untreated, the condition leads to biventricular heart failure and cyanosis.
Congenital Cyanotic Defects
Tetralogy of Fallot As the name implies, this condition is created by four cardiac defects, namely: ventricular septal defect (VSD), right ventricular outflow tract obstruction (pulmonary stenosis), right ventricular hypertrophy, and dextroposition of the aorta with an overriding of the ventricular septal defect. These defects allow unoxygenated blood to mix with oxygenated blood, causing cyanosis.
Degenerative Cardiovascular Disorders
Coronary Artery Disease (CAD) CAD is associated with narrowing of the coronary arteries sufficient to prevent an adequate supply of blood to the myocardium (heart muscle). The usual cause is atherosclerosis, the most common form of arteriosclerosis, which is marked by cholesterol-lipid-calcium deposits in the linings of the arteries.
Dilated Cardiomyopathy In this condition, the striated muscle fibers of the myocardium (heart muscle) suffer extensive damage, interfering with myocardial metabolism and causing gross dilatation of all four chambers of the heart.
Heart Failure This condition results from failure of the heart to maintain adequate circulation to the heart. As a consequence, failure of the right, left, or both ventricles may occur.
Hypertension Hypertension is a condition in which a person has greater than normal blood pressure. A person is said to have hypertension if the systolic pressure is persistently above 140 mm Hg, if the diastolic pressure is persistently above 90 mm Hg, and when either the systolic pressure is 160 or above, or the diastolic pressure is 115 or above.
Hypertrophic Cardiomyopathy This is a primary disease of cardiac muscle. Another name for it is idio-pathic hypertrophic subaortic stenosis. It is associated with thickening of the interventricular septum (especially in the free wall of the left ventricle). If low cardiac output occurs, the condition may lead to fatal heart failure.
Myocardial Infarction (MI) Myocardial infarction is commonly known as a heart attack. It is a consequence of prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. MI is the leading cause of death in the United States and Western Europe.
Restrictive Cardiomyopathy Characterized by restricted ventricular filling, this condition is the result of left ventricular hypertrophy as well as endocardial fibrosis and thickening. In some cases, it may be irreversible.
Abdominal Aneurysm An abdominal aneurysm is a localized dilatation (ballooning) of the wall of the abdominal aorta. This disorder may be asymptomatic; however, symptoms may include generalized abdominal pain, low back pain that is unaffected by movement, a feeling of gastric fullness, and a pulsating mass in the periumbilical area.
Arterial Occlusive Disease This disease is characterized by the narrowing of the lumen of the aorta and the major branches of the aorta. This narrowing affects blood flow to the legs and feet. Occlusions may cause ischemia, skin ulcerations, and gangrene.
Beurger's Disease This disease is associated with chronic recurring inflammation and vascular occlusion. It typically affects the peripheral arteries and veins of the extremities. Smoking tobacco is thought to be the main cause. Treatment includes the discontinuation of tobacco in any form.
Femoral and Popliteal Aneurysms Also known as peripheral arterial aneurysms, these are the result of progressive atherosclerotic changes in the walls of the major peripheral arteries. Symptoms include pain in the legs and feet due to ischemia.
Raynaud's Disease This is a peripheral vascular disorder found almost exclusively in women between 18 and 40 years of age. It is characterized by severe vasoconstriction in the extremities when exposed to cold or vasoconstriction associated with emotional stress. Symptoms include intermittent attacks of pallor or cyanosis in the digits (typically the fingers). Other symptoms include numbness and tingling in the fingers. Rarely, gangrene necessitating amputation of the affected digits may occur.
Thoracic Aortic Aneurysm This condition is characterized by widening (ballooning) of either the ascending, transverse, or descending parts of the aorta. The most common cause is atherosclerosis, which weakens the wall of the aorta and slowly distends the lumen. Pain is the most common symptom.
Thrombophlebitis An acute condition associated with inflammation and thrombus formation in deep or superficial veins, this disease is usually progressive and may lead to pulmonary embolism. Superficial thrombophlebitis is generally self-limiting and rarely leads to pulmonary embolism.
valvular heart diseases
All of these conditions interfere with the normal flow of blood into, through, and out of the heart. They include
 Mitral insufficiency
 Mitral stenosis
 Mitral valve prolapse (MVP)
 Aortic insufficiency
 Aortic stenosis
 Pulmonic insufficiency
 Pulmonic stenosis
 Tricuspid insufficiency
Practice Test 1
Which of the following findings by the nurse would constitute a significant index of hypertension?
1. a pulse of 10 beats per minute
2. a regular pulse of 90 beats per minute
3. a systolic pressure fluctuating between 150 and 160 mm Hg
4. a diastolic pressure sustained at greater than 90 mm Hg
A client with thrombophlebitis is placed on bed rest. The client asks why bed rest is necessary. Which of the following responses by the nurse would be best?
1. "Bed rest promotes venous pressure in the extremities."
2. "Bed rest improves the venous circulation."
3. "Bed rest minimizes the potential for release of a blood clot."
4. "Bed rest prevents blood clot formation in the unaffected extremity."
A client has 0.08 mg of digoxin prescribed. The bottle contains 0.05 mg of the drug in 1 cc of solution. How much solution should the nurse prepare for administration?
Fill in the blank
Supportive stockings have been prescribed to reduce and prevent edema. If the client has been ambulating, the nurse should:
1. have the client wash and dry the feet prior to applying the stockings.
2. wrap the legs with soft gauze prior to applying the stockings.
3. tell the client that the shoe size may be increased to accommodate the stockings.
4. have the client lie down and elevate the legs for 15 to 20 minutes before applying the stockings.
A client has vascular occlusion of the left leg. Which of the following will the nurse include in the client's assessment?
1. Compare pulses in the lower extremities.
2. Compare temperatures of the lower extremities.
3. Note the pulse in the left leg.
4. Note the temperature of the left leg.
A diversional activity for a client recently diagnosed with a myocardial infarction needs to be selected. To which of these questions should the nurse give the greatest consideration?
1. Will the diversion be new to the client?
2. Will the diversion amuse the client?
3. Does the diversion promote relaxation?
4. Does the diversion require mental concentration?
A client is to receive nitroglycerin. The desired effect of this medication is to:
1. constrict peripheral blood vessels.
2. improve coronary blood flow.
3. produce slower and stronger heartbeats.
4. increase the rate and depth of respirations.
You are preparing a client for an electrocardiogram. Which of the following information about the procedure should be included?
1. The client will have nothing by mouth for 12 hours before the procedure.
2. The client will have no discomfort during the procedure.
3. The client will be required to do mild exercise during the procedure.
4. The client will have to remain flat in bed for several hours after the procedure.
A client has coronary artery disease (CAD). The nurse is teaching the client to recognize modifiable risk factors associated with this condition. Which one of the following risk factors is modifiable?
1. genetic predisposition
2. cigarette smoking and physical inactivity
A client has been discharged from the hospital. Prescriptions include a digitalis preparation. Which of the following statements, if made by the client, would indicate a need for further teaching?
1. "I am a little thirsty today, but I should take the medicine anyway."
2. "I have been urinating a little more than usual, but I should take my medicine anyway."
3. "I have been nauseated for a couple of days, but I should take my medicine anyway."
4. "My pulse was 64 today, but I should take my medicine anyway."
Excerpted from The Chicago Review Press NCLEX-PN by Linda Waide, Berta Roland. Copyright © 2004 Linda Waide and Berta Roland. Excerpted by permission of Chicago Review Press Incorporated.
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