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NURS617/ NURS 617 E XAM 5 (NEW 2024/ 2025
UPDATE) PHARMACOTHERAPEUTICS GUIDE| QS & AS|
GRADE A| 100% CORRECT (VERIFIED ANSWERS)-
3 factors governing blood flow - ANS ✓pressure, resistance, flow
-increase in viscosity and decrease in temp=decrease in blood flow
Compliance - ANS ✓-total quantity of blood that can be stored in a given portion
of circulation for each mm HG increase in pressure
-compliance=increase in volume/increase in pressure; ability to increase of
decrease depending on BP
-most distended=veins
Pre load vs after load vs inotropy - ANS ✓-pre-load: ventricular filling/end-
diastolic pressure; volume of blood prior to systole, largely determined by
venous return to heart
-after-load: resistance of ejection of blood from the heart; pressure muscles are
exerted to move blood into aorta and around body; aortic stenosis can increase
afterload
-inotropy: force of cardiac contractility; increase in inotropy=increase in ejection
fraction + SV
Heart Sounds
S1
S2
S3
S4 - ANS ✓S1 - normal; lub, produced by closure of the mitral valve
S2 - norma; dub, produced by closure of the aortic valve
S3 - abnormal; early diastole, occurs after the mitral valve opens; rapid
ventricular fillingsyss
S4 - abnormal; late diastole, occurs during atrial contraction
**S3 + S4=indicative of resistance of ventricular filling
Law of laplace - ANS ✓-pressure is directly proportional to surface tension and
inversely proportional to radius of alveolus
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-wall tension increases as wall becomes thinner, wall tension decreases as wall
becomes thicker
Frank-Starling Mechanism - ANS ✓-A mechanism by which the stroke volume
of the heart is increased by increasing the venous return of the heart (thus
stretching the ventricular muscle).
-allows heart to adjust pumping ability to accommodate venous return
-increase in force of contract=increase in ventricular end diastolic volume
Pulmonary vs. Systemic Circulation: pressure/resistance - ANS
✓pulmonary=low pressure, low resistance; avg 90mm Hg; right side of heart
Systemic=high pressure, high resistance; avg 12mm Hg; left side of heart
Blood flow through the heart - ANS ✓1-Superior & Inferior Vena Cava, 2-Rt
Atrium, 3-Tricuspid Valve, 4- Rt Ventricle, 5-Pulmonary Valve, 6-Pulmonary
Artery, 7- Lungs-pick up oxygen, 8-Pulmonary Veins, 9- Lt Atrium, 10- Mitral
Valve (Bicuspid), 11-Lt Ventricle, 12- Aortic Valve, 13-Aorta, 14- Body, repeat
Lub vs dub - ANS ✓lub=mitral and tricuspid valves shutting
Dub=shutting of aortic and pulmonary (semilunar) valves
Pericardium - ANS ✓-A loose-fitting membrane that encloses the heart,
consisting of a superficial fibrous layer and a deep serous layer
-holds heart in fixed position
-protects from infection and physical trauma
Myocardium - ANS ✓-muscular, middle layer of the heart; cardiac muscle,
behaves as a single unit
-regulated by tropomyosin and troponin complex (T and I)
-calcium retrieved from skeletal muscles for contraction
Endocardium - ANS ✓-innermost layer of the heart; 3 thin layers
-inner=smooth endocardium
4 heart valves and roles - ANS ✓R ventricle: pumps blood to lungs
L ventricle: pumps blood to systemic circulation
R atrium: receives blood returning to heart from circulatuin
L atrium: receives oxygenated blood from lungs
Fibrous skeleton of the heart - ANS ✓-4 interconnecting valve rings
-separates artia and ventricles, forms rigid support for attachment of valves and
insertion of cardiac muscle
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Digoxin - ANS ✓-increases force of contraction by increasing calcium, slows
conduction through AV node
L vs R side HF - ANS ✓L: pulmonary congestion
R: venous pooling/edema
Reactive hyperemia - ANS ✓-a bright red flush on the skin occurring after
pressure is relieved
-local increase in blood flow after temporary occlusion of blood flow;
compensatory mechanism
Albumin - ANS ✓-protein in blood; maintains the proper amount of water in the
blood, major osmotic force
-excessive fluid returned to circulation via lymphatic channels
Systolic vs diastolic heart murmors - ANS ✓systolic: mitral regurgitation,
aortia stenosis, mitral valve prolapse
Diastolic: mitral stenosis, aortic regurgitation
HR effects on CO & SV - ANS ✓-increase in HR=decrease in SV & CO
-time spent in diastole decreases, time spent in systole stays the same
Stable vs unstable plaque - ANS ✓Unstable plaque - white/grey, platelet rich;
large lipid core with a thin fibrous cap made of smooth muslce -- can easily
rupture
Stable plaque - red; small lipid core with a thick fibrous cap made of smooth
muscle -- doesn't easily rupture
Pericarditis - ANS ✓-inflammation of the sac surrounding the heart; associated
w/ increased capillary permeability
-can be acute (<2 weeks); d/t viral or bacterial infx, reoccurring=d/t autoimmune
dx
-fibrous exudate deposes scar tissue on pericardium; can lead to
adhesions/thrombosis
-causes increase in fluid and pain d/t fluid friction (high pitch/scratchy on
systole), decreased CO
-s/s: chest pain relieved by leaning forward, pericardial friction rub, increased
ESR & CRP
Tx: nsaids, abx, corticosteroids, colchicine
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