Chapter 23: Structure and Function of the Cardiovascular and Lymphatic Systems

Power-Kean et al: Huether and McCance's Understanding Pathophysiology, Second

Canadian Edition

MULTIPLE CHOICE

1. What is the pericardium?

a. The outer muscular layer of the heart
b. The innermost layer of the heart chambers
c. A membranous sac that encloses the heart
d. The heart’s fibrous skeleton
ANS: C
The pericardium is the membranous sac that surrounds the heart. The outer layer that acts as
the fibrous skeleton of the heart is the myocardium. The innermost layer of the heart is the
endocardium.

DIF: Cognitive Level: Understand REF: The Heart Wall

TOP: Physiological Integrity

2. What is a function of the pericardium?

a. It provides a barrier against extracardial infections.
b. It serves to improve blood flow through the heart.
c. It plays a role in cardiac conduction.
d. It assists in cardiac contraction.
ANS: A
A function of the pericardium is to provide a barrier against extracardial infections. The
pericardium does not improve blood flow through the heart as it is on the outside. The inner
portions of the heart control cardiac conduction. The muscular layers assist with cardiac
contraction.

DIF: Cognitive Level: Understand REF: The Heart Wall

TOP: Physiological Integrity

3. As a result of blockage in the pulmonary artery, blood would first back up into the:
a. aorta.
b. left ventricle.
c. pulmonary veins.
d. right ventricle.
ANS: D
Blockage in the pulmonary artery would cause blood to back up into the right ventricle, not
the aorta since these two vessels do not communicate. The pulmonary artery and left ventricle
do not communicate. Blockage in the pulmonary artery would not cause blood to back up into
the pulmonary vein since the pulmonary vein takes blood to the left atrium.

DIF: Cognitive Level: Understand REF: Figure 23.1 TOP: Physiological Integrity

4. Which chamber of the heart generates the highest pressure?

 a. Right atrium
b. Left atrium
c. Left ventricle
d. Right ventricle
ANS: C
The left ventricle generates the highest pressure of all the heart’s chambers.

DIF: Cognitive Level: Understand REF: Chambers of the Heart

TOP: Physiological Integrity

5. The internal lining of the cardiovascular system is formed by what tissue?

a. Tunica adventitia
b. Connective
c. Mesothelium
d. Endothelium
ANS: D
The endothelium, not the tunica adventitia, is the lining of blood vessels. Connective tissues
help make up arterial walls but are not the lining of blood vessels. The mesothelium is a part
of the pericardial cavity.

DIF: Cognitive Level: Understand REF: The Heart Wall

TOP: Physiological Integrity

6. What vessel(s) carry oxygenated blood?

a. The superior vena cava
b. Pulmonary veins
c. Pulmonary arteries
d. The cardiac veins
ANS: B
Oxygenated blood flows through the pulmonary veins, not the superior vena cava, which
carries venous blood. The pulmonary artery carries unoxygenated blood to the lungs. The
cardiac veins carry unoxygenated blood.

DIF: Cognitive Level: Understand REF: Figure 23.1 TOP: Physiological Integrity

7. A 20-year-old patient underwent an echocardiogram to assess chest pain. Results revealed a

congenital defect in the papillary muscles. Which of the following would the nurse expect to
occur?
a. Closure of the semilunar valve
b. Backward expulsion of the atrioventricular valves
c. Closure of the atrioventricular valve
d. Backward expulsion of the semilunar valves
ANS: B
The papillary muscles are extensions of the myocardium that pull the cusps together and
downward at the onset of ventricular contraction, thus preventing their backward expulsion
into the atria. Defects in the papillary muscles would not affect either the semilunar or
atrioventricular valves.
 DIF: Cognitive Level: Understand REF: Valves of the Heart
TOP: Physiological Integrity

8. Which structures act as anchors for the atrioventricular valves?

a. Chordae tendineae
b. Great vessels
c. Coronary ostia
d. Trabeculae carneae
ANS: A
The atrioventricular valve openings are attached to the papillary muscles by the chordae
tendineae. The great vessels are the vessels that bring blood to and out of the heart and are not
attached to the chordae tendineae. The coronary ostia are openings in the aorta for the
coronary arteries. The trabeculae carneae are a portion of the myocardium.

DIF: Cognitive Level: Understand REF: The Heart Wall

TOP: Physiological Integrity

9. Where are the coronary ostia (the openings to the coronary arteries) found?
a. The left ventricle
b. The inferior vena cava
c. The coronary sinus
d. The aorta
ANS: D
The ostia are found on the aorta, not the ventricle, the vena cava, or the coronary sinus.

DIF: Cognitive Level: Understand

REF: Structures That Support Cardiac Metabolism: The Coronary Vessels
TOP: Physiological Integrity

10. What structure conducts action potentials down the atrioventricular septum?
a. Bachmann bundle
b. Bundle of His
c. Sinoatrial node
d. Atrioventricular node
ANS: B
The bundle of His conducts action potentials down the atrioventricular septum, not the
Bachmann bundle. The sinoatrial node conducts the potential along the atria while the
atrioventricular node conducts impulses to the ventricles.

DIF: Cognitive Level: Understand REF: The Conduction System

TOP: Physiological Integrity

11. The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node
because it:
a. has a superior location in the right atrium.
b. is the only area of the heart capable of spontaneous depolarization.
c. has rich sympathetic innervation via the vagus nerve.
d. depolarizes between –50 and –60 mV, rather than between –60 and –70 mV.
 ANS: D
Cardiac impulses occur in the SA node because its cells depolarize more rapidly than other
automatic cells (between –50 and –16 mV), not because of its superior location. The SA node
is not the only area of the heart capable of spontaneous depolarization. The SA node does
have rich innervations but by parasympathetic innervation from the vagus nerve.

DIF: Cognitive Level: Understand REF: The Conduction System

TOP: Physiological Integrity

12. Which structure would not receive an electrical impulse when the patient is experiencing a left
bundle branch block?
a. Atrioventricular (AV) node
b. Sinoatrial (SA) node
c. Bundle of His
d. The left ventricle
ANS: D
The left bundle branch conducts impulses to the left ventricle; the AV node feeds conduction
of the bundles. The SA node initiates conduction while the bundle of His precedes the division
of the left and right bundles.

DIF: Cognitive Level: Understand REF: The Conduction System

TOP: Physiological Integrity

13. Why does depolarization of a cardiac muscle cell occur?

a. There is a decrease in the permeability of the cell membrane to ions.
b. A rapid movement of ions across the cell membrane occurs.
c. A blockade by calcium ions takes place.
d. There is a stimulus instigated during the refractory period.
ANS: B
Depolarization is caused by the movement of electrically charged solutes (ions) across cardiac
cell membranes. Permeability must be increased for movement to occur. A blockage of
calcium ions would decrease depolarization. No cardiac action potential can be initiated in the
refractory period.

DIF: Cognitive Level: Understand REF: The Conduction System

TOP: Physiological Integrity

14. What is the nurse monitoring when observing the QRS complex on the electrocardiogram?
a. Ventricular activity
b. Pulmonary artery closure
c. Mitral valve opening
d. Aortic valve closing
ANS: A
The QRS complex represents the sum of all ventricular muscle cell depolarizations, not the
closure of the pulmonary artery. The QRS complex does not reflect activity of either the mitral
or aortic valves.

DIF: Cognitive Level: Understand REF: Electrocardiogram

TOP: Physiological Integrity
15. What term represents the period during electrical activity of the heart when no new cardiac
potential can be propagated?
a. The absolute refractory period
b. Hyperpolarization
c. The resting phase
d. The cardiac threshold
ANS: A
A refractory period is the time during which no new cardiac action potential can be initiated
by a stimulus. It follows depolarization. Neither hyperpolarization nor resting correctly
identifies this period. Threshold is related to depolarization.

DIF: Cognitive Level: Understand REF: The Conduction System

TOP: Physiological Integrity

16. What does the PR interval viewed on a normal electrocardiogram represent?

a. Atrial depolarization
b. Ventricular depolarization
c. The onset of atrial activation to onset of ventricular activity
d. The “electrical systole” of the ventricles
ANS: C
The PR interval represents the onset of atrial activation to the onset of ventricular activity. The
P wave represents atrial depolarization. The QRS complex represents ventricular
depolarization. The QT interval represents “electrical systole” of the ventricles.

DIF: Cognitive Level: Understand REF: The Electrocardiogram

TOP: Physiological Integrity

17. What represents the sum of all ventricular muscle cell depolarization?
a. PR interval
b. QRS complex
c. QT interval
d. P wave
ANS: B
The QRS complex represents the sum of all ventricular muscle cell depolarizations. The PR
interval represents the onset of atrial activation to the onset of ventricular activity. The QT
interval represents “electrical systole” of the ventricles. The P wave represents atrial
depolarization.

DIF: Cognitive Level: Understand REF: The Electrocardiogram

TOP: Physiological Integrity

18. A 13-year-old took a weight loss drug that activated the sympathetic nervous system. Which
of the following assessment findings would the nurse expect?
a. Decreased myocardial contraction
b. Decreased heart rate
c. Increased cardiac conduction
d. Increased intranodal conduction time
 ANS: C
Stimulation of the SA node by the sympathetic nervous system rapidly increases cardiac
conduction. Stimulation of the sympathetic nervous system would increase myocardial
contraction and heart rate. Such simulation would not affect conduction time within the node.
These are inherent rates.

DIF: Cognitive Level: Analyze REF: Sympathetic and Parasympathetic Nerves

TOP: Physiological Integrity

19. A 50-year-old received trauma to the chest that caused severe impairment of the primary
pacemaker cells of the heart. Which of the following areas received the greatest damage?
a. Atrioventricular (AV) node
b. Sinoatrial (SA) node
c. Bundle of His
d. Ventricles
ANS: B
The SA node, not the AV node, is considered the pacemaker of the heart. Neither the bundle of
His nor the ventricles are involved.

DIF: Cognitive Level: Understand REF: Heart Rate TOP: Physiological Integrity

20. A 28-year-old with seizure disorder has a vagus nerve stimulator implanted to help control
seizure activity. Which result will the nurse expect to occur?
a. Increased speed of cardiac cycle
b. Increased cardiac contractility
c. Decreased vasodilation
d. Decreased cardiac conduction
ANS: D
The vagus nerve releases acetylcholine. Acetylcholine causes decreased heart rate and slows
conduction through the AV node, thus decreasing the speed of the cardiac cycle. This reaction
also decreases contractility but does not cause decreased vasodilation.

DIF: Cognitive Level: Understand REF: Heart Rate TOP: Physiological Integrity

21. A nurse assesses the heart after acetylcholine because the effect of acetylcholine on the heart
is to:
a. decrease the refractory period.
b. increase calcium influx.
c. increase the strength of myocardial contraction.
d. decrease the heart rate.
ANS: D
Acetylcholine causes decreased heart rate and slows conduction through the AV node; it does
not decrease the refractory period nor does it increase calcium influx. It does not increase the
strength of myocardial contraction.

DIF: Cognitive Level: Understand REF: Sympathetic and Parasympathetic Nerves

TOP: Physiological Integrity

22. What is one difference between cardiac muscle and skeletal muscle?
 a. Cardiac muscle cells are arranged in branching networks.
b. Skeletal muscle cells have only one nucleus.
c. Only cardiac muscle cells appear striped.
d. Only skeletal muscle cells contain sarcomeres.
ANS: A
Cardiac cells are arranged in branching networks throughout the myocardium, whereas
skeletal muscle cells tend to be arranged in parallel units throughout the length of the muscle.
Cardiac muscle cells have only one nucleus, whereas skeletal muscle cells have many nuclei.
Both cardiac and muscle cells appear striped and contain sarcomeres.

DIF: Cognitive Level: Understand REF: Myocardial Cells

TOP: Physiological Integrity

23. What are the thickened areas of the sarcolemma that allow impulses to move rapidly between
myocardial cells?
a.Myosins
b.Intercalated disks
c.Troponin Ts
d.I bands
ANS: B
Intercalated disks allow electrical impulses to be transmitted rapidly from cardiac fibre to
cardiac fibre because the network of fibres is connected at these disks. Myosins do not play a
role in conduction. Troponin Ts are involved in contraction but are not part of the sarcolemma.
I bands are a part of the filaments bud, which do not conduct impulses in a cell-to-cell fashion.

DIF: Cognitive Level: Understand REF: Myocardial Cells

TOP: Physiological Integrity

24. What area of the sarcomere decreases when muscle contraction occurs?
a. The distance between Z lines
b. A band length
c. Z line length
d. I band distance
ANS: A
Anatomically, contraction occurs when the sarcomere shortens, so adjacent Z lines move
closer together. Such a contraction does not occur in relationship to a decrease in A band or Z
line length or a decrease in I band distance.

DIF: Cognitive Level: Understand REF: Myocardial Cells

TOP: Physiological Integrity

25. What is the process by which an action potential in a myocardial cell triggers the contraction
of the cell?
a. Electrocontraction
b. Intercalated communication
c. Excitation-contraction coupling
d. Myosin communication
ANS: C
 Excitation-contraction coupling, not electrocontraction, is the process by which an action
potential in the plasma membrane of the muscle fibre triggers the cycle, leading to cross-
bridge activity and contraction. Neither intercalated nor myosin communication is associated
with a myocardial cell leading to cross-bridge activity and contraction.

DIF: Cognitive Level: Understand REF: Myocardial Contraction and Relaxation

TOP: Physiological Integrity

26. What is the molecule that aids in bonding of the troponin complex to actin and tropomyosin is
troponin:
a. Troponin C
b. Troponin I
c. Troponin T
d. Troponin M
ANS: C
Troponin T aids in the binding of the troponin complex to actin and tropomyosin. Troponin C
contains binding sites for the calcium ions involved in contraction. Troponin I inhibits the
ATPase of actomyosin. Troponin M is not a substance.

DIF: Cognitive Level: Understand REF: Myocardial Cells

TOP: Physiological Integrity

27. A nurse is discussing the pressure generated at the end of diastole. Which term is the nurse
describing?
a. Preload
b. Afterload
c. Systemic vascular resistance
d. Total peripheral resistance
ANS: A
Preload, not afterload, is the volume and associated pressure generated in the ventricle at the
end of diastole. Afterload is the resistance to ejection of blood from the left ventricle.
Systemic vascular resistance is related to afterload. Total peripheral resistance increases
afterload.

DIF: Cognitive Level: Understand REF: Preload TOP: Physiological Integrity

28. As stated by Starling’s law, there is a direct relationship between the _____ of the blood in the
heart at the end of diastole and the _____ of contraction during the next systole.
a. pressure; duration
b. volume; force
c. viscosity; force
d. viscosity; duration
ANS: B
Starling’s law of the heart describes the length-tension relationship of ventricular end-diastolic
volume (VEDV) (preload) to myocardial contractility (as measured by stroke volume). It does
not refer to duration, pressure, or viscosity.

DIF: Cognitive Level: Understand REF: Preload TOP: Physiological Integrity

29. Within a normal physiological range, an increase in left ventricular end-diastolic volume
would lead the nurse to monitor for:
a.an increased force of contraction.
b.a decrease in cardiac output.
c.an increase in heart rate.
d.heart failure.
ANS: A
An increase in end-diastolic volume leads to an increased force of contraction because fibres
are stretched to handle increased volume. Cardiac output would increase. Although volume
increases, heart rate does not respond accordingly. An increase in end-diastolic volume would
not lead to heart failure since failure results in output decrease.

DIF: Cognitive Level: Understand REF: Preload TOP: Physiological Integrity

30. A 50-year-old was prescribed a medication that acts as a negative inotrope. Which
endogenous substances would be most similar?
a. Acetylcholine
b. Dopamine
c. Epinephrine
d. Thyroid hormone
ANS: A
The most important negative inotropic agent is acetylcholine. Dopamine, epinephrine, and
thyroid hormone are positive inotropes.

DIF: Cognitive Level: Understand REF: Myocardial Contractility

TOP: Physiological Integrity

31. Where is the primary cardiovascular control centre located?

a. In the cerebral cortex
b. The thalamus
c. The medulla
d. The hypothalamus
ANS: C
The primary cardiovascular control centre is in the brainstem in the medulla. The cerebral
cortex, the thalamus, and hypothalamus are secondary control sites.

DIF: Cognitive Level: Understand REF: Cardiovascular Control Centres in the Brain
TOP: Physiological Integrity

32. After activation of the Bainbridge reflex in a patient, the nurse assesses for:
a. a change in heart rate
b. decreased blood pressure
c. increased rate and depth of respirations
d. decreased myocardial contractility
ANS: A
Activation of the Bainbridge reflex changes (increases) heart rate. It does not decrease blood
pressure, it does not increase rate and depth of respirations, and it does not decrease
myocardial contractility.
 DIF: Cognitive Level: Understand REF: Atrial Receptors
TOP: Physiological Integrity

33. A nurse observes a cardiologist multiplying the heart rate by stroke volume. What is the
cardiologist measuring?
a. Vascular resistance
b. Preload
c. Cardiac output
d. Ejection fraction
ANS: C
Cardiac output is found by the heart rate times stroke volume. Vascular resistance is not a
factor in the calculation of cardiac output; it does play a role in blood pressure. Preload affects
cardiac output but is not the result of heart rate times stroke volume. Ejection fraction is the
amount ejected per beat.

DIF: Cognitive Level: Understand REF: Factors Affecting Cardiac Output

TOP: Physiological Integrity

34. Where are baroreceptors located?

a. The renal arteries
b. The superior vena cava
c. The aortic arch
d. In the circle of Willis
ANS: C
Baroreceptors are found in the aortic arch and the carotid arteries. They are not found in the
renal artery, the superior vena cava, or the circle of Willis.

DIF: Cognitive Level: Understand REF: Neural Reflexes

TOP: Physiological Integrity

35. What term describes the ability of an organ to adjust arteriole diameter to regulate its own
blood flow?
a. Venous regulation
b. Somatic regulation
c. Autoregulation
d. Metabolic regulation
ANS: C
Autoregulation enables organs to regulate blood flow by altering the resistance of their
arterioles. Somatic, venous, or metabolic regulatory factors are not components of
autoregulation.

DIF: Cognitive Level: Understand REF: Autoregulation

TOP: Physiological Integrity

36. Where does the thoracic lymphatic duct drain?

a. Left subclavian artery
b. Right atrium
c. Right subclavian vein
 d. Left subclavian vein
ANS: D
The thoracic duct drains lymph into the left subclavian vein, not the right subclavian vein. The
right lymphatic duct drains into the right subclavian vein. The thoracic duct does not drain
lymph into the right atrium.

DIF: Cognitive Level: Understand REF: The Lymphatic System

TOP: Physiological Integrity

MULTIPLE RESPONSE

1. Blood flow is affected by which of the following? (Select all that apply.)
a. Blood viscosity
b. Blood vessel diameter
c. Blood pressure
d. Blood vessel length
e. Blood antibodies
ANS: A, B, C, D
Resistance to flow is generally greater in longer tubes because resistance increases with length
but decreases with a wider diameter. Blood flow varies inversely with the viscosity of the
fluid. Thick fluids move more slowly and experience greater resistance to flow than thin
fluids. Increased blood pressure decreases blood flow because resistance is increased. Blood
volume, not antibodies, plays a role in blood flow.

DIF: Cognitive Level: Understand REF: Factors Affecting Blood Flow

TOP: Physiological Integrity

2. A nurse is evaluating stroke volume. Which of the following factors affect stroke volume?
(Select all that apply.)
a. Preload
b. Peripheral vascular resistance
c. Afterload
d. Ejection fraction
e. Contractility
ANS: A, C, E
Preload, afterload, and contractility affect stroke volume.

DIF: Cognitive Level: Understand REF: Factors Affecting Cardiac Output

TOP: Physiological Integrity