NUSC 1P30 Jarvis Chapter 20: Heart and Neck Vessels (Updated)

The sac that surrounds and protects the heart is called the:

a.

Pericardium.

b.

Myocardium.

c.

Endocardium.

d.

Pleural space.

A

The direction of blood flow through the heart is best described by which of these?

a.

Vena cava right atrium right ventricle lungs pulmonary artery left atrium left ventricle

b.

Right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle

c.

Aorta right atrium right ventricle lungs pulmonary vein left atrium left ventricle vena cava

d.

Right atrium right ventricle pulmonary vein lungs pulmonary artery left atrium left ventricle

A

The nurse is reviewing anatomy and physiology of the heart. Which statement best describes what is meant by atrial kick?

a.

The atria contract during systole and attempt to push against closed valves.

b.

Contraction of the atria at the beginning of diastole can be felt as a palpitation.

c.

Atrial kick is the pressure exerted against the atria as the ventricles contract during systole.

d.

The atria contract toward the end of diastole and push the remaining blood into the ventricles.

D

When listening to heart sounds, the nurse knows that the valve closures that can be heard best at the base of the heart are:

a.

Mitral and tricuspid.

b.

Tricuspid and aortic.

c.

Aortic and pulmonic.

d.

Mitral and pulmonic.

C

Which of these statements describes the closure of the valves in a normal cardiac cycle?

a.

The aortic valve closes slightly before the tricuspid valve.

b.

The pulmonic valve closes slightly before the aortic valve.

c.

The tricuspid valve closes slightly later than the mitral valve.

d.

Both the tricuspid and pulmonic valves close at the same time.

C

The component of the conduction system referred to as the pacemaker of the heart is the:

a.

Atrioventricular (AV) node.

b.

Sinoatrial (SA) node.

c.

Bundle of His.

d.

Bundle branches.

B

The electrical stimulus of the cardiac cycle follows which sequence?

a.

AV node SA node bundle of His

b.

Bundle of His AV node SA node

c.

SA node AV node bundle of His bundle branches

d.

AV node SA node bundle of His bundle branches

D

The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. The nurse knows that this finding indicates:

a.

Decreased fluid volume.

b.

Increased cardiac output.

c.

Narrowing of jugular veins.

d.

Elevated pressure related to heart failure.

D

When assessing a newborn infant who is 5 minutes old, the nurse knows that which of these statements would be true?

a.

The left ventricle is larger and weighs more than the right ventricle.

b.

The circulation of a newborn is identical to that of an adult.

c.

Blood can flow into the left side of the heart through an opening in the atrial septum.

d.

The foramen ovale closes just minutes before birth, and the ductus arteriosus closes immediately after.

C

A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous exam, the nurse notes that her blood pressure in her second month was 124/80 mm Hg. In evaluating this change, what does the nurse know to be true?

a.

This decline in blood pressure is the result of peripheral vasodilatation and is an expected change.

b.

Because of increased cardiac output, the blood pressure should be higher at this time.

c.

This change in blood pressure is not an expected finding because it means a decrease in cardiac output.

d.

This decline in blood pressure means a decrease in circulating blood volume, which is dangerous for the fetus.

A

In assessing a 70-year-old man, the nurse finds the following: blood pressure 140/100 mm Hg; heart rate 104 and slightly irregular; split S2. Which of these findings can be explained by expected hemodynamic changes related to age?

a.

Increase in resting heart rate

b.

Increase in systolic blood pressure

c.

Decrease in diastolic blood pressure

d.

Increase in diastolic blood pressure

B

A 45-year-old man is in the clinic for a routine physical. During the history the patient states he's been having difficulty sleeping. "I'll be sleeping great and then I wake up and feel like I can't get my breath." The nurse's best response to this would be:

a.

"When was your last electrocardiogram?"

b.

"It's probably because it's been so hot at night."

c.

"Do you have any history of problems with your heart?"

d.

"Have you had a recent sinus infection or upper respiratory infection?"

C

In assessing a patient's major risk factors for heart disease, which would the nurse want to include when taking a history?

a.

Family history, hypertension, stress, and age

b.

Personality type, high cholesterol, diabetes, and smoking

c.

Smoking, hypertension, obesity, diabetes, and high cholesterol

d.

Alcohol consumption, obesity, diabetes, stress, and high cholesterol

C

The mother of a 3-month-old infant states that her baby has not been gaining weight. With further questioning, the nurse finds that the infant falls asleep after nursing and wakes up after a short amount of time, hungry again. What other information would the nurse want to have?

a.

Infant's sleeping position

b.

Sibling history of eating disorders

c.

Amount of background noise when eating

d.

Presence of dyspnea or diaphoresis when sucking

D

In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would:

a.

Palpate the artery in the upper one third of the neck.

b.

Listen with the bell of the stethoscope to assess for bruits.

c.

Simultaneously palpate both arteries to compare amplitude.

d.

Instruct the patient to take slow deep breaths during auscultation.

B

During an assessment of a 68-year-old man with a recent onset of right-sided weakness, the nurse hears a blowing, swishing sound with the bell of the stethoscope over the left carotid artery. This finding would indicate:

a.

Valvular disorder.

b.

Blood flow turbulence.

c.

Fluid volume overload.

d.

Ventricular hypertrophy.

B.

During inspection of the precordium of an adult patient, the nurse notices the chest moving in a forceful manner along the sternal border. This finding most likely suggests:

a.

Normal heart.

b.

Systolic murmur.

c.

Enlargement of the left ventricle.

d.

Enlargement of the right ventricle.

D

During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse?

a.

Third left intercostal space at the midclavicular line

b.

Fourth left intercostal space at the sternal border

c.

Fourth left intercostal space at the anterior axillary line

d.

Fifth left intercostal space at the midclavicular line

D

The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true?

a.

Percussion is a useful tool for outlining the heart's borders.

b.

Percussion is easier in patients who are obese.

c.

Studies show that percussed cardiac borders do not correlate well with the true cardiac border.

d.

Only expert health care providers should attempt percussion of the heart.

C

The nurse is preparing to auscultate for heart sounds. Which technique is correct?

a.

Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral areas

b.

Listening by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex

c.

Listening to the sounds only at the site where the apical pulse is felt to be the strongest

d.

Listening for all possible sounds at a time at each specified area

B

While counting the apical pulse on a 16-year-old patient, the nurse notices an irregular rhythm. His rate speeds up on inspiration and slows on expiration. What would be the nurse's response?

a.

Talk with the patient about his intake of caffeine.

b.

Perform an electrocardiogram after the examination.

c.

No further response is needed because sinus arrhythmia can occur normally.

d.

Refer the patient to a cardiologist for further testing.

C

When listening to heart sounds, the nurse knows that S1:

a.

Is louder than the S2 at the base of the heart.

b.

Indicates the beginning of diastole.

c.

Coincides with the carotid artery pulse.

d.

Is caused by the closure of the semilunar valves.

C

During the cardiac auscultation the nurse hears a sound occurring immediately after S2 at the second left intercostal space. To further assess this sound, what should the nurse do?

a.

Have the patient turn to the left side while the nurse listens with the bell of the stethoscope.

b.

Ask the patient to hold his or her breath while the nurse listens again.

c.

No further assessment is needed because the nurse knows this sound is an S3.

d.

Watch the patient's respirations while listening for the effect on the sound.

D

Which of these findings would the nurse expect to notice during a cardiac assessment on a 4-year-old child?

a.

S3 when sitting up

b.

Persistent tachycardia above 150 beats per minute

c.

Murmur at the second left intercostal space when supine

d.

Palpable apical impulse in the fifth left intercostal space lateral to midclavicular line

C

While auscultating heart sounds on a 7-year-old child for a routine physical, the nurse hears an S3, a soft murmur at left midsternal border, and a venous hum when the child is standing. Which of these would be a correct interpretation of these findings?

a.

S3 is indicative of heart disease in children.

b.

These findings can all be normal in a child.

c.

These findings are indicative of congenital problems.

d.

The venous hum most likely indicates an aneurysm.

B

During the precordial assessment on an patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. This finding would indicate:

a.

Right ventricular hypertrophy.

b.

Increased volume and size of the heart as a result of pregnancy.

c.

Displacement of the heart from elevation of the diaphragm.

d.

Increased blood flow through the internal mammary artery.

C

In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the:

a.

Bell of the stethoscope at the base with the patient leaning forward.

b.

Bell of the stethoscope at the apex with the patient in the left lateral position.

c.

Diaphragm of the stethoscope in the aortic area with the patient sitting.

d.

Diaphragm of the stethoscope in the pulmonic area with the patient supine.

B

A 70-year-old patient with a history of hypertension has a blood pressure of 180/100 mm Hg and a heart rate of 90 beats per minute. The nurse hears an extra heart sound at the apex immediately before S1. The sound is heard only with the bell while the patient is in the left lateral position. With these findings and the patient's history, the nurse knows that this extra heart sound is most likely a(n):

a.

Split S1.

b.

Atrial gallop.

c.

Diastolic murmur.

d.

Summation sound.

B

The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her myocardial infarction. Heart sounds are normal when she is supine, but when she is sitting and leaning forward, the nurse hears a high-pitched, scratchy sound with the diaphragm of the stethoscope at the apex. It disappears on inspiration. The nurse suspects:

a.

Increased cardiac output.

b.

Another MI.

c.

Inflammation of the precordium.

d.

Ventricular hypertrophy resulting from muscle damage.

C

The mother of a 10-month-old infant tells the nurse that she has noticed that her son becomes blue when he is crying and that the frequency of this is increasing. He is also not crawling yet. During the examination the nurse palpates a thrill at the left lower sternal border and auscultates a loud systolic murmur in the same area. What would be the most likely cause of these findings?

a.

Tetralogy of Fallot

b.

Atrial septal defect

c.

Patent ductus arteriosus

d.

Ventricular septal defect

A

A 30-year-old woman with a history of mitral valve problems states that she has been "very tired." She has started waking up at night and feels like her "heart is pounding." During the assessment, the nurse palpates a thrill and lift at the fifth left intercostal space midclavicular line. In the same area the nurse also auscultates a blowing, swishing sound right after S1. These findings would be most consistent with:

a.

Heart failure.

b.

Aortic stenosis.

c.

Pulmonary edema.

d.

Mitral regurgitation.

D

During a cardiac assessment on a 38 year-old patient in the hospital for "chest pain," the nurse finds the following: jugular vein pulsations 4 cm above sternal angle when he is elevated at 45 degrees, blood pressure 98/60 mm Hg, heart rate 130 beats per minute, ankle edema, difficulty in breathing when supine, and an S3 on auscultation. Which of these conditions best explains the cause of these findings?

a.

Fluid overload

b.

Atrial septal defect

c.

MI

d.

Heart failure

D

The nurse knows that normal splitting of the second heart sound is associated with:

a.

Expiration.

b.

Inspiration.

c.

Exercise state.

d.

Low resting heart rate.

B

During a cardiovascular assessment, the nurse knows that a "thrill" is:

a.

Vibration that is palpable.

b.

Palpated in the right epigastric area.

c.

Associated with ventricular hypertrophy.

d.

Murmur auscultated at the third intercostal space.

A

During a cardiovascular assessment, the nurse knows that an S4 heart sound is:

a.

Heard at the onset of atrial diastole.

b.

Usually a normal finding in the older adult.

c.

Heard at the end of ventricular diastole.

d.

Heard best over the second left intercostal space with the individual sitting upright.

C

During an assessment, the nurse notes that the patient's apical impulse is displaced laterally, and it is palpable over a wide area. This indicates:

a.

Systemic hypertension.

b.

Pulmonic hypertension.

c.

Pressure overload, as in aortic stenosis.

d.

Volume overload, as in heart failure.

D

When the nurse is auscultating the carotid artery for bruits, which of these statements reflects correct technique?

a.

While listening with the bell of the stethoscope, the patient is asked to take a deep breath and hold it.

b.

While auscultating one side with the bell of the stethoscope, the carotid artery is palpated on the other side to check pulsations.

c.

While lightly applying the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.

d.

While firmly placing the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.

D

The nurse is preparing for a class on risk factors for hypertension, and reviews recent statistics. Which racial group has the highest prevalence of hypertension in the world?

a.

Blacks

b.

Whites

c.

American Indians

d.

Hispanics

A

The nurse is assessing a patient with possible cardiomyopathy and assesses the hepatojugular reflux. If heart failure is present, then the nurse should see which finding while pushing on the right upper quadrant of the patient's abdomen, just below the rib cage?

a.

The jugular veins will rise for a few seconds and then recede back to the previous level if the heart is properly working.

b.

The jugular veins will remain elevated as long as pressure on the abdomen is maintained.

c.

An impulse will be visible at the fourth or fifth intercostal space at or inside the midclavicular line.

d.

The jugular veins will not be detected during this maneuver.

B

The nurse is assessing the apical pulse of a 3-month-old infant and finds that the heart rate is 135 beats per minute. The nurse interprets this result as:

a.

Normal for this age.

b.

Lower than expected.

c.

Higher than expected, probably as a result of crying.

d.

Higher than expected, reflecting persistent tachycardia.

A

The nurse is presenting a class on risk factors for cardiovascular disease. Which of these are considered modifiable risk factors for myocardial infarction (MI)? Select all that apply.

a.

Ethnicity

b.

Abnormal lipids

c.

Smoking

d.

Gender

e.

Hypertension

f.

Diabetes

g.

Family history

B

C

E

F

Mrs. Wysnicki brings her newborn infant into the ambulatory health centre for a health assessment. When auscultating the heart of a newborn, you hear a continuous sound that mimics the sound of a machine. Based on your knowledge of newborn cardiac physiology, you know that this:

A. is an expected sound due to nonclosure of the ductus arteriosus.

B. is a normal sound due to the thinner chest wall of the newborn.

C. is highly suspicious for the presence of congenital heart disease.

D. sound is only pathological when accompanied by an increased heart rate.

A

Mrs. Marcos is a 27-year-old pregnant woman who goes to the clinic for general prenatal care. On examination, which of the following cardiac assessment findings are commonly associated with the pregnant woman?

A. An apical impulse that is displaced higher and medially

B. A soft S4

C. An exaggerated splitting of S1

D. A loud, diastolic murmur that disappears shortly after delivery

C

Mrs. Cousineau is an 86-year-old woman who comes to the ambulatory clinic for a routine health assessment. On examination, which of the following cardiac assessment findings would be expected?

A. A displaced apical impulse

B. The presence of an S3

C. A diastolic murmur

D. The presence of an S4

D

The top of the heart, as it is positioned in the chest, is anatomically identified as the:

A. crux.

B. apex.

C. integrant.

D. base.

D

The leaflets of the tricuspid and mitral valves are anchored by __________________ to the _________________, which are embedded in the ventricular floor.

A. chordae tendineae; papillary muscles

B. pericardial cords; ventricular sheaths

C. endocardial ligaments; mediastinal muscles

D. AV tendon of Todaro; pericardial bundles

A

Which of the following statements is true regarding murmurs?

A. A murmur graded 5 can be heard with the stethoscope that is lifted just off the chest wall.

B. Low-pitched murmurs are less pathological than high-pitched murmurs.

C. All systolic murmurs are generally considered functional or innocent.

D. Diastolic murmurs always indicate heart disease.

D

During inspiration, intrathoracic pressure is decreased and causes which of the following to occur?

A. An increase in blood return to the right side of the heart

B. Early closing of the mitral valve

C. A greater pressure is needed to open the aortic valve.

D. An increase in blood return to the left side of the heart

A

The ability of the heart to contract independently of any signals or stimulation is due to which of the following characteristics?

A. Authenticity

B. Automaticity

C. Autocracy

D. Autonomy

B

The ability of the heart to increase cardiac output is affected by:

foreload and hindload.

B. frontload and afterload.

C. preload and postload.

D. preload and afterload.

D

In the fetal circulation, which of the following structures is responsible for rerouting the blood in the heart?

A. Foramen ellipse

B. Ductus venosus

C. Foramen mitrale

D. Ductus arteriosus

D

Mrs. Granowska is 30 years old and pregnant. She comes to the office during the second trimester for a routine follow-up health assessment. As the health care provider, which of the following does not increase in the pregnant woman?

A. Blood volume

B. Blood pressure

C. Stroke volume

D. Heart rate

B

Mr. Jamila is a 48-year-old patient who comes to the clinic for a cardiac risk assessment. Which of the following is not considered a risk factor for the development of CAD?

A. Smoking

B. Elevated blood pressure

C. Obesity

D. Hemoptysis

D

Displacement of the apical impulse down and toward the left, with an increased size that occupies more than one interspace, occurs with:

A. pulmonary emphysema.

B. left ventricular hypertrophy without dilatation.

C. left ventricular dilatation.

D. left atrial dilatation.

C

Which of the following guidelines may be used to identify which heart sound is S1?

A. S1 coincides with the A wave of the jugular venous pulse wave.

B. S1 is louder than S2 at the base of the heart.

C. S1 coincides with the Q wave of the QRS ECG complex.

D. S1 coincides with the carotid artery pulse.

D

Ms. Kelson is a 26-year-old patient who comes to the clinic for a routine health assessment. On examination, you note a split S2 heart sound. Which of the following is a characteristic of this finding?

A. It is only heard with the bell of the stethoscope.

B. It is affected by respiration.

C. It is auscultated at the second right intercostal space.

D. It is more than likely to be pathological.

B

An increase in blood volume and workload in the pregnant woman results in the development of:

A. orthostatic hypotension.

B. a loud and easily heard S3.

C. a sustained rise of 30 mm Hg or greater in the systolic blood pressure.

D. a venous hum.

B

The first heart sound is caused by closure of the:

A. AV valves.

B. semilunar valves.

C. right-sided valves.

D. left-sided valves.

A

Characteristics of sound that are used to describe heart sounds include which of the following?

a. Quality

b. Tone

c. Synchrony and strength

d. Duration and intensity

D

The QRS complex of the ECG represents:

a. ventricular depolarization.

b. atrial depolarization.

c. ventricular repolarization.

d. an impulse passing through the AV node.

A

The cardiac output is defined as the:

A. amount of blood pumped by the heart in 1 minute.

B. amount of blood returned to the heart.

C. amount of blood ejected with each contraction.

D. ability of the heart to pump blood.

A

Which of the following is true regarding the jugular venous pulse wave?

A. It is located in the groove between the trachea and the sternomastoid muscle.

B. Its timing closely coincides with ventricular systole.

C. It results from a backwash of pressure from events that occur in the heart.

D. It is characterized by a rapid upstroke and a gradual downstroke with a dicrotic notch.

C

Blood in the fetal circulation is shunted around the lungs by way of two bypasses, which are identified as the:

A. placenta and umbilicus arteriosus.

B. ductus arteriosus and foramen circularus.

C. foramen magnum and ductus venosus.

D. foramen ovale and ductus arteriosus.

D

Which of the following cardiac alterations occurs in the pregnant woman?

A. An increased stroke volume with decreased cardiac output

B. An increased heart rate and increased blood pressure

C. An increase in cardiac volume and a decrease in blood pressure

D. An increase in cardiac output and blood pressure

C

As individuals age, the arterial walls become stiffer and less compliant. Which of the following can be attributed to this age-related change?

A. Decreased cardiac output

B. Decreased pulse pressure

C. Rising systolic blood pressure

D. Decreasing diastolic blood pressure

C

Which of the following statements regarding the sound produced by heart valves is true?

A. The sound produced radiates in the direction of blood flow.

B. The intensity of the sound produced is directly related to the stroke volume.

C. Heart valve sounds are best heard over the exact anatomic location of the valves.

D. The duration of the sound is directly related to the heart rate and rhythm.

A

Mrs. Borner is a 43-year-old patient who goes to the emergency department with complaints of chest pain. When auscultating the heart, which of the following guidelines may be used to identify S2?

A. S2 coincides with the R wave on the ECG.

B. S2 coincides with the carotid artery pulse.

C. S2 is louder at the apex than S1.

D. S2 is louder at the base than S1.

D

Ms. Kelson is a 26-year-old patient who comes to the clinic for a routine health assessment. On examination, you note a fixed split. Which is a characteristic of this finding?

A. It is unaffected by respiration.

B. It is only heard with the bell of the stethoscope.

C. It generally only occurs with S1.

D. It is more than likely to be pathological.

A

How would you assess for a pulse deficit?

A. Count the radial pulse and then the apical pulse for 1 minute and subtract the apical rate from the peripheral pulse rate, if different.

B. Auscultate the apical pulse while simultaneously palpating the radial pulse, counting one after another for 1 minute, and then subtract the radial from the apical, if different.

C. Count the apical pulse and then a peripheral pulse for 1 minute and subtract the peripheral pulse rate from the apical rate, if different.

D. Auscultate the apical pulse while simultaneously palpating the radial pulse, counting one after another for 1 minute, and then subtract the apical from the radial, if different.

B