Heart and Vascular PrepU

What is the most important lifestyle changes a client can make to improve cardiovascular health?

Quitting smoking

Which of the following would the nurse suspect when a client with a cardiac condition complains of not sleeping well and having to get up frequently at night to urinate?

Increased urination at rest may indicate heart failure

A group of students is reviewing the structures of the heart, noting that the thickest layer of the heart is made up of contractile muscle cells. How would the students identify this layer?

Myocardium

Temporary heart pain, resolving in less than 20 minutes, aggravated by physical activity and stress is known as what?

Angina

A nurse auscultates a client's heart sounds and obtains a rate of 56 beats per minute. How should this rate be documented by the nurse?

Bradycardia

A group of students is reviewing the structures of the heart, noting that the thickest layer of the heart is made up of contractile muscle cells. The students are correct in identifying it as which of the following?

Myocardium

The nurse is preparing to assess a client's apical impulse. The nurse would palpate at which location?

Fifth intercostal space, left midclavicular line

While performing an admission assessment, the nurse auscultates a high-pitched, scratching, and grating sound at the left lower sternal border. The nurse should use what term to document the sound?

Pericardial friction rub

A nursing student is reviewing the electrical conduction of the heart. The student is correct in identifying the sinoatrial node of the heart as which of the following?

Pacemaker

A nurse auscultates a client's heart sounds and obtains a rate of 56 beats per minute. How should this rate be documented by the nurse?

Bradycardia

The nurse assesses a client’s chest as shown. What is the nurse assessing?

Apical impulse

A nurse is working with a client who recently suffered a heart attack. As a result, the client has experienced the death of the muscle tissues that make up the thickest layer of the heart. This layer of muscle is known as which of the following?

Myocardium

While auscultating the client's heart at the third intercostal space and on the left sternal border, the nurse notes a high-pitched, scratchy sound that increases with exhalation with the client leaning forward. How would the nurse document the findings?

Pericardial friction rub

The nurse understands that when the sympathetic nervous system is stimulated what occurs? Select all that apply.

Increased cardiac output

Increased blood pressure

Increased heart rate

When a client is obese or has a thick chest wall, what is difficult to palpate?

Apical impulse

While auscultating the heart at the third intercostal space, left sternal border, the nurse notes a high-pitched, scratchy sound that increases with exhalation with the client leaning forward. The nurse would document which of the following?

Pericardial friction rub

When describing the cardiac cycle to a group of students, the instructor correlates heart sounds with events of the cycle. Which heart sound would the instructor explain as being associated with systole?

S1

After teaching a group of students about blood flow through the heart, the instructor determines that the teaching was successful when the students state that after being received by the atria, the blood goes to which of the following?

Ventricles

During the health history interview with a 40-year-old man, the nurse uses the genogram to specifically assess for major family risk for cardiovascular disease by asking about which of the following?

Heart attacks in his father and siblings

During an interview with the nurse, a client complains of a fatigue that seems to get worse in the evening. Which of the following causes of fatigue would explain this pattern?

Decreased cardiac output

The nurse is integrating health promotion education into the assessment of a client's heart and neck vessels. What teaching point addresses the most significant risk factor for coronary artery disease?

“Your risk for heart disease will drop greatly if you're able to stop smoking.”

The nurse assesses a hospitalized adult client and observes that the client’s jugular veins are fully extended. The nurse contacts the client’s physician because the client’s signs are indicative of

increased central venous pressure.

The nurse is conducting a health history with a female client who reports upper back and jaw pain. In order to assess the client's risk for a cardiac event, which question should the nurse ask first?

"Do you have any pain or discomfort in your chest?"

The nurse is caring for a client in a medical-surgical unit and reviews the above assessment notes. Which is the priority question that the nurse should ask the client?

"How long have your feet been swollen?"

A client complains of difficulty sleeping, stating he has to sit up with the help of several pillows and cannot breathe when lying flat. This client has a condition known as what?

Orthopnea

A student states that a client has palpable rushing vibration in the area of the pulmonic valve. What should the instructor explain that the student is feeling?

A thrill

A 58-year-old teacher presents with breathlessness with activity. The client has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?

Orthopnea

The nurse is preparing to assess a client's carotid arteries. Which nursing action would be most appropriate?

Palpate each artery individually to compare

Where are the heart and great vessels located in the human body?

The mediastinum, between the lungs above the diaphragm

The nurse is preparing to assess a client's carotid arteries. Which of the following would be most appropriate?

Palpate each artery individually to compare

In order to palpate an apical pulse when performing a cardiac assessment, where should the nurse place the fingers?

left midclavicular line at the fifth intercostal space

In auscultating a client's heart sounds, a nurse hears a swooshing sound over the pre cordium. The nurse recognizes this sound as which of the following?

Murmur

A nurse is preparing a health education session for a local community group. When addressing the relationship between coronary artery disease (CAD) and culture, what information would the nurse include?

Hypertension is more prevalent in African Americans than among White Americans.

The nurse is providing teaching about cardiovascular disease in a community setting. What risk factors would the nurse identify to the group as those they can modify through lifestyle choices? Select all that apply.

• Smoking

• Blood pressure

• Cholesterol

A nurse is unable to palpate the apical impulse on an older client. Which assessment data in the client's history should the nurse recognize as the reason for this finding?

Client has an increased chest diameter

When, in the cardiac cycle, does blood pressure peak?

Systole

The nurse is auscultating the heart sounds of an adult client. To auscultate Erb point, the nurse should place the stethoscope at the

third to fifth intercostal space at the left sternal border.

A nurse provides prevention strategies to a group of clients who are identified as at risk for hypertension. Which strategies should the nurse include? Select all that apply.

• Walk briskly 30 minutes per day.

• Use a low sodium seasoning to flavor food.

• Choose foods like bananas and sweet potatoes.

The nurse hears high-pitched swooshing sounds over the carotid artery on the right side. What is this sound indicative of?

Bruits

A client comes to the emergency department reporting a sudden onset of dyspnea. What finding is a manifestation of dyspnea?

Shortness of breath

When auscultating the heart sounds of a client, a nurse notes that the S₂ is louder than the S₁. How should the nurse describe S₂?

Accentuated

A nurse cares for a client who suffered a myocardial infarction 2 days ago. A high-pitched, scratchy, scraping sound is heard that increases with exhalation and when the client leans forward. The nurse recognizes this sound as a result of what process occurring within the pericardium?

Inflammation of the pericardial sac

A client with dehydration or volume depletion has barely visible neck veins, even when lying flat. These are described as what?

Flat neck veins

Where is Erb's point located?

3rd left rib space

A nurse cares for a client who suffered a myocardial infarction two (2) days ago. A high pitched, scratchy, scraping sound is heard that increase with exhalation and when the client leans forward. The nurse recognizes this sound as a result of what process occurring within the pericardium?

Inflammation of the pericardial sac

The bicuspid, or mitral, valve is located

between the left atrium and the left ventricle.

A student is asked to define the continuous rhythmic movement of blood during contraction and relaxation of the heart. This best describes which of the following?

Cardiac cycle

Before the nurse begins the physical examination of a client with congestive heart failure, the client reports having to get up at night to void frequently. Which action should the nurse take in response to the client's report?

Inspect for dependent edema

The nurse begins auscultating a client’s heart sounds at the 2nd intercostal space right sternal border. Which location should the nurse assess next?

2nd intercostal space left sternal border

A nurse is unable to palpate the apical impulse on a client. Which assessment data in the client's history should the nurse recognize as the reason for this finding?

Client has an increased chest diameter

While completing the cardiovascular system health history, a client reports difficulty falling asleep unless she is in an upright position. Which of the following potential problems should the nurse further investigate?

Shortness of breath

A 52-year-old man is skeptical about the potentially harmful effect of his smoking on his heart, citing the fact that both his father and grandfather lived long lives despite being lifelong smokers. Which of the following facts would underlie the explanation that the nurse provides the client?

Smoking increases the heart's workload and contributes to atherosclerosis

The nurse is assessing a client with a cardiac condition who complains of fatigue and nocturia. The nurse should recognize what implication of this statement?

The client may be experiencing symptoms of heart failure.

The nurse performs an admission assessment on an adult client admitted through the ED with a myocardial infarction. The nurse auscultates a swooshing sound over right carotid artery. What phrase should the nurse use to correctly document this finding?

“Right carotid bruit auscultated”

While conducting a physical examination of the cardiovascular system, the nurse hears fine crackles on auscultation of the lungs. This finding is most likely a manifestation of which problem?

left-sided heart failure

The nurse places the stethoscope on the 3^rd intercostal space at the left sternal border. Which area is the nurse auscultating for heart sounds?

Erb point

When auscultating the heart sounds of a client, a nurse notes that the S2 is louder than the S1. How should the nurse describe this heart sound? S2 is:

Accentuated

A nurse is reviewing the electrical conduction system of the heart in preparation for assessing a client with a conduction problem. The nurse should be aware that the electrical signal originates in what location?

Sinoatrial node

When auscultating the heart, the nurse is most likely to hear a diastolic murmur after which heart sound?

S2

The nurse is caring for a client who has an elevated cholesterol level. To reduce the mean total blood cholesterol and low-density lipoprotein (LDL) cholesterol levels, what diet should the nurse discuss with the client?

Low-fat, low-cholesterol meals

A client has sought care with complaints of increasing swelling in her feet and ankles, and the nurse's assessment confirms the presence of bilateral edema. The nurse's subsequent assessment should focus on the signs and symptoms of what health problem?

Heart failure

A 25-year-old optical technician comes to the clinic for evaluation of fatigue. As part of the physical examination, the nurse listens to her heart and hears a murmur only at the cardiac apex. Which valve is most likely to be involved based on the location of the murmur?

Mitral

The nurse is conducting a workshop on the measurement of jugular venous pulsation. As part of instruction, the nurse tells the students to make sure that they can distinguish between the jugular venous pulsation and carotid pulse. Which of the following characteristics is typical of the carotid pulse?

Palpable

A nurse is assessing a client for possible dehydration. Which of the following should the nurse do?

Observe for a decrease in jugular venous pressure

The nurse is analyzing the data from the assessment of a client's heart and neck vessels. The client's first heart sound corresponds with what event in the cardiac cycle?

Closure of the atrioventricular valves

The client asks the nurse what the small P wave on her ECG indicates. What would the nurse answer?

Atrial depolarization

An older adult client has come to the clinic for a routine checkup. The nurse practitioner notes that the carotid artery pulse is diminished bilaterally and a systolic bruit is auscultated bilaterally. What would the nurse practitioner want to have this client assessed for by a cardiologist?

Atherosclerotic stenotic carotid arteries

Which statement describes the correct technique by a nurse for use of a stethoscope to auscultate the chest for heart sounds?

Auscultate to determine the heart rate and if the rhythm is normal

A nurse auscultates a client's heart rate and rhythm and finds the rhythm to be irregular. What would the nurse do next?

Auscultate for pulse rate deficit.

The nurse notes that a client’s heart rate increases with inspiration and slows down with expiration. How should the nurse document this finding?

Sinus arrhythmia

A nurse is preparing a class for a local community group on coronary heart disease. Which of the following recommendations would the nurse include as appropriate for reducing a person's risk? Select all that apply.

• Eat foods low in sodium.

• Walk for at least 30 minutes/ day

• Use relaxation techniques to manage stress.

The nurse is assessing a client diagnoses with mitral stenosis. Which technique should the nurse use to listen to this condition?

Place the bell of the stethoscope over the apex with client on left side.

A client has engorged jugular veins. What should this finding suggest to the nurse?

right atrial pressure

A nurse auscultates a very loud murmur that occurs throughout systole and can be heard with the stethoscope partly off the chest. How should the nurse grade this murmur?

Grade 5

During a cardiac examination, the nurse can best hear the S1 heart sound by placing the stethoscope at the client’s

apex of the heart

A client is diagnosed with mitral valve stenosis. Using the diagram, where should the nurse identify this valve when teaching the client about the health problem?

When auscultating a client's heart sounds, the nurse hears a louder S₂ when listening at the 2nd intercostal space right sternal border. The nurse determines that this finding is consistent with the closure of which heart valves?

Aortic and pulmonic

Which is true of a third heart sound (S₃)?

It is caused by rapid deceleration of blood against the ventricular wall.

The nurse has begun the objective assessment of a client's heart and neck vessels and is assessing the client's jugular veins. What finding would the nurse consider to be normal in a healthy client?

The jugular venous pulse is not visible when the client is sitting upright.

A client, scheduled for pacemaker insertion, does not understand why the device is needed. Where should the nurse identify the location of the sinoatrial node on the diagram when instructing the client about the surgery?

A nurse suspects that a client may have a pericardial friction rub. To ensure that the nurse hears this, the nurse would place the client in which position?

Leaning forward while in a sitting position

When auscultating a client's heart, the nurse hears both S3 and S4. What is this known as?

Summation gallop

Which anterior neck structure is found in the depression between the trachea and the sternomastoid muscle?

Carotid artery

A nurse is assessing a client for the presence of stenosis in the carotid arteries. Which of the following should the nurse do?

Check for pulse inequality between right and left carotid arteries

A nurse auscultates the heart rate of a young male and notices that the rate speeds with inspiration and slows with exhalation. S₁ and S₂ are normal. The nurse recognizes this as what dysrhythmia?

Sinus arrhythmia

A nurse is auscultating a client's heart sounds. What action should the nurse perform during this assessment?

Systematically listen to the entire precordium.

A client is experiencing decreased cardiac output. Which vital sign is priority for the nurse to monitor frequently?

Blood pressure

An adult client visits the clinic and tells the nurse that she feels chest pain and pain down her left arm. The nurse should refer the client to a physician for possible

angina

While assessing an adult client, the nurse detects opening snaps early in diastole during auscultation of the heart. The nurse should refer the client to a physician because this is usually indicative of

mitral valve stenosis

A new nurse on the telemetry unit is reviewing information about how to correctly read electrocardiograms. The nurse is expected to know that the PR interval represents what event?

The time from firing of the sinoatrial (SA) node to the beginning of depolarization in the ventricle

The nurse notes that a client’s heart rate speeds up with inspiration and slows down with expiration. What should the nurse suspect this client is demonstrating?

sinus arrhythmia

The nurse assesses a client’s neck as shown. What is the nurse assessing?

Carotid artery

The nurse is assessing a client who has a complex cardiac history. The nurse has asked the client to lean forward while in a sitting position. This position will allow the nurse to do which of the following?

Identify heart sounds that may be inaudible in other positions.

The nurse's auscultation of the client's heart sounds reveals the presence of a split S1. What conclusion should the nurse draw from this assessment finding?

The client's ventricles are not contracting simultaneously.

The anterior chest area that overlies the heart and great vessels is called the

precordium

The nurse working in a hospital reviews the assessment notes for a 67-year-old male client’s heart and neck vessels.

Apex of the heart located left of the anterior axillary line

shortness of breath

jugular vein distention

Ventricular gallop present

edema of the lower legs, ankles, and feet

To function adequately, the nurse knows that the heart valves need to open simultaneously.

False

What is responsible for the inspiratory splitting of S₂?

Closure of aortic then pulmonic valves

The nurse is performing a cardiac examination of a client with shortness of breath and palpitations. The nurse listens to the heart with the client sitting upright, then has him change to a supine position, and finally has him turn onto his left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position?

Mitral

A nurse is having trouble finding the apical pulse on an obese person. What is the most likely reason for this?

Increased distance from the apex of the heart to the pre cordium