Cardiac and Vascular Assessment: Heart Sounds, Murmurs, and Peripheral Pulses

Which heart sound is produced by the closure of the AV valves?

S1

Which heart sound is produced by the closure of the semilunar valves?

S2

Where is the point of maximal impulse (PMI) normally located?

Fifth intercostal space, left midclavicular line

During which phase of the cardiac cycle do the ventricles contract?

Systole

During which phase of the cardiac cycle do the ventricles relax and fill with blood?

Diastole

Which condition is indicated by jugular vein distention at 45 degrees?

Congestive heart failure

What should the nurse do before palpating the carotid arteries?

Auscultate for bruits

Why should each carotid artery be palpated separately?

To prevent compromising cerebral blood flow

Which pulse is compared with the apical pulse to assess for a pulse deficit?

Carotid pulse

Which landmark is used for auscultation at the aortic area?

Second intercostal space, right sternal border

Which landmark is used for auscultation at the pulmonic area?

Second intercostal space, left sternal border

Which landmark is used for auscultation at Erb's point?

Third intercostal space, left sternal border

Which landmark is used for auscultation at the tricuspid area?

Fourth intercostal space, left sternal border

Which landmark is used for auscultation at the mitral area?

Fifth intercostal space, left midclavicular line

Which sound is commonly referred to as a "ventricular gallop"?

S3

In which population is an S3 sound often a benign finding?

Children, adolescents, and young adults

Which sound is commonly referred to as an "atrial gallop"?

S4

Which heart sound is most often pathologic and associated with stiff ventricles?

S4

What is the grading scale for heart murmurs?

Grade 1 (barely audible) to Grade 6 (loudest, audible without stethoscope on chest)

What does a palpable thrill with a murmur indicate?

A louder, more severe murmur (Grade 4 or above)

Which valve disorder is commonly caused by rheumatic fever and presents with a murmur at the apex?

Mitral stenosis

Which congenital defect involves an abnormal opening between the ventricles?

Ventricular septal defect

Which jugular vein provides information about central venous pressure?

External jugular vein

At what angle should the patient be positioned to assess jugular venous distention?

45 degrees

Which psychosocial factor contributes to longer SNS stimulation and increased cardiac workload?

Stress

Which behavior type is linked to increased risk of heart disease?

Type A behavior

What is the normal visible range of jugular vein distention above the sternal angle at 45 degrees?

3 cm

Which auscultation tool part is best for hearing high-pitched sounds like S1 and S2?

Diaphragm

Which auscultation tool part is best for hearing low-pitched sounds like murmurs and S3/S4?

Bell

Which pulse site is palpated to assess perfusion of the lower leg and foot?

Dorsalis pedis

Which test evaluates the patency of the ulnar and radial arteries?

Allen test

In the Allen test, how long should color return to the palm normally?

3-5 seconds

What does persistent pallor during the Allen test indicate?

Arterial insufficiency

Which arteries are palpated in the groin area?

Femoral arteries

Which arteries are palpated behind the knee?

Popliteal arteries

Which arteries are palpated posterior to the medial malleolus?

Posterior tibial arteries

What is the scale used to grade pitting edema?

+1 to +4

Which vascular disorder is indicated by pale, cool skin and delayed capillary refill?

Arterial insufficiency

Which vascular disorder is indicated by brown pigmentation, edema, and varicosities?

Venous insufficiency

Which condition is a severe complication of arterial obstruction?

Gangrene

Which condition involves dilated, tortuous superficial veins?

Varicose veins

Which condition involves localized dilation of an artery?

Aneurysm

An aneurysm extending from renal arteries to iliac arteries is called what?

Large arteriosclerotic aneurysm

What condition is associated with unilateral swelling after breast surgery?

Lymphedema

Which disease is characterized by episodic vasospasm of extremities triggered by cold or stress?

Raynaud's disease

What is the correct patient position when palpating carotid arteries?

Supine or sitting with head straight

What is the expected strength of carotid pulses?

Strong, but not bounding

Which heart sound is heard at the beginning of systole?

S1

Which heart sound is heard at the end of systole?

S2

Which cardiac cycle begins with closure of the aortic and pulmonic valves?

Diastole

Which cardiac cycle begins with closure of the AV valves?

Systole

Which technique is used to compare apical and carotid pulses?

Simultaneous auscultation and palpation

What is a pulse deficit?

Difference between apical and radial pulse

Which condition can cause a pulse deficit?

Atrial fibrillation

Which side of the stethoscope is used to assess murmurs?

Bell

Which heart sound is often associated with heart failure in adults?

S3

Which heart sound indicates noncompliant ventricles?

S4

What is mottling?

Irregular skin discoloration due to poor perfusion

Which finding is common in Marfan syndrome?

Skeletal abnormalities and CV abnormalities

What does auscultating the carotid artery for a bruit assess?

Turbulent blood flow

Which vascular abnormality increases risk of rupture and hemorrhage?

Aneurysm

What does bilateral absence of dorsalis pedis pulses suggest?

Arterial obstruction

Which peripheral pulse is most difficult to palpate?

Popliteal pulse

Which abnormality is associated with venous stasis?

Varicose veins

What is the normal range for adult blood pressure classification according to NIHS guidelines?

Less than 120/80 mmHg

Which blood pressure reading indicates hypertension stage 1?

130-139/80-89 mmHg

Which blood pressure reading indicates hypertensive crisis?

Higher than 180/120 mmHg

Which test is used to evaluate arterial patency before radial artery puncture?

Allen test

What does delayed return of color in the Allen test suggest?

Arterial insufficiency

What is the expected normal capillary refill time?

Less than 2 seconds

What does a capillary refill time greater than 3 seconds suggest?

Poor perfusion

What type of insufficiency presents with shiny, hairless legs and weak pulses?

Arterial insufficiency

What type of insufficiency presents with edema and brown pigmentation?

Venous insufficiency

Which cardiac landmark is known as Erb's point?

Third intercostal space, left sternal border

What type of murmur is heard with mitral stenosis?

Diastolic murmur at apex

What diagnostic finding is common with congestive heart failure?

Jugular venous distention

Which cardiac sound corresponds to the closing of the tricuspid and mitral valves?

S1

Which cardiac sound corresponds to the closing of the aortic and pulmonic valves?

S2

Which pulse is graded as 0?

Absent pulse

Which pulse is graded as +1?

Weak, thready pulse

Which pulse is graded as +2?

Normal pulse

Which pulse is graded as +3?

Bounding pulse

Which abnormal sound is best heard with the bell at the apex in left lateral position?

S3

Which sound is best heard immediately before S1?

S4

Which patient position best enhances detection of mitral stenosis murmur?

Left lateral decubitus

Which condition is associated with irregular, chaotic atrial activity?

Atrial fibrillation

What condition results from narrowing of the mitral valve?

Mitral stenosis

What condition results from failure of valve leaflets to close properly?

Regurgitation

Which disorder is associated with obstruction of lymphatic drainage?

Lymphedema

Which vascular finding is common after lymph node removal?

Unilateral swelling

What is the PMI shift in left ventricular hypertrophy?

Laterally displaced PMI

What finding suggests right-sided heart failure?

Jugular venous distention

What finding suggests left-sided heart failure?

Pulmonary congestion and crackles

Which maneuver enhances venous return for JVD assessment?

Supine with head of bed at 45 degrees

What is the purpose of auscultating heart sounds at five landmarks?

To assess valve closure and detect abnormalities

What does S2 splitting indicate?

Delayed closure of pulmonic valve

What does a systolic murmur occur between?

S1 and S2

What does a diastolic murmur occur between?

S2 and S1

Which patient population is at higher risk for varicose veins?

Pregnant women

Which vascular disease involves cholesterol plaque buildup in arteries?

Atherosclerosis