Deck 19: Heart and Neck Vessels

Question 1

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) The 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

Answer 1

Presence of dyspnea or diaphoresis when sucking

Question 2

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

A) pericardium.
B) myocardium.
C) endocardium.
D) pleural space.

Answer 2

pericardium.

Question 3

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) palpate both arteries simultaneously to compare amplitude.
D) instruct patient to take slow deep breaths during auscultation.

Answer 3

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

Question 4

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.

Question 5

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.

Question 6

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

Question 7

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, age
B) Personality type, high cholesterol, diabetes, smoking
C) Smoking, hypertension, obesity, diabetes, high cholesterol
D) Alcohol consumption, obesity, diabetes, stress, high cholesterol

Question 8

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 is the result of peripheral vasodilatation and is an expected change.
B) Because of increased cardiac output, the blood pressure should be higher this time.
C) This is not an expected finding because it would mean a decreased cardiac output.
D) This would mean a decrease in circulating blood volume, which is dangerous for the fetus.

Question 9

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.

Question 10

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

Question 11

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

A) Listen to the sounds at the aortic, tricuspid, pulmonic, and mitral areas.
B) Listen by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex.
C) Listen to the sounds only at the site where the apical pulse is felt to be the strongest.
D) Listen for all possible sounds at a time at each specified area.

Question 12

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?"

Question 13

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 obese patients.
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.

Question 14

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) a normal heart.
B) a systolic murmur.
C) enlargement of the left ventricle.
D) enlargement of the right ventricle.

Question 15

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

Question 16

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) The contraction of the atria at the beginning of diastole can be felt as a palpitation.
C) This 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.

Question 17

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) There is an opening in the atrial septum where blood can flow into the left side of the heart.
D) The foramen ovale closes just minutes before birth and the ductus arteriosus closes immediately after.

Question 18

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

Question 19

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.

Question 20

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) a valvular disorder.
B) blood flow turbulence.
C) fluid volume overload.
D) ventricular hypertrophy.

Question 21

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 elderly.
C) heard at the end of ventricular diastole.
D) heard best over the second left intercostal space with the individual sitting upright.

Question 22

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.
B) Ask the patient to hold his breath while the nurse listens again.
C) No further assessment is needed because the nurse knows it is an S3.
D) Watch the patient's respirations while listening for effect on the sound.

Question 23

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 this is normal.
D) Refer the patient to a cardiologist for further testing.

Question 24

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
C) Murmur at second left intercostal space when supine
D) Palpable apical impulse in fifth left intercostal space lateral to midclavicular line

Question 25

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) Myocardial infarction
D) Heart failure

Question 26

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 mitral regurgitation.

Question 27

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

Question 28

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 myocardial infarction.
C) inflammation of the precordium.
D) ventricular hypertrophy resulting from muscle damage.

Question 29

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) African-Americans
B) Whites
C) American Indians
D) Hispanics

Question 30

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

A) bell at the base with the patient leaning forward.
B) bell at the apex with the patient in the left lateral position.
C) diaphragm in the aortic area with the patient sitting.
D) diaphragm in the pulmonic area with the patient supine.

Question 31

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 can all be normal findings in a child.
C) These are indicative of congenital problems.
D) The venous hum most likely indicates an aneurysm.

Question 32

The nurse is assessing a patient's apical impulse.Which of these statements is true regarding the apical impulse?

A) It is palpable in all adults.
B) It occurs with the onset of diastole.
C) Its location may be indicative of heart size.
D) It should normally be palpable in the anterior axillary line.

Question 33

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.

Question 34

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.

Question 35

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.

Question 36

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.

Question 37

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

A) is louder than S2 at the base of the heart.
B) indicates the beginning of diastole.
C) coincides with the carotid artery pulse.
D) is caused by closure of the semilunar valves.

Question 38

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

A) a vibration that is palpable.
B) palpated in the right epigastric area.
C) associated with ventricular hypertrophy.
D) a murmur auscultated at the third intercostal space.

Question 39

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 working properly.
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.

Question 40

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, have the patient take a deep breath and hold it.
B) While auscultating one side with the bell of the stethoscope, palpate the carotid artery on the other side to check pulsations.
C) Lightly apply the bell of the stethoscope over the carotid artery, and while listening, have the patient take a breath, exhale, and hold it briefly.
D) Firmly place the bell of the stethoscope over the carotid artery, and while listening, have the patient take a breath, exhale, and hold it briefly.

Question 41

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.

Question 42

The nurse is assessing a patient's pulses and notices a difference between the patient's apical pulse and radial pulse.The apical pulse was 118 beats per minute,and the radial pulse was 105 beats per minute.What is the pulse deficit?

Question 43

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