Deck 19: Heart and Neck Vessels

Question 1

Which of the following best describes what is meant by atrial kick?
1)The atria contract during systole and attempt to push against closed valves.
2)The contraction of the atria at the beginning of diastole can be felt as a palpitation.
3)This is the pressure exerted against the atria as the ventricles contract during systole.
4)The atria contract toward the end of diastole and push the remaining blood into the ventricles.

Answer 1

4
Toward the end of diastole,the atria contract and push the last amount of blood (about 25% of stroke volume)into the ventricles.This active filling phase is called presystole,or atrial systole,or sometimes the "atrial kick."

Question 2

During inspection of the precordium of an adult patient,the nurse notices the chest moving in a forceful manner along the fourth-fifth left intercostal space at the midclavicular line.This finding most likely suggests:
1)a normal heart.
2)a systolic murmur.
3)enlargement of the left ventricle.
4)enlargement of the right ventricle.

Answer 2

4
A heave or lift is a sustained forceful thrusting of the ventricle during systole.It occurs with ventricular hypertrophy as a result of increased workload.A right ventricular heave is seen at the sternal border;a left ventricular heave is seen at the apex.

Question 3

The mother of a 3-month-old states that her daughter 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?
1)The position that baby sleeps in
2)Sibling history of eating disorders
3)Amount of background noise when eating
4)Presence of dyspnea or diaphoresis when sucking

Answer 3

4
To screen for heart disease in an infant,focus on feeding.Note fatigue during feeding.Infant with heart failure takes fewer ounces each feeding,becomes dyspneic with sucking,may be diaphoretic and then falls into exhausted sleep and awakens after a short time hungry again.

Question 4

The electrical stimulus of the cardiac cycle follows which sequence?
1)AV node-SA node-bundle of His
2)Bundle of His-AV node-SA node
3)SA node-AV node-bundle of His-bundle branches
4)AV node-SA node-bundle of His-bundle branches

Question 5

In assessing a patient's major risk factors for heart disease,which would the nurse want to include when taking a history?
1)Family history,hypertension,stress,age
2)Personality type,high cholesterol,diabetes,smoking
3)Smoking,hypertension,obesity,diabetes,high cholesterol
4)Alcohol consumption,obesity,diabetes,stress,high cholesterol

Question 6

The component of the conduction system referred to as the pacemaker of the heart is the:
1)atrioventricular (AV)node.
2)sinoatrial (SA)node.
3)bundle of His.
4)bundle branches.

Question 7

The sac that surrounds and protects the heart is called the:
1)pericardium.
2)myocardium.
3)endocardium.
4)pleural space.

Question 8

Which of the following describes the closure of the valves in a normal cardiac cycle?
1)The aortic valve closes slightly before the tricuspid valve.
2)The pulmonic valve closes slightly before the aortic valve.
3)The tricuspid valve closes slightly later than the mitral valve.
4)Both the tricuspid and pulmonic valves close at the same time.

Question 9

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

Question 10

In performing auscultation of heart sounds,which sequence would the nurse use?
1)Aortic area-pulmonic area-Erb's point-tricuspid area-mitral area
2)Pulmonic area-aortic area-Erb's point-tricuspid area-mitral area
3)Aortic area-tricuspid area-Erb's point-mitral area-pulmonic area
4)Pulmonic area-Erb's point-tricuspid area-pulmonic area-mitral area

Question 11

In percussing the left cardiac border,the nurse would expect to hear dullness at the:
1)third left intercostal space midclavicular line and fifth left intercostal space left sternal border.
2)fourth left intercostal space medial to midclavicular line and second left intercostal space midclavicular line.
3)fifth left intercostal space midclavicular line and second left intercostal space sternal border.
4)fifth left intercostal space sternal border and second right intercostal space midclavicular line.

Question 12

The direction of blood flow through the heart is best described by which of the following?
1)Vena cava-right atrium-right ventricle-lungs-pulmonary artery-left atrium-left ventricle
2)Right atrium-right ventricle-pulmonary artery-lungs-pulmonary vein-left atrium-left ventricle
3)Aorta-right atrium-right ventricle-lungs-pulmonary vein-left atrium-left ventricle-vena cava
4)Right atrium-right ventricle-pulmonary vein-lungs-pulmonary artery-left atrium-left ventricle

Question 13

During an assessment of a healthy adult,where would the nurse expect to palpate the apical impulse?
1)Third left intercostal space at the midclavicular line
2)Fourth left intercostal space at the sternal border
3)Fourth left intercostal space at the anterior axillary line
4)Fifth left intercostal space at the midclavicular line

Question 14

When assessing a newborn infant who is just 5 minutes old,the nurse knows that which of the following would be true?
1)The left ventricle is larger and weighs more than the right.
2)The circulation of a newborn is identical to that of an adult.
3)There is an opening in the atrial septum where blood can flow into the left side of the heart.
4)The foramen ovale closes just minutes before birth and the ductus arteriosus closes immediately after.

Question 15

In assessing the carotid arteries of an older patient with cardiovascular disease,the nurse would:
1)palpate the artery in the upper one third of the neck.
2)listen with the bell of the stethoscope to assess for bruits.
3)palpate both arteries simultaneously to compare amplitude.
4)instruct patient to take slow deep breaths during auscultation.

Question 16

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:
1)decreased fluid volume.
2)increased cardiac output.
3)narrowing of jugular veins.
4)increased pressure in the right side of his heart.

Question 17

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:
1)"When was your last electrocardiogram?"
2)"It's probably because it's been so hot at night."
3)"Do you have any history of problems with your heart?"
4)"Have you had a recent sinus infection or upper respiratory infection?"

Question 18

While counting the apical pulse on a 16-year-old patient,the nurse notes an irregular rhythm.His rate speeds up on inspiration and slows on expiration.What would be the nurse's response?
1)Talk with the patient about his intake of caffeine.
2)Do an electrocardiogram after the exam.
3)No further response is needed because this is normal.
4)Refer the patient to a cardiologist for further testing.

Question 19

When listening to heart sounds,the nurse knows that which of the following statements concerning S₁ is true?
1)S₁ is louder than S₂ at the base.
2)S₁ indicates the beginning of diastole.
3)S₁ coincides with the carotid artery pulse.
4)S₁ is caused by closure of the semilunar valves.

Question 20

In assessing a 70-year-old man,the nurse finds the following: BP 140/100 mm Hg;HR 104 and slightly irregular;split S₂.Which of these findings can be explained by expected hemodynamic changes related to age?
1)Increase in resting heart rate
2)Increase in systolic blood pressure
3)Decrease in diastolic blood pressure
4)Increase in diastolic blood pressure

Question 21

During a cardiovascular assessment,the nurse knows that an S₄ heart sound is:
1)heard at the onset of atrial diastole.
2)usually a normal finding in the elderly.
3)heard at the end of ventricular diastole.
4)heard best over the second left intercostal space with the individual sitting upright.

Question 22

Which of the following would the nurse expect to find during a cardiac assessment on a 4-year-old child?
1)S₃ when sitting up
2)Persistent tachycardia above 150
3)Murmur at second left intercostal space when supine
4)Palpable apical impulse in fifth left intercostal space lateral to midclavicular line

Question 23

The nurse knows that normal splitting of the second heart sound is associated with:
1)expiration.
2)inspiration.
3)exercise state.
4)low resting heart rate.

Question 24

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 would the nurse do?
1)Have patient turn to the left side and listen with the bell.
2)Ask patient to hold his breath while the nurse listens again.
3)No further assessment is needed because the nurse knows it is an S₃.
4)Watch patient's respirations while listening for effect on the sound.

Question 25

During an assessment,the nurse notes that the apical impulse is displaced laterally,and it is palpable over a wide area.This indicates:
1)systemic hypertension.
2)pulmonic hypertension.
3)pressure overload,as in aortic stenosis.
4)volume overload,as in mitral regurgitation.

Question 26

During a cardiac assessment on an adult 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,BP 98/60,HR 130;ankle edema;difficulty in breathing when supine;and an S₃ on auscultation.Which of the following best explains the cause of these findings?
1)Fluid overload
2)Atrial septal defect
3)Myocardial infarction
4)Heart failure

Question 27

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 with the patient sitting and leaning forward,the nurse hears a high-pitched,scratchy sound at the apex with the diaphragm.It disappears on inspiration.The nurse suspects:
1)increased cardiac output.
2)another myocardial infarction.
3)inflammation of the precordium.
4)ventricular hypertrophy resulting from muscle damage.

Question 28

When the nurse is auscultating the carotid artery for bruits,which of the following reflects correct technique?
1)While listening with the bell of the stethoscope,have the patient take a deep breath and hold it.
2)While auscultating one side with the bell of the stethoscope,palpate the carotid artery on the other side to check pulsations.
3)Lightly apply the bell of the stethoscope over the carotid artery;have the patient take a breath,exhale,and hold it briefly while the nurse listens.
4)Firmly place the bell of the stethoscope over the carotid artery,have the patient take a breath,exhale,and hold it briefly while the nurse listens.

Question 29

The vital signs of a 70-year-old patient with a history of hypertension are BP 180/100 and HR 90.The nurse hears an extra heart sound at the apex immediately before S₁.The sound is heard only with the bell while patient is in left lateral position.With these findings and the patient's history,the nurse knows that this extra heart sound is most likely:
1)split S₁.
2)atrial gallop.
3)diastolic murmur.
4)summation sound.

Question 30

During the precordial assessment on an 8-month pregnant patient,the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line.This would indicate:
1)right ventricular hypertrophy.
2)increased volume and size of the heart as a result of pregnancy.
3)displacement of the heart from elevation of the diaphragm.
4)increased blood flow through the internal mammary artery.

Question 31

The mother of a 10-month-old 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?
1)Tetralogy of Fallot
2)Atrial septal defect
3)Patent ductus arteriosus
4)Ventricular septal defect

Question 32

Which racial group has the highest prevalence of heart disease and stroke in the United States?
1)Blacks
2)Whites
3)American Indians
4)Mexican-Americans

Question 33

Which of the following statements is true regarding the apical impulse?
1)It is palpable in all adults.
2)It occurs with the onset of diastole.
3)Its location may be indicative of heart size.
4)It should normally be palpable in the anterior axillary line.

Question 34

During a cardiovascular assessment,the nurse knows that a "thrill" is:
1)a vibration that is palpable.
2)palpated in the right epigastric area.
3)associated with ventricular hypertrophy.
4)a murmur auscultated at the third intercostal space.

Question 35

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;the radial pulse was 105 beats per minute.Calculate the pulse deficit.
Pulse deficit equals: _________