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?

Accepted Answer

To screen for heart disease in an infant,focus on feeding.Note fatigue during feeding.An 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 2

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

Accepted Answer

The pericardium is a tough fibrous double-walled sac that surrounds and protects the heart.It has two layers that contain a few milliliters of serous pericardial fluid.

Question 3

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

Accepted Answer

If cardiovascular disease is suspected,then the nurse should auscultate each carotid artery for the presence of a bruit.The nurse should avoid compressing the artery because this could create an artificial bruit,and it could compromise circulation if the carotid artery is already narrowed by atherosclerosis.Avoid excessive pressure on the carotid sinus area higher in the neck;excessive vagal stimulation here could slow down the heart rate,especially in older adults.Palpate only one carotid artery at a time to avoid compromising arterial blood to the brain.

Question 4

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

Accepted Answer

Events occur just slightly later in the right side of the heart because of the route of myocardial depolarization.As a result,two distinct components to each of the heart sounds exist,and sometimes they can be heard separately.In the first heart sound,the mitral component (M1)closes just before the tricuspid component (T1).

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:

Accepted Answer

Because no cardiac valve exists to separate the superior vena cava from the right atrium,the jugular veins give information about activity on the right side of the heart.They reflect filling pressures and volume changes.Normal jugular venous pulsation is 2 cm or less above the sternal angle.Elevated pressure is more than 3 cm above the sternal angle at 45 degrees and occurs with heart failure.

Question 6

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

Accepted Answer

The apical impulse should occupy only one intercostal space,the fourth or fifth,and it should be at or medial to 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?

Accepted Answer

For major risk factors for coronary artery disease,collect data regarding elevated serum cholesterol,elevated blood pressure,blood glucose levels above 130 mg/dL or known diabetes mellitus,obesity,cigarette smoking,low activity level.

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?

Accepted Answer

Despite the increased cardiac output,arterial blood pressure decreases in pregnancy because of peripheral vasodilatation.The blood pressure drops to its lowest point during the second trimester and then rises after that.

Question 9

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

Accepted Answer

Specialized cells in the SA node near the superior vena cava initiate an electrical impulse.Because the SA node has an intrinsic rhythm,it is the "pacemaker."

Question 10

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

Accepted Answer

Returning blood from the body empties into the right atrium and flows into the right ventricle and then goes to the lungs through the pulmonary artery.The lungs oxygenate the blood and it is then returned to the left atrium by the pulmonary vein.It goes from there to the left ventricle and then out to the body through the aorta.

Question 11

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

Accepted Answer

Do not limit auscultation of breath sounds to only four locations.Sounds produced by the valves may be heard all over the precordium.Inch the stethoscope in a rough Z pattern from the base of the heart across and down,then over to the apex.Or,start at the apex and work your way up.See Figure 19-22.Listen selectively to one sound at a time.

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:

Accepted Answer

Paroxysmal nocturnal dyspnea occurs with heart failure.Lying down increases volume of intrathoracic blood,and the weakened heart cannot accommodate the increased load.Classically,the person awakens after 2 hours of sleep,arises,and flings open a window with the perception of needing fresh air.

Question 13

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

Accepted Answer

Numerous comparison studies have shown that the percussed cardiac border correlates "only moderately" with the true cardiac border.Percussion is of limited usefulness with the female breast tissue or in an obese person,or a person with a muscular chest wall.Chest x-rays or echocardiogram examinations are much more accurate in detecting heart enlargement.

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:

Accepted Answer

Normally,the examiner may or may not see an apical impulse;when visible,it occupies the fourth or fifth intercostal space at or inside the midclavicular line.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 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?

Accepted Answer

With aging,there is an increase in systolic blood pressure.No significant change in diastolic pressure occurs with age.No change in resting heart rate occurs with aging.Cardiac output at rest is not changed with aging.

Question 16

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

Accepted Answer

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 17

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

Accepted Answer

First,about two thirds of the blood is shunted through an opening in the atrial septum,the foramen ovale into the left side of the heart,where it is pumped out through the aorta.The foramen ovale closes within the first hour because the pressure in the right side of the heart is now lower than in the left side.

Question 18

The electrical stimulus of the cardiac cycle follows which sequence?

Accepted Answer

Specialized cells in the SA node near the superior vena cava initiate an electrical impulse.The current flows in an orderly sequence,first across the atria to the AV node low in the atrial septum.There it is delayed slightly so that the atria have time to contract before the ventricles are stimulated.Then the impulse travels to the bundle of His,the right and left bundle branches,and then through the ventricles.

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:

Accepted Answer

The second heart sound (S₂)occurs with closure of the semilunar (aortic and pulmonic)valves and signals the end of systole.Although it is heard over all the precordium,S₂ is loudest at the base of the heart.

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:

Accepted Answer

A bruit is a blowing,swishing sound indicating blood flow turbulence;normally none is present.

Quiz 19: Heart and Neck Vessels