Deck 14: Heart

Question 1

Heart position can vary depending on body habitus. In a short, stocky individual, you would expect the heart to be located

A)more to the right and hanging more vertically.
B)more to the left and lying more horizontally.
C)riding higher in the chest and pushed anteriorly.
D)hanging lower in the chest and riding more vertically.
E)more to the right and lying more horizontally.

Answer 1

more to the left and lying more horizontally.

Question 2

Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the

A)P wave.
B)PR interval.
C)QRS complex.
D)ST segment.
E)T wave.

Answer 2

P wave.

Question 3

Which ECG change would not be expected as an age-related pattern?

A)First-degree block
B)Bundle branch block
C)Left ventricular hypertrophy
D)Ventricular fibrillation
E)Atrial fibrillation

Answer 3

Ventricular fibrillation

Question 4

In what group are the right and left ventricles equal in weight and muscle mass?

A)Newborns
B)School-age children
C)Adolescents
D)Older adults
E)Pregnant women

Question 5

Purkinje fibers are located in the

A)sinoatrial node.
B)atrioventricular node.
C)myocardium.
D)aortic arch.
E)pericardium.

Question 6

Which two heart structures are most anterior in the chest?

A)Both atria
B)Both ventricles
C)The right atrium and ventricle
D)The left atrium and ventricle
E)Superior and inferior venae cavae

Question 7

Thin-walled reservoirs of the heart are the

A)atria.
B)pericardia.
C)sinuses.
D)ventricles.
E)septa.

Question 8

Closure of the ductus arteriosus usually occurs

A)just before the initiation of labor.
B)24 to 48 hours after birth.
C)after 7 days of life.
D)between the second and third months of life.
E)during the toddler stage.

Question 9

The "pacing" structure of the heart's electrical activity is the

A)atrioventricular (AV) node.
B)bundle of His.
C)Purkinje fibers.
D)coronary sinus.
E)sinoatrial (SA) node.

Question 10

The condition in which a patient's heart is either rotated or displaced to the right or is situated as a mirror image of the expected position is called

A)amyloidosis.
B)cardiomyopathy.
C)dextrocardia.
D)situs inversus.
E)coarctation.

Question 11

The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the

A)P wave.
B)QRS complex.
C)PR interval.
D)T wave.
E)U wave.

Question 12

Which cardiac structure is responsible for the heart's pumping action?

A)Pericardium
B)Epicardium
C)Myocardium
D)Endocardium
E)Atria

Question 13

The apex of a 2-month-old baby's heart typically lies closest to the

A)left midsternal area.
B)fourth left intercostal space.
C)midthoracic spinal area.
D)sixth left intercostal space.
E)right midsternal area.

Question 14

Contraction of the ventricles causes

A)closure of the atrioventricular valves.
B)closure of the pulmonic and aortic valves.
C)opening of the mitral valve and closure of the tricuspid valve.
D)opening of the mitral and tricuspid valves.
E)opening of the auricular septa.

Question 15

The major heart sounds are normally created by

A)valves opening.
B)valves closing.
C)the rapid movement of blood.
D)rubbing together of the cardiac walls.
E)pulmonic veins.

Question 16

In a fetus, the right ventricle pumps blood through the

A)left atrium.
B)ductus arteriosus.
C)lungs.
D)foramen ovale.
E)septum primum.

Question 17

Which two structures together form the primary muscle mass of the heart?

A)Right atria and left ventricle
B)Left ventricle and the aorta
C)Right and left atria
D)Left atrium and the pulmonary vein
E)Right and left ventricles

Question 18

Mr. O, age 50 years, comes for his yearly health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O mentions that he routinely engages in light exercise. At this time, you should

A)ask if he makes his own bed daily.
B)have the patient describe his exercise.
C)make a note that he walks each day.
D)record "light exercise" in the history.
E)record "questionable exercise" in the history.

Question 19

Normal cardiac changes that occur during pregnancy include

A)decreased cardiac output.
B)increased thickness and mass of the left ventricle.
C)decreased heart rate.
D)dilation of the ventricles.
E)heart is shifted more vertical.

Question 20

A third heart sound is created by

A)atrial contraction.
B)ventricular contraction.
C)diastolic filling.
D)regurgitation between the right and left ventricles.
E)blood in the pericardium.

Question 21

Which of the following information belongs in the past medical history section related to heart and blood vessel assessment?

A)Adolescent inguinal hernia
B)Childhood mumps
C)Past incidence of bee stings
D)Previous unexplained fever
E)Parents with a history of cardiac problems

Question 22

A split second heart sound is

A)abnormal.
B)greatest at the peak of inspiration.
C)heard best after forceful expiration.
D)supposed to disappear with deep inspiration.
E)always accompanied by a thrill.

Question 23

If the apical impulse is more vigorous than expected to the chest wall, it is called

A)a lift.
B)a thrill.
C)a bruit.
D)a murmur.
E)crepitus.

Question 24

An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may indicate

A)decreased cardiac output.
B)dextrocardia.
C)left ventricular hypertrophy.
D)hyperventilation.
E)obesity.

Question 25

You are listening to a patient's heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following?

A)S₁
B)S₂
C)S₃
D)S₄
E)S_3-4

Question 26

A grade I or II murmur, without radiation and of medium pitch, is a common variation found in

A)school-age children.
B)older women.
C)middle-aged men.
D)sedentary individuals.
E)older adults.

Question 27

A palpable rushing vibration over the base of the heart at the second intercostal space is called a

A)heave.
B)lift.
C)thrill.
D)thrust.
E)murmur.

Question 28

The carotid pulse should coincide with which heart sound?

A)S₁
B)S₂
C)S₃
D)S₄
E)S_3-4

Question 29

To hear diastolic heart sounds, you should ask patients to

A)lie on their backs.
B)lie on their left sides.
C)lie on their right sides.
D)sit up and lean forward.
E)lie prone.

Question 30

Which one of the following is a common symptom of cardiovascular disorders in an older adult?

A)Fatigue
B)Joint pain
C)Poor night vision
D)Urticaria
E)Fevers

Question 31

In an adult, the apical impulse should be most visible when the patient is in which position?

A)Supine
B)Leaning backward
C)Lithotomy
D)Right lateral recumbent
E)Upright

Question 32

A lift along the left sternal border is most likely the result of

A)aortic stenosis.
B)atrial septal defect.
C)pulmonary hypertension.
D)right ventricular hypertrophy.
E)left ventricular hypertrophy.

Question 33

The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing

A)the splitting of S₂.
B)high-pitched murmurs.
C)presystolic gallops.
D)systolic ejection sounds.
E)pericardial friction rub.

Question 34

Normal heart sounds are best heard

A)directly over the semilunar and bicuspid heart valves.
B)over areas where blood flows after it passes through a valve.
C)near the carotid vessels.
D)over the central sternum.
E)over the ribs.

Question 35

An example of a functional heart murmur is one that is caused by

A)anemia.
B)a ventricular septal defect.
C)an atrial septal defect.
D)mitral valve prolapse.
E)a leaking aortic valve.

Question 36

You are conducting an examination of Mr. C's heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is

A)barely discernible.
B)quiet but audible.
C)moderately loud.
D)loud with palpable thrill.
E)very loud without a stethoscope.

Question 37

During auscultation of heart tones, you are uncertain whether the sound you hear is an S₂ split. You should ask the patient to inhale deeply while listening at the _____ area.

A)aortic
B)pulmonic
C)tricuspid
D)mitral
E)apex

Question 38

To estimate heart size by percussion, you should begin tapping at the

A)apex.
B)left sternal border.
C)midclavicular line.
D)midsternal line.
E)anterior axillary line.

Question 39

A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history interview of his family history, he relates that his father died of heart trouble. The most important follow-up question you should pose is which of the following?

A)"Did your father have coronary bypass surgery?"
B)"Did your father's father have heart trouble also?"
C)"What were your father's usual dietary habits?"
D)"What age was your father at the time of his death?"
E)"Did your mother also have heart trouble?"

Question 40

Pleural pain differs from chest discomfort caused by other conditions in that it is

A)precipitated by breathing.
B)eased with deep breathing.
C)usually described as dull in nature.
D)related to the time of day.
E)eased with coughing.

Question 41

Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting, and is often associated with focal tenderness is most likely

A)cardiac.
B)pleural.
C)esophageal.
D)musculoskeletal.
E)psychoneurotic.

Question 42

The earliest sign of heart failure in an infant is frequently

A)an apical impulse in the fourth intercostal space.
B)moisture in the lungs.
C)enlarged thyroid.
D)clubbing of the fingers.
E)liver enlargement.

Question 43

An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an expected finding in

A)adults under stress.
B)4-year-old children.
C)pregnant women.
D)older adults.
E)premature infants.

Question 44

Which dysrhythmia is a physiologic event during childhood?

A)First-degree AV block
B)Mobitz type II
C)Multifocal PVCs
D)Sinus arrhythmia
E)Third-degree AV block

Question 45

The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to suspect

A)congestive heart failure.
B)mitral stenosis.
C)endocarditis.
D)cardiac tamponade.
E)pericarditis.

Question 46

Ms. S. is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She reports a recent severe sore throat. You suspect

A)angina.
B)acute rheumatic fever.
C)cardiac amyloidosis.
D)aortic sclerosis.
E)sick sinus syndrome.

Question 47

A holosystolic murmur in an infant that is best heard along the left sternal border in the third to fifth intercostal spaces and does not radiate to the neck is indicative of

A)a ventricular septal defect.
B)patent ductus arteriosus.
C)pulmonary stenosis.
D)aortic sclerosis.
E)dextrocardia.

Question 48

Chest pain in a child with an organic cause is more likely the result of

A)cardiac disease.
B)asthma.
C)esophageal reflux.
D)arthritis.
E)peptic ulcer disease.

Question 49

Fat deposits in the circulatory system of an older adult can lead to

A)diffuse conduction disturbances.
B)exaggerated contractility.
C)heart failure.
D)thinning of the ventricles.
E)amyloidosis.

Question 50

The most helpful finding in determining left-sided heart failure is

A)dyspnea.
B)orthopnea.
C)jugular vein distention.
D)an S₄ heart sound.
E)tachycardia.

Question 51

A grade IV mitral regurgitation murmur would

A)be described as a diastolic murmur.
B)not be expected to have a thrill.
C)radiate to the axilla.
D)be heard best at the base.
E)radiate to the neck.

Question 52

Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of

A)rheumatic fever.
B)cor pulmonale.
C)pericarditis.
D)endocarditis.
E)cardiac tamponade.

Question 53

A condition that is likely to present with dizziness and fainting is

A)bacterial endocarditis.
B)hypertension.
C)sick sinus syndrome.
D)pericarditis.
E)hyperlipidemia.