Deck 16: Heart

Question 1

The normal pacemaker of the heart is the

A) S-A node at 120 bpm.
B) A-V node at 60 bpm.
C) S-A node at 70 bpm.
D) A-V node at 40 bpm.

Answer 1

S-A node at 70 bpm.

Question 2

Drugs for erectile dysfunction (phosphodiesterase type 5 inhibitors)should not be taken by patients who already take

A) nitrate drugs.
B) proton pump inhibitors.
C) lithium.
D) over-the-counter medications.

Answer 2

nitrate drugs.

Question 3

Which heart sound does closure of the atrioventricular (A-V)valves produce?

A) S₁
B) S₂
C) S₃
D) S₄

Answer 3

S₁

Question 4

Questions on sexual practices should be included in a social history because of their potentially harmful effect on the heart as commonly evidenced by

A) chest pain and syncope.
B) palpitations and systolic murmur.
C) peripheral edema and dyspnea.
D) cardiomyopathy and diaphoresis.

Question 5

On the EKG,the end of ventricular repolarization is the

A) upslope of the P wave.
B) negative Q wave.
C) QRS complex.
D) downslope of the T wave.

Question 6

An example of a minor modifiable cardiovascular risk factor is

A) hyperlipidemia.
B) hypertension.
C) obesity.
D) smoking.

Question 7

In the cardiac cycle,once the pressure in the left ventricle exceeds that in the aorta and the pressure in the right ventricle exceeds that in the pulmonary artery,the

A) A-V node is stimulated.
B) semilunar valves open.
C) A-V valves open.
D) semilunar valves close.

Question 8

A patient reports that her only exercise is walking on Saturdays and Sundays for 15 minutes.Recommended guidelines to increase cardiovascular tone are to engage in sustained physical activity at least

A) 15 to 30 minutes daily.
B) 20 to 30 minutes, three to five times per week.
C) 30 minutes, five times per week.
D) 30 to 60 minutes daily.

Question 9

Which finding is most likely to be an associated manifestation of peripheral edema in a 64-year-old female whose chief complaint is swelling of the legs?

A) recent weight gain
B) sense of impending doom
C) pain in the lower abdomen
D) aching in the joints of her fingers

Question 10

When taking a past health history on a 64-year-old male scheduled for a cardiac catheterization that afternoon,which of the following is a priority for the nurse to report?

A) currently taking an antilipemic for hypercholesterolemia
B) allergic to iodine-containing substances such as shellfish
C) had rheumatic fever as a child
D) had two broken ribs from a fall off a ladder 15 years ago

Question 11

A patient with a chief complaint of palpitations reports excessive alcohol intake over the past 10 years.Which of the following is most useful in understanding the possible relationship between his substance abuse and his symptoms?

A) Prolonged use of alcohol can lead to neurological damage.
B) Increased high-density lipoprotein cholesterol is associated with daily intake of 2 oz of alcohol.
C) Prolonged use of alcohol can interfere with normal pump function and electrical activity of the heart.
D) Liver disease is a common finding in patients with a history of alcohol abuse.

Question 12

An example of a major modifiable cardiovascular risk factor is

A) stress.
B) race.
C) diet.
D) family history.

Question 13

The mitral area,one of the cardiac landmarks,is located in the

A) second intercostal space to the left of the sternum.
B) second intercostal space to the right of the sternum.
C) third intercostal space to the left of the sternum.
D) fifth intercostal space at the left midclavicular line.

Question 14

A patient's primary care provider has indicated that her symptoms of dyspnea and fatigue related to heart failure are class IV.This classification indicates that she experiences

A) symptoms with any activity or even at rest.
B) symptoms with ordinary physical activity and has a slight limitation of physical activity.
C) no symptoms with ordinary physical activity.
D) symptoms with ordinary physical activity and has a marked limitation of physical activity.

Question 15

When a child faints during exercise because of decreased oxygen supply to the body,which of the following is the most likely cause?

A) transposition of the great vessels
B) truncus arteriosus
C) tetralogy of Fallot
D) hypoplastic left heart syndrome

Question 16

Angina pain is typically described as

A) a sudden onset of pain that is tearing and worsens with breathing.
B) aching, tightness, or heaviness in the chest, which may be relieved with rest.
C) a sudden onset of sharp, tearing pain that radiates to shoulders, neck, back, and abdomen.
D) pain reproducible by chest wall palpation and relieved by position changes.

Question 17

When examining an elderly patient,which finding should be reported immediately to the patient's primary care provider?

A) pulse of 62 beats/minute, regular
B) blood pressure of 120/82
C) capillary refill of less than 3 seconds
D) detection of an S₃

Question 18

Patients complaining of fluttering,pounding,or throbbing sensations in their chest are most likely experiencing

A) angina.
B) aortic dissection.
C) palpitations
D) claudication.

Question 19

The target heart rate (THR)zone range for a patient 50 years old would be

A) 80-136.
B) 85-145.
C) 90-153.
D) 95-162.

Question 20

The major components of the cardiovascular physical examination are the

A) pericardium, periphery, and hepatic area.
B) precordium and periphery.
C) mid-precordial area, peripheral vasculature, and gastric area.
D) gastric area and periphery.

Question 21

The procedure for locating the second intercostal space (ICS)is to first locate

A) Erb's point.
B) the angle of Louis.
C) the apical impulse.
D) the xiphoid process.

Question 22

A patient with mitral stenosis may also have an opening snap caused by the opening of a diseased valve.This sound

A) occurs early in diastole, following S₂.
B) is low pitched.
C) varies with respirations and is localized.
D) is best auscultated with the bell of the stethoscope.

Question 23

A visible,systolic pulsation in the tricuspid area is most likely caused by increased stroke volume resulting in

A) right atrial enlargement.
B) left atrial enlargement.
C) right ventricular enlargement.
D) left ventricular enlargement.

Question 24

A normal pulsation palpated in the mitral area is the apical impulse,which

A) has a large amplitude.
B) can be felt immediately after the first heart sound.
C) is often easier to palpate with the patient turned to the right side.
D) is present in about 10% of adults.

Question 25

S₁ is loudest,and therefore best heard,in the:

A) tricuspid area.
B) mitral area.
C) midprecordium area.
D) aortic area.

Question 26

When palpating the cardiac landmarks,you should examine for the presence of a thrill,which is best examined using the

A) palmar surface of the hand at the base of the fingers.
B) finger pads of all five fingers.
C) ulnar aspect of a closed fist.
D) fingertips along with a stethoscope as a guide.

Question 27

When auscultating a patient’s heart at the pulmonic area,you hear a split S₂ with the louder A₂ component occurring slightly before the P₂ component during inspiration.You recognize that this finding most likely is

A) normal physiological splitting.
B) fixed splitting.
C) paradoxical splitting.
D) S₃.

Question 28

An S₃ originating from the right ventricle is best heard with the

A) bell of the stethoscope over the fifth intercostal space.
B) diaphragm of the stethoscope over the fifth intercostal space.
C) bell of the stethoscope over the third intercostal space.
D) diaphragm of the stethoscope over the third intercostal space.

Question 29

An S₄ is best described as

A) an early diastolic filling sound associated with rapid ventricular filling.
B) a rumbling or blowing sound heard throughout systole.
C) a high-pitched clicking sound occurring early in diastole.
D) a late diastolic filling sound associated with atrial contraction.

Question 30

The diaphragm of the stethoscope is used in the cardiac examination to auscultate

A) high-frequency sounds.
B) bruits.
C) low-pitched sounds.
D) all murmurs.

Question 31

Discovered upon inspection,a pulsation or systolic bulge found at the third intercostal space,left sternal border,is considered

A) normal, caused by blood pulsating against the left ventricular wall.
B) abnormal, possibly caused by a left ventricular aneurysm.
C) abnormal, possibly caused by pericardial disease with constriction.
D) abnormal, possibly caused by a right ventricular rupture.

Question 32

When auscultating the tricuspid area,you hear a split S₁.You determine that the split is wider than usual during inspiration and is still heard during expiration.An abnormally split S₁ is commonly heard in mitral stenosis because the

A) tricuspid valve closes before the mitral valve.
B) mitral valve closes before the tricuspid valve.
C) mitral valve causes a longer and louder sound as it closes.
D) mitral valve causes a loud sound as it opens.

Question 33

A pulsation in the aortic area,discovered upon inspection,is considered

A) normal, due to blood pulsating against the aortic wall.
B) abnormal, possibly caused by an aortic root aneurysm.
C) abnormal, possibly caused by right ventricular hypertrophy.
D) abnormal, possibly caused by aortic regurgitation.

Question 34

You detect the presence of a heave,which is best described as

A) a lifting of the cardiac area.
B) a pulsating mass.
C) periodic gasping respirations causing the chest wall to rise.
D) vibrations similar to those felt when your hand is placed on a purring cat.

Question 35

Hypokinetic pulsations in the mitral area can be caused by

A) the presence of fluid between the left ventricle and the chest wall.
B) decreased subcutaneous tissue in the individual.
C) high-output states such as warm septic shock.
D) left ventricular hypertrophy.

Question 36

A summation gallop is the sound heard when the following heart sounds are present

A) S₁, S₂, S₃.
B) S₁, S₂, S₄.
C) S₁, S₂, S₃-₄.
D) opening snap, S₁, S₂, S₃, S₄.

Question 37

After auscultating the aortic area,you determine that a patient has a diminished A₂ and an ejection click.The most likely cause of these two findings is

A) arterial hypertension.
B) aortic stenosis.
C) the presence of an artificial aortic valve.
D) ruptured chordae tendineae of the aortic valve.

Question 38

When palpating the aortic area,you detect the presence of a thrill,which is an abnormal finding related to aortic stenosis and aortic regurgitation resulting in turbulent blood flow in the

A) aorta.
B) left ventricle.
C) right ventricle.
D) pulmonary artery.

Question 39

You are unable to distinguish S₁ from S₂,so you proceed by placing the diaphragm of your stethoscope over the mitral area while

A) palpating a radial pulse.
B) palpating a carotid pulse.
C) the patient holds his breath.
D) the patient takes a deep breath.

Question 40

You are auscultating a patient's heart during a routine physical examination.You should position the patient

A) in a flat, supine position or a sitting position.
B) in the left lateral position.
C) leaning forward slightly.
D) on his back with the bed raised 45°.

Question 41

Which type of murmur has a configuration that goes from loud to soft?

A) crescendo
B) holosystolic
C) pansystolic
D) decrescendo

Question 42

Which of the following are the three phases of systole? Select all that apply.

A) Relaxation phase
B) Atrial systole
C) Isovolumic contraction
D) Rapid ejection (early systole)
E) Reduced ejection (late systole)
F) Ventricular systole

Question 43

The bicuspid valve is also known as the ____________________ valve.

Question 44

Potential causes of hyperkinetic pulsations include which of the following? Select all that apply.

A) Shock
B) Thyrotoxicosis
C) Mitral regurgitation
D) Severe Anemia
E) Left-to-right heart shunts
F) Decreased myocardial contractibility

Question 45

An obstruction in the left main coronary artery is often referred to as a(n)____________________ because of its lethal effect.

Question 46

The nurse examining a patient's antiembolitic stockings would do which of the following? Select all that apply.

A) Prescribe Coumadin to be given daily.
B) Ensure that the stockings are the correct size.
C) Determine whether the stockings are knee-high or thigh-high.
D) Determine that the patient has audible pulses in the lower extremities.
E) Wash the patient's stockings every night when the patient goes to sleep.
F) Assure that the stockings have been removed at least once per day to examine the patient's skin.

Question 47

The condition in which a valve that should be open remains partially closed is

A) stenosis.
B) regurgitation.
C) prosthesis.
D) normal.

Question 48

A patient has a blowing,high-pitched sound heard at the fifth intercostal space,left midclavicular line,that radiates to his left axilla.This sound is most likely the result of

A) mitral stenosis.
B) mitral regurgitation.
C) pericardial friction rub.
D) ventricular gallop.

Question 49

The heart muscle (myocardium)receives oxygen from the coronary arterial system.Which vessels comprise the coronary arterial system? Select all that apply.

A) Left anterior descending (LAD) coronary artery
B) Circumflex branch of left coronary artery
C) Right branch of pulmonary artery
D) Inferior vena cava
E) Right coronary artery (RCA)
F) Marginal artery

Question 50

A patient has a high-pitched grating sound over the third intercostal space to the left of the sternum.Upon further examination,you determine that the patient has a pericardial friction rub because

A) the sound does not change with respiration.
B) the sound radiates to the right side.
C) she is complaining of pain with breathing.
D) the sound disappears when she holds her breath.

Question 51

A healthy adult heart pumps up to ____________________ liters of blood per minute.

Question 52

The lower portion of the heart,called the ____________________,extends into the left thoracic cavity.

Question 53

The LAD supplies blood to which of the following? Select all that apply.

A) Lateral and posterior portions of the left ventricle.
B) Apex of the left ventricle.
C) Anterior wall.
D) Anterior portion of the interventricular septum.
E) Left atrium.
F) Inferior wall of the left ventricle.

Question 54

The visceral layer,a serous layer that lies against the heart,is also called the ____________________.