Deck 20: Heart and Neck Vessels

Question 1

What component of the conduction system is referred to as the pacemaker of the heart?

A) Bundle of His
B) Bundle branches
C) Sinoatrial (SA) node
D) Atrioventricular (AV) node

Answer 1

Sinoatrial (SA) node

Question 2

During an inspection of the precordium of an adult patient, the nurse notices the chest moving in a forceful manner along the sternal border. What does this finding most likely indicate?

A) Systolic murmur
B) Diastolic murmur
C) Enlargement of the left ventricle
D) Enlargement of the right ventricle

Answer 2

Enlargement of the right ventricle

Question 3

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

Answer 3

Smoking, hypertension, obesity, diabetes, and high cholesterol

Question 4

The nurse is reviewing the anatomy and physiologic functioning 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) Contraction of the atria at the beginning of diastole can be felt as a palpitation.
C) Atrial kick 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 5

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

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

Question 6

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 should the nurse do?

A) Document this as a normal finding.
B) Talk with the patient about his intake of caffeine.
C) Perform an electrocardiogram after the examination.
D) Refer the patient to a cardiologist for further testing.

Question 7

In assessing a 70-year-old man, the nurse finds the following: blood pressure 140/100 mm Hg; heart rate 104 beats per minute and slightly irregular; and the split S₂ heart sound. Which of these findings can be explained by the expected hemodynamic changes r/t 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 8

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

A) The pulmonic valve closes slightly before the aortic valve.
B) The aortic valve closes slightly before the tricuspid valve.
C) Both the tricuspid and pulmonic valves close at the same time.
D) The tricuspid valve closes slightly later than the mitral valve.

Question 9

What is the sac that surrounds and protects the heart is called?

A) Myocardium
B) Pericardium
C) Endocardium
D) Pleural space

Question 10

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

A) Vena cava $\rightarrow$ right atrium $\rightarrow$ right ventricle $\rightarrow$ lungs $\rightarrow$ pulmonary artery $\rightarrow$ left atrium $\rightarrow$ left ventricle
B) Right atrium $\rightarrow$ right ventricle $\rightarrow$ pulmonary artery $\rightarrow$ lungs $\rightarrow$ pulmonary vein $\rightarrow$ left atrium $\rightarrow$ left ventricle
C) Aorta $\rightarrow$ right atrium $\rightarrow$ right ventricle $\rightarrow$ lungs $\rightarrow$ pulmonary vein $\rightarrow$ left atrium $\rightarrow$ left ventricle $\rightarrow$ vena cava
D) Right atrium $\rightarrow$ right ventricle $\rightarrow$ pulmonary vein $\rightarrow$ lungs $\rightarrow$ pulmonary artery $\rightarrow$ left atrium $\rightarrow$ left ventricle

Question 11

A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous examination, 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 decline in blood pressure is the result of peripheral vasodilatation and is an expected change.
B) Because of increased cardiac output, the blood pressure should be higher at this time.
C) This change in blood pressure is not an expected finding because it means a decrease in cardiac output.
D) This decline in blood pressure means a decrease in circulating blood volume, which is dangerous for the fetus.

Question 12

What should the nurse do when assessing the carotid arteries of an older patient with cardiovascular disease?

A) Palpate the artery in the upper one-third of the neck.
B) Simultaneously palpate both arteries to compare amplitude.
C) Listen with the bell of the stethoscope to assess for bruits.
D) Instruct the patient to take slow deep breaths during auscultation.

Question 13

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-time hungry again. What other information would the nurse want to have?

A) 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

Question 14

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. What does this finding indicate?

A) Valvular disorder
B) Blood flow turbulence
C) Fluid volume overload
D) Ventricular hypertrophy

Question 15

Which sequence does the electrical stimulus of the cardiac cycle follow?

A) AV node $\rightarrow$ SA node $\rightarrow$ bundle of His
B) Bundle of His $\rightarrow$ AV node $\rightarrow$ SA node
C) SA node $\rightarrow$ AV node $\rightarrow$ bundle of His $\rightarrow$ bundle branches
D) AV node $\rightarrow$ SA node $\rightarrow$ bundle of His $\rightarrow$ bundle branches

Question 16

When listening to heart sounds, which valve closures are heard best at the base of the heart?

A) Aortic and pulmonic
B) Mitral and pulmonic
C) Mitral and tricuspid
D) Tricuspid and aortic

Question 17

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 18

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. What does this finding indicate?

A) Decreased fluid volume
B) Increased cardiac output
C) Narrowing of jugular veins
D) Elevated pressure r/t heart failure

Question 19

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

A) Percussion is easier in patients who are obese.
B) Percussion is a useful tool for outlining the heart's borders.
C) Only expert health care providers should attempt percussion of the heart.
D) Studies show that percussed cardiac borders do not correlate well with the true cardiac border.

Question 20

A 45-year-old man is in the clinic for a routine physical examination. During the recording of his health history, the patient states that he has been having difficulty sleeping. "I'll be sleeping great, and then I wake up and feel like I can't get my breath." Which is the best response by the nurse?

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 21

The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her myocardial infarction (MI). 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. What does the nurse suspect?

A) Another MI
B) Increased cardiac output
C) Inflammation of the precordium
D) Ventricular hypertrophy resulting from muscle damage

Question 22

During an assessment, the nurse notes that the patient's apical impulse is laterally displaced and is palpable over a wide area. What does this finding indicate?

A) Systemic hypertension
B) Pulmonic hypertension
C) Pressure overload, as in aortic stenosis
D) Volume overload, as in heart failure

Question 23

What is the best description of the S₁ heart sound?

A) Indicates the beginning of diastole.
B) Coincides with the carotid artery pulse.
C) Louder than the S₂ at the base of the heart.
D) Is caused by the closure of the semilunar valves.

Question 24

The nurse is assessing the apical pulse of a 3-month-old infant and finds that the heart rate is 135 beats per minute. How should the nurse interpret this finding?

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 25

The nurse is preparing to teach a class on cardiovascular assessment. When explaining a thrill, what should the nurse include in the teaching?

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 26

While auscultating heart sounds on a 7-year-old child for a routine physical examination, the nurse hears an S₃, a soft murmur at the left midsternal border, and a venous hum when the child is standing. What would be a correct interpretation of these findings?

A) These findings can all be normal in a child.
B) An S₃ is indicative of heart disease in children.
C) The venous hum most likely indicates an aneurysm.
D) These findings are indicative of congenital problems.

Question 27

When the nurse is auscultating the carotid artery for bruits, which of these statements reflects the correct technique?

A) While listening with the bell of the stethoscope, the patient is asked to take a deep breath and hold it.
B) While auscultating one side with the bell of the stethoscope, the carotid artery is palpated on the other side to check pulsations.
C) While lightly applying the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.
D) While firmly placing the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.

Question 28

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 29

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

Question 30

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 the sternal angle when the patient is elevated at 45 degrees, blood pressure 98/60 mm Hg, heart rate 130 beats per minute, ankle edema, difficulty breathing when supine, and an S₃ on auscultation. Which of these conditions best explains the cause of these findings?

A) Heart failure
B) Fluid overload
C) Atrial septal defect
D) Myocardial infarction

Question 31

What is the normal splitting of the S₂ is associated with?

A) Expiration
B) Inspiration
C) Exercise state
D) Low resting heart rate

Question 32

During the precordial assessment of a patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. What does this finding indicate?

A) Right ventricular hypertrophy
B) Increased blood flow through the internal mammary artery
C) Displacement of the heart from elevation of the diaphragm
D) Increased volume and size of the heart as a result of pregnancy

Question 33

In assessing for an S₄ heart sound, what part of the stethoscope should the nurse use and in what location?

A) Bell of the stethoscope at the base with the patient leaning forward
B) Diaphragm of the stethoscope in the aortic area with the patient sitting
C) Diaphragm of the stethoscope in the pulmonic area with the patient supine
D) Bell of the stethoscope at the apex with the patient in the left lateral position

Question 34

When performing a cardiovascular assessment, what should the nurse understand about an S₄ heart sound?

A) Heard at the onset of atrial diastole
B) Often a normal finding in the older adult
C) Heard at the end of ventricular diastole
D) Heard best over the second left intercostal space with the individual sitting upright

Question 35

During cardiac auscultation, the nurse hears a sound immediately occurring after the S₂ at the second left intercostal space. What should the nurse do to further assess this sound?

A) Ask the patient to hold his or her breath while the nurse listens again.
B) No further assessment is needed because the nurse knows this sound is an S₃.
C) Watch the patient's respirations while listening for the effect on the sound.
D) Have the patient turn to the left side while the nurse listens with the bell of the stethoscope.

Question 36

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 the S₁. The sound is heard only with the bell of the stethoscope while the patient is in the left lateral position. Based on these findings and the patient's history, the nurse should recognize this extra heart sound is most likely what?

A) Split S₁
B) Atrial gallop
C) Diastolic murmur
D) Summation sound

Question 37

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) Blacks
B) Whites
C) Hispanics
D) American Indians

Question 38

The nurse is assessing a patient with possible cardiomyopathy and assesses the hepatojugular reflux. If heart failure is present, then the nurse should recognize which finding while pushing on the right upper quadrant of the patient's abdomen, just below the rib cage?

A) The jugular veins will not be detected during this maneuver.
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 rise for a few seconds and then recede back to the previous level if the heart is properly working.

Question 39

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 the S₁. What do these findings most likely indicate?

A) Heart failure
B) Aortic stenosis
C) Pulmonary edema
D) Mitral regurgitation