19

Question 1

1.	The sac that surrounds and protects the heart is called the:
a.
Pericardium.
b.
Myocardium.
c.
Endocardium.
d.
Pleural space.

Answer 1

ANS: A

Question 2

2. The direction of blood flow through the heart is best described by which of these?
   a.
   Vena cava right atrium right ventricle lungs pulmonary artery left atrium left ventricle
   b.
   Right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle
   c.
   Aorta right atrium right ventricle lungs pulmonary vein left atrium left ventricle vena cava
   d.
   Right atrium right ventricle pulmonary vein lungs pulmonary artery left atrium left ventricle

Answer 2

ANS: B

Question 3

3. 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.

Answer 3

ANS: D

Question 4

4.	When listening to heart sounds, the nurse knows the valve closures that can be heard best at the base of the heart are:
a.
Mitral and tricuspid.
b.
Tricuspid and aortic.
c.
Aortic and pulmonic.
d.
Mitral and pulmonic.

Answer 4

ANS: C

Question 5

5. Which of these statements describes the closure of the valves in a normal cardiac cycle?
   a.
   The aortic valve closes slightly before the tricuspid valve.
   b.
   The pulmonic valve closes slightly before the aortic valve.
   c.
   The tricuspid valve closes slightly later than the mitral valve.
   d.
   Both the tricuspid and pulmonic valves close at the same time.

Answer 5

ANS: C

Question 6

6.	The component of the conduction system referred to as the pacemaker of the heart is the:
a.
Atrioventricular (AV) node.
b.
Sinoatrial (SA) node.
c.
Bundle of His.
d.
Bundle branches.

Answer 6

ANS: B

Question 7

7. The electrical stimulus of the cardiac cycle follows which sequence?
   a.
   AV node SA node bundle of His
   b.
   Bundle of His AV node SA node
   c.
   SA node AV node bundle of His bundle branches
   d.
   AV node SA node bundle of His bundle branches

Answer 7

ANS: D

Question 8

8.	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:
a.
Decreased fluid volume.
b.
Increased cardiac output.
c.
Narrowing of jugular veins.
d.
Elevated pressure related to heart failure.

Answer 8

ANS: D

Question 9

9. When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to be true?
   a.
   The left ventricle is larger and weighs more than the right ventricle.
   b.
   The circulation of a newborn is identical to that of an adult.
   c.
   Blood can flow into the left side of the heart through an opening in the atrial septum.
   d.
   The foramen ovale closes just minutes before birth, and the ductus arteriosus closes immediately after.

Answer 9

ANS: C

Question 10

10. 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.

Answer 10

ANS: A

Question 11

11.	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 expected hemodynamic changes related to 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

Answer 11

ANS: B

Question 12

12. 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.” The nurse’s best response to this would be:
    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?”

Answer 12

ANS: C

Question 13

13. 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 13

ANS: C

Question 14

14.	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

Answer 14

ANS: D

Question 15

15. In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would:
    a.
    Palpate the artery in the upper one third of the neck.
    b.
    Listen with the bell of the stethoscope to assess for bruits.
    c.
    Simultaneously palpate both arteries to compare amplitude.
    d.
    Instruct the patient to take slow deep breaths during auscultation.

Answer 15

ANS: B

Question 16

16.	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:
a.
Valvular disorder.
b.
Blood flow turbulence.
c.
Fluid volume overload.
d.
Ventricular hypertrophy.

Answer 16

ANS: B

Question 17

17.	During an 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 a(n):
a.
Normal heart.
b.
Systolic murmur.
c.
Enlargement of the left ventricle.
d.
Enlargement of the right ventricle.

Answer 17

ANS: D

Question 18

18. 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

Answer 18

ANS: D

Question 19

19. The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true?
    a.
    Percussion is a useful tool for outlining the heart’s borders.
    b.
    Percussion is easier in patients who are obese.
    c.
    Studies show that percussed cardiac borders do not correlate well with the true cardiac border.
    d.
    Only expert health care providers should attempt percussion of the heart.

Answer 19

ANS: C

Question 20

20. The nurse is preparing to auscultate for heart sounds. Which technique is correct?
    a.
    Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral areas
    b.
    Listening by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex
    c.
    Listening to the sounds only at the site where the apical pulse is felt to be the strongest
    d.
    Listening for all possible sounds at a time at each specified area

Answer 20

ANS: B

Question 21

21. 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 would be the nurse’s response?
    a.
    Talk with the patient about his intake of caffeine.
    b.
    Perform an electrocardiogram after the examination.
    c.
    No further response is needed because sinus arrhythmia can occur normally.
    d.
    Refer the patient to a cardiologist for further testing.

Answer 21

ANS: C

Question 22

22. When listening to heart sounds, the nurse knows that the S1:
    a.
    Is louder than the S2 at the base of the heart.
    b.
    Indicates the beginning of diastole.
    c.
    Coincides with the carotid artery pulse.
    d.
    Is caused by the closure of the semilunar valves.

Answer 22

ANS: C

Question 23

23. During the cardiac auscultation, the nurse hears a sound immediately occurring after the S2 at the second left intercostal space. To further assess this sound, what should the nurse do?
    a.
    Have the patient turn to the left side while the nurse listens with the bell of the stethoscope.
    b.
    Ask the patient to hold his or her breath while the nurse listens again.
    c.
    No further assessment is needed because the nurse knows this sound is an S3.
    d.
    Watch the patient’s respirations while listening for the effect on the sound.

Answer 23

ANS: D

Question 24

24. 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

Answer 24

ANS: C

Question 25

25. 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.
    S3 is indicative of heart disease in children.
    b.
    These findings can all be normal in a child.
    c.
    These findings are indicative of congenital problems.
    d.
    The venous hum most likely indicates an aneurysm.

Answer 25

ANS: B

Question 26

26. During the precordial assessment on an patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. This finding would indicate:
    a.
    Right ventricular hypertrophy.
    b.
    Increased volume and size of the heart as a result of pregnancy.
    c.
    Displacement of the heart from elevation of the diaphragm.
    d.
    Increased blood flow through the internal mammary artery.

Answer 26

.

Question 27

27. In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the:
    a.
    Bell of the stethoscope at the base with the patient leaning forward.
    b.
    Bell of the stethoscope at the apex with the patient in the left lateral position.
    c.
    Diaphragm of the stethoscope in the aortic area with the patient sitting.
    d.
    Diaphragm of the stethoscope in the pulmonic area with the patient supine.

Answer 27

ANS: B

Question 28

28.	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. With these findings and the patient’s history, the nurse knows that this extra heart sound is most likely a(n):
a.
Split S1.
b.
Atrial gallop.
c.
Diastolic murmur.
d.
Summation sound.

Answer 28

ANS: B

Question 29

29.	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. The nurse suspects:
a.
Increased cardiac output.
b.
Another MI.
c.
Inflammation of the precordium.
d.
Ventricular hypertrophy resulting from muscle damage.

Answer 29

ANS: C

Question 30

30.	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

Answer 30

ANS: A

Question 31

31.	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. These findings would be most consistent with:
a.
Heart failure.
b.
Aortic stenosis.
c.
Pulmonary edema.
d.
Mitral regurgitation.

Answer 31

ANS: D

Question 32

32.	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.
Fluid overload
b.
Atrial septal defect
c.
MI
d.
Heart failure

Answer 32

ANS: D

Question 33

33.	The nurse knows that normal splitting of the S2 is associated with:
a.
Expiration.
b.
Inspiration.
c.
Exercise state.
d.
Low resting heart rate.

Answer 33

ANS: B

Question 34

34.	During a cardiovascular assessment, the nurse knows that a thrill is:
a.
Vibration that is palpable.
b.
Palpated in the right epigastric area.
c.
Associated with ventricular hypertrophy.
d.
Murmur auscultated at the third intercostal space.

Answer 34

ANS: A

Question 35

35. During a cardiovascular assessment, the nurse knows that an S4 heart sound is:
    a.
    Heard at the onset of atrial diastole.
    b.
    Usually 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.

Answer 35

ANS: C

Question 36

36.	During an assessment, the nurse notes that the patient’s apical impulse is laterally displaced and is palpable over a wide area. This finding indicates:
a.
Systemic hypertension.
b.
Pulmonic hypertension.
c.
Pressure overload, as in aortic stenosis.
d.
Volume overload, as in heart failure.

Answer 36

ANS: D

Question 37

37. 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.

Answer 37

ANS: C

Question 38

38.	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.
American Indians
d.
Hispanics

Answer 38

ANS: A

Question 39

39. 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 rise for a few seconds and then recede back to the previous level if the heart is properly working.
    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 not be detected during this maneuver.

Answer 39

ANS: B

Question 40

40. The nurse is assessing the apical pulse of a 3-month-old infant and finds that the heart rate is 135 beats per minute. The nurse interprets this result as:
    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.

Answer 40

ANS: A

Question 41

1.	The nurse is presenting a class on risk factors for cardiovascular disease. Which of these are considered modifiable risk factors for MI? Select all that apply.
a.
Ethnicity
b.
Abnormal lipids
c.
Smoking
d.
Gender
e.
Hypertension
f.
Diabetes
g.
Family history

Answer 41

ANS: B, C, E, F