Cardiovascular Flashcards
Deoxygenated blood is pumped from _____ to ______
A. Right atrium to tricuspid
B. Right ventricle to pulmonary artery
C. Right atrium to right ventricle
B. Right ventricle to pulmonary artery
Really, it is both A and B.
Auscultating over the 2nd intercostal space left of the sternal boarder will hear:
A. Aortic valve
B. Pulmonic valve
C. Tricuspid valve
D. Mitral valve
B. Pulmonic valve
Auscultating over the 2nd intercostal space right of the sternal boarder
A. Aortic valve
B. Pulmonic valve
C. Tricuspid valve
D. Mitral valve
A. Aortic valve
Auscultating over the 4th intercostal space left of the sternal boarder
A. Aortic valve
B. Pulmonic valve
C. Tricuspid valve
D. Mitral valve
C. Tricuspid valve
Auscultating over the 5th intercostal space left of the sternal boarder is
A. Aortic valve
B. Pulmonic valve
C. Tricuspid valve
D. Mitral valve
D. Mitral valve
What is S1?
A. Closing of the atrial-ventricular valves
B. Opening of the atrial-ventricular valves
C. Closing of the semi-lunar valves
A. Closing of the atrial-ventricular valves
Which factors could indicate right sided heart failure
A. Weight gain
B. Rales and crackles
C. JVD and/or +4 pitting edema
C. JVD and/or +4 pitting edema
What is the blowing or swishing sound in the carotid artery
A. Bruit
B. Rales
C. Crackles
D. Murmurs
A. Bruit
What is S4?
A. The end of diastole
B. The early sound of diastole
C. The closing of the semilunar valves
A. The end of diastole
Atrial Kick- Active filling/ presystole
What does 20/50 vision mean
A. The person can see at 20 ft what normal vision sees at 50ft
B. The person can see at 50ft what a normal person sees at 20ft
A. The person can see at 20 ft what normal vision sees at 50ft
What grade is 2mm pitting edema?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
A. Grade 1
What is shallow rapid breathing
A. Tachypnea
B. Bradycardia
C. Tachycardia
A. Tachypnea
High pitched monophonic crowing
A. Wheezing
B. Crackles
C. Rhonchi
D. Stridor
D. Stridor
What could hyper-inflated alveoli cause
A. AP< T
B. AP=T
C. COPD
D. Emphysema
B. AP=T
Barrel chest
Stimulation of the vagus nerve could cause:
A. Decrease in blood pressure
B. Increase in blood pressure
C. Increase in blood sugar
D. Decrease in blood sugar
A. Decrease in blood pressure
How could the nurse assess for impaired arterial circulation
A. Assessing turgor
B. Assessing radial pulse pressure
C. Assessing capillary refill
C. Assessing capillary refill
During which are the ventricles relaxed?
A. Systole
B. Isometric contraction
C. Arterial kick
D. Diastole
D. Diastole
What happens during S3?
A. Closure of the semilunar valves
B. Blood ejection into aorta and pulmonary artery
C. Atrial contraction
D. Blood pours from the atria into the ventricles
D. Blood pours from the atria into the ventricles
When does protodiastolic or passive filling happen?
A. S1
B. S2
C. S3
D. S4
C. S3
What is atrial contraction?
A. Semilunar valves close
B. Active filling/ pre systolic
C. Isometric contraction
D. AV valves are open
B. Active filling/ pre systolic
What are the AV valves?
A. Aortic and pulmonic valves
B. Mitral and tricuspid
C. Aortic and mitral
D. Tricuspid and pulmonic
B. Mitral and tricuspid
What happens to the AV valves during diastole?
A. AV valves are open (silent)
B. Atrial contraction
C. AV valves are closed
D. Pressure exceeds aortic pressure
A. AV valves are open (silent)
What happens to the AV valves during systole?
A.A. AV valves are open (silent)
B. Atrial contraction
C. AV valves are closed
D. Pressure exceeds aortic pressure
C. AV valves are closed
When are the AV valves closed?
A. S1
B. S2
C. S3
D. S4
A. S1
What is isometric contraction?
A. Blood pours from the atria into the ventricles
B. Atrial Contraction
C. Ventricles relax
D. Ventricle walls contract
D. Ventricle walls contract
What happens during isometric contraction?
A. Pressure in the ventricle exceed aortic pressure
B. Blood pores from the atria into the ventricles
C. The atriums of the heart contract
A. Pressure in the ventricle exceed aortic pressure
When does isometric contraction occur?
A. Systole
B. Diastole
A. Systole
Which happens in systole?
A. AV valves are open
B. Active filling of atriums
C. Ventricles are relaxed
D. Blood ejection into aorta and pulmonary artery
D. Blood ejection into aorta and pulmonary artery
What happens during inspiration in relation to venous flow?
A. Thoracic pressure increases, abdominal pressure decreases
B. Thoracic pressure decreases, abdominal pressure increases
C. A drop in BP of more than 20mm Hg
D. Increase of 20 BPM
B. Thoracic pressure decreases, abdominal pressure increases
What is a mechanism of venous blood flow?
A. Skeletal muscle pressure
B. Viscosity of veins increase
C. Elasticity of arterial walls is triggered
A. Skeletal muscle pressure
Which happens during venous flow?
A. Intraluminal valves open and close
B. Semilunar valves close
C. Ventricles relax
D. AV valves open
A. Intraluminal valves open and close
Which steps should the nurse take to complete a peripheral vascular assessment?
A. Inspect and palpate skin
B. Palpate peripheral pulses
C. Take radial pulse and blood pressure
D. Examine neck vessels and heart
E. All of the above
E. All of the above
How should the nurse palpate radial pulse?
A. Use pads of first three fingers
B. Use pads of first two fingers
C. Count for 30 seconds for all patients
D. Use the thumb
A. Use pads of first three fingers
The nurse should count for 30 seconds only if regular pulse, 60 if pulse is irregular.
Should not use thumb because the examiner’s pulse may interfere.
What is the expected pulse rate for a healthy individual?
A. 1+
B. 2+
C. 3+
D. 4+
B. 2+
Which of the following should the nurse document when assessing pulse?
A. Rate, rhythm, depth
B. Rate, rhythm, amplitude
C. Rate, strength, symmetry
B. Rate, rhythm, amplitude
The nurse should also assess for equality bilaterally
Which amplitude would be expected for a patient with low blood pressure?
A. Bounding 4
B. Strong 3
C. Normal 2
D. Thread 1
E. Absent 0
D. Thread 1
What is blood pressure?
A. The force of blood against vessel wall
B. The force of blood against arterial wall
A. The force of blood against vessel wall
What is systolic pressure?
A. Resting pressure
B. Maximum pressure
C. Normal pressure
D. The pressure exerted by the ventricles
B. Maximum pressure
What is diastolic pressure?
A. Resting pressure
B. Maximum pressure
C. Normal pressure
D. The pressure exerted by the ventricles
A. Resting pressure
Which is considered normal blood pressure?
A. 120/60
B. 120/70
C. 120/80
D. 110/50
C. 120/80
Which are risk factors for hypertension?
A. Age, weight, exercise, stress
B. Gender, weight, diet, exercise
C. Diet, age, gender, exercise
A. Age, weight, exercise, stress
Factors that influence blood pressure?
- Cardiac output
- Vascular resistance
- Volume
- Viscosity
- Elasticity of the arterial walls
Viscosity: a fluid’s resistance to flow, or how thick it is.
How would the nurse establish a patient baseline blood pressure?
A. Only need to take in each arm once
B. Only need to take in one arm
C. Should be taken from the same arm twice. Waiting 2 minutes between assessments
D. Ask the patient for their typical blood pressure reading before assessing
A. Only need to take in each arm once
How should the nurse measure blood pressure?
A. Pump up cuff 20-30 mm Hg beyond where you stop hearing the pulse
B. Pump up cuff 20-30 mm Hg beyond their typical BP
C. Deflate cuff slowly after placing stethoscope over
D. Note first and last clear tapping sound
E. All of the above
E. All of the above
Which of the following could cause false BP readings?
A. Cuff too narrow/ short
B. Deflating cuff to quickly (causing low systolic/ high diastolic reading)
C. Deflating cuff to slowly (false high diastolic)
D. Failure to wait 1-2 minutes between readings (false high)
E. All of the above
E. All of the above
When are orthostatic vital signs assessed?
A. After taking the blood pressure of a patient
B. Before taking the blood pressure of a patient
C. When volume depletion is suspected
D. When client is taking hypertensive medication
E. Both A and C
F. Both C and D
F. Both C and D
What could indicate orthostatic hypotension?
A. A drop of 20 mm Hg or increase in pulse of 20 or more
B. Family history and life style
C. Years of hypertension
D. Fainting or dizziness
E. Both A and D
F. Both B and C
E. Both A and D
Orthostatic hypotension is a decrease in blood pressure after standing
Which of the following should the nurse avoid while palpating the carotid arteries?
A. palpating and the same time or too high (carotid sinus)
B. Palpating contour and amplitude
C. Palpating inside the sternomastoid muscle
A. palpating and the same time or too high (carotid sinus)
You should palpate inside the sternomastoid muscle
What does amplitude reflect in correlation to the carotid arteries?
A. Pulse strength and elasticity of the arterial wall
B. Pulse strength and elasticity of ventricular wall
C. Pressure of blood on the vessel walls
A. Pulse strength and elasticity of the arterial wall
When should the nurse assess for bruits?
A. When auscultating the trachea
B. When auscultating the posterior thorax
C. When auscultating the carotid arteries
C. When auscultating the carotid arteries
What could be considered abnormal in regards to auscultation of the carotid arteries?
A. Bruit heard when lumen is occluded by 1/2 to 1/3
B. A murmur heard when auscultating the pericardium
C. Jugular vein distention
A. Bruit heard when lumen is occluded by 1/2 to 1/3
a tube-like passageway (the lumen) is completely blocked or closed off, preventing anything from passing through it
Which part of the stethoscope should the nurse use while auscultating the carotid arteries?
The bell at angle of the jaw, mid-cervical area, base of neck
Client holds breath briefly
Which could indicate right sided heart failure?
A. distended jugular vein
B. weight gain
C. Dependent edema
D. Secondary to chronic pulmonary problems
E. All of the above
F. None of the above
E. All of the above
D. Secondary to chronic pulmonary problems:
“a health issue is arising as a complication or consequence of a pre-existing chronic lung condition”
What type of lighting should be used in movement of the precordium is noted?
Tangential lighting
Where is the apical impulse located?
A. 2nd intercostal space
B. 4th intercostal space
C. 5th intercostal space
D. 4th or 5th intercostal space
4th or 5th intercostal space
Usually occupies only 1 intercostal space
How should the nurse palpate the apical pulse?
A. Use 1-2 fingers
B. Normally short tap
C. Normally 1 ICS (intercostal space) wide
D. 5th space medial to the mid-clavicular line
E. Not palpable in some clients
F. All of the above
F. All of the above
Where should the nurse palpate when assessing thrills and extra pulsations?
Apex, Left sternal boarder, base
What are thrills?
A. Extra pulsations
B. Normal findings
C. Accentuated first and second heart sounds or extra sounds
D. Palpable vibration accompanies loud murmurs
D. Palpable vibration accompanies loud murmurs
What are extra pulsations?
A. Extra pulsations
B. Normal findings
C. Accentuated first and second heart sounds or extra sounds may produce extra pulsations
D. Palpable vibration accompanies loud murmurs
C. Accentuated first and second heart sounds or extra sounds may produce extra pulsations
“means the normal heart sounds (S1 and S2) are louder than usual, which can sometimes be felt as extra pulsations.”
How should the nurse auscultate the heart
A. Begin at the bottom or base of heart
B. Using palmar surface of four fingers
C. Listen with bell and diaphragm interchangeably
D. Try not to tell patient about the assessment in order to mitigate fears or false readings
A. Begin at the bottom or base of heart
You should listen with diaphragm for high frequencies and the bell for low frequencies separately
What else should the nurse consider with irregular pulse?
A. Sinus arrhythmia
B. Pulse deficit
C. Bruits
D. Both A and C
E. Both A and B
E. Both A and B
Bruits indicate turbulent blood flow and can suggest problems like narrowed arteries or vascular disease. While related to circulation, they are not directly related to an irregular pulse itself.
Describe the characterisitics of S1
Mitral and tricuspid valves (AV valves) closure-dull- beginning of ventricular contraction… Loudest at apex, coincides with carotid pulse.
Apex is the located at the bottom, Base at the top
Describe the characteristics of S2
Aortic and pulmonic valve (semi-lunar) closure-louder than S1. End of ventricular contraction, loudest at the base
base is the top (aorta is also at top)
What else should the nurse assess for when assessing heart sounds?
Extra heart sounds S3 and S4 and murmurs
These are abnormal
How are murmurs best heard?
(Using the stethoscope)
Use diaphragm and bell (often heard best with bell)
What is meant by “normal” findings when auscultating the heart?
these are adjectives
Classified as innocent or functional
What is meant by “abnormal” findings when auscultating the heart?
pathological
Which murmur grade is associated with thrill?
A. Grade I to III
B. Grade IV to VI
B. Grade IV to VI
Loud, even without stethoscope
What do murmurs sound like?
Blowing, swishing sound due to turbulent blood flow
“Bruits of the heart”
Bruits are only found in the arteries, but murmurs and bruits have similar sounds.
What causes angina pain?
reduced blood flow to the heart
What is myocardial ischemia?
A. Death of the heart tissue
B. Prolonged deoxygenation of tissues
C. Reduced blood flow to the heart
C. Reduced blood flow to the heart
B = severe or chronic ischemia
What is myocardial infarction?
A. Death of the heart tissue
B. Prolonged deoxygenation of tissues
C. Reduced blood flow to the heart
A. Death of the heart tissue
Due to prolonged ischemia
Which symptoms are related to left sided heart failure?
A. Backs up to neck veins, abdomen, liver. Symptoms are SOB, JVD, and fatigue
B. Backs up to lungs. Symptoms are cough, crackles, and orthopnea
B. Backs up to lungs. Symptoms are cough, crackles, and orthopnea
Which symptoms are related to right sided heart failure?
A. Backs up to neck veins, abdomen, liver. Symptoms are SOB, JVD, and fatigue
B. Backs up to lungs. Symptoms are cough, crackles, and orthopnea
A. Backs up to neck veins, abdomen, liver. Symptoms are SOB, JVD, and fatigue
Limitations to carotid assessment?
nail polish
thick nails
fungal nails
How many millimeters is equal to 1 inch
25.4 millimeters
Which of the following are indicative of peripheral vascular disease? PVD
A. Arteriosclerosis - ischemic ulcer
B. Venous (stasis) ulcer
C. Superficial varicose veins
D. Deep vein thrombophlebitis
All of the above
Arteriosclerosis could be either PVD or PAD
- Arteriosclerosis is a common cause of PVD, where plaque buildup narrows the arteries.
- Venous stasis ulcers are a result of poor venous circulation, leading to skin ulcers.
- Superficial varicose veins are visible enlarged veins, usually not a major health concern on their own.
- DVT is a serious condition involving a blood clot in a deep vein.
What is Virchow’s triad?
Chronic presentation
Hyper coagulability
Endothelial injury
Stasis of blood flow
“venous stasis (slow blood flow), endothelial damage (injury to the lining of blood vessels), and hypercoagulability (abnormally increased tendency of blood to clot)”
What are varicosities
Chronic presentation of PVD
Incompetent valves
What are venous stasis ulcers?
Chronic presentation of PVD
chronic incompetent valves. Cause weeping and bacterial invasion
Brown - discoloration due to RBC count
Medial malleolus- bleeding, uneven edges
What is DVT
Acute presentation of PVD
asymmetric calf circumference (1cm)
unilateral
swelling
redness
warmth
intense and sharp pain in 35%
cancer/ cancer treatment
immobility- bed rest > 3 days, major surgery
previous DVT
What is erythema?
Redness
vasodilation
Chronic presentation
What is PVI (pulmonary vein insufficiency) caused by?
metabolic waste build up
What is PAD (pulmonary artery disease) caused by?
Oxygen deficit
What is a common chronic presentation of PAD?
Delayed capillary refill (>2-3 seconds)
Pallor - vasoconstriction
unilateral or distal coolness (elevational pallor)
bilateral can be due to the environment (cool room)
What is a concerning chronic presentation of PAD?
Weak thready peripheral pulses
bilateral pitting edema associated with heart disease, hypertension, diabetic neuropathy, hepatic cirrhosis
PAD chronic presentation:
A. Deep calf pain after movement
B. Edema
C. Immobility
D. Hairless shiny thin skin with thick rigid nails
Both A and D
What type of ulcers are found in correlation to PAD?
Ulcers on tips of toes, metatarsal heads, lateral malleoli
What is a severe chronic presentation of PAD?
Dependent rubor (red/blue) motor loss, sensory loss
What is meant when by acute presentation of PAD?
Occlusion/ arterial emboli
What are the 6ps and what are they related to?
Acute presentation of PAD
Pain
Pallor
Pulslessness
Paresthesia (tingling)
Poikilothermic (coldness)
Paralysis (severe)
