Cardiovascular Flashcards
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.
ANS: C
The second heart sound (S2) occurs with the closure of the semilunar (aortic and pulmonic) valves and signals the end of systole. Although it is heard over all the precordium, the S2 is loudest at the base of the heart.
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.
ANS: C
Events occur just slightly later in the right side of the heart because of the route of myocardial depolarization. As a result, two distinct components to each of the heart sounds exist, and sometimes they can be heard separately. In the first heart sound, the mitral component (M1) closes just before the tricuspid component (T1).
ANS: C
Events occur just slightly later in the right side of the heart because of the route of myocardial depolarization. As a result, two distinct components to each of the heart sounds exist, and sometimes they can be heard separately. In the first heart sound, the mitral component (M1) closes just before the tricuspid component (T1).
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. Ill be sleeping great, and then I wake up and feel like I cant get my breath. The nurses best response to this would be:
a.
When was your last electrocardiogram?
b.
Its probably because its 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?
ANS: C
Paroxysmal nocturnal dyspnea (shortness of breath generally occurring at night) occurs with heart failure. Lying down increases the volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the perception of needing fresh air.
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
ANS: D
The apical impulse should occupy only one intercostal space, the fourth or fifth, and it should be at or medial to the midclavicular line.
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
ANS: B
Auscultation of breath sounds should not be limited to only four locations. Sounds produced by the valves may be heard all over the precordium. The stethoscope should be inched in a rough Z pattern from the base of the heart across and down, then over to the apex; or, starting at the apex, it should be slowly worked up (see Figure 19-22). Listening selectively to one sound at a time is best.
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.
ANS: C
The S1 coincides with the carotid artery pulse, is the start of systole, and is louder than the S2 at the apex of the heart; the S2 is louder than the S1 at the base. The nurse should gently feel the carotid artery pulse while auscultating at the apex; the sound heard as each pulse is felt is the S1.
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 patients respirations while listening for the effect on the sound.
d.
Watch the patients respirations while listening for the effect on the sound.
ANS: D
A split S2 is a normal phenomenon that occurs toward the end of inspiration in some people. A split S2 is heard only in the pulmonic valve area, the second left interspace. When the split S2 is first heard, the nurse should not be tempted to ask the person to hold his or her breath so that the nurse can concentrate on the sounds. Breath holding will only equalize ejection times in the right and left sides of the heart and cause the split to go away. Rather, the nurse should concentrate on the split while watching the persons chest rise up and down with breathing.
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.
ANS: B
The S4 is a ventricular filling sound that occurs when the atria contract late in diastole and is heard immediately before the S1. The S4 is a very soft sound with a very low pitch. The nurse needs a good bell and must listen for this sound. An S4 is heard best at the apex, with the person in the left lateral position.
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.
ANS: D
These findings are consistent with mitral regurgitation. Its subjective findings include fatigue, palpitation, and orthopnea, and its objective findings are: (1) a thrill in systole at the apex; (2) a lift at the apex; (3) the apical impulse displaced down and to the left; (4) the S1 is diminished, the S2 is accentuated, and the S3 at the apex is often present; and (5) a pansystolic murmur that is often loud, blowing, best heard at the apex, and radiating well to the left axilla.
During an assessment, the nurse notes that the patients 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.
ANS: D
With volume overload, as in heart failure and cardiomyopathy, cardiac enlargement laterally displaces the apical impulse and is palpable over a wider area when left ventricular hypertrophy and dilation are present.
