CH 20 Heart and Neck Vessels

Question 1

The sac that surrounds and protects the heart is called the:

Pericardium.
Myocardium.
Endocardium.
Pleural space.

Answer 1

Pericardium

Question 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

b) Right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle

Question 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

d. The atria contract toward the end of diastole and push the remaining blood into the ventricles.

Question 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

c. Aortic and pulmonic.

Question 5

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.

The aortic valve closes slightly before the tricuspid valve.

The pulmonic valve closes slightly before the aortic valve.

The tricuspid valve closes slightly later than the mitral valve.

Both the tricuspid and pulmonic valves close at the same time

Answer 5

The tricuspid valve closes slightly later than the mitral valve.

Question 5

The component of the conduction system referred to as the pacemaker of the heart is the:

Atrioventricular (AV) node.
Sinoatrial (SA) node.
Bundle of His.
Bundle branches.

Answer 5

Sinoatrial (SA) node.

Question 6

The electrical stimulus of the cardiac cycle follows which sequence?

AV node SA node bundle of His

Bundle of His AV node SA node

SA node AV node bundle of His bundle branches

AV node SA node bundle of His bundle branches

Answer 6

AV node SA node bundle of His bundle branches

Question 7

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 7

D. elevated pressure related to heart failure

Question 8

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 8

c. Blood can flow into the left side of the heart through an opening in the atrial septum.

Question 9

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 9

a. This decline in blood pressure is the result of peripheral vasodilatation and is an expected change.

Question 10

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 10

b. Increase in systolic blood pressure

Question 11

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. 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?

Answer 11

c. Do you have any history of problems with your heart?

Question 12

13. In assessing a patients 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 12

c. Smoking, hypertension, obesity, diabetes, and high cholesterol

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. Infants sleeping position
b. Sibling history of eating disorders
c. Amount of background noise when eating
d. Presence of dyspnea or diaphoresis when sucking

Answer 13

d. Presence of dyspnea or diaphoresis when sucking

Question 14

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 14

b. Listen with the bell of the stethoscope to assess for bruits.

Question 15

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 15

b. Blood flow turbulence.

Question 16

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 16

d. Enlargement of the right ventricle.

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

Answer 17

d. Fifth left intercostal space at the midclavicular line

Question 18

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

Percussion is a useful tool for outlining the hearts borders.
Percussion is easier in patients who are obese.
Studies show that percussed cardiac borders do not correlate well with the true cardiac border.

Only expert health care providers should attempt percussion of the heart.

Answer 18

Studies show that percussed cardiac borders do not correlate well with the true cardiac border.

Question 19

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 19

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

Question 20

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 nurses 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 20

c. No further response is needed because sinus arrhythmia can occur normally.

Question 21

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 21

c. Coincides with the carotid artery pulse.

Question 22

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.

Answer 22

d. Watch the patients respirations while listening for the effect on the sound.

Question 23

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 23

c. Murmur at the second left intercostal space when supine

Question 24

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 24

b. These findings can all be normal in a child.

Question 25

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 25

c. Displacement of the heart from elevation of the diaphragm.

Question 26

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 26

b. Bell of the stethoscope at the apex with the patient in the left lateral position.

Question 27

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 patients 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 27

b. Atrial gallop.

Question 28

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 28

c. Inflammation of the precordium.

Question 29

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. V entricular septal defect

Answer 29

a. Tetralogy of Fallot

Question 30

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 30

d. Mitral regurgitation.

Question 31

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 31

d. Heart failure

Question 32

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 32

b. Inspiration.

Question 33

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 33

a. Vibration that is palpable.

Question 34

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 34

c. Heard at the end of ventricular diastole.

Question 35

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.

Answer 35

d. Volume overload, as in heart failure.

Question 36

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 36

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.

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. American Indians
d. Hispanics

Answer 37

a. Blacks

Question 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

a. Blacks

Question 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 patients 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

b. The jugular veins will remain elevated as long as pressure on the abdomen is maintained.

Question 40

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 40

b. Abnormal lipids
c. Smoking
e. Hypertension
f. Diabetes