Chapter 12: Cardiovascular Clinical Assessment Flashcards
Which condition is usually associated with clubbing?
a. Central cyanosis
b. Peripheral cyanosis
c. Carbon monoxide poisoning
d. Acute hypoxemia
ANS: A
Clubbing in the nail bed is a sign associated with longstanding central cyanotic heart disease or pulmonary disease with hypoxemia. Peripheral cyanosis, a bluish discoloration of the
nail bed, is seen more commonly. Peripheral cyanosis results from a reduction in the quantity of oxygen in the peripheral extremities from arterial disease or decreased cardiac
output. Central cyanosis is a bluish discoloration of the tongue and sublingual area. Multiracial studies indicate that the tongue is the most sensitive site for observation of
central cyanosis.
The abdominojugular reflux test determines the presence of which disorder?
a. Right ventricular failure
b. Cirrhosis
c. Liver failure
d. Coronary artery disease
ANS: A
The abdominojugular reflux sign can assist with the diagnosis of right ventricular failure. A positive abdominojugular reflux sign is an increase in the jugular venous pressure (CVP equivalent) of greater than 3 cm sustained for at least 15 seconds.
Which statement best describes the purpose of the Allen test?
a. The Allen test assesses the adequacy of blood flow through the ulnar artery.
b. The Allen test evaluates oxygen saturation in the brachial artery.
c. The Allen test assesses the patency of an internal graft.
d. The Allen test determines the size of needle to be used for puncture.
ANS: A
The Allen test assesses the adequacy of blood flow to the hand through the ulnar artery.
Evaluation of arterial circulation to an extremity is accomplished by assessing which of the following?
a. Homan’s sign
b. Skin turgor
c. Peripheral edema
d. Capillary refill
ANS: D
Capillary refill assessment is a maneuver that uses the patient’s nail beds to evaluate both arterial circulation to the extremity and overall perfusion. The severity of arterial insufficiency is directly proportional to the amount of time necessary to reestablish flow and
color.
When checking the patient’s back, the nurse pushes her thumb into the patient’s sacrum. An indentation remains. What assessment finding should the nurse document?
a. Sacral compromise
b. Delayed skin turgor
c. Pitting edema
d. Dehydration
ANS: C
Pitting edema occurs when an impression is left in the tissue when the thumb is removed. The dependent tissues within the legs and sacrum are particularly susceptible. Edema may be dependent, unilateral, or bilateral and pitting or nonpitting.
An assessment finding of pulsus alternans may indicate evidence of what disorder?
a. Left-sided heart failure
b. Jugular venous distention
c. Pulmonary embolism
d. Myocardial ischemia
ANS: A
Pulsus alternans describes a regular pattern of pulse amplitude changes that alternate between stronger and weaker beats. This finding is suggestive of end-stage left ventricular heart failure.
The presence of a carotid or femoral bruit may be evidence of what anomaly?
a. Left-sided heart failure
b. Blood flow through a partially occluded vessel
c. Early onset of pulmonary embolism
d. Myocardial rupture
ANS: B
A bruit is an extracardiac vascular sound that results from blood flow through a tortuous or partially occluded vessel.
A patient is admitted with a diagnosis of “rule out myocardial infarction.” The patient reports midchest pressure radiating into the jaw and shortness of breath when walking up stairs. When inspecting the patient, the nurse notes that the patient needs to sit in a high Fowler position to breathe. The nurse suspects the patient may be experiencing what problem?
a. Pericarditis
b. Anxiety
c. Heart failure
d. Angina
ANS: C
Sitting upright to breathe may be necessary for the patient with acute heart failure, and leaning forward may be the least painful position for a patient with pericarditis.
A patient is admitted with a diagnosis of “rule out myocardial infarction.” The patient reports midchest pressure radiating into the jaw and shortness of breath when walking up stairs. What factor influences the amount of history obtained during the admission assessment?
a. Presence of cardiovascular risk factors
b. Prior medical history
c. Presenting symptoms
d. Current medications
ANS: C
For a patient in acute distress, the history taking is shortened to just a few questions about the patient’s chief complaint, precipitating events, and current medications. For a patient who is not in obvious distress, the history focuses on the following four areas: review of the patient’s present illness; overview of the patient’s general cardiovascular status; review of the patient’s general health status, including family history of coronary artery disease (CAD), hypertension, diabetes, peripheral arterial disease, or stroke; and survey of the patient’s lifestyle, including risk factors for CAD.
A patient is admitted with left-sided heart failure related to mitral stenosis. Physical assessment findings reveal tachycardia with an S3 and a 3/6 systolic murmur. Which
statement about an S3 is accurate?
a. It is normal for a person this age.
b. It is synonymous with a ventricular gallop.
c. It is only heard during systole.
d. It is best heard best with the diaphragm of the stethoscope.
ANS: B
The abnormal heart sounds are labeled the third heart sound (S3) and the fourth heart sound (S4) and are referred to as gallops when auscultated during an episode of tachycardia. Not unexpectedly, the development of an S3 heart sound is strongly associated with elevated
levels of brain natriuretic peptide
A patient is admitted with left-sided heart failure related to mitral stenosis. Physical assessment findings reveal tachycardia with an S3 and a 3/6 systolic murmur. The grading of a murmur as a 3/6 refers to which characteristics of the murmur?
a. Intensity
b. Quality
c. Timing
d. Pitch
ANS: A
Intensity, or the “loudness,” is graded on a scale of 1 to 6; the higher the number, the louder the murmur.
An 82-year-old patient is admitted into the critical care unit with a diagnosis of left-sided heart failure related to mitral stenosis. Physical assessment findings reveal tachycardia with an S3 and a 3/6 systolic murmur. Which of the following descriptions best describes the murmur heard with mitral stenosis?
a. High-pitched systolic sound
b. Medium-pitched systolic sound
c. High-pitched diastolic sound
d. Low-pitched diastolic sound
ANS: D
Mitral stenosis describes a narrowing of the mitral valve orifice. This produces a low-pitched murmur, which varies in intensity and harshness depending on the degree of valvular stenosis. It occurs during diastole, is auscultated at the mitral area (fifth ICS, midclavicular line), and does not radiate.
What sounds are created by the turbulence of blood flow through a vessel caused by constriction of the blood pressure cuff?
a. Korotkoff sounds
b. Grating murmurs
c. Blowing murmurs
d. Gallops
ANS: A
Korotkoff sounds are the sounds created by turbulence of blood flow within a vessel caused by constriction of the blood pressure cuff. Abnormal heart sounds are known as the third
heart sound (S3) and the fourth heart sound (S4); they are referred to as gallops when auscultated during an episode of tachycardia. Murmurs are produced by turbulent blood flow through the chambers of the heart, from forward flow through narrowed or irregular valve openings, or backward regurgitate flow through an incompetent valve.
Abnormal heart sounds are labeled S3 and S4 and are referred to as what when auscultated
during a tachycardic episode?
a. Korotkoff sounds
b. Grating murmurs
c. Blowing murmurs
d. Gallops
ANS: D
Abnormal heart sounds are known as the third heart sound (S3) and the fourth heart sound (S4); they are referred to as gallops when auscultated during an episode of tachycardia. Murmurs are produced by turbulent flood flow through the chambers of the heart, from forward flow through narrowed or irregular valve openings, or backward regurgitate flow through an incompetent valve. Korotkoff sounds are the sounds created by turbulence of blood flow within a vessel caused by constriction of the blood pressure cuff. Pulse pressure describes the difference between systolic and diastolic values. A normal pulse pressure is 40 mm Hg.
A heart murmur is described as blowing, grating, or harsh. This description would fall under which criteria?
a. Intensity
b. Quality
c. Timing
d. Pitch
ANS: B
Quality is whether the murmur is blowing, grating, or harsh. Intensity is the loudness graded on a scale of 1 through 6; the higher the number, the louder is the murmur. Timing is the place in the cardiac cycle (systole/diastole). Pitch is whether the tone is high or low.
The nurse assesses the dorsalis pedis and posterior tibial pulses as weak and thready. What should the nurse document for the pulse volume?
a. 0
b. 1+
c. 2+
d. 3+
ANS: B
Pulse volumes are 0, not palpable; 1+, faintly palpable (weak and thready); 2+, palpable (normal pulse); and 3+, bounding (hyperdynamic pulse).
A nurse palpates the descending aorta and feels a strong, bounding pulse. The nurse reports the findings to the physician because this result is suggestive of what disorder?
a. Decreased cardiac output
b. Increased cardiac output
c. An aneurysm
d. Aortic insufficiency
ANS: C
When the patient is in the supine position, the abdominal aortic pulsation is located in the epigastric area and can be felt as a forward movement when firm fingertip pressure is applied above the umbilicus. An abnormally strong or bounding pulse suggests the presence of an aneurysm or an occlusion distal to the examination site. If it is prominent or diffuse,
the pulsation may indicate an abdominal aneurysm. A diminished or absent pulse may indicate low cardiac output (CO), arterial stenosis, or occlusion proximal to the site of the examination.
A nurse admits a patient with a diagnosis of syncope of unknown etiology. Orthostatic vital signs are lying: 110/80 mm Hg; sitting: 100/74 mm Hg; standing: 92/40 mm Hg. Based on this information, what should the nurse monitor?
a. Respirations
b. Fluid intake
c. Peripheral pulses
d. Activity
ANS: D
Postural (orthostatic) hypotension occurs when the systolic blood pressure drops by 10 to 20
mm Hg or the diastolic blood pressure drops by 5 mm Hg after a change from the supine posture to the upright posture. This is usually accompanied by dizziness, lightheadedness, or syncope. If a patient experiences these symptoms, it is important to complete a full set of postural vital signs before increasing the patient’s activity level.
A patient’s blood pressure is 90/72 mm Hg. What is the patient’s pulse pressure?
a. 40 mm Hg
b. 25 mm Hg
c. 18 mm Hg
d. 12 mm Hg
ANS: C
Pulse pressure describes the difference between systolic and diastolic values. The normal pulse pressure is 40 mm Hg (i.e., the difference between an SBP of 120 mm Hg and a DBP of 80 mm Hg). A patient with a blood pressure of 90/72 mm Hg has a pulse pressure of 18 mm Hg.
A sudden increase in left atrial pressure, acute pulmonary edema, and low cardiac output, caused by the ventricle contracting during systole, are all characteristics of what condition?
a. Acute mitral regurgitation
b. Aortic insufficiency
c. Chronic mitral regurgitation
d. Pericardial friction rub
ANS: A
Acute mitral regurgitation occurs when the ventricle contracts during systole and a jet of blood is sent in a retrograde manner to the left atrium, causing a sudden increase in left atrial pressure, acute pulmonary edema, and low cardiac output (CO) and leading to cardiogenic shock. Chronic mitral regurgitation is auscultated in the mitral area and occurs during systole. It is high pitched and blowing, although the pitch and intensity vary, depending on the degree of regurgitation. As mitral regurgitation progresses, the murmur radiates more widely. Aortic insufficiency is an incompetent aortic valve. If the valve cusps do not maintain this seal, the sound of blood flowing back into the left ventricle during diastole is heard as a decrescendo, high-pitched, blowing murmur. A pericardial friction rub is a sound that can occur within 2 to 7 days after a myocardial infarction. The friction rub results from
pericardial inflammation (pericarditis). Classically, a pericardial friction rub is a grating or scratching sound that is both systolic and diastolic, corresponding to cardiac motion within the pericardial sac.
A patient was admitted 3 days ago with a myocardial infarction. The patient is complaining of increased chest pain when coughing, swallowing, and changing positions. The nurse hears a systolic scratching sound upon auscultation of the apical pulse. Based on the symptoms, the nurse suspects the patient may have developed what condition?
a. Acute mitral regurgitation
b. Aortic insufficiency
c. Chronic mitral regurgitation
d. Pericarditis
ANS: D
A pericardial friction rub is a sound that can occur within 2 to 7 days after a myocardial infarction. The friction rub results from pericardial inflammation (pericarditis). Classically, a pericardial friction rub is a grating or scratching sound that is both systolic and diastolic,
corresponding to cardiac motion within the pericardial sac. Acute mitral regurgitation occurs when the ventricle contracts during systole and a jet of blood is sent in a retrograde manner to the left atrium, causing a sudden increase in left atrial pressure, acute pulmonary edema, and low cardiac output (CO) and leading to cardiogenic shock. Chronic mitral regurgitation is auscultated in the mitral area and occurs during systole. It is high pitched and blowing, although the pitch and intensity vary, depending on the degree of regurgitation. As mitral regurgitation progresses, the murmur radiates more widely. Aortic insufficiency is an incompetent aortic valve. If the valve cusps do not maintain this seal, the sound of blood flowing back into the left ventricle during diastole is heard as a decrescendo, high-pitched, blowing murmur.
During a history examination, a patient tells the nurse, “The cardiologist says I have a leaking valve.” The nurse documents that the patient has a history of what condition?
a. Acute mitral regurgitation
b. Aortic insufficiency
c. Chronic mitral regurgitation
d. Pericarditis
ANS: B
Aortic insufficiency is an incompetent aortic valve. If the valve cusps do not maintain this seal, the sound of blood flowing back into the left ventricle during diastole is heard as a decrescendo, high-pitched, blowing murmur. A pericardial friction rub is a sound that can occur within 2 to 7 days after a myocardial infarction. The friction rub results from pericardial inflammation (pericarditis). Classically, a pericardial friction rub is a grating or scratching sound that is both systolic and diastolic, corresponding to cardiac motion within the pericardial sac. Acute mitral regurgitation occurs when the ventricle contracts during
systole and a jet of blood is sent in a retrograde manner to the left atrium, causing a sudden increase in left atrial pressure, acute pulmonary edema, and low cardiac output (CO) and leading to cardiogenic shock. Chronic mitral regurgitation is auscultated in the mitral area
and occurs during systole. It is high pitched and blowing, although the pitch and intensity vary, depending on the degree of regurgitation. As mitral regurgitation progresses, the
murmur radiates more widely.
A patient was admitted with of acute myocardial infarction. Upon auscultation, the nurse hears a harsh, holosystolic murmur along the left sternal border. The nurse notifies the physician immediately because the symptoms indicate the patient has developed what complication?
a. Papillary muscle rupture
b. Tricuspid stenosis
c. Ventricular septal rupture
d. Pericarditis
ANS: C
Ventricular septal rupture is a new opening in the septum between the two ventricles. It creates a harsh, holosystolic murmur that is loudest (by auscultation) along the left sternal border. Papillary muscle rupture is auscultation of a new, high-pitched, holosystolic, blowing murmur at the cardiac apex. Tricuspid stenosis is a quiet murmur that becomes louder with inspiration and is located in the epigastrium area. A pericardial friction rub is a sound that can occur within 2 to 7 days after a myocardial infarction. The friction rub results from pericardial inflammation (pericarditis). Classically, a pericardial friction rub is a grating or scratching sound that is both systolic and diastolic, corresponding to cardiac
motion within the pericardial sac.
Which statements describe S1, the first heart sound? (Select all that apply, one, some, or all.)
a. It is associated with closure of the mitral and tricuspid valves.
b. It is a high-pitched sound.
c. It can be heard most clearly with the diaphragm of the stethoscope.
d. The best listening point is in the aortic area.
e. The “split” sound can best be detected in the tricuspid area.
ANS: A, B, C, E
S1 is the sound associated with mitral and tricuspid valve closure and is heard most clearly in the mitral and tricuspid areas. S1 sounds are high pitched and heard best with the
diaphragm of the stethoscope.
Heart murmurs are characterized by which criteria? (Select all that apply, one, some, or all.)
a. Intensity
b. Location
c. Quality
d. Pitch
e. Pathologic cause
ANS: A, B, C, D
Murmurs are characterized by specific criteria. Timing is the place in the cardiac cycle (systole/diastole). Location is where it is auscultated on the chest wall (mitral or aortic area).
Radiation is how far the sound spreads across chest wall. Quality is whether the murmur is blowing, grating, or harsh. Pitch is whether the tone is high or low. Intensity is the loudness is graded on a scale of 1 through 6; the higher the number, the louder the murmur.
