Chapter 15: Heart Flashcards
Mr. O, age 50 years, comes for his annual health assessment, which is provided by his
employer. During your initial history-taking interview, Mr. O mentions that he routinely
engages in light exercise. At this time, you should
a. ask if he makes his own bed daily.
b. have the patient describe his exercise.
c. make a note that he walks each day.
d. record ―light exercise‖ in the history.
ANS: B
When Mr. O says that he engages in light exercise, have him describe his exercise. To qualify
his use of the term light, ask him the type, length of time, frequency, and intensity of his
activities
Which of the following information belongs in the past medical history section related to heart
and blood vessel assessment?
a. Adolescent inguinal hernia
b. Childhood mumps
c. History of bee stings
d. Previous unexplained fever
ANS: D
Previous unexplained fever should be included in the past medical history of a heart and blood
vessel assessment. This incidence may be related to acute rheumatic fever, with potential heart
valve damage.
A patient you are seeing in the emergency department for chest pain is believed to be having a
myocardial infarction. During the health history interview of his family history, he relates that
his father had died of ―heart trouble.‖ The most important follow-up question you should pose
is which of the following?
a. ―Did your father have coronary bypass surgery?‖
b. ―Did your father’s father have heart trouble also?‖
c. ―What were your father’s usual dietary habits?‖
d. ―What age was your father at the time of his death?‖
ANS: D
A family history of sudden death, particularly in young and middle-aged relatives,
significantly increases one’s chance of a similar occurrence.
Which one of the following is a common symptom of cardiovascular disorders in the older
adult?
a. Fatigue
b. Joint pain
c. Poor night vision
d. Weight gain
ANS: A
Common symptoms of cardiovascular disorders in older adults include confusion, dizziness,
blackouts, syncope, palpitations, coughs and wheezes, hemoptysis, shortness of breath, chest
pains or tightness, impotence, fatigue, and leg edema.
In the adult, the apical impulse should be most visible when the patient is in what position?
a. Supine
b. Upright
c. Lithotomy
d. Right lateral recumbent
ANS: B
In most adults, the apical impulse should be visible at about the midclavicular line in the fifth
left intercostal space, but it is easily obscured by obesity, large breasts, or muscularity. The
apical impulse may become visible only when the patient sits upright and the heart is brought
closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests
an intensity that may be the result of a problem. In most adults, the apical impulse will not be
visible in the upright, lithotomy, or right lateral recumbent positions.
If the apical impulse is more vigorous than expected, it is called a
a. lift.
b. thrill.
c. bruit.
d. murmur.
ANS: A
If the apical impulse is more vigorous than expected, it is referred to as a lift or heave. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated
sound caused by turbulent blood flow into, through, or out of the heart.
A palpable rushing vibration over the base of the heart at the second intercostal space is called
a
a. heave.
b. lift.
c. thrill.
d. thrust.
ANS: C
A thrill is a fine, palpable, rushing vibration—a palpable murmur. Cardiac thrills generally
indicate a disruption of the expected blood flow related to some defect in the closure of one of
the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial
septal defect. A heave or lift is a more vigorous apical impulse. A lift is another term for a
heave, which is a more vigorous apical impulse. A thrust is sudden, forcible forward
movement.
An apical PMI palpated beyond the fifth intercostal space may indicate
a. decreased cardiac output.
b. obesity.
c. left ventricular hypertrophy.
d. hyperventilation.
ANS: C
An apical impulse that is more forceful and widely distributed, fills systole, or is displaced
laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large
breasts, and muscularity can obscure the visibility of the apical impulse.
A lift along the left sternal border is most likely the result of
a. aortic stenosis.
b. atrial septal defect.
c. pulmonary hypertension.
d. right ventricular hypertrophy.
ANS: D
A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill
indicates a disruption of the expected blood flow related to a defect in the closure of one of
the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or
atrial septal defect.
To estimate heart size by percussion, you should begin tapping at the
a. anterior axillary line.
b. left sternal border.
c. midclavicular line.
d. midsternal line.
ANS: A
Estimating the size of the heart can be done by percussion. Begin tapping at the anterior
axillary line, moving medially along the intercostal spaces toward the sternal border. The
change from a resonant to a dull note marks the cardiac border.
To hear diastolic heart sounds, you should ask patients to
a. lie on their back.
b. lie on their left side.
c. lie on their right side.
d. sit up and lean forward.
ANS: B
Left lateral recumbent is the best position to hear the low-pitched filling sounds in diastole
with the bell of the stethoscope. Sitting up and leaning forward is the best position in which to
hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral
recumbent position is the best position for evaluating the right rotated heart of dextrocardia.
You are listening to a patient’s heart sounds in the aortic and pulmonic areas. The sound
becomes asynchronous during inspiration. The prevalent heart sound in this area is most likely
a. S1.
b. S2.
c. S3.
d. S4.
ANS: B
S2 marks the closure of the semilunar valves, which indicates the end of systole; it is best
heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically
splits during inspiration.
Chest pain with an organic cause in a child is most likely the result of
a. cardiac disease.
b. asthma.
c. esophageal reflux.
d. arthritis
ANS: B
Unlike chest pain in adults, chest pain in children and adolescents is seldom caused by a cardiac problem. More likely, the case is related to trauma, exercise-induced asthma, or
cocaine use
A condition that is likely to present with dizziness and syncope is
a. bacterial endocarditis.
b. hypertension.
c. sick sinus syndrome.
d. pericarditis.
ANS: C
Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension,
arteriosclerotic heart disease, or rheumatic heart disease. SSS causes dysrhythmia with
subsequent syncope, transient dizzy spells, light-headedness, seizures, palpitations, angina, or
congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of
neurologic dysfunction, and sudden onset of CHF. Chest pain is an initial symptom in acute
pericarditis, along with a triphasic friction rub.
Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the
palms. These findings are consistent with the development of
a. rheumatic fever.
b. cor pulmonale.
c. pericarditis.
d. endocarditis.
ANS: D
Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected
with at-risk patients (e.g., IV drug abusers) who present with fever and sudden onset of
congestive heart symptoms. The lesions described are Janeway lesions
