Chapter 20: Heart and Neck Vessels

Question 1

1. The sac that surrounds and protects the heart is called the:
   a. Pericardium.
   b. Myocardium.
   c. Endocardium.
   d. Pleural space.

Answer 1

A

Question 2

2. Which of these is best described as the direction of blood flow through the heart?
   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

Question 3

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 3

C

Question 4

5. 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.

Answer 4

C

Question 5

6. The component of the conduction system referred to as the pacemaker of the heart is the:
   a. Atrioventricular (AV) node.
   b. Sinoatrial (SA) node.
   c. Bundle of His.
   d. Bundle branches.

Answer 5

B

Question 6

7. Which sequence follows the electrical stimulus of the cardiac cycle?
   a. AV node -SA node - bundle of His
   b. Bundle of His - AV node - SA node
   c. SA node - AV node - bundle of His bundle branches
   d. AV node - SA node -bundle of His bundle branches

Answer 6

D

Question 7

8. 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

Question 8

11. 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 8

B

Question 9

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. “I’ll be sleeping great, and then I wake up and feel like I can’t get my breath.” The nurse’s best response to this would be:
    a. “When was your last electrocardiogram?”
    b. “It’s probably because it’s 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 9

C

Question 10

13. In assessing a patient’s 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 10

C

Question 11

15. 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 11

B

Question 12

16. 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 12

B

Question 13

17. 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 13

D

Question 14

18. 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 14

D

Question 15

20. 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 15

B

Question 16

21. 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 nurse’s 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 16

C

Question 17

22. 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 17

C

Question 18

23. 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 patient’s respirations while listening for the effect on the sound.

Answer 18

D

Question 19

28. 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 patient’s 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 19

B

Question 20

29. 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 20

C

Question 21

31. 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 21

D

Question 22

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 22

D

Question 23

33. 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 23

B

Question 24

36. During an assessment, the nurse notes that the patient’s 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 24

D

Question 25

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 25

C

Question 26

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 26

A

Question 27

1. 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 27

B,C,E,F

Question 28

1. When assessing a patient’s cardiovascular system, the nurse notes a high pitched scratchy sound at the apex of the heart. The nurse recognizes this as rubbing between the two walls of the sac surrounding and protecting the heart, called the:
   a. Pericardium
   b. Myocardium
   c. Endocardium
   d. Pleural space

Answer 28

A