Heart & Neck vessels ch.19 ?s

Question 1

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

a. pericardium
b. myocardium
c. endocardium
d. pleural space

Answer 1

a. 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 anatomy and physiology 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. The contraction of the atria at the beginning of diastole can be felt as a palpitation.
c. This 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 that 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

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 5

C) The tricuspid valve closes slightly later than the mitral valve.

Question 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 6

B) sinoatrial (SA) node.

Question 7

The electrical stimulus of the cardiac cycle follows which sequence?
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 7

D) AV node SA node bundle of His bundle branches

Question 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 8

D) elevated pressure related to heart failure.

Question 9

In assessing a 70-year-old man, the nurse finds the following: blood pressure 140/100 mm Hg; heart rate 104 and slightly irregular; split S2. 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 9

B) Increase in systolic blood pressure

Question 10

A 45-year-old man is in the clinic for a routine physical. During the history the patient states he’s 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 10

C) “Do you have any history of problems with your heart?”

Question 11

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, age
B) Personality type, high cholesterol, diabetes, smoking
C) Smoking, hypertension, obesity, diabetes, high cholesterol
D) Alcohol consumption, obesity, diabetes, stress, high cholesterol

Answer 11

C) Smoking, hypertension, obesity, diabetes, high cholesterol

Question 12

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) palpate both arteries simultaneously to compare amplitude.
D) instruct patient to take slow deep breaths during auscultation.

Answer 12

B) listen with the bell of the stethoscope to assess for bruits.

Question 13

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) a valvular disorder.
B) blood flow turbulence.
C) fluid volume overload.
D) ventricular hypertrophy

Answer 13

B) blood flow turbulence.

Question 14

During 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) a normal heart.
B) a systolic murmur.
C) enlargement of the left ventricle.
D) enlargement of the right ventricle

Answer 14

D) enlargement of the right ventricle

Question 15

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 15

D) Fifth left intercostal space at the midclavicular line

Question 16

The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true?
A) Percussion is a useful tool for outlining the heart’s borders.
B) Percussion is easier in obese patients.
C) Studies show that percussed cardiac borders do not correlate well with the true cardiac border.
D) Only expert health care providers should attempt percussion of the heart

Answer 16

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

Question 17

The nurse is preparing to auscultate for heart sounds. Which technique is correct?
A) Listen to the sounds at the aortic, tricuspid, pulmonic, and mitral areas.
B) Listen by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex.
C) Listen to the sounds only at the site where the apical pulse is felt to be the strongest.
D) Listen for all possible sounds at a time at each specified area

Answer 17

B) Listen by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex.

Question 18

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 this is normal.
D) Refer the patient to a cardiologist for further testing

Answer 18

C) No further response is needed because this is normal.

Question 19

When listening to heart sounds, the nurse knows that S1:
A) is louder than S2 at the base of the heart.
B) indicates the beginning of diastole.
C) coincides with the carotid artery pulse.
D) is caused by closure of the semilunar valves

Answer 19

C) coincides with the carotid artery pulse.

Question 20

During the cardiac auscultation the nurse hears a sound occurring immediately after 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.
B) Ask the patient to hold his breath while the nurse listens again.
C) No further assessment is needed because the nurse knows it is an S3.
D) Watch the patient’s respirations while listening for effect on the sound.

Answer 20

D) Watch the patient’s respirations while listening for effect on the sound.

Question 21

While auscultating heart sounds on a 7-year-old child for a routine physical, the nurse hears an S3, a soft murmur at left midsternal border, and a venous hum when the child is standing. Which of these would be a correct interpretation of these findings?
A) S3 is indicative of heart disease in children.
B) These can all be normal findings in a child.
C) These are indicative of congenital problems.
D) The venous hum most likely indicates an aneurysm.

Answer 21

B) These can all be normal findings in a child.

Question 22

In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the:
A) bell at the base with the patient leaning forward.
B) bell at the apex with the patient in the left lateral position.
C) diaphragm in the aortic area with the patient sitting.
D) diaphragm in the pulmonic area with the patient supine.

Answer 22

B) bell at the apex with the patient in the left lateral position.

Question 23

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 S1. The sound is heard only with the bell 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 23

B) atrial gallop.

Question 24

The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her myocardial infarction. 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 myocardial infarction.
C) inflammation of the precordium.
D) ventricular hypertrophy resulting from muscle damage.

Answer 24

C) inflammation of the precordium.

Question 25

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 S1. These findings would be most consistent with:
A) heart failure.
B) aortic stenosis.
C) pulmonary edema.
D) mitral regurgitation

Answer 25

D) mitral regurgitation

Question 26

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 sternal angle when he is elevated at 45 degrees, blood pressure 98/60 mm Hg, heart rate 130 beats per minute, ankle edema, difficulty in 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) Myocardial infarction
D) Heart failure

Answer 26

D) Heart failure

Question 27

The nurse knows that normal splitting of the second heart sound is associated with:
A) expiration.
B) inspiration.
C) exercise state.
D) low resting heart rate

Answer 27

B) inspiration.

Question 28

During a cardiovascular assessment, the nurse knows that a “thrill” is:
A) a vibration that is palpable.
B) palpated in the right epigastric area.
C) associated with ventricular hypertrophy.
D) a murmur auscultated at the third intercostal space

Answer 28

A) a vibration that is palpable.

Question 29

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 elderly.
C) heard at the end of ventricular diastole.
D) heard best over the second left intercostal space with the individual sitting upright.

Answer 29

C) heard at the end of ventricular diastole.

Question 30

The nurse is assessing a patient’s apical impulse. Which of these statements is true regarding the apical impulse?
A) It is palpable in all adults.
B) It occurs with the onset of diastole.
C) Its location may be indicative of heart size.
D) It should normally be palpable in the anterior axillary line

Answer 30

C) Its location may be indicative of heart size.

Question 31

During an assessment, the nurse notes that the patient’s apical impulse is displaced laterally, and it is palpable over a wide area. This indicates:
A) systemic hypertension.
B) pulmonic hypertension.
C) pressure overload, as in aortic stenosis.
D) volume overload, as in mitral regurgitation.

Answer 31

D) volume overload, as in mitral regurgitation.

Question 32

When the nurse is auscultating the carotid artery for bruits, which of these statements reflects correct technique?
A) While listening with the bell of the stethoscope, have the patient take a deep breath and hold it.
B) While auscultating one side with the bell of the stethoscope, palpate the carotid artery on the other side to check pulsations.
C) Lightly apply the bell of the stethoscope over the carotid artery, and while listening, have the patient take a breath, exhale, and hold it briefly.
D) Firmly place the bell of the stethoscope over the carotid artery, and while listening, have the patient take a breath, exhale, and hold it briefly

Answer 32

C) Lightly apply the bell of the stethoscope over the carotid artery, and while listening, have the patient take a breath, exhale, and hold it briefly.

Question 33

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) African-Americans
B) Whites
C) American Indians
D) Hispanics

Answer 33

A) African-Americans

Question 34

The nurse is assessing a patient with possible cardiomyopathy and assesses the hepatojugular reflux. If heart failure is present, then the nurse should see which finding while pushing on the right upper quadrant of the patient’s 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 working properly.
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 34

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