Heart and neck Flashcards
• This is made up of the heart and blood vessels.
THE CARDIOVASCULAR SYSTEM
• The main functions of this system are delivering oxygen and nutrients to the cells of the body, removing waste products, and maintaining perfusion to the organs and tissues.
THE CARDIOVASCULAR SYSTEM
The heart is a _______ muscular organ a little larger organa than the patient’s fist.
hollow
It lies in the pericardial cavity in the mediastinum under the sternum and between 2nd and 5th intercostal spaces. About 2/3 of the heart lies to the left of the midline of the sternum.
location of heart and great vessels
The area of the exterior chest that overlays the heart and great vessels is called the?
precordium
The right ventricle narrows as it rises to meet the pulmonary artery just below the sternal angle. This is called the ___________ and is located at the right and left 2nd intercostal spaces next to the sternum.
“base of the heart”
• Its tapered inferior tip is often termed the cardiac “________.” It is clinically important because it produces the apical impulse
apex
• Sounds and murmurs arising from the mitral valve are usually heard best at and around the?
cardiac apex.
- The sound produced by the closure of the semilunar valves is known as:
A. S1
B. S2
C. S3
D. S4
B. S2
S2 is the heart sound produced by the closure of the semilunar valves (aortic and pulmonic valves) at the end of systole, marking the beginning of diastole.
Section 1: Assessing the Heart and neck
- Which heart sound marks the beginning of systole?
A. S1
B. S2
C. S3
D. S4
S1
kasi S1 yung nag mamark as beginning of systole.
- Atrial fibrillation is best identified by which of the following on auscultation of the neck?
A. Regular rhythm
B. Irregularly irregular rhythm
C. Presence of a thrill
D. Systolic murmur
B. Irregularly irregular rhythm
Atrial fibrillation is characterized by an irregularly irregular rhythm, meaning there is no predictable pattern to the heartbeats, and it is often detected on auscultation of the neck, particularly when listening to the carotid pulse.
When palpating the carotid artery, which of the following is most important?
A. Checking for bruits
B. Assessing skin temperature
C. Measuring blood pressure
D. Observing color changes
A. Checking for bruits
When palpating the carotid artery, it is most important to check for bruits. A bruit is an abnormal sound that can indicate turbulent blood flow, often due to narrowing or plaque buildup in the carotid artery, which may suggest an increased risk of stroke.
- An S4 heart sound is most often associated with:
A. Mitral valve prolapse
B. A stiff or noncompliant ventricle
C. Normal heart function
D. Ventricular septal defect
B. A stiff or noncompliant ventricle
An S4 heart sound, also known as an “atrial gallop,” is most often associated with a stiff or noncompliant ventricle, which occurs in conditions like hypertensive heart disease, aortic stenosis, or ischemic heart disease. It occurs just before S1, when the atria contract to fill the ventricle.
When assessing the jugular venous pulse, an elevated JVP may indicate:
A. Hypovolemia
B. Right-sided heart failure
C. Atrial fibrillation
D. Left ventricular hypertrophy
B. Right-sided heart failure
An elevated jugular venous pressure (JVP) is often a sign of right-sided heart failure. It indicates increased pressure in the right atrium, which leads to venous congestion, and the jugular veins reflect this increase in pressure.
Which of the following best describes the “thrill” in the neck?
A. A palpable murmur indicating turbulent flow
B. A sign of bradycardia
C. A normal finding in young adults
D. A vibration from heart valve closure
A. A palpable murmur indicating turbulent flow
A “thrill” is a palpable vibration that can be felt over the carotid artery or neck when there is turbulent blood flow, often due to a heart murmur or stenosis of the valves or vessels. It indicates significant blood flow disturbance.
- In a patient with suspected carotid artery stenosis, the nurse should:
A. Auscultate for bruits
B. Check the pulse rate only
C. Assess the peripheral pulses in the legs
D. Measure blood glucose levels
A. Auscultate for bruits
In a patient with suspected carotid artery stenosis, auscultation for bruits is essential. A bruit is an abnormal sound caused by turbulent blood flow through a narrowed artery, and it can be heard over the carotid artery. This is a key sign of stenosis.
- Which of the following is a proper technique for auscultating heart sounds?
A. Placing the stethoscope over clothing
B. Using the diaphragm for high-pitched sounds
C. Using the bell for high-pitched sounds
D. Asking the patient to hold their breath
B. Using the diaphragm for high-pitched sounds
When auscultating heart sounds, the diaphragm of the stethoscope is best for high-pitched sounds, such as S1, S2, and murmurs of the aortic and mitral valves. The bell is used for lower-pitched sounds, such as S3 and S4. It’s also important to have the patient breathe normally during the exam, not holding their breath, to avoid interfering with heart sounds.
- When assessing the carotid artery, the nurse should avoid which of the following actions?
A. Palpating gently
B. Bilateral simultaneous compression
C. Observing for pulsations
D. Comparing both sides
B. Bilateral simultaneous compression
When assessing the carotid artery, the nurse should avoid compressing both carotid arteries simultaneously, as this can reduce blood flow to the brain and potentially cause dizziness, fainting, or even a stroke. It is important to palpate each carotid artery separately.
- A heart murmur heard best at the left lower sternal border is most likely associated with:
A. Mitral regurgitation
B. Aortic stenosis
C. Ventricular septal defect
D. Tricuspid regurgitation
D. Tricuspid regurgitation
Explanation:
A heart murmur heard best at the left lower sternal border typically points to a problem involving the tricuspid valve or the right side of the heart. Tricuspid regurgitation occurs when the tricuspid valve fails to close properly, allowing blood to flow backward into the right atrium during systole. This murmur is best heard along the left lower sternal border, often increasing with inspiration (Carvallo’s sign).
- The point of maximal impulse (PMI) is normally located in which area?
A. Right midclavicular line, 2nd intercostal space
B. Left midclavicular line, 5th intercostal space
C. Left sternal border, 3rd intercostal space
D. Right sternal border, 4th intercostal space
B. Left midclavicular line, 5th intercostal space
Explanation:
The point of maximal impulse (PMI) is the location where the heart’s apex beat is most strongly felt or seen. In a healthy adult, it is normally located at the 5th intercostal space, at or just medial to the left midclavicular line. This corresponds to the location of the apex of the heart.
- A displaced PMI may suggest which of the following conditions?
A. Cardiac tamponade
B. Left ventricular hypertrophy
C. Atrial septal defect
D. Pericarditis
B. Left ventricular hypertrophy**
Explanation:
A displaced PMI, typically shifted laterally and/or downward, often indicates enlargement of the left ventricle, which is seen in left ventricular hypertrophy (LVH). This can result from conditions like hypertension or aortic stenosis, where the heart has to work harder to pump blood, leading to muscle thickening and enlargement.
- When assessing the heart, which position is most appropriate for auscultation?
A. Prone
B. Supine
C. Semi-Fowler’s
D. Trendelenburg
B. Supine
Explanation:
The supine position (lying flat on the back) is the standard and most appropriate position for auscultating the heart. It allows for optimal access to all valve areas (aortic, pulmonic, tricuspid, and mitral). In some cases, other positions (like left lateral decubitus for mitral murmurs) may be used to enhance specific sounds, but supine is the general starting position for a cardiac exam.
