Heart & Neck Part 2

Question 1

Normal jugular venous pulsation is________. (Also state the person’s position, for example, “internal jugular vein pulsations 3 cm above sternal angle when elevated 30 degrees.”)

Answer 1

2 cm or less above the sternal angle

Question 2

Elevated pressure is a level of pulsation that is more than 3 cm above the sternal angle while at 45 degrees. This occurs with _____________.

Answer 2

heart failure

Question 3

If venous pressure is elevated or if you suspect heart failure, perform __________. (Position: ____)

Answer 3

hepatojugular reflux supine

Question 4

If heart failure is present, the jugular veins will ________________. (in hepatojugular reflux)

Answer 4

elevate and stay elevated as long as you push

Question 5

If the heart is able to pump this additional volume (i.e., if no elevated CVP is present), the jugular veins will ______________.

Answer 5

rise for a few seconds and then recede back to the previous level.

Question 6

(Inspecting Anterior Chest w/ light): A heave or lift is a sustained forceful thrusting of the ventricle during systole. It occurs with ________ as a result of increased workload.

Answer 6

ventricular hypertrophy *A right ventricular heave is seen at the sternal border; a left ventricular heave is seen at the apex

Question 7

_______ the pulsation created as the left ventricle rotates against the chest wall during systol

Answer 7

apical impulse

Question 8

Norms of the apical impulse

Answer 8

•Location—The apical impulse should occupy only one interspace, the fourth or fifth, and be at or medial to the midclavicular line •Size—Normally 1 × 2 cm •Amplitude—Normally a short, gentle tap •Duration—Short, normally occupies only first half of systole

Question 9

(When palpating across the precordium abnormal:) A _______ is a palpable vibration. It feels like the throat of a purring cat. This signifies turbulent blood flow and accompanies loud murmurs. -Absence of this, however, does not necessarily rule out the presence of a murmur.

Answer 9

thrill

Question 10

Cardiac enlargement is due to ______________; it occurs with hypertension, CAD, heart failure, and cardiomyopathy.

Answer 10

increased ventricular volume or wall thickness

Question 11

(When ausculating:) Begin with the diaphragm endpiece and use the following routine over each valve:

Answer 11

(1) note the rate and rhythm, (2) identify S1 and S2(3) assess S1 and S2 separately, (4) listen for extra heart sounds, and (5) listen for murmurs.

Question 12

With ________, the rhythm varies with the person’s breathing, increasing at the peak of inspiration and slowing with expiration

Answer 12

sinus arrhythmia

Question 13

When you notice any irregularity, check for a _______ by auscultating the apical beat while simultaneously palpating the radial pulse. **(Norm. the two counts should be identical)

Answer 13

pulse deficit

Question 14

A pulse deficit signals a _______________; it occurs with atrial fibrillation, premature beats, and heart failure.

Answer 14

weak contraction of the ventricles

Question 15

characteristics of S1 when auscultating

Answer 15

-S1 is louder than S2 at the apex -S1 coincides with the carotid artery pulse. -S1 coincides with the R wave (the upstroke of the QRS complex) if the person is on an ECG monitor.

Question 16

A ______ is a normal phenomenon that occurs toward the end of inspiration in some people

Answer 16

split s2

Question 17

(split S2 abnorms) -A ________ is the opposite of what you would expect; the sounds fuse on inspiration and split on expiration -A ______ is unaffected by respiration; the split is always there

Answer 17

paradoxical split fixed split

Question 18

A A pathologic S3 (ventricular gallop) occurs with _______; a pathologic S4 (atrial gallop) occurs with _______

Answer 18

heart failure and volume overload CAD

Question 19

a _______ murmur always indicates heart disease.

Answer 19

diastolic

Question 20

Heart Attack: Women: Symptoms

Answer 20

More likely to feel a hot or cold burning sensation or a tenderness to touch in their back, shoulders, arms, or jaw—not sharp pain. Women’s symptoms often include nausea, vomiting, indigestion, and shortness of breath, which are easy to attribute to something other than the heart.

Question 21

Decreased cardiac output occurs when _________, and the circulation becomes backed up and congested.

Answer 21

the heart fails as a pump

Question 22

Signs and symptoms of heart failure come from two basic mechanisms:

Answer 22

(1) the heart’s inability to pump enough blood to meet the metabolic demands of the body; and (2) the kidney’s compensatory mechanisms of abnormal retention of sodium and water to compensate for the decreased cardiac output. This increases blood volume and venous return, which causes further congestion.

Question 23

Onset of heart failure may be:

Answer 23

(1) acute, as following a myocardial infarction when direct damage to the heart’s contracting ability has occurred; or (2) chronic, as with hypertension, when the ventricles must pump against chronically increased pressure.

Question 24

This sound is high pitched and scratchy, like sandpaper being rubbed. ________

Answer 24

Inflammation of the pericardium gives rise to a friction rub.