Heart & Neck Vessels Flashcards by B -

Heart and Neck Vessels

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STRUCTURE AND FUNCTION

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The _________ system consists of the heart (a muscular pump) and the blood vessels.

cardiovascular

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The blood vessels are arranged in two continuous loops, the__________ circulation and the ______________circulation.
A) pulmonary, systemic
B)periphery. systemic

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When the heart contracts, it pumps blood simultaneously into both loops.
A)true
B)false

True

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POSITION AND SURFACE LANDMARKS

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The __________ is the area on the anterior chest directly overlying the heart and great vessels.
A)myocardium
B)percordium

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The ________ vessels are the major arteries and veins connected to the heart.
A)lung
B)great
C)heart

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The heart and great vessels are located?A)between the lungs in the middle third of the thoracic cage (mediastinum)
B)between the ribs in the middle third of the thoracic cage (mediastinum)

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The ________ extends from the 2nd to 5th intercostal space and from the right border of the sternum to the left midclavicular line.
A)lungs
B)RT ATRIUM
C)heart

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The heart is thought of like an upside down triangle in the chest cavity
A)true
B)false

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The “top” of the heart is the broader base, and the “bottom” is the apex, which points down and to the left.
A)true
B)false

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Apex of the heart points in which direction.
A)right
B)left

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The apex of the heart produces what pulse
A)apical
B)brachial
C)radial

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Of the heart’s four chambers, the right ventricle forms the greatest area of anterior cardiac surface.
A)true
B)false

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The great vessels lie bunched above the base of the heart.
A)true
B)false

True

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The superior and inferior vena cava return unoxygenated venous blood to the right side of the heart.
A)true
B)fase

True

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The pulmonary artery leaves the right ventricle, bifurcates, and carries the venous blood to the lungs. Also is the only artery that Carrys deoxygenated blood
A)true
B)false

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The pulmonary veins return the freshly oxygenated blood to the left side of the heart, and the aorta carries it out to the body. Also the only veins that carry oxygenated blood in the body
A)true
B)false

True

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The aorta ascends from the left ventricle, arches back at the level of the sternal angle, and descends behind the heart.
A)true
B)false

True

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HEART WALL, CHAMBERS, AND VALVES

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The___________ is a tough, fibrous, double-walled sac that surrounds and protects the heart. It has two layers that contain a few milliliters of serous pericardial fluid. This ensures smooth, friction-free movement of the heart muscle.
A)myocardium
B)pericardium
C)both a and b

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The __________ is adherent to the great vessels, esophagus, sternum, and pleurae and is anchored to the diaphragm.
A)pericardium
B)myocardium

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The _________ is the muscular wall of the heart; it does the pumping.
A)myocardium
B)pericardium

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The________ is the thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves. A)myocardium B)endocardium C) pericardium

``` The atrium (Latin for "anteroom") is a thin-walled reservoir for holding blood, and the thick-walled ventricle is the muscular pumping chamber. (It is common to use the following abbreviations to refer to the chambers: RA, right atrium; RV, right ventricle; LA, left atrium; and LV, left ventricle. A)true B)fase ```

True

The four chambers are separated by swinging-door-like structures, called _______, whose main purpose is to prevent backflow of blood. The _______ are unidirectional; they can open only one way. The _________ open and close passively in response to pressure gradients in the moving blood. A)valves B)lumens C)vessels

The two atrioventricular (AV) valves separate the atria and the ventricles. The right AV valve is the tricuspid, and the left AV valve is the bicuspid or mitral valve (so named because it resembles a bishop's mitred cap). The valves' thin leaflets are anchored by collagenous fibers (chordae tendineae) to papillary muscles embedded in the ventricle floor. A)true B) false

True

The AV valves open during the heart's filling phase, or diastole, to allow the ventricles to fill with blood. During the pumping phase, or systole, the AV valves close to prevent regurgitation of blood back up into the atria A)true B)false

True

``` The semilunar (SL) valves are set between the ventricles and the arteries. Each valve has three cusps that look like half moons. The SL valves are the pulmonic valve in the right side of the heart and the aortic valve in the left side of the heart. They open during pumping, or systole, to allow blood to be ejected from the heart. A)true B)false ```

True

DIRECTION OF BLOOD FLOW

I. From liver to right atrium (RA) through inferior vena cava Superior vena cava drains venous blood from the head and upper extremities From RA, venous blood travels through tricuspid valve to right ventricle (RV) 2. From RV, venous blood flows through pulmonic valve to pulmonary artery Pulmonary artery delivers unoxygenated blood to lungs 3. Lungs oxygenate blood Pulmonary veins return fresh blood to left atrium (LA) 4. From LA, arterial blood travels through mitral valve to left ventricle (LV) LV ejects blood through aortic valve into aorta 5. Aorta delivers oxygenated blood to body Remember that the circulation is a continuous loop. The blood is kept moving along by continually shifting pressure gradients. The blood flows from an area of higher pressure to one of lower pressure.

CARDIAC CYCLE

The rhythmic movement of blood through the heart is the cardiac cycle. It has two phases, diastole and systole. A)true B)false

True

In diastole, the ventricles relax and fill with blood. This takes up two thirds of the cardiac cycle. A)true B)false

True

The heart's contraction is systole. During systole, blood is pumped from the ventricles and fills the pulmonary and systemic arteries. This is one third of the cardiac cycle. A)true B)false

True

Diastole.

In diastole, the ventricles are relaxed and the AV valves (i.e., the tricuspid and mitral) are open. (Opening of the normal valve is acoustically silent.) The pressure in the atria is higher than that in the ventricles, so blood pours rapidly into the ventricles. This first passive filling phase is called early or protodiastolic filling. Toward the end of diastole, the atria contract and push the last amount of blood (about 25% of stroke volume) into the ventricles. This active filling phase is called presystole, or atrial systole, or sometimes the "atrial kick." lt causes a small rise in left ventricular pressure. (Note that atrial systole occurs during ventricular diastole, a confusing but important point. A)true B)false

True

Systole.

Now so much blood has been pumped into the ventricles that ventricular pressure is finally higher than that in the atria, so the mitral and tricuspid valves swing shut. The closure of the AV valves contributes to the first heart sound (S1) and signals the beginning of systole. A)true B)false

True

The AV valves close to prevent any regurgitation of blood back up into the atria during contraction. For a very brief moment, all four valves are closed. The ventricular walls contract. This contraction against a closed system works to build pressure inside the ventricles to a high level (isometric contraction). Consider first the left side of the heart. When the pressure in the ventricle finally exceeds pressure in the aorta, the aortic valve opens and blood is ejected rapidly. After the ventricle's contents are ejected, its pressure falls. When pressure falls below pressure in the aorta, some blood flows backward toward the ventricle, causing the aortic valve to swing shut. This closure of the semilunar valves causes the second heart sound (S2) and signals the end of systole A)true B)false

True

HEART SOUNDS

Events in the cardiac cycle generate sounds that can be heard through a stethoscope over the chest wall. These include normal heart sounds and, occasionally, extra heart sounds and murmurs A)true B)false

True

Normal Heart Sounds

The first heart sound (S1) occurs with closure of the AV valves and thus signals the beginning of systole. The mitral component of the first sound (M1) slightly precedes the tricuspid component (T1 ), but you usually hear these two components fused as one sound. You can hear S1 over all the precordium, but usually it is loudest at the apex. A)true B)false

True

S1 is at loudest at the apex. A)true B)false

True

The second heart sound (S2) occurs with closure of the semilunar valves and signals the end of systole. The aortic component of the second sound (A2) slightly precedes the pulmonic component (P2) . Although it is heard over all the precordium, S2 is loudest at the base. A)true B)fase

True

S2 is loudest at the base. A)true B)false

True

Effect of Respiration.

The volume of right and left ventricular systole is just about equal, but this can be affected by respiration. To learn this, consider the phrase: MoRe to the Right heart, Less to the Left. That means that during inspiration, intrathoracic pressure is decreased. This pushes more blood into the vena cava, increasing venous return to the right side of the heart, which increases right ventricular stroke volume. The increased volume prolongs right ventricular systole and delays pulmonic valve closure. Meanwhile, on the left side, a greater amount of blood is sequestered in the lungs during inspiration. This momentarily decreases the amount returned to the left side of the heart, decreasing left ventricular stroke volume. The decreased volume shortens left ventricular systole and allows the aortic valve to close a bit earlier. When the aortic valve closes significantly earlier than the pulmonic valve, you can hear the two components separately. This is a split S2. A)true B)false

True

Extra Heart Sounds

Third Heart Sound (S3). Normally, diastole is a silent event. However, in some conditions, ventricular finding creates vibrations that can be heard over the chest. These vibrations are S3. A)true B)false

True

S3 occurs when the ventricles are resistant to filling during the early rapid filling phase (protodiastole). This occurs immediately after S2, when the AV valves open and atrial blood first pours into the ventricles. A)true B)fase

True

Fourth Heart Sound (S4). S4 occurs at the end of diastole, at presystole, when the ventricle is resistant to filling. The atria contract and push blood into a noncompliant ventricle. This creates vibrations that are heard as S4.S4 occurs just before S1 A)true B)false

True

Murmurs

_________, much like a pile of stones or a sharp turn in a stream creates a noisy water flow. A _________ is a gentle, blowing, swooshing sound that can be heard on the chest wall.

Murmur

Conditions resulting in a murmur are as follows: l. Velocity of blood increases (flow murmur) (e.g., in exercise, thyrotoxicosis) 2. Viscosity of blood decreases (e.g., in anemia) 3. Structural defects in the valves (narrowed valve, incompetent valve) or unusual openings occur in the chambers (dilated chamber, wall defect)

True

Characteristics of Sound

All heart sounds are described by: I. Frequency (pitch)-heart sounds are described as high pitched or low pitched, although these terms are relative because all are low-frequency sounds, and you need a good stethoscope to hear them 2. Intensity (loudness)-loud or soft 3. Duration-very short for heart sounds; silent periods are longer 4. Timing-systole or diastole

CONDUCTION

The heart contracts in response to an electrical current conveyed by a conduction system. Specialized cells in the sinoatrial (SA) node near the superior vena cava initiate an electrical impulse. (Because the SA node has an intrinsic rhythm, it is the "pacemaker.") The current flows in an orderly sequence, first across the atria to the AV node low in the atrial septum. A)true B)false

True

The electrical impulse stimulates the heart to do its work, which is to contract. A small amount of electricity spreads to the body surface, where it can be measured and recorded on the electrocardiograph (ECG). A)true B)false

True SA NODE

The ECG waves are arbitrarily labeled PQRST, which stand for the following elements: -P wave-depolarization of the atria --PR interval- from the beginning of the P wave to the beginning of the QRS complex (the time necessary for atrial depolarization plus time for the impulse to travel through the AV node to the ventricles) ---QRS complex-depolarization of the ventricles ----T wave-repolarization of the ventricles

PUMPING ABILITY

In the resting adult, the heart normally pumps between 4 and 6 L of blood per minute throughout the body. A)true B)false

True

cardiac output equals the volume of blood in each systole (called the stroke volume) times the number of beats per minute (rate). A)true B)false

True

The heart can alter its cardiac output to adapt to the metabolic needs of the body. Preload and afterload affect the heart's ability to increase cardiac output. A)true B)false

True

Preload is the venous return that builds during diastole. It is the length to which the ventricular muscle is stretched at the end of diastole just before contraction. A)true B)false

True

___________ law, the greater the stretch, the stronger is the heart's contraction. This increased contractility results in an increased volume of blood ejected (increased stroke volume) A)erickonson B)Frank-Starling C)both a and b

Afterload is the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. It is the resistance against which the ventricle must pump its blood. Once the ventricle is filled with blood, the ventricular end diastolic pressure is 5 to 10 mm Hg, whereas that in the aorta is 70 to 80 mm Hg. To overcome this difference, the ventricular muscle tenses (isovolumic contraction). After the aortic valve opens, rapid ejection occurs A)true B)false

True

THE NECK VESSELS

Cardiovascular assessment includes the survey of vascular structures in the neck-the carotid artery and the jugular veins. These vessels reflect the efficiency of cardiac function. A)true B)false

True

The Carotid Artery Pulse

The carotid artery is a central artery-that is, it is close to the heart. Its timing closely coincides with ventricular systole. A)true B)false

True

The ____________ is located in the groove between the trachea and the sternomastoid muscle, medial to and alongside that muscle. Note the characteristics of its waveform: a smooth rapid upstroke, a summit that is rounded and smooth, and a downstroke that is more gradual and that has a dicrotic notch caused by closure of the aortic valve. What artery is this

carotid artery

Jugular Venous Pulse and Pressure

The jugular veins empty unoxygenated blood directly into the superior vena cava. Because no cardiac valve exists to separate the superior vena cava from the right atrium, the jugular veins give information about activity on the right side of the heart. Specifically, they reflect filling pressure and volume changes. Because volume and pressure increase when the right side of the heart fails to pump efficiently, the jugular veins expose this. A)true B)false

True

The larger _________ jugular lies deep and medial to the sternomastoid muscle. It is usually not visible, although its diffuse pulsations may be seen in the sternal notch when the person is supine. A)internal B)external

The ________ jugular vein is more superficial; it lies lateral to the sternomastoid muscle, above the clavicle. A)internal B)external

The jugular pulse results from a backwash, a waveform moving backward caused by events upstream. A)true B)false

The five components of the jugular venous pulse occur because of events in the right side of the heart. >The A wave reflects atrial contraction because some blood flows backward to the vena cava during right atrial contraction. >The C wave, or ventricular contraction, is backflow from the bulging upward of the tricuspid valve when it closes at the beginning of ventricular systole (not from the neighboring carotid artery pulsation). >Next, the X descent shows atrial relaxation when the right ventricle contracts during systole and pulls the bottom of the atria downward. >The V wave occurs with passive atrial filling because of the increasing volume in the right atria and increased pressure. >Finally, the Y descent reflects passive ventricular filling when the tricuspid valve opens and blood flows from the RA to the RV.

DEVELOPMENTAL COMPETENCE | Infants and Children

The fetal heart functions early; it begins to beat at the end of 3 weeks' gestation. The lungs are nonfunctional, but the fetal circulation compensates for this. Oxygenation takes place at the placenta, and the arterial blood is returned to the right side of the fetal heart. A)true B)false

Oxygenation takes place at the placenta, and the arterial blood is returned to the right side of the fetal heart. A)true B)false

True

There is no point in pumping all this freshly oxygenated blood through the lungs, so it is rerouted in two ways. >First, about two thirds of it is shunted through an opening in the atrial septum, the foramen ovale, into the left side of the heart, where it is pumped out through the aorta. >Second, the rest of the oxygenated blood is pumped by the right side of the heart out through the pulmonary artery, but it is detoured through the ductus arteriosus to the aorta. (Because they are both pumping into the systemic circulation, the right and left ventricles are equal in weight and muscle wall thickness.)

Inflation and aeration of the lungs at birth produces circulatory changes. Now the blood is oxygenated through the lungs rather than through the placenta. The foramen ovale closes within the first hour because of the new lower pressure in the right side of the heart than in the left side. A)true B)false

At brith,The foramen ovale closes within the first hour because of the new lower pressure in the right side of the heart than in the left side. A)true B)false

The ductus arteriosus closes later, usually within 10 to 15 hours of birth. Now the left ventricle has the greater workload of pumping into the systemic circulation, so that when the baby has reached 1 year of age, the left ventricle's mass increases to reach the adult ratio of 2: I, left ventricle to right ventricle. A)true B)false

The heart's position in the chest is more horizontal in the infant than in the adult; thus the apex is higher, located at the fourth left intercostal space. It reaches the adult position when the child reaches age 7 years. A)true B)false

True

DEVELOPMENTAL COMPETENCE | The Pregnant Woman

Blood volume increases by 30% to 40% during pregnancy, with the most rapid expansion occurring during the second trimester A)true B)false

True

This creates an increase in stroke volume and cardiac output and an increased pulse rate of 10 to 15 .beats per minute. Despite the increased cardiac output, arterial blood pressure decreases in pregnancy as a result of peripheral vasodilation. The blood pressure drops to its lowest point during the second trimester and then rises after that. A)Blood volume increases by 30% to 40% during pregnancy, with the most rapid expansion occurring during the second trimester B)Blood volume increases by 30% to 40% during pregnancy, with the most rapid expansion occurring during the third trimester

DEVELOPMENTAL COMPETENCE | The Aging Adult

It is difficult to isolate the "aging process" of the cardiovascular system per se because it is so closely interrelated with lifestyle, habits, and diseases. A)true B)false

True

We now know that lifestyle is a modifying factor in the development of cardiovascular disease; smoking, diet, alcohol use, exercise patterns, and stress have an influence on coronary artery disease. A)true B) false

Lifestyle also affects the aging process; cardiac changes once thought to be due to aging are partially due to the sedentary lifestyle accompanying aging. A)true B)fase

True

Hemodynamic Changes with Aging

With aging, there is an increase in systolic blood pressure (BP).6 This is due to stiffening of the large arteries, which in turn is due to calcification of vessel walls (arteriosclerosis). This stiffening creates an increase in pulse wave velocity because the less compliant arteries cannot store the volume ejected. A)true B)false

The overall size of the heart does not increase with age, but left ventricular wall thickness increases. This is an adaptive mechanism to accommodate the vascular stiffening mentioned earlier that creates an increased workload on the heart. A)true B)false

True

No significant change in diastolic pressure occurs with age. A rising systolic pressure with a relatively constant diastolic pressure increases the pulse pressure (the difference between the two). A)true B)false

No change in resting heart rate occurs with aging A)true B)false

Cardiac output at rest is not changed with aging A)true B)false

True

There is a decreased ability of the heart to augment cardiac output with exercise. This is shown by a decreased maximum heart rate with exercise and diminished sympathetic response. Non cardiac factors also cause a decrease in maximum work performance with aging: decrease in skeletal muscle performance, increase in muscle fatigue, increased sense of dyspnea. Chronic exercise conditioning will modify many of the aging changes in cardiovascular function. A)true B)false

True

Dysrhythmias. | The Aging Adult

The presence of supraventricular and ventricular dysrhythmias increases with age. Ectopic beats are common in aging people; although these are usually asymptomatic in healthy older people, they may compromise cardiac output and blood pressure when disease is present. A)true,aging adult B)false,aging adult

Tachydysrhythmias may not be tolerated as well in older people. The myocardium is thicker and less compliant, and early diastolic filling is impaired at rest. Thus it may not tolerate a tachycardia as well because of shortened diastole. A)true,aging adult B)false, aging adult

tachydysrhythmias may further compromise a vital organ whose function has already been affected by aging or disease. For example, a ventricular tachycardia produces a 40o/o to 70o/o decrease in cerebral blood flow. Although a younger person may tolerate this, an older person with cerebrovascular disease may experience syncope. A)true, aging adult B) false,aging adult

The incidence of coronary artery disease increases sharply with advancing age and accounts for about half of the deaths of older people. A)true,aging adult B)false,aging adult

Hypertension (systolic >140 mm Hg and/or diastolic >90 mm Hg) and heart failure also increase with age. A)true,aging adult B)false,aging adult

Certainly, lifestyle habits (smoking, chronic alcohol use, lack of exercise, diet) play a significant role in the acquisition of heart disease. A)true,aging adult B)false,aging adult

increasing the physical activity of older adults-even at a moderate level-is associated with a reduced risk of death from cardiovascular diseases and respiratory illnesses. Both points underscore the need for health teaching as an important treatment parameter. A)true,aging adult B)false,aging adult

CULTURE AND GENETICS

The annual rates of first CVD event increase with age. For women, comparable rates occur 10 years later in life than for men, but this gap narrows with advancing age. A)true B)false

Causes of CVD include an interaction of genetic, environmental, and lifestyle factors. However, evidence shows potentially modifiable risk factors attribute to the overwhelming majority of cardiac risk. For example, myocardial infarction (MI) is an important type of CVD. The INTERHEART study covering 52 countries indicated that nine potentially modifiable risk factors accounted for 90o/o of the population attributable risk for MI in men and 94% in women! A)true B)false

These nine modifiable risk factors include abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits and vegetables, alcohol use, and regular physical activity. A)true B)false

HEART DISEASE.These nine modifiable risk factors include abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits and vegetables, alcohol use, and regular physical activity. A)true B)false

Hypertension is a systolic blood pressure (SBP) of ;:::140 mm Hg or diastolic blood pressure (DBP) of >90 mm Hg or currently taking antihypertensive medicine. A higher percentage of men than women have hypertension until age 45 years. A)true B)false

Also, hypertension is 2 to 3 times more common among women taking oral contraceptives (especially among obese and older women) than in women who do not take them. A)true B)false

Blacks is among the highest in the world and it is rising. A)true B)fase

This results in African Americans having a greater rate of stroke, death due to heart disease, and end-stage kidney disease. A)true B)false

True

Nicotine increases the risk of MI and stroke by causing the following: increase in oxygen demand with a concomitant decrease in oxygen supply; an activation of platelets, activation of fibrinogen; and an adverse change in the lipid profile. A)true B)false

True

High levels of low-density lipoprotein gradually add to the lipid core of thrombus formation in arteries, which results in MI and stroke. The current cutpoints for cholesterol risk in adults are the following: total cholesterol levels of 240 mgldL are high risk; and levels from 200 to 239 mgldL are borderline-high risk. The age-adjusted prevalence of total cholesterol levels over 200 mgldL are as follows: 51.1 o/o of Mexican-American men and 49o/o of Mexican-American women; 45o/o of white men and 48.7% of white women; and 40.2% of African American men and 41.8% of African American women. A)true B)false

Hispanic are at the highest risk for cholesterol A)true B) flase

The epidemic of obesity in the United States is well known and is referenced in many chapters of this text. Among Americans ages 20 years and older, the prevalence of overweight or obesity (body mass index [BMI] of 25 kg/m for overweight and 30.0 for obesity) is as follows: 74.8% of Mexican-American men and 73o/o of Mexican-American women; 73.7% of African American men and 77.7% of African American women; and 72.4% of white men and 57.5% o( white women) A)true B)flase

Obesity is highest in African Americans? A)true B)flase

The risk of CVD is twofold greater among persons with diabetes mellitus (DM) than without DM. The increased prevalence of DM in the United States is being followed by an increasing prevalence of CVD morbidity and mortality.Diabetes causes damage to the large blood vessels that nourish the brain, heart, and extremities; this results in stroke, coronary artery disease, and peripheral vascular disease A)true B)false

True

About 13% of African Americans 20 years of age and older have DM. A)true B)false

SUBJECTIVE DATA

1. Chest pain 2. Dyspena 3. Orthopnea 4. Cough 5. Fatigue 6. Cyanosis or pallor 7. Edema 8. Nocturia 9. Past cardiac history 10. Family cardiac history 11. Personal habits (cardiac risk factors)

CHEST PAIN

Chest pain. Any chest pain or tightness? A)Angina, an important cardiac symptom, occurs when the heart's own blood supply cannot keep up with metabolic demand. B)Chest pain also may have pulmonary, musculoskeletal, or gastrointestinal origin; it is important to differentiate. C)both a and b

• Character: How would you describe it? Crushing, stabbing, burning, viselike? (Allow the person to offer adjectives before you suggest them.) (Note if uses clenched fist to describe pain.) A)A squeezing "clenched fist" sign is characteristic of angina, but the symptoms below may be anginal equivalents in the absence of chest pain. B)false

• Pain brought on by: Activity-what type; rest; emotional upset; after eating; during sexual intercourse; with cold weather? A)true B)false

True

Any associated symptoms: Sweating, ashen gray or pale skin, heart skips beat, shortness of breath, nausea or vomiting, racing of heart? A)Diaphoresis, cold sweats, pallor, grayness. B)Palpitations, dyspnea, nausea, tachycardia, fatigue. C)both a and b

Pain made worse by moving the arms or neck, breathing, lying flat? A)Try to differentiate pain of cardiac versus noncardiac origin. B)false

Pain relieved by rest or nitroglycerin? How many tablets? A)ask patient if experiencing chest pain B)false

DYSPENA

Dyspnea. Any shortness of breath? A)ask the patient B)false

What type of activity and how much brings on shortness of breath? How much activity brought it on 6 months ago? A)questions regarding dyspena B)false

What type of activity and how much brings on shortness of breath? How much activity brought it on 6 months ago? A)Dyspnea on exertion (DOE)-quantify exactly (e.g., DOE after walking two level blocks). B)false

Onset: Does the shortness of breath come on unexpectedly? A)assessing for Paroxysmal B)false

Duration: Constant or does it come and go? A)Constant or intermittent. B)false

Seem to be affected by position: Lying down? A)dyspena can be affected if patient is in the Recumbent position B)false

Awaken you from sleep at night? A)Paroxysmal nocturnal dyspnea (PND) occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically, the person awakens after 2 hours of sleep with the perception of needing fresh air. B)false

___________) occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically, the person awakens after 2 hours of sleep with the perception of needing fresh air. A)Paroxysmal nocturnal dyspnea (PND) B)false

ORTHOPENA

Orthopnea. How many pillows do you use when sleeping or lying down? A)Orthopnea is the need to assume a more upright position to breathe. Note the exact number of pillows used. B)false

COUGH

Cough. Do you have a cough? • Duration: How long have you had it? Frequency: Is it related to time of day? • Type: Dry, hacking, barky, hoarse, or congested? A)true B)false

Do you cough up mucus? Color? Any odor? Blood tinged? A)Sputum production, mucoid or purulent. Hemoptysis is often a pulmonary disorder but also occurs with mitral stenosis. B)false

Associated with: Activity, position (lying down), anxiety, talking? Does activity make it better or worse (sit, walk, exercise)? Relieved by rest or medication? A)true B)fase

FATIGUE

Fatigue. Do you seem to tire easily? Able to keep up with your family and co-workers? • Onset: When did fatigue start? Sudden or gradual? Has any recent change occurred in energy level? A)true B)false

True

Fatigue related to time of day: All day, morning, evening? A)Fatigue from decreased cardiac output is worse in the evening, whereas fatigue from anxiety or depression occurs all day or is worse in the morning. B) fase

Fatigue from decreased cardiac output is worse in the evening, A)true B)false

fatigue from anxiety or depression occurs all day or is worse in the morning. A)true B)false

True

CYANOSIS AND PALLOR

Cyanosis or pallor. Ever noted your facial skin turn blue or ashen? A)Cyanosis or pallor occurs with myocardial infarction or low cardiac output states as a result of decreased tissue perfusion. B)false

EDEMA

Edema. Any swelling of your feet and legs? • Onset: When did you first notice this? Any recent change? A)Edema is dependent when caused by heart failure. B)false

Edema is dependent when caused by heart failure. A)true B)false

What time of day does the swelling occur? Do your shoes feel tight at the end of day? A)Cardiac edema is worse at evening and better in morning after elevating legs all night. B)false

Cardiac edema is worse at evening and better in morning after elevating legs all night. A)true B)false

How much swelling would you say there is? Are both legs equally swollen? A)Cardiac edema is bilateral; unilateral swelling has a local vein cause B)false

Does the swelling go away with: Rest, elevation, after a night's sleep? • Any associated symptoms, such as shortness of breath? If so, does the shortness of breath occur before leg swelling or after? A)true, regarding edema B)false, regarding edema

NOCTURIA

Nocturia. Do you awaken at night with an urgent need to urinate? How long has this been occurring? Any recent change? A)Nocturia-Recumbency at night promotes fluid reabsorption and excretion; this occurs with heart failure in the person who is ambulatory during the day. B)false

Nocturia-Recumbency at night promotes fluid reabsorption and excretion; this occurs with heart failure in the person who is ambulatory during the day. A)true B)false

CARDIAC HISTORY

. Cardiac history. Any past history of: Hypertension, elevated cholesterol or triglycerides, heart murmur, congenital heart disease, rheumatic fever or unexplained joint pains as child or youth, recurrent tonsillitis, anemia? Ever had heart disease? When was this? Treated by medication or heart surgery? • Last ECG, stress ECG, serum cholesterol measurement, other heart tests? A)true B)false

FAMILY CARDIC HISTORY

Family cardiac history. Any family history of: Hypertension, obesity, diabetes, coronary artery disease (CAD), sudden death at younger age? A)true B) false

PERSONAL HABITS (CARDIC RISK FACTORS)

``` Personal habits (cardiac risk factors). Nutrition: Please describe your usual daily diet. (Note if this diet is representative of the basic food groups, the amount of calories, cholesterol, and any additives such as salt.) What is your usual weight? Has there been any recent change? A)Risk factors for CAD-Collect data regarding elevated cholesterol, elevated blood pressure, blood sugar levels above 130 mg!dL or known diabetes mellitus, obesity, cigarette smoking, low activity level, and length of any hormone replacement therapy for posbnenopausal women. B)false ```

Risk factors for CAD-Collect data regarding elevated cholesterol, elevated blood pressure, blood sugar levels above 130 mg/dL or known diabetes mellitus, obesity, cigarette smoking, low activity level, and length of any hormone replacement therapy for posbnenopausal women. A)true B)false

Smoking: Do you smoke cigarettes or other tobacco? At what age did you start? How many packs per day? For how many years have you smoked this amount? Have you ever tried to quit? If so, how did this go? A)true B)false

Alcohol: How much alcohol do you usually drink each week, or each day? When was your last drink? What was the number of drinks during that episode? Have you ever been told you had a drinking problem? A)true B)false

Exercise: What is your usual amount of exercise each day or week? What type of exercise (state type or sport)? If a sport, what is your usual amount (light, moderate, heavy)? A)true B)false

Drugs: Do you take any antihypertensives, beta-blockers, calcium channel blockers, digoxin, diuretics, aspirin/anticoagulants, over-thecounter or street drugs? A)true B)false

Additional History for Infants

How was the mother's health during pregnancy: Any unexplained fever, rubella first trimester, other infection, hypertension, drugs taken? A)true B)false

Have you noted any cyanosis while nursing, crying? Is the baby able to eat, nurse, or finish bottle without tiring? A)To screen for heart disease in infant, note fatigue during feeding. Infant with heart failure takes fewer ounces each feeding; becomes dyspneic with sucking; may be diaphoretic, then falls into exhausted sleep; awakens after a short time hungry again. B)false

To screen for heart disease in infant, note fatigue during feeding. Infant with heart failure takes fewer ounces each feeding; becomes dyspneic with sucking; may be diaphoretic, then falls into exhausted sleep; awakens after a short time hungry again. A)true B)false

Growth: Has this baby grown as expected by growth charts and about the same as siblings or peers? A)Poor weight gain B)false

Activity: Were this baby's motor milestones achieved as expected? Is the baby able to play without tiring? How many naps does the baby take each day? How long does a nap last? A)true B)false

Additional History for Children

Growth: Has this child grown as expected by growth charts? A)Poor weight gain. B)false

Activity: Is this child able to keep up with siblings or age mates? Is the child willing or reluctant to go out to play? Is the child able to climb stairs, ride a bike, walk a few blocks? Does the child squat to rest during play or to watch television, or assume a knee-chest position while sleeping? Have you noted "blue spells" during exercise? A)Fatigue. Record specific limitations. B)Cyanosis. C)both a and b

Has the child had any unexplained joint pains or unexplained fever? A)true B)false

True

Does the child have frequent headaches, nosebleeds? A)true B)false

True

Does the child have frequent respiratory infections? How many per year? How are they treated? Have any of these proved to be streptococcal infections? A)true B)false

True

Family history: Does the child have a sibling with heart defect? Is anyone in the child's family known to have chromosomal abnormalities, such as Down syndrome? A)true B)false

Additional History for the Pregnant Woman

Have you had any high blood pressure during this or earlier pregnancies? • What was your usual blood pressure level before pregnancy? How has your blood pressure been monitored during the pregnancy? • If high blood pressure, what treatment has been started? • Any associated symptoms: Weight gain, protein in urine, swelling in feet, legs, or face? A)true B)false

True

Do you take any medications for your illness such as digitalis? Aware of side effects? Have you recently stopped taking your medication? Why? A) Noncompliance may be related to side effects or lack of finances. B)false

Environment: Does your home have any stairs? How often do you need to climb them? Does this have any effect on activities of daily living? A)true B)false

OBJECTIVE DATA

To evaluate the carotid arteries, the person can be sitting up. To assess the jugular veins and the precordium, the person should be supine with the head and chest slightly elevated. A)true B)false

To assess the jugular veins and the precordium, the person should be _______ with the head and chest slightly elevated. A)supine B)recumbent

Stand on the person's right side; this will facilitate your hand placement, viewing of the neck veins, and auscultation of the precordium. A)true B)false

The room must be warm-chilling makes the person uncomfortable, and shivering interferes with heart sounds. Take scrupulous care to ensure quiet; heart sounds are very soft, and any ambient room noise masks them. A)true B)false

Ensure the female's privacy by keeping her breasts draped. The female's left breast overrides part of the area you will need to examine. Gently displace the breast upward, or ask the woman to hold it out of the way. A)true B)false

When performing a regional cardiovascular assessment, use this order: 1. Pulse and blood pressure (see Chapter 9) 2. Extremities (see Peripheral Vascular Assessment in Chapter 20) 3. Neck vessels 4. Precordium

True

The logic of this order is that you will begin observations peripherally and move in toward the heart A)true B)false

EQUIPMENT NEEDED

``` EQUIPMENT NEEDED >Marking pen >Small centimeter ruler >Stethoscope with diaphragm and bell end pieces >Alcohol wipe (to clean endpiece) A)true B)false ```

Palpate the Carotid Artery

Located central to the heart, the carotid artery yields important information on cardiac function. A)true B)false

True

Located central to the heart, the__________ artery yields important information on cardiac function.

carotid

Palpate each carotid artery medial to the sternomastoid muscle in the neck. Avoid excessive pressure on the carotid sinus area higher in the neck; excessive vagal stimulation here could slow down the heart rate, especially in older adults. Take care to palpate gently. A)true B)false

Palpate only one carotid artery at a time to avoid compromising arterial blood to the brain. A)true B)false

Carotid sinus hypersensitivity is the condition in which pressure over the carotid sinus leads to a decreased heart rate, decreased BP, and cerebral ischemia with syncope. This may occur in older adults with hypertension or occlusion of the carotid artery. A)true B)false

___________ is the condition in which pressure over the carotid sinus leads to a decreased heart rate, decreased BP, and cerebral ischemia with syncope. This may occur in older adults with hypertension or occlusion of the carotid artery. A)sinusitis B)Carotid sinus hypersensitivity

Feel the contour and amplitude of the pulse. Normally the contour is smooth with a rapid upstroke and slower downstroke, and the normal strength is 2+ or moderate.assessment of the ______artery A)jugular B)carotid C)both a and b

Diminished pulse feels small and weak (decreased stroke volume). Is? A)abnormal finding of the carotid artery B)normal finding of the carotid artery

Increased pulse feels full and strong in hyperkinetic states of the carotid artery is A)normal finding B)abnormal finding

Auscultate the Carotid Artery

For persons middle-aged or older or who show symptoms or signs of cardiovascular disease, auscultate each carotid artery for the presence of a bruit.This is a blowing, swishing sound indicating blood flow turbulence; normally none is present. A)true B) false

.This is a blowing, swishing sound indicating blood flow turbulence A)bruit B)crack

A bruit indicates turbulence due to a local vascular cause, such as atherosclerotic narrowing A)true B)false

A ______ indicates turbulence due to a local vascular cause, such as atherosclerotic narrowing. A)crack B)bruit C)overflow

``` Keep the neck in a neutral position. Lightly apply the bell of the stethoscope over the carotid artery at three levels: (I) the angle of the jaw, (2) the midcervical area, and (3) the base of the neck A)true B)false ```

Keep the neck in a neutral position. Lightly apply the bell of the stethoscope over the carotid artery at three levels: (I) the angle of the jaw, (2) the midcervical area, and (3) the base of the neck

Recite

Avoid compressing the artery because this could create an artificial bruit, and it could compromise circulation if the carotid artery is already narrowed by atherosclerosis. A)true B)false

Ask the person to take a breath, exhale, and hold it briefly while you listen so that tracheal breath sounds do not mask or mimic a carotid artery bruit. (Holding the breath on inhalation will also tense the levator scapulae muscles, which makes it hard to hear the carotids.) Sometimes you can hear normal heart sounds transmitted to the neck; do not confuse these with a bruit. A)true B)false

Avoid compressing the artery,if so it could create an artificial bruit, and it could compromise circulation if the carotid artery is already narrowed by atherosclerosis. A)true B) fase

Ask the person to take a breath, exhale, and hold it briefly while you listen so that tracheal breath sounds do not mask or mimic a carotid artery bruit. A)true B)false

(Holding the breath on inhalation will also tense the levator scapulae muscles, which makes it hard to hear the carotids.) when assessing the carotid artery so be aware. Have the patient exhale and pause slightly A)true B)false

A carotid bruit is audible when the lumen is occluded by 1/2 to 2/3% . Bruit loudness increases as the atherosclerosis worsens until the lumen is occluded by 2/3% . After that, bruit loudness decreases. When the lumen is completely occluded, the bruit disappears. Thus absence of a bruit does not ensure absence of a carotid lesion. A)abnormal findings B)normal findings

A carotid bruit is audible when the lumen is occluded by 1/2 to 2/3% . A)abnormal finding B)normal finding

Bruit loudness increases as the atherosclerosis worsens until the lumen is occluded by 2/3% . After that, bruit loudness decreases. A)abnormal finding B)normal finding

When the lumen is completely occluded, the bruit disappears. Thus absence of a bruit does not ensure absence of a carotid lesion. A)abnormal finding B)normal finding

A murmur sounds much the same but is caused by a cardiac disorder. Some aortic valve murmurs (aortic stenosis) radiate to the neck and must be distinguished from a local bruit. A)abnormal finding B)normal finding

You must distinguish a murmur from a bruit, because a murmur comes from a cardiac disorder. Some aortic valve murmurs (aortic stenosis) radiate to the neck and must be distinguished from a local bruit. A)true B)false

Inspect the Jugular Venous Pulse

From the jugular veins you can assess the central venous pressure (CVP) and thus judge the heart's efficiency as a pump. Stand on the person's right side because the veins there have a direct route to the heart. Traditionally we have been taught to use the internal jugular vein pulsations for CVP assessment. However, you may use either the external or the internal jugular veins because measurements in both are similar.You can see the top of the external jugular vein distention overlying the sternomastoid muscle or the pulsation of the internal jugular vein in the sternal notch. A)true B) false

From the jugular veins i can assess the central venous pressure (CVP) and thus judge the heart's efficiency as a pump. I Stand on the person's right side because the veins there have a direct route to the heart. A)true B)false

Traditionally we have been taught to use the internal jugular vein pulsations for CVP assessment. you may use either the external or the internal jugular veins because measurements in both are similar. A)true for assessment B)false for assessment

You can see the top of the external jugular vein distention overlying the sternomastoid muscle during a CVP assessment A)true B)false

the pulsation of the internal jugular vein in the sternal notch. A)true for assessment of CVP B)false for assessment for CVP

Position the person supine anywhere from a 30- to a 45-degree angle, wherever you can best see the top of the vein or pulsations. A)true B)false

In general, the higher the venous pressure is, the higher the position you need. A)true B)false

The higher the venous pressure the hight the bed needs to be. A)true B)false

Remove the pillow to avoid flexing the neck; the head should be in the same plane as the trunk. Turn the person's head slightly away from the examined side, and direct a strong light tangentially onto the neck to highlight pulsations and shadows. A)assessing for the jugular venous pulse B)false

Note the external jugular veins overlying the sternomastoid muscle. In some persons, the veins are not visible at all, whereas in others they are full in the supine position. As the person is raised to a sitting position, these external jugulars flatten and disappear, usually at 45 degrees. A)true B)false

As you rise the person to a sitting position, these external jugulars flatten and disappear, usually at 45 degrees. A)true B)false

external jugulars flatten and disappear, usually at 45 degrees. A)true B)false

Unilateral distention of external jugular veins is due to local cause (kinking or aneurysm) A)true,abnormal B)false,normal

Unilateral distention of external jugular veins is due to local cause such as kinking or aneurysm so be aware A)true B)false

Full distended external jugular veins above 45 degrees signify increased CVP as with heart failure. A)true B)false

Full distended external jugular veins above 45 degrees greatly increases CVP as with heart failure along with it so this would be A)abnormal finding B)true, normal finding

Now look for pulsations of the internal jugular veins in the area of the suprasternal notch or around the origin of the sternomastoid muscle around the clavicle. You must be able to distinguish internal jugular vein pulsation from that of the carotid artery. It is easy to confuse them because they lie close together A)true B)false

You must be able to distinguish internal jugular vein pulsation from that of the carotid artery pulsations A)true B)false

Characteristics of Jugular Versus Carotid Pulsations

Internal Jugular Pulse

Located, Lower, more lateral, under or behind the sternomastoid muscle.Undulant and diffuse, two visible waves per cycle.Varies with respiration; its level descends during inspiration when intrathoracic pressure is decreased. You can not palpate either.Light pressure at the base of the neck easily obliterates.Level of pulse drops and disappears as the person is brought to a sitting position. A)Internal Jugular Pulse B)Carotid Pulse

Carotid Pulse

Higher and medial to this muscle,Brisk and localized, one wave per cycle,Does not vary, you can palpate the location. A)Internal Jugular Pulse B)Carotid Pulse

Carotid pulse is unchanged by change of position and by pressure,whereas internal jugular changes A)true B)false

Estimate the Jugular Venous Pressure

Think of the jugular veins as a CVP manometer attached directly to the right atrium. You can "read" the CVP at the highest level of pulsations. Use the angle of Louis (sternal angle) as an arbitrary reference point, and compare it with the highest level of the distended vein or venous pulsation. A)true B)false

You can "read" the CVP at the highest level of pulsations. Use the angle of Louis (sternal angle) as an arbitrary reference point, and compare it with the highest level of the distended vein or venous pulsation. A)true B)false

Hold a vertical ruler on the sternal angle. Align a straight edge on the ruler like a T-square, and adjust the level of the horizontal straight edge to the level of pulsation. Read the level of intersection on the vertical ruler; normal jugular venous pulsation is 2 cm or less above the sternal angle. Also state the person's position, for example, "internal jugular vein pulsations 3 cm above sternal angle when elevated 30 degrees." A)true B)false

normal jugular venous pulsation is 2 cm or less above the sternal angle. Also state the person's position, for example, "internal jugular vein pulsations 3 cm above sternal angle when elevated 30 degrees." A)true B)false

Elevated pressure is a level of pulsation that is more than 3 cm above the sternal angle while at 45 degrees. This occurs with heart failure. A)abnormal finding B)normal finding

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

Heart failure

If you cannot find the internal jugular veins, use the external jugular veins and note the point where they look collapsed. Be aware that the technique of estimating venous pressure is difficult and is not always a reliable predictor of CVP. Consistency in grading among examiners is difficult to achieve. A)true B)false

If venous pressure is elevated or if you suspect heart failure, perform hepatojugular reflux. A)true B)false

Position the person comfortably supine, and instruct him or her to breathe quietly through an open mouth. Hold your right hand on the right upper quadrant of the person's abdomen just below the rib cage. Watch the level of jugular pulsation as you push in with your hand. Exert firm sustained pressure for 30 seconds. This displaces venous blood out of the liver sinusoids and adds its volume to the venous system. If the heart is able to pump this additional volume (i.e., if no elevated CVP is present), the jugular veins will rise for a few seconds and then recede back to the previous level. A) performing hepatojugular reflux B) internal jugular palpitations

If venous pressure is elevated or if you suspect heart failure, perform A)hepatojugular reflux B)carotid pulsations test

If heart failure is present, the jugular veins will elevate and stay elevated as long as you push. A)positive of a hepatojugular reflux B)negative of a hepatojugular reflux

THE PRECORDIUM

Inspect the Anterior Chest

Arrange tangential lighting to accentuate any flicker of movement. A)true B)false

Pulsations. You may or may not see the apical impulse, the pulsation created as the left ventricle rotates against the chest wall during systole. When visible, it occupies the fourth or fifth intercostal space, at or inside the midclavicular line. It is easier to see in children and in those with thinner chest walls. A) true B)false

It is easier to see in children and in those with thinner chest walls. A) apical pulse B) radial pulse C)brachial pulse

A heave or lift is a sustained forceful thrusting of the ventricle during systole. It occurs with ventricular hypertrophy as a result of increased workload. A right ventricular heave is seen at the sternal border; a left ventricular heave is seen at the apex A)abnormal finding of anterior chest B)normal finding of anterior chest

A right ventricular heave is seen at the sternal border; A)normal finding anterior to the chest B)abnormal finding anterior to the chest

a left ventricular heave is seen at the apex A)abnormal finding is anterior to the chest B)normal finding is anterior to the chest

A_________ or lift is a sustained forceful thrusting of the ventricle during systole. It occurs with ventricular hypertrophy as a result of increased workload. A)heave B)split

Palpate the Apical Impulse

(This used to be called the point of maximal impulse, or PMI. Because some abnormal conditions may cause a maximal impulse to be felt elsewhere on the chest, use the term apical impulse specifically for the apex beat.) A)true B)false

Localize the apical impulse precisely by using one finger pad. Asking the person to "exhale and then hold it" aids the examiner in locating the pulsation. You may need to roll the person midway to the left to find it; note that this also displaces the apical impulse farther to the left. A)true B)false

Asking the person to "exhale and then hold it" aids the examiner in locating the pulsation. A)true B)false

You may need to roll the person midway to the left to find the apical pulse in do so I need to note that this also A)displaces the apical impulse farther to the left B)displaces the apical impulse farther to the right

Location- The apical impulse should occupy only one interspace, the fourth or fifth, and be at or medial to the midclavicular line • Size-Normally l x 2 cm Amplitude-Normally a short, gentle tap • Duration-Short, normally occupies only first half of systole A)all from apical pulse B)all from brachial pulse

Cardiac enlargement: • Left ventricular dilation (volume overload) displaces impulse down and to left and increases size more than one space. • A sustained impulse with increased force and duration but no change in location occurs with left ventricular hypertrophy and no dilation. A)true B)false

Cardiac enlargement: • Left ventricular dilation (volume overload) displaces impulse down and to left and increases size more than one space. A)abnormal finding of apical pulse B)normal finding of apical pulse

sustained impulse with increased force and duration but has no change in the location that it occurs with left ventricular hypertrophy and no dilation. A)true B)false

The apical impulse is palpable in about half of adults. A)true B)false

It is not palpable in obese persons or in persons with thick chest walls. A)true B)false

With high cardiac output states (anxiety, fever, hyperthyroidism, anemia), the apical impulse increases in A)amplitude and duration. B)intensity and duration.

Not palpable with pulmonary emphysema due to overriding lungs. A)apical pulse B)brachial pulse

Palpate Across the Precordium

Using the palmar aspects of your four fingers, gently palpate the apex, the left sternal border, and the base, searching for any other pulsations. Normally none occur. If any are present, note the timing. Use the carotid artery pulsation as a guide, or auscultate as you palpate. A)true B)false

A thrill is a palpable vibration. It feels like the throat of a purring cat. The thrill signifies turbulent blood flow and accompanies loud murmurs. Absence of a thrill, however, does not necessarily rule out the presence of a murmur. A)true B)false

A ______ is a palpable vibration. It feels like the throat of a purring cat. The ______ signifies turbulent blood flow and accompanies loud murmurs. Absence of a ______, however, does not necessarily rule out the presence of a murmur.

Thrill

The _______ signifies turbulent blood flow and accompanies loud murmurs.

Thrill

Absence of a thrill, however, does not necessarily rule out the presence of a murmur. A)true B)false

A thrill can indicate a murmur but also even without a thrill an heart murmur can still be present. A)true B)false

Accentuated first and second heart sounds and extra heart sounds also may cause abnormal pulsations. A)true B)false

Percussion

Percussion is used to outline the heart's borders, but it has been displaced by the chest x-ray or echocardiogram. Evidence shows these are more accurate in detecting heart enlargement. When the right ventricle enlarges, it does so in the anteroposterior diameter, which is better seen on x-ray film. Evidence from numerous comparison studies shows the percussed cardiac border correlates "only moderately" with the true cardiac border.Also, percussion is of limited usefulness with the female breast tissue or in an obese person or a person with a muscular chest wall A)true B)false

percussion is of limited usefulness with the female breast tissue or in an obese person or a person with a muscular chest wall A)true B)false

The nurse wants to perform a percussion test on a female and a obese patient the nurse should A)continue the procedure B)take x-rays

Cardiac enlargement is due to increased ventricular volume or wall thickness; it occurs with hypertension, CAD, heart failure, and cardiomyopathy. A)true B)false

Cardiac enlargement is due to increased ventricular volume or wall thickness; it occurs with ______________, CAD, heart failure, and cardiomyopathy. A)hypertension B)hypotension

Auscultation

Identify the auscultatory areas where you will listen. These include the four traditional valve "areas". The valve areas are not over the actual anatomic locations of the valves but are the sites on the chest wall where sounds produced by the valves are best heard. The sound radiates with the direction of blood flow. A)true B)false

The valve areas are: • Second right interspace-aortic valve area • Second left interspace-pulmonic valve area >Left lower sternal border-tricuspid valve area >Fifth interspace at around left midclavicular line-mitral valve area

True

Do not limit your auscultation to only four locations. Sounds produced by the valves may be heard all over the precordium. (For this reason, many experts even discourage the naming of the valve areas.) Thus learn to inch your stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex. Or start at the apex and work your way up A)true B)false

Thus learn to inch your stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex. Or start at the apex and work your way up. A)is the best way when ascultating the heart sounds B)false

Clean the end pieces with an alcohol wipe; you will use both endpieces. Although all heart sounds are low frequency, the diaphragm is for relatively higher pitched sounds and the bell is for relatively lower pitched ones. A)true B)false

all heart sounds are low frequency A)true B)false

the diaphragm is for relatively higher pitched sounds A)true B)false

The bell of the stethoscope is used for low pitch sounds A)true B)false

Before you begin, alert the person: "I always listen to the heart in a number of places on the chest. Just because I am listening a long time, it does not necessarily mean that something is wrong. A)true B)false

``` After you place the stethoscope, try closing your eyes briefly to tune out any distractions. Concentrate, and listen selectively to one sound at a time. Consider that at least two, and perhaps three or four, sounds may be happening in less than I second. You cannot process everything at once. Begin with the diaphragm end piece and use the following routine: (I) 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. ```

True

The rate ranges normally from 50 to 90 beats per minute.or 60-100 A)true B)false

The rhythm should be regular, although sinus arrhythmia occurs normally in young adults and children. With sinus arrhythmia, the rhythm varies with the person's breathing, increasing at the peak of inspiration and slowing with expiration. Note any other irregular rhythm. If one occurs, check if it has any pattern or if it is totally irregular. A)true B)false

sinus arrhythmia occurs normally in young adults and children. A)true B)false

With ___________, the rhythm varies with the person's breathing, increasing at the peak of inspiration and slowing with expiration. Note any other irregular rhythm. If one occurs, check if it has any pattern or if it is totally irregular.

Sinus arrhythmia

Premature beat-an isolated beat is early, or a pattern occurs in which every third or fourth beat sounds early. A)abnormal finding of the heart B) normal finding of the heart

Irregularly irregular- no pattern to the sounds; beats come rapidly and at random intervals. A)abnormal finding of the heart B)normal finding of the heart

When you notice any irregularity, check for a pulse deficit by auscultating the apical beat while simultaneously palpating the radial pulse. Count a serial measurement (one after the other) of apical beat and radial pulse. Normally, every beat you hear at the apex should perfuse to the periphery and be palpable. The two counts should be identical. When different, subtract the radial rate from the apical and record the remainder as the pulse deficit. A)true B)false

When you notice any irregularity, check for a pulse deficit by auscultating the apical beat while simultaneously palpating the radial pulse. A)true B)false

Normally, every beat you hear at the apex should perfuse to the periphery and be palpable. The two counts should be identical. When different, subtract the radial rate from the apical and record the remainder as the pulse deficit. A)true B)false

Subtract radial from apical for a pulse deficit A)true B)false

A pulse deficit signals a weak contraction of the ventricles; it occurs with atrial fibrillation, premature beats, and heart failure A)abnormal finding B)normal finding

A __________ signals a weak contraction of the ventricles; it occurs with atrial fibrillation, premature beats, and heart failure

pulse deficit

A pulse deficit signals a weak contraction of the ventricles; it occurs with atrial fibrillation, A)premature beats B)heart failure C)both a and b

Identify S1 and S2• This is important because S1 is the start of systole and thus serves as the reference point for the timing of all other cardiac sounds. Usually, you can identify S1 instantly because you hear a pair of sounds close together (lub-dup), and S1 is the first of the pair. This guideline works, except in the cases of the tachydysrhythmias (rates> 100 per minute). Then the diastolic filling time is shortened, and the beats are too close together to distinguish. A) true B)false

S1 is the start of systole and thus serves as the reference point for the timing of all other cardiac sounds. A)true B)false

Usually, you can identify S1 instantly because you hear a pair of sounds close together (lub-dup), and S1 is the first of the pair. This guideline works, except in the cases of the tachydysrhythmias (rates> 100 per minute). Then the diastolic filling time is shortened, and the beats are too close together to distinguish. A)true B)false

Other guidelines to distinguish S1 from S2 are • S1 is louder than s2 at the apex; S2 is louder than s1 at the base. • S1 coincides with the carotid artery pulse. Feel the carotid gently as you auscultate at the apex; the sound you hear as you feel each pulse is S1 >S1 coincides with the R wave (the upstroke of the QRS complex) if the person is on an ECG monitor.

True

S1is louder at the apex than s2 A)true B)false

S2is louder at the base then s1 A)true B)false

Listen to S1 and S2 Separately. Note whether each heart sound is normal, accentuated, diminished, or split. Inch your diaphragm across the chest as you do this. A)true B)false

First Heart Sound (S1). Caused by closure of the AV valves, S1 signals the beginning of systole. You can hear it over the entire precordium, although it is loudest at the apex. (Sometimes the two sounds are equally loud at the apex, because s1 is lower pitched than s2.) A)true B)false

Both heart sounds are diminished with conditions that place an increased amount of tissue between the heart and your stethoscope: emphysema (hyperinflated lungs), obesity, pericardial fluid. A)abnormal findings of the heart B)normal findings of the heart

You can hear S1 with the diaphragm with the person in any position and equally well in inspiration and expiration. A split S1 is normal, but it occurs rarely. A split S1 means you are hearing the mitral and tricuspid components separately. It is audible in the tricuspid valve area, the left lower sternal border. The split is very rapid, with the two components only 0.03 second apart. A)true B)false

A split S1 is normal, but it occurs rarely. A split S1 means you are hearing the mitral and tricuspid components separately. It is audible in the tricuspid valve area, the left lower sternal border. The split is very rapid, with the two components only 0.03 second apart. A)true B)false

A split is normal A)true B)false

A split S1 means you are hearing the mitral and tricuspid components separately. It is audible in the tricuspid valve area, the left lower sternal border. The split is very rapid, with the two components only 0.03 second apart A)true B)false

A split means you hear the tricuspid and mitral valve separately A)true B) false

Second Heart Sound (S2) The S2 is associated with closure of the semilunar valves. You can hear it with the diaphragm, over the entire precordium, although S2 is loudest at the base A)true B)false

S2is closure of the semilunar valves A)true B)false

Splitting of S2 • A split S2 is a normal phenomenon that occurs toward the end of inspiration in some people. Recall that closure of the aortic and pulmonic valves is nearly synchronous. Because of the effects of respiration on the heart described earlier, inspiration separates the timing of the two valves' closure, and the aortic valve closes 0.06 second before the pulmonic valve. Instead of one DUP, you hear a split sound- T-DUP. During expiration, synchrony returns and the aortic and pulmonic components fuse together. A split S2 is heard only in the pulmonic valve area, the second left interspace. A)true B)false

Splitting of S2 • A split S2 is a normal phenomenon that occurs toward the end of inspiration in some people. Because of the effects of respiration on the heart described earlier, inspiration separates the timing of the two valves' closure, and the aortic valve closes 0.06 second before the pulmonic valve. Instead of one DUP, you hear a split sound- T-DUP . During expiration, synchrony returns and the aortic and pulmonic components fuse together. A split S2 is heard only in the pulmonic valve area, the second left interspace. A)true B)false

A split S2 is heard only in the pulmonic valve area, the second left interspace. A)true B)false

S2 splitting is the aortic valve and the pulmonic valve A)true B)false

When you first hear the split s2, do not be tempted to ask the person to hold his or her breath so that you can concentrate on the sounds. Breath holding will only equalize ejection times in the right and left sides of the heart and cause the split to go away. Instead, concentrate on the split as you watch the person's chest rise up and down with breathing. The split S2 occurs about every fourth heartbeat, fading in with inhalation and fading out with exhalation. A)true B)false

The split S2 occurs about every fourth heartbeat, fading in with inhalation and fading out with exhalation. A)true B)false

A fixed split is unaffected by respiration; the split is always there A)true B)false

A paradoxical split is the opposite of what you would expect; the sounds fuse on inspiration and split on expiration. A)true B)false

A________ split is the opposite of what you would expect; the sounds fuse on inspiration and split on expiration

paradoxical

A_____ split is unaffected by respiration; the split is always there

fixed

Focus on Systole , Then on Diastole, and Listen for any Extra Heart Sounds. Listen with the diaphragm, then switch to the bell, covering all auscultatory areas. Usually these are silent periods. When you do detect an extra heart sound, listen carefully to note its timing and characteristics. During systole, the midsystolic click (which is associated with mitral valve prolapse) is the most common extra sound. The third and fourth heart sounds occur in diastole; either may be normal or abnormal. A)true B)false

When you do detect an extra heart sound, listen carefully to note its timing and characteristics. A)true B)false

During systole, the midsystolic click (which is associated with mitral valve prolapse) is the most common extra sound. A)true B)false

The most common extra sound during the systolic is the midsystolic click which is associated with the mitral valve prolapse A)true B) false

The third and fourth heart sounds occur in diastole; either may be normal or abnormal A)true B)false

A pathologic S3 (ventricular gallop) occurs with heart failure and volume overload; a pathologic S4 (atrial gallop} occurs with CAD A)true B)false

A pathologic S3 (ventricular gallop) occurs with A)heart failure B)volume overload; C)both a and b

a pathologic S4 (atrial gallop} occurs with CAD A)true B)false

Listen for Murmurs. A murmur is a blowing, swooshing sound that occurs with turbulent blood flow in the heart or great vessels. Except for the innocent murmurs described, murmurs are abnormal A)true B)false

. A ___________ is a blowing, swooshing sound that occurs with turbulent blood flow in the heart or great vessels. Except for the innocent __________ described, _______ are abnormal

murmur

All murmurs are abnormal except innocent murmur A)true B)false

Murmurs may be due to congenital defects and acquired valvular defects. A)true B)false

Murmurs may be do to congenital heart disease and valvular(relating or acting as valves) defects A)true B)false

If you hear a murmur, describe it by indicating these following characteristics:

Timing. It is crucial to define the murmur by its occurrence in systole or diastole. You must be able to identify S1 and S2 accurately to do this. Try to further describe the murmur as being in early, mid-, or late systole or diastole; throughout the cardiac event (termed pansystolic, holosystolic/pandiastolic, or holodiastolic); and whether it obscures or muffles the heart sounds. A)true B)false

A systolic murmur may occur with a normal heart or with heart disease; a diastolic murmur always indicates heart disease. A)true B)false

A systolic murmur may occur with a normal heart or with heart disease; A)true B)false

a diastolic murmur always indicates heart disease. A)true B)false

Loudness. Describe the intensity in terms of six "grades." For example, record a grade ii murmur as "ii/vi." Grade i-Barely audible, heard only in a quiet room and then with difficulty Grade ii-Clearly audible, but faint Grade iii-Moderately loud, easy to hear Grade iv-Loud, associated with a thrill palpable on the chest wall Grade v-Very loud, heard with one corner of the stethoscope lifted off the chest wall Grade vi- Loudest, still heard with entire stethoscope lifted just off the chest wall

True

Pitch. Describe the pitch as high, medium, or low. The pitch depends on the pressure and the rate of blood flow producing the murmur. A)true B)false

Pattern. The intensity may follow a pattern during the cardiac phase, growing louder (crescendo), tapering off (decrescendo), or increasing to a peak and then decreasing (crescendo-decrescendo, or diamond shaped). Because the whole murmur is just milliseconds long, it takes practice to diagnose any pattern. A)true B)false

``` growing louder (crescendo), A)true B)false ```

``` tapering off (decrescendo), A)true B)false ```

Quality. Describe the quality as musical, blowing, harsh, or rumbling. A)true B)false

The murmur of mitral stenosis is rumbling, whereas that of aortic stenosis is harsh A)true B)false

The murmur of mitral sound stenosis is rumbling, A)true B)false

The murmur that of aortic stenosis sound is harsh A)true B)false

Location. Describe the area of maximum intensity of the murmur (where it is best heard) by noting the valve area or intercostal spaces. A)true B)false

True

Radiation. The murmur may be transmitted downstream in the direction of blood flow and may be heard in another place on the precordium, the neck, the back, or the axilla. A)true B)false

Posture. Some murmurs disappear or are enhanced by a change in position. A)true B)false

Some murmurs are common in healthy children or adolescents and are termed innocent or functional. A)true B)false

Innocent indicates having no valvular or other pathologic cause; A)true B)false

Innocent heart murmur indicates no pathological conditions A)true B)false

functional murmur is due to increased blood flow in the heart (e.g., in anemia, fever, pregnancy, hyperthyroidism). A)true B)false

The contractile force of the heart is greater in children. This increases blood flow velocity. The increased velocity plus a smaller chest measurement makes an audible murmur. A)true,functional murmur B) false

functional murmur is due to increased blood flow in the heart such as anemia, fever, pregnancy and hyperthyroidism A)true B)false

The innocent murmur is generally soft (grade ii), midsystolic, short, crescendo-decrescendo, and with a vibratory or musical quality ("vooot" sound like fiddle strings). Also, the innocent murmur is heard at the second or third left intercostal space and disappears with sitting, and the young person has no associated signs of cardiac dysfunction. A)true B)false

The innocent murmur is generally soft (grade ii), midsystolic, short, crescendo-decrescendo, and with a vibratory or musical quality ("vooot" sound like fiddle strings). A)true B)false

Also, the innocent murmur is heard at the second or third left intercostal space and disappears with sitting, and the young person has no associated signs of cardiac dysfunction A)true B)false

The innocent murmur disappears when sitting A)true B)false

Although it is important to distinguish innocent murmurs from pathologic ones, it is best to suspect all murmurs as pathologic until they are proved other wise. Diagnostic tests such as ECG, phonocardiogram, and echocardiogram are needed to establish an accurate diagnosis. A)true B)false

Change Position. After auscultating in the supine position, roll the person toward his or her left side. Listen with the bell at the apex for the presence of any diastolic filling sounds (i.e., the S3 or S4) A)true B)false

the nurse turns the pt on his leftbside and Listen with the bell at the apex for the presence of any diastolic filling sounds (i.e., the S3 or S4) A)true B)false

S3 and S4, and the murmur of mitral stenosis sometimes may be heard only when on the left side. A)true B)false

S3 and S4, and the murmur of mitral stenosis sometimes may be heard only when on the patient is on _________ side

Left

Ask the person to sit up, lean forward slightly, and exhale. Listen with the diaphragm firmly pressed at the base, right, and left sides. Check for the soft, high-pitched, early diastolic murmur of aortic or pulmonic regurgitation . A)true B)false

Checking for the soft, high-pitched, early diastolic murmur of aortic or pulmonic regurgitation the nurse will A)Ask the person to sit up, lean forward slightly, and exhale. Listen with the diaphragm firmly pressed at the base, right, and left sides. B)false, put pt in supine

Murmur of aortic regurgitation sometimes may be heard only when the person is leaning forward in the sitting position. A)true B)false

Murmur of ________ regurgitation sometimes may be heard only when the person is leaning forward in the sitting position. A)pulmonic B) aortic

DEVELOPMENTAL COMPETENCE | Infants

The transition from fetal to pulmonic circulation occurs in the immediate newborn period. Fetal shunts normally close within 10 to 15 hours but may take up to 48 hours. Thus you should assess the cardiovascular system during the first 24 hours and again in 2 to 3 days. A)true B)false

He often should the nurse assess an newborn after brith of the cardiovascular system A)I should assess the cardiovascular system during the first 24 hours and again in 2 to 3 days. B)only for the first hour

A newborn, Fetal shunts normally close within 10 to 15 hours but may take up to 48 hours. A)true B)false

Failure of shunts to close (e.g., patent ductus arteriosus [PDA], atrial septal defect [ASD]); A)abnormal finding of infant B)normal finding of infant

Failure of shunts to close results in A) patent ductus arteriosus [PDA] B)atrial septal defect [ASD]) C)both a and b

Note any extracardiac signs that may reflect heart status (particularly in the skin), liver size, and respiratory status. The skin color should be pink to pinkish brown, depending on the infant's genetic heritage. If cyanosis occurs, determine its first appearance-at or shortly after birth versus after the neonatal period. Normally, the liver is not enlarged and the respirations are not labored. Also, note the expected parameters of weight gain throughout infancy. A)true B)false

A newborn skin color should be from pink to pinkish brown depending on the heritage/race A)true B) false

If cyanosis occurs, determine its first appearance-at or shortly after birth versus after the neonatal period. Normally, the liver is not enlarged and the respirations are not labored. A)true B)false

Cyanosis at or just after birth signals oxygen desaturation of congenital heart disease A)true,abnormal finding B)false,normal finding

Cyanosis at or just after birth signals which f the following A)oxygen desaturation of congenital heart disease B)false,normal for brith

The most important signs of heart failure in an infant are persistent tachycardia, tachypnea, and liver enlargement. Engorged veins, gallop rhythm, and pulsus alternans also are signs. Respiratory crackles (rales) are an important sign in adults but not in infants. A)true B)false

The most important signs of heart failure in an infant are persistent tachycardia, tachypnea, and liver enlargement. Engorged veins, gallop rhythm, and pulsus alternans also are signs. A)true B)false

``` Signs of heart failure in an infant would show A)tachycardia B)tachypena C)liver enlargement D)all the above ```

``` Respiratory crackles (rales) are an important sign in adults but not in infants for heart failure A)true B)false ```

Failure to thrive occurs with cardiac disease. A)true B)false

An infant failure to thrive occurs with _________ disease

Cardiac

Palpate the apical impulse to determine the size and position of the heart. Because the infant's heart has a more horizontal placement, expect to palpate the apical impulse at the fourth intercostal space just lateral to the midclavicular line. A)true B)false

The apex is displaced with: • Cardiac enlargement, shifts to the left • Pneumothorax, shifts away from the affected side • Diaphragmatic hernia, shifts usually to right because this hernia occurs more often on the left • Dextrocardia, a rare anomaly in which the heart is located on right side of chest

True

The apex is displaced with: • Cardiac enlargement, shifts to the left A)true B)false

The apex is displaced with: • Pneumothorax, shifts away from the affected side A)true B)false

The apex is displaced with: • Diaphragmatic hernia, shifts usually to right because this hernia occurs more often on the left A)true B)false

The apex is displaced with: • Dextrocardia, a rare anomaly in which the heart is located on right side of chest A)true B)false

___________, a rare anomaly in which the heart is located on right side of chest

Dextrocardia

The heart rate is best auscultated because radial pulses are hard to count accurately. Use the small (pediatric size) diaphragm and bell. A)for infants B)for adults

Best site to go readings of the heart on an infant is the apical pulse A)true B)false

Persistent tachycardia is >200 per minute in newborns, or > 150 per minute in infants A)abnormal B)normal

Heart rate at brith would be from 100 to 180 A)true B)false

Heart of a newborn then stabilizes to 120 to 140. A)true B)false

Infant crying heart rate may jump to 170 Infant sleeping may drop to 70 to 90 A)normal B)abnormal

Bradycardia is

Expect the heart rhythm to have sinus arrhythmia, the phasic speeding up or slowing down with the respiratory cycle. A)true B)false

It is normal for an infant to have sinus arrhythmia, A)true B)false

___________, the phasic speeding up or slowing down with the respiratory cycle.

sinus arrhythmia

Investigate any irregularity except sinus arrhythmia. On an infant A)true B)false

Rapid rates make it more challenging to evaluate heart sounds. Expect heart sounds to be louder in infants than in adults because of the infant's thinner chest wall. A)true B)false

Heart sounds are louder in infants do to infants having thinner chest walls A)true B)false

Also, S2 has a higher pitch and is sharper than S1• Splitting of S2 just after the height of inspiration is common, not at birth, but beginning a few hours after birth. A)true for infant B)false for infant

Splitting of S2 just after the height of inspiration is common, not at birth, but beginning a few hours after birth. A)true for infant B)false for infant

S2 is louder, shaper, higher pitch in the infant than S1 A)true B)false

Fixed split S2 indicates atrial septal defect A)infant abnormal finding B)infant normal finding

Murmurs in the immediate newborn period do not necessarily indicate congenital heart disease. A)true B)false

Murmurs are relatively common in the first 2 to 3 days because of fetal shunt closure. These murmurs are usually grade i or ii, are systolic, accompany no other signs of cardiac disease, and disappear in 2 to 3. A)true B)false

absence of a murmur in the immediate newborn period does not ensure a perfect heart; congenital defects can be present that are not signaled by an early murmur. It is best to listen frequently and to note and describe any murmur according to the characteristics listed on. A)true B)false

Absent of a murmur does not ensure a perfect heart so still keep on assessing the infant A)true B)false

Persistent murmur after 2 to 3 days, holosystolic murmurs or those that last into diastole, and those that are loud-all warrant further evaluation. A)abnormal finding on an infant B)normal finding on an infant

DEVELOPMENTAL COMPETENCE | Children

Note any extracardiac or cardiac signs that may indicate heart disease: poor weight gain, developmental delay, persistent tachycardia, tachypnea, dyspnea on exertion, cyanosis, and clubbing. A)true B)false

extracardiac or cardiac signs that may indicate ____________in children which is poor weight gain, developmental delay, persistent tachycardia, tachypnea, dyspnea on exertion, cyanosis, and clubbing.

Heart disease

____________in children show signs of poor weight gain, developmental delay, persistent tachycardia, tachypnea, dyspnea on exertion, cyanosis, and clubbing.

Heart diseases

Note that clubbing of fingers and toes usually does not appear until late in the lst year, even with severe cyanotic defects occurs in children related to heart disease A) true B)false

The apical impulse is sometimes visible in children with thin chest walls. A)true B)false

A precordial bulge to the left of the sternum with a hyperdynamic precordium signals cardiac enlargement. The bulge occurs because the cartilaginous rib cage is more compliant A)true, for children B)false, for children

A precordial bulge to the left of the sternum with a hyperdynamic precordium signals ___________. The bulge occurs because the cartilaginous rib cage is more compliant

cardiac enlargement

A substernal heave occurs with right ventricular enlargement; an apical heave occurs with left ventricular hypertrophy A)true B)false

A substernal heave occurs with right ventricular enlargement; A) true B)false

an apical heave occurs with left ventricular hypertrophy A)true B)false

Palpate the apical impulse in the fourth intercostal space to the left of the midclavicular line until age 4 years; at the fourth interspace at the midclavicular line from age 4 to 6 years; and in the fifth interspace to the right of the midclavicular line at age 7 years A)true B)false

Palpate apical pulse at the 4th intercostal from Brith to 6. A)true B)false

At age 7 then you palpate the apical pulse at the 5th intercostal A)true B)false

The apical impulse moves laterally with cardiac enlargement. A)true B)false

Thrill is a (palpable vibration). A)true B)false

The average heart rate slows as the child grows older, although it is still variable with rest or activity. A)true B)false

The heart rhythm remains characterized by sinus arrhythmia.is common in children A)true B)false

The heart rhythm remains characterized by sinus arrhythmia. Physiologic S3 is common in children.It occurs in early diastole, just after S2, and is a dull soft sound that is best heard at the apex. A)true B)false

A venous hum- due to turbulence of blood flow in the jugular venous system-is common in healthy children and has no pathologic significance. It is a continuous, low-pitched, soft hum that is heard throughout the cycle, although it is loudest in diastole.Listen with the bell over the supraclavicular fossa at the medial third of the clavicle, especially on the right, or over the upper anterior chest. A)true B)false

________-due to turbulence of blood flow in the jugular venous system-is common in healthy children and has no pathologic significance. It is a continuous, low-pitched, soft hum that is heard throughout the cycle, although it is loudest in diastole.Listen with the bell over the supraclavicular fossa at the medial third of the clavicle, especially on the right, or over the upper anterior chest.

Venous hum

It is a continuous, low-pitched, soft hum that is heard throughout the cycle, although it is loudest in diastole.Listen with the bell over the supraclavicular fossa at the medial third of the clavicle, especially on the right, or over the upper anterior chest.

Venous hum

The venous hum is usually not affected by respiration, may sound louder when the child stands, and is easily obliterated by occluding the jugular veins in the neck with your fingers. A)true B)false

The venous hum sounds louder when child stands up and is easily obliterated when you press on the jugular veins A)true B)false

True

This latter maneuver helps differentiate the venous hum from other cardiac murmurs A)true B)false

maneuver helps differentiate the venous hum from other cardiac murmurs

Latter

Heart murmurs that are innocent (or functional) in origin are very common through childhood A)true B)false

Distinguish innocent murmurs from pathologic ones. This may involve referral to another examiner or the performance of diagnostic tests such as the EGG or ultrasonography. A)true B)false

Most innocent murmurs have these characteristics: soft, relatively short systolic ejection murmur; medium pitch; vibratory; best heard at the left lower sternal or midsternal border, with no radiation to the apex, base, or back. A)true B)false

For the child whose murmur has been shown to be innocent, it is very important that the parents understand this completely. A)true B)false

They need to believe that this murmur is just a "noise" and has no pathologic significance. Otherwise, the parents may become overprotective and limit activity for the child which may result Ill the child developing a negative self-concept. For what murmur

Innocent murmur

DEVELOPMENTAL COMPETENCE | The Pregnant Woman

The vital signs usually yield an increase in resting pulse rate of 10 to 15 beats per minute and a drop in blood pressure from the normal prepregnancy level. A)true B)false

The BP decreases to its lowest point during the second trimester and then slowly rises during the third trimester A)true B)false

The BP varies with position. It is usually lowest in the left lateral recumbent position A)pregnant woman B)adult

BP in a pregnant woman is a bit higher when A)supine B)lateral recumbents

BP of a pregnant woman is highest when A)sitting B)laying down

Suspect pregnancy-induced hypertension with a sustained rise of 30 mm Hg systolic or 15 mm Hg diastolic under basal conditions A)abnormal finding B)normal finding

Inspection of the skin often shows a mild hyperemia in light-skinned women because the increased cutaneous blood flow tries to eliminate the excess heat generated by the increased metabolism. A)pregnant woman normal B)false, pregnant woman abnormal

Skin in light skinned pregnant woman is hyperemia at times because the increased cutaneous blood flow tries to eliminate the excess heat generated by the increased metabolism. A)true B)false

Palpation of the apical impulse is higher and lateral compared with the normal position, because the enlarging uterus elevates the diaphragm and displaces the heart up and to the left and rotates it on its long axis. A)pregnant woman B)adult men

apical impulse is higher and lateral in a pregnant woman because the enlarging uterus elevates the diaphragm and displaces the heart up and to the left and rotates it on its long axis. A)true B)false

Auscultation of the heart sounds shows changes caused by the increased blood volume and workload: -Heart sounds Exaggerated splitting of S1 and increased loudness of S1 A loud, easily heard S3 -Heart murmurs A systolic murmur in 90%, Which disappears soon after delivery A soft, diastolic murmur heard transiently in 19% A continuous murmur from breast vasculature in 10%

True

The last-mentioned murmur is termed a mammary souffle (pronounced soof' f'l), which occurs near term or when the mother is lactating; it is due to increased blood flow through the internal mammary artery. The murmur is heard in the second, third, or fourth intercostal space; it is continuous, although it is accented in systole. You can obliterate it by pressure with the stethoscope or one finger lateral to the murmur. A)true B)false

The last-mentioned murmur is termed a ___________ (pronounced soof' f'l), which occurs near term or when the mother is lactating; it is due to increased blood flow through the internal mammary artery. The murmur is heard in the second, thjrd, or fourth intercostal space; it is continuous, although it is accented in systole. You can obliterate it by pressure with the stethoscope or one finger lateral to the murmur.

mammary souffle

Murmur occurs in the term where the mother is lactating, the murmur is called mammary souffle A)true B)false

Murmurs of aortic valve disease cannot be obliterated. A)true B)false

True

The ECG has no changes except for a slight left axis deviation due to the change in the heart's position. A)true B)false

DEVELOPMENTAL COMPETENCE | The Aging Adult

A gradual rise in systolic blood pressure is common with aging; the diastolic blood pressure stays fairly constant with a resulting widening of pulse. A)aging adult B)adult

In the aging adult a gradual rise in systolic is normal. A)true B)false

Some older adults experience orthostatic hypotension, a sudden drop in blood pressure when rising to sit or stand. A)true B)false

Use caution in palpating and auscultating the carotid artery. Avoid pressure in the carotid sinus area, which could cause a reflex slowing of the heart rate. A)aging adult B)adult

pressure on the carotid artery could compromise circulation if the artery is already narrowed by atherosclerosis A)aging adult B)adut

When measuring jugular venous pressure, view the right internal jugular vein. The aorta stiffens, dilates and elongates with aging, which may compress the left neck veins and obscure pulsations on the left side A)true B)false

measuring jugular venous pressure, view the right internal jugular vein. Because The aorta stiffens, dilates and elongates with aging, which may compress the left neck veins and obscure pulsations on the left side. A)aging adult B)adult

Measure jugular venous pressure on the right side do to aging of aorta stiffness in the left side of vein structures A)true B)false

The chest often increases in the anteroposterior diameter with aging. This makes it more difficult to palpate the apical impulse and to hear the splitting of S2. A)aging adult B)adult

The S4 often occurs in older people with no known cardiac disease. A)true B)false

Systolic murmurs are common, occurring in over 50% of aging people A)true B)false

Occasional premature ectopic beats are common and do not necessarily indicate underlying heart disease. When in doubt, obtain an ECG. A)true,aging adult B)false, aging adult

Accurately assess the heart on a ECG for a full 24 hrs for best results of any abnormal findings A)true B)false

The S3 is associated with heart failure and is always abnormal over age 35 years A)true B)false

S3 in an 35 y/o or older is abnormal and associated with heart failure A)true. B)false.

PROMOTING A HEALTHY LIFESTYLE: WOMEN AND HEART ATTACKS | The Heart Truth

When someone complains of chest pain or pain radiating down the left arm, we think heart attack A)true B)false

They are the most "typical" symptoms men have when having a myocardial infarction (MI), but not women. For women, symptoms can be quite different. A woman's "atypical" symptoms may be one of the reasons that more women are dying from heart disease than men these days A)true B)false

Women are 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. The evidence now shows that women tend to minimize their symptoms or attribute them to something else. This may be due to a lack of awareness A)true B)false

The Heart Truth is a national awareness and prevention campaign about heart disease in women sponsored by the National Heart, Lung, and Blood Institute (NHLBI). The campaign includes three components: (1) professional education, (2) patient education, and (3) public awareness.

True

ABNORMAL FINDINGS --- - -- --- ------ - - - - ---- -

Clinical Portrait of Heart Failure

>Dilated pupils, a sympathetic nervous system response Skin pale, gray, or cyanotic >Dyspnea, SOBOE is early symptom from pulmonary congestion >Orthopnea, cannot breathe unless sitting up >Crackles, wheeze are adventitious breath sounds >Cough, frothy pink or white sputum >Decreased blood pressure stimulates sympathetic nervous system, which acts on heart to increase rate and increase force of contraction >Nausea and vomiting as peristalsis slows and bile and fluids back up into stomach >Dependent, pitting edema in sacrum, legs >acites large amount of fluid in the lungs A)Clinical Portrait of Heart Failure B)false

True

>Anxiety, gasping from pulmonary congestion >Falling 02 saturation >Confusion, unconsciousness from decreased 02 to brain >Infarct, may be cause of decreased cardiac output >Fatigue, weakness from decreased cardiac output S3 gallop, tachycardia S3 >Enlarged spleen and liver from venous congestion, which causes pressure on breathing >Decreased urine output as kidneys compensate for decreased cardiac output by retaining sodium and H20 >Weak pulse Cool, moist skin as peripheral vasoconstriction shunts blood to vital organs >Jugular vein distention from venous congestion A)Clinical Portrait of Heart Failure B)false

True

Decreased cardiac output occurs when the heart fails as a pump, and the circulation becomes backed up and congested. A)congestive heart failure B)false

Signs and symptoms of heart failure come from two basic mechanisms: (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. A)true B)false

Onset of heart failure may be: ( l) 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. A)true B)false

ABNORMAL FINDINGS FOR ADVANCED PRACTICE

The intensity of S1 depends on three factors: (1) position of AV valve at the start of systole, (2) structure of the valve leaflets, and (3) how quickly pressure rises in the ventricle A)Variations in S1 B)variations in S2

Mitral and tricuspid components are heard separately, normal but uncommon A)S1 spilt B)S2 split

Semilunar valves thickened and calcified, with decreased mobility.Aortic or pulmonic stenosis. A)Diminished S2 B)false

Aortic stenosis,Left bundle branch block ,Patent ductus arteriosus also is affected by respirations A)Paradoxical Split B)wide split

A fixed split is unaffected by respiration;the spilt is always there,Atrial septal defect,Right ventricular failure, associated with the condition of a A)fixed split B)wide split

When the right ventricle has delayed electrical activation, the split is very wide on inspiration and is still there on expiration, ex;Right bundle branch block (which delays P2) A)wide spilt B)fixed split

Systolic Extra Sounds

The __________ occurs early in systole at the start of ejection because it results from opening of the semilunar valves. Normally, the SL valves open silently, but in the presence of stenosis (e.g., aortic stenosis, pulmonic stenosis), their opening makes a sound. It is short and high pitched, with a click quality, and is heard better with the diaphragm. A)ejection click B)aortic click

The __________ is heard at the second right interspace and apex and may be loudest at the apex. Its intensity does not change with respiration. A) aortic ejection click B)The pulmonic ejection .

The ___________ is best heard in the second left interspace and often grows softer with inspiration A)pulmonic ejection click B)aortic ejection click

As a sequela of modern technologic intervention for heart problems, some people now have iatrogenically induced heart sounds. The opening of a mechanical aortic ball-in-cage prosthesis produces an early systolic sound. This sound is less intense with a tilting disk prosthesis and is absent with a biologic tissue prosthesis (e.g., porcine) A)Aortic Prosthetic Valve Sounds B)Midsystolic Click

Although it is systolic, this is not an ejection click. It is associated with mitral valve prolapse, in which the mitral valve leaflets not only close with contraction but balloon back up into the left atrium. During ballooning, the sudden tensing of the valve leaflets and the chordae tendineae creates the click. A)Midsystolic Click B)Aortic Prosthetic Valve Sounds

The sound occurs in mid- to late systole and is short and high pitched, with a click quality. It is best heard with the diaphragm, at the apex, but also may be heard at the left lower sternal border. The click usually is followed by a systolic murmur. The click and murmur move with postural change; when the person assumes a squatting position, the click may move closer to S2, and the murmur may sound louder and delayed. The Valsalva maneuver also moves the click closer to S2. A)Midsystolic Click B)Opening Snap

The Valsalva maneuver also moves the click closer to S2. A)true B) false

Diastolic Extra Sounds

Normally the opening of the AV valves is silent. In the presence of stenosis, increasingly higher atrial pressure is required to open the valve. The deformed valve opens with a noise: the opening snap. It is sharp and high pitched, with a snapping quality. It sounds after S2 and is best heard with the diaphragm at the third or fourth left interspace at the sternal border, less well at the apex. A)Opening Snap B)Mitral Prosthetic Valve Sound

The opening snap usually is not an isolated sound. As a sign of mitral stenosis, the opening snap usually ushers in the lowpitched diastolic rumbling murmur of that condition A)true B)false

An iatrogenic sound, the opening of a ball-in-cage mitral prosthesis gives an early diastolic sound: an opening click just after S2, It is loud, is heard over the whole precordium, and is loudest at the apex and left lower sternal border. A)Opening Snap B)Mitral Prosthetic Valve Sound

Third Heart Sound The S3 is a ventricular filling sound. It occurs in early diastole during the rapid filling phase. Your hearing quickly accommodates to the S3, so it is best heard when you listen initially. It sounds after S2 but later than an opening snap would be. It is a dull, soft sound, and it is low pitched, like "distant thunder." It is heard best in a quiet room, at the apex, with the bell held lightly (just enough to form a seal), and with the person in the left lateral position A)S3 B)S2

The S3 can be confused with a split S2. Use these guidelines to distinguish the S3: • Location- The S3 is heard at the apex or left lower sternal border; the split S2 at the base. • Respiratory variation-The S3 does not vary in timing with respirations; the split S2 does. • Pitch-The S3 is lower pitched; the pitch of the split S2 stays the same A)true B)false

In adults, the S3 is usually abnormal. The pathologic S3 is also called a ventricular gallop or an S3 gallop, and it persists when sitting up. The S3 indicates decreased compliance of the ventricles, as in heart failure. A)true B)false

The S3 may be the earliest sign of heart failure. The S3 may originate from either the left or the right ventricle; a left-sided S3 is heard at the apex in the left lateral position, and a right-sided S3 is heard at the left lower sternal border with the person supine and is louder in inspiration. A)true B)false

The S3 occurs also with conditions of volume overload, such as mitral regurgitation and aortic or tricuspid regurgitation. A)true B)false

The S3 is also found in high cardiac output states in the absence of heart disease, such as hyperthyroidism, anemia, and pregnancy. When the primary condition is corrected, the gallop disappears. A)true B)false

Fourth Heart Sound The S4 is a ventricular filling sound. It occurs when the atria contract late in diastole. It is heard immediately before S1. This is a very soft sound, of very low pitch. You need a good bell, and you must listen for it. S4 is heard best at the apex, with the person in left lateral position. A)true B)false

A physiologic S4 may occur in adults older than 40 or 50 years with no evidence of cardiovascular disease, especially after exercise. A)true B)false

A pathologic S4 is termed an atrial gallop or an S4 gallop. It occurs with decreased compliance of the ventricle (e.g., coronary artery disease, cardiomyopathy) and with systolic overload (afterload), including outflow obstruction to the ventricle (aortic stenosis) and systemic hypertension. A left-sided S4 occurs with these conditions. It is heard best at the apex, in the left lateral position. A)true B)false

A right-sided S4 is less common. It is heard at the left lower sternal border and may increase with inspiration. It occurs with pulmonary stenosis or pulmonary hypertension A)true B)false

When both the pathologic S3 and S1 are present, a quadruple rhythm is heard. Often, in cases of cardiac stress, one response is tachycardia. During rapid rates, the diastolic filling time shortens and the S3 and S4 move closer together. They sound superimposed in mid-diastole, and you hear one loud, prolonged, summated sound, often louder than either S1 or S2. A)Summation Sound B)cardiac arrest

EXTRACARDIAC SOUNDS

Inflammation of the pericardium gives rise to a friction rub. The sound is high pitched and scratchy, like sandpaper being rubbed. lt is best heard with the diaphragm, with the person sitting up and leaning forward, and with the breath held in expiration. A)Pericardial Friction Rub B)heart failure

A friction rub can be heard any place on the precordium but usually is best heard at the apex and left lower sternal border, places where the pericardium comes in close contact with the chest wall. Timing may be systolic and diastolic. The friction rub of pericarditis is common during the 1st week after a myocardial infarction and may last only a few hours. A)Pericardial Friction Rub B)JVD

After a MI what is common for a few hours A)pericardial friction rub B)heart failure

Abnormal Pulsations on the Precordium

A thrill in the second and third right interspaces occurs with severe aortic stenosis and systemic hypertension. A)bash B)apex

A thrill in the second and third left interspaces occurs with pulmonic stenosis and pulmonic hypertension. A)base B)apex

A lift (heave) occurs with right ventricular hypertrophy, as found in pulmonic valve disease, pulmonic hypertension, and chronic lung disease. You feel a diffuse lifting impulse during systole at the left lower sternal border. It may be associated with retraction at the apex because the left ventricle is rotated posteriorly by the enlarged right ventricle. A)Left Sternal Border B)base

Cardiac enlargement displaces the apical impulse laterally and over a wider area when left ventricular hypertrophy and dilation are present. This is volume overload, as in mitral regurgitation, aortic regurgitation, and left-to-right shunts. A)Apex B)base

The apical impulse is increased in force and duration but is not necessarily displaced to the left when left ventricular hypertrophy occurs alone without dilation. This is pressure overload, as found in aortic stenosis or systemic hypertension A)apex B)base

Congenital Heart Defects

Persistence of the channel joining left pulmonary artery to aorta. This is normal in the fetus and usually closes spontaneously within hours of birth. S: Usually no symptoms in early childhood; growth and development are normal. 0 : Blood pressure has wide pulse pressure and bounding peripheral pulses from rapid runoff of blood into low-resistance pulmonary bed during diastole. Thrill often palpable at left upper sternal border. The continuous murmur heard in systole and diastole is called a machinery murmur. A)Patent Ductus Arteriosus (PDA) B)Atrial Septal Defect (ASD)

Abnormal opening in the atrial septum, resulting usually in left-to-right shunt and causing large increase in pulmonary blood flow. S: Defect is remarkably well tolerated. Symptoms in infants are rare; growth and development normal. Children and young adults have mild fatigue and DOE. 0: Sternal lift often present. S2 has fixed split, with P2 often louder than A2. Murmur is systolic, ejection, medium pitch, best heard at base in second left interspace. Murmur caused not by shunt itself but by increased blood flow through pulmonic valve. A)Atrial Septal Defect (ASD) B)Ventricular Septal Defect (VSD)

Abnormal opening in septum between the ventricles, usually subaortic area. The size and exact position vary considerably. S: Small defects are asymptomatic. Infants with large defects have poor growth, slow weight gain; later look pale, thin, delicate. May have feeding problems; DOE; frequent respiratory infections; and when the condition is severe, heart failure. 0: Loud, harsh holosystolic murmur, best heard at left lower sternal border, may be accompanied by thrill. Large defects also have soft diastolic murmur at apex (mitral flow murmur) due to increased blood flow through mitral valve. A)Ventricular Septal Defect (VSD) B)Tetralogy of Fallot

Four components: (I) right ventricular outflow stenosis, (2) VSD, (3) right ventricular hypertrophy, and (4) overriding aorta. Result: shunts a lot of venous blood directly into aorta away from pulmonary system, so blood never gets oxygenated. S: Severe cyanosis, not in first months of life but develops as infant grows and RV outflow (i.e., pulmonic) stenosis gets worse. Cyanosis with crying and exertion at first, then at rest. Uses squatting posture after starts walking. DOE common. Development is slowed. 0: Thrill palpable at left lower sternal border. S1 normal; S2 has A2 loud and P2 diminished or absent. Murmur is systolic, loud, crescendo-decrescendo. A)Tetralogy of Fallot B)Coarctation of the Aorta

Severe narrowing of descending aorta, usually at the junction of the ductus arteriosus and the aortic arch, just distal to the origin of the left subclavian artery. Results in increased workload on left ventricle. Associated with defects of aortic valve in most cases, as well as associated patent ductus arteriosus; and associated ventricular septal defect. S: In infants with associated lesions or symptoms, diagnosis occurs in first few months as symptoms of heart fa ilure develop. For asymptomatic children and adolescents, growth and development are normal. Diagnosis usually incidental due to blood pressure findings. Adolescents may complain of vague lower extremity cramping that is worse with exercise. 0 : Upper extremity hypertension over 20 mm Hg higher than lower extremity measures is a hallmark of coarctation. Another important sign is absent or greatly diminished femoral pulses. A systolic murmur is heard best at the left sternal border, radiating to the back. A)Coarctation of the Aorta B)Aortic Stenosis

Murmurs Due to Valvular Defects

Midsystolic Ejection Murmurs Due to forward flow through semilunar valves A)true B)false

Calcification of aortic valve cusps restricts forward flow of blood during systole; LV hypertrophy develops. S: Fatigue, DOE, palpitation, dizziness, fainting, anginal pain. 0: Pallor, slow diminished radial pulse, low blood pressure, and auscultatory gap are common. Apical impulse sustained and displaced to left. Thrill in systole over second and third right interspaces and right side of neck. S1 normal, often ejection click present, often paradoxical split S2, S4 present with LV hypertrophy. Murmur: Loud, harsh, midsystolic, crescendodecrescendo, loudest at second right interspace, radiates widely to side of neck, down left sternal border, or apex. A)Aortic Stenosis B)Pulmonic Stenosis

Calcification of pulmonic valve restricts forward flow of blood. 0: Thrill in systole at second and third left interspace, ejection click often present after S., diminished s2 and usually with wide split, s4 common with RV hypertrophy. Murmur: Systolic, medium pitch, coarse, crescendo-decrescendo (diamond shape), best heard at second left interspace, radiates to the left and neck. A)Pulmonic Stenosis B)Tricuspid Regurgitation

Pansystolic Regurgitant Murmurs Due to backward flow of blood from area of higher pressure to one of lower pressure A)true B)false

Stream of blood regurgitates back into LA during systole through incompetent mitral valve. In diastole, blood passes back into LV again along with new flow; results in LV dilation and hypertrophy. S: Fatigue, palpitation, orthopnea, PND. 0: Thrill in systole at apex. Lift at apex. Apical impulse displaced down and to left. S1 diminished, S2 accentuated, S3 at apex often present. Murmur: Pansystolic, often loud, blowing, best heard at apex, radiates well to left axilla. A)Mitral Regurgitation B)Tricuspid Regurgitation

Backflow of blood through incompetent tricuspid valve into RA. 0: Engorged pulsatjng neck veins, liver enlarged. Lift at sternum if RV hypertrophy present, often thrill at left lower sternal border. Murmur: Soft, blowing, pansystolic, best heard at left lower sternal border, increases with inspiration. A)Tricuspid Regurgitation B)Aortic Regurgitation

Early Diastolic Murmurs Due to SL valve incompetence. A)true B)false

Stream of blood regurgitates back through incompetent aortic valve into LV during diastole. LV dilation and hypertrophy due to increased LV stroke volume. Rapid ejection of large stroke volume into poorly filled aorta, then rapid runoff in diastole as part of blood pushed back into LV. S: Only minor symptoms for many years, then rapid deterioration: DOE, PND, angina, dizziness 0: Bounding "water-hammer" pulse in carotid, brachial, and femoral arteries. Blood pressure has wide pulse pressure. Pulsations in cervical and suprasternal area, apical impulse displaced to left and down, apical impulse feels brief. Murmur starts almost simultaneously with S2: soft high pitched, blowing diastolic, decrescendo, best heard at third left interspace at base, as person sits up and leans forward, radiates down. A)Aortic Regurgitation B)Pulmonic Regurgitation

Backflow of blood through incompetent pulmonic valve, from pulmonary artery to RV. Murmur has same timing and characteristics as that of aortic regurgitation, and is hard to distinguish on physical examination. A)Pulmonic Regurgitation B)Aortic Regurgitation

Summary Checklist: Heart and Neck Vessels Exam

Neck 1. Carotid pulse- Observe and palpate 2. Observe jugular venous pulse 3. Estimate jugular venous pressure Precordium Inspection and palpation 1. Describe location of apical impulse 2. Note any heave (lift) or thrill Auscultation 1. Identify anatomic areas where you listen 2. Note rate and rhythm of heartbeat 3. Identify S, and S2 and note any variation 4. Listen in systole and diastole for any extra heart sounds 5. Listen in systole and diastole for any murmurs 6. Repeat sequence with bell 7. Listen at the apex with person in left lateral position 8. Listen at the base with person in sitting position

the first heart sound is produced by the A)closure of the AV valves B)opening of the AV valves

S3 heard with opening of the AV valves A)true B)false

S2 is heard by closure of the SL valves A)true B)false

S1 coincides with the carotid artery pluse A)true B)false

an increase in cardiac volume and a decrease in blood pressure occurs during A)pregnancy B)adult

which of the following is an appropriate position to have the patient assume when auscultating for extra heart sounds or murmurs A)roll toward the left side B)recumbent position

the leaflets of the tricuspid and mitral valves are anchored by __________to the__________,which are embedded in the ventricular floor. A)chordae tendineae, papillary muscles B)none

the ability of the heart to contract independently of any signal or stimulation is due to A)automatically B)conduction

when auscultating the heart of a newborn within 24hrs after brith, the examiner hears a continuous sound that mimics the sound of a machine.this finding most likely indicates A)an expected sound caused by non-closure of the ductus arteriosus B)none

the murmur of a patent ductus arteriosus is a continuos machinery murmur which disappears by 2-3 days of a new born A)true B)false

a bruit heard while auscultating the carotid artery of a 65y/o pt is caused by A)turbulent blood flow through the carotid artery B)false

the JVP is a indirect reflection of the A)hearts efficiency as a pump B)vena caava

the SL valves separate the A)ventricles from the arteries B)none

EXTRA INFORMATION

Angina is temporary heart pain, resolving in less than 20 minutes. It can be aggravated by physical activity and stress, or there may be no triggers (unstable angina) A)true B)false

Temporary heart pain, resolving in less than 20 minutes, aggravated by physical activity and stress is known as what? ``` Choose one of the following A Crushing B Musculoskeletal C Angina D Gastrointestinal ```

A patient with dehydration or volume depletion has barely visible neck veins, even when lying flat. These are described as what? ``` Choose one of the following A Flat neck veins B Distended neck veins C Round neck veins D Invisible neck veins ```

When educating a patient about healthy habits relating to cardiovascular health, it is important to include which of the following? Select all that apply. ``` Select all that apply: A Undergo regular cholesterol screening B Quit or do not start smoking C Eat a low-fat diet D Undergo regular screening for diabetes E Exercise regularly ```

A B C D E

When auscultating a patient's heart, the nurse hears both S3 and S4. What is this known as? ``` Choose one of the following A Summation gallop B Atrial kick C Diastolic clicks D Ejection clicks ```

The nurse hears high-pitched swooshing sounds over the carotid artery on the right side. What is this sound indicative of? ``` Choose one of the following A Murmurs B Bruits C Gallops D Normal findings ```

Where are the heart and great vessels located in the human body? ``` Choose one of the following A The mediastinum, between the lungs below the diaphragm B The mediastinum, between the lungs above the diaphragm C The peritoneum, above the diaphragm D The peritoneum, below the diaphragm ```

Consuming more than two drinks of alcohol per day for men or one drink of alcohol per day for women can raise blood pressure and contribute to failure. ``` Choose one of the following A True B False ```

Maternal blood volume increases during pregnancy. The volume may increase as much as __________% with a multiple pregnancy. A)70 B)20

How does the nurse differentiate a pleural friction rub from a pericardial friction rub? Choose one of the following A Auscultate the base of the heart; if a rub is present, it is pericardial B Turn the patient on the right side; if the rub persists, it is pericardial C Have the patient hold his or her breath; if the rub persists, it is pericardial D Auscultate the upper back; if a rub is present, it is pleural

Pericardial friction rubs can be differentiated from pleural friction rubs by having the patient hold the breath A)true B)false

The cardiovascular system delivers oxygen and nutrients to the cells and tissues and returns waste products to the central circulation for excretion. ``` Choose one of the following A True B False ```

A nurse receives a patient from the cardiac catheterization laboratory. The patient is on bed rest and has a weight on the puncture site of the right groin. What must the nurse assess for frequently? Select all that apply. ``` Select all that apply: A Increased blood pressure, which could cause excess bleeding or hematoma B Bleeding at the puncture site C Hematoma at the puncture site D Pulses distal to the puncture site ```

A B C D

The top of the heart is referred to as the apex because it is broad; the bottom of the heart is referred to as the base. ``` Choose one of the following A True B False ```

One of the most important lifestyle changes a patient can make to improve cardiovascular health is what? ``` Choose one of the following A Eating a diet high in fat B Living a more sedentary lifestyle C Getting less exercise and more rest D Quitting smoking ```

The nurse positions the patient for auscultation of heart sounds. What does the nurse do first? ``` Choose one of the following A Warm the bell of the stethoscope B Clean the stethoscope C Wash the patient's chest D Auscultate the carotid arteries ```

By what percent can patients reduce their risk of cardiac events the first year after quitting smoking? ``` Choose one of the following A 50% B 60% C 40% D 30% ```

When S3 exists, it follows S2 and sounds like "lub dub-dub." It usually is heard best in the base of the heart with the patient lying on the left side. ``` Choose one of the following A True B False ```

What is the most important physical sign of acute pericarditis? ``` Choose one of the following A Murmur heard over the left sternal border B Elevated white cell count C Pericardial friction rub D Intense pain ```

A patient complains of difficulty sleeping. He states he has to sit up with the help of several pillows and cannot breathe when lying flat. This patient has a condition known as what? ``` Choose one of the following A Tachypnea B Pneumonia C Orthopnea D Sleep apnea ```

the AV valves separate the A)atria and ventricles B)none