Jarvis Ch-20 Heart & Neck Vessels Flashcards
When assessing a patient’s cardiovascular system, the nurse notes a high pitched scratchy sound at the apex of the heart. The nurse recognizes this as rubbing between two walls of the sac surrounding and protecting the heart, called the:
a. Pericardium
b. Myocardium
c. Endocardium
d. Pleural space
a. Pericardium
The pericardium 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. Inflammation of the precordium gives rise to a friction rub. The sound is high pitched and scratchy, like sandpaper being rubbed.
The direction of blood flow through the heart is best described by which of these?
a. Vena cava > right atrium > right ventricle > lungs > pulmonary artery > left atrium > left ventricle
b. Right atrium > right ventricle > pulmonary artery > lungs > pulmonary vein > left atrium > left ventricle
c. Aorta > right atrium > right ventricle > lungs > pulmonary vein > left atrium > left ventricle > vena cava
d. Right atrium > right ventricle > pulmonary vein > lungs > pulmonary artery > left atrium > left ventricle
b. Right atrium > right ventricle > pulmonary artery > lungs > pulmonary vein > left atrium > left ventricle
Returning blood from the body empties into the right atrium, flows into the right ventricle, and then goes to the lungs through the pulmonary artery. The lungs oxygenate blood, and it is then returned to the left atrium through the pulmonary vein. Blood goes from there to the left ventricle and then to the aorta and out to other areas of the body.
The nurse is reviewing the anatomy and physiological functioning of the heart. Which statement best describes what is meant by atrial kick?
a. The atria contract during systole and attempt to push against closed valves.
b. Contraction of the atria at the beginning of diastole can be felt as a palpitation.
c. Atrial kick is the pressure exerted against the atria as the ventricles contract during systole.
d. The atria contract toward the end of diastole and push the remaining blood into the ventricles.
d. The atria contract toward the end of diastole and push the remaining blood into the ventricles.
Towards the end of diastole, the atria contract and push the last amount of blood (approximately 25% of stroke volume) into the ventricles. This active filling phase is called presytole, or atrial systole, or sometimes the atrial kick.
When listening to heart sounds, the nurse knows the valve closures that can be heard best at the base of the heart are:
a. Mitral and tricuspid
b. Tricuspid and aortic
c. Aortic and pulmonic
d. Mitral and pulmonic
c. Aortic and pulmonic
The second heart sound (S2) occurs with the closure of the semilunar (aortic & pulmonic) valves and signals the end of systole. Although it is heard over all the precordium, the S2 is loudest at the base of the heart.
Which of these statements describes the closure of the valves in a normal cardiac cycle?
a. The aortic valve closes slightly before the tricuspid valve.
b. The pulmonic valve closes slightly before the aortic valve.
c. The tricuspid valve closes slightly later than the mitral valve.
d. Both the tricuspid and pulmonic valves close at the same time.
c. The tricuspid valve closes slightly later than the mitral valve.
Events occur just slightly later in the right side of the heart because of the route of myocardial depolarization. As a result. two distinct components to each of the heart sounds exist, and sometimes they can be heard separately. If the first heart sound, the mitral component (M1) closes just before the tricuspid component (T1).
The component of the conduction system referred to as the pacemaker of the heart is the:
a. Atrioventricular (AV) node
b. Sinoatrial (SA) node
c. Bundle of His
d. Bundle branches
b. Sinoatrial (SA) node
Specialized cells in the SA node near the superior vena cava initiate an electrical impulse. Because the SA node has an intrinsic rhythm, it is called the pacemaker of the heart.
The electrical stimulus of the cardiac cycle follows which sequence?
a. AV node > SA node > bundle of His
b. Bundle of His > AV node > SA node
c. SA node > AV node > bundle of His > bundle branches
d. AV node > SA node > bundle of His > bundle branches
c. SA node > AV node > bundle of His > bundle branches
Specialized cells in the SA node near the superior vena cava initiate an electrical impulse. The current flows in an orderly sequence, first across the atria to the AV node low in the atrial septum. There it is delayed slightly, allowing the atria the time to contract before the ventricles are stimulated. Then the impulses travels to the bundle of His, to the right and left bundle branches, and then through the ventricles.
The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. The nurse knows that this finding indicates:
a. Decreased fluid volume
b. Increased cardiac output
c. Narrowing of jugular veins
d. Elevated pressure related to heart failure
d. Elevated pressure related to heart failure
Because no cardiac valve exists to separate the superior vena cava from the right atrium, the jugular veins give information about the activity on the right side of the heart. They reflect filling pressures and volume changes. Normal jugular venous pulsation is 2 cm or less above the sternal angle. Elevated pressure is a level of pulsation of more than 3 cm above the sternal angle at 45 degrees and occurs with heart failure.
When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to be true?
a. The left ventricle is larger and weighs more than the right ventricle.
b. The circulation of a newborn is identical to that of an adult.
c. Blood can flow into the left side of the heart through an opening in the atrial septum.
d. The foramen ovale closes just minutes before birth, and the ductus arteriosus closes immediately after.
About two-thirds of the freshly oxygenated blood from the placenta 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. The foramen ovale closes within the first hour after birth because the pressure in the right side of the heart is now lower than in the left side.
A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous examination findings, the nurse notes that her blood pressure in her second month was 124/80 mm Hg. In evaluating this change, what does the nurse know to be true?
a. This decline in blood pressure is the result of peripheral vasodilation and is an expected change.
b. Because of increased cardiac output, the blood pressure should be higher at this time.
c. This change in blood pressure is not an expected finding because it means a decrease in cardiac output.
d. This decline in blood pressure means a decrease in circulating blood volume, which is dangerous for the fetus.
a. This decline in blood pressure is the result of peripheral vasodilation and is an expected change.
Despite the increased cardiac output, arterial blood pressure decreases in pregnancy because of peripheral vasodilation. The blood pressure drops to its lowest point during the second trimester and then rises after that.
In assessing a 70-year-old man, the nurse finds the following: BP of 140/100 mm Hg; HR of 104 and slightly irregular; and split S₂. Which of these findings is an expected hemodynamic change related to age?
a. Increase in resting HR
b. Increase in systolic BP
c. Decrease in diastolic BP
d. Increase in diastolic BP
b. Increase in systolic BP
With aging, an increase in systolic BP occurs.
A 45-year-old man is in the clinic for a routine physical examination. During the recoding of his health hx, the patient states that he has been having difficulty sleeping. “I’ll be sleeping great, and then I wake up and feel I can’t get my breath.” The nurses best response to this would be:
a. “when was your last electrocardiography done?”
b. “it’s probably because it’s been so hot at night.”
c. “Do you have any hx of problems with your heart?”
d. “Have you had a recent sinus infection or upper respiratory infection?”
c. “Do you have any hx of problems with your heart?”
Paroxysmal nocturnal dyspnea (SOB generally occurring at night_ occurs with heart failure. Lying down increases the volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and fligs open a window with the perception of needing fresh air.
In assessing a patient’s major risk factors for heart disease, which would the nurse want to include when taking a hx?
a. Family history, hypertension, stress, and age.
b. personality type, high cholesterol, diabetes, and smoking
c. smoking, hypertension, obesity, diabetes, and high cholesterol
d. Alcohol consumption, obesity, diabetes, stress, and high cholesterol
c. smoking, hypertension, obesity, diabetes, and high cholesterol
The mother of a 3-month-old infant states that her baby has not been gaining weight. With further questioning, the nurse finds that the infant falls asleep after nursing and wakes up after a short time, hungry again. What other information would the nurse need?
a. Infants sleeping position
b. Sibling hx of eating disorders
c. Amount of background noise when eating
d. Presence of dyspnea or diaphoresis when sucking.
d. Presence of dyspnea or diaphoresis when sucking.
To screen for heart disease in an infant, the focus should be on feeding. Fatigue during feeding should be noted. An infant with heart failure takes fewer ounces each feeding, becomes dyspneic with sucking, may be diaphoretic, and then falls into exhausted sleep and awakens after a short time hungry again.
In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would:
a. Palpate the artery in the upper one-third of the neck.
b. Listen with the bell of the stethoscope to assess for bruits
c. Simultaneously palpate both arteries to compare amplitude
d. instruct the patient to take slow deep breaths during auscultation.
b. Listen with the bell of the stethoscope to assess for bruits.
If cardiovascular disease is suspected, then the nurse should auscultate each carotid artery for the presence of a bruit by using the bell of the stethoscope. The nurse should avoid compressing the artery, which would create an artificial bruit and compromise circulation if the carotid artery is already narrowed by atherosclerosis. Excessive pressure on the carotid sinus area high in the next should be avoided, and excessive vagal stimulation could slow down the heart rate, especially in older adults. Palpating only one carotid artery at a time will avoid compromising arterial blood to the brain.
During an assessment of a 68-year-old man with a recent onset of right-sided weakness, the nurse hears a blowing, swishing sound with the bell of the stethoscope over the left carotid artery. This finding would indicate:
a. Valvular disorder
b. Blood flow turbulence
c. Fluid volume overload
d. Ventricular hypertrophy
b. Blood flow turbulence
A bruit is an blowing, swishing sound indicating blood flow turbulence; normally, none is present.
During an inspection of the precordium of an adult patient, the nurse notices the chest moving in a forceful manner along the sternal border. This finding most likely suggests:
a. A normal heart
b. Systolic murmur
c. Enlargement of the left ventricle
d. Enlargement of the right ventricle
d. Enlargement of the right ventricle
Normally, the examiner may or may not see an apical impulse; when visible, it occupies the fourth or fifth intercostal space at or inside the midclavicular line (MCL). 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.
Before administering certain cardiovascular medications, the nurse needs to check the rate of the apical impulse at the:
a. Third intercostal space at the midclavicular line
b. Fourth left intercostal space at the sternal border
c. Fourth left intercostal space at the anterior axillary line.
d. Fifth left intercostal space at the midclavicular line.
d. Fifth left intercostal space at the midclavicular line.
The apical impulse should occupy only one intercostal space, the fourth or fifth, and it should be at or medial to the midclavicular line.
The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true?
a. Percussion is a useful tool for outlining the hearts borders.
b. Percussion is easier in patients who are obese.
c. Studies show that percussed cardiac borders do not correlate well with the true cardiac border.
d. Only expert health care providers should attempt percussion of the heart.
c. Studies show that percussed cardiac borders do not correlate well with the true cardiac border.
Numerous comparison studies have shown that the percussed cardiac border correlates only moderately with the true cardiac borer. Percussion is of limited usefulness in the female breast tissue, in a person who is obese, or in a person with a muscular chest wall. Chest radiography and echocardiography are significantly more accurate in detecting heart enlargement.
The nurse is preparing to auscultate for heart sounds. Which technique is correct?
a. Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral areas.
b. Listening by including the stethoscope in a rough “Z” pattern, from the base of the heart across and down, then over to the apex.
c. Listening to the sounds only at the site where the apical pulse is felt to be the strongest.
d. Listening for all possible sounds at a time at each specified area.
b. Listening by including the stethoscope in a rough “Z” pattern, from the base of the heart across and down, then over to the apex.
Auscultation of breath sounds should not be limited to only four locations. Sounds produced by the valves may be heard all over the precordium. The stethoscope should be inched in a rough “Z” pattern from the base of the heart, across and down, and then over to the apex; or, starting at the apex, it should be slowly worked up.
While counting the apical pulse on a 16-year-old patient, the nurse notices an irregular rhythm. His rate speeds up on inspiration and slows on expiration. What would be the nurse’s response?
a. Talk with the patient about his intake of caffeine.
b. Perform ECG after the examination.
c. No further response is needed because sinus arrhythmia can occur normally.
d. Refer the patient to a cardiologist for further testing.
c. No further response is needed because sinus arrhythmia can occur normally.
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.
When listening to heart sounds, the nurse knows that S₁:
a. Is louder than S₂ at the base of the heart.
b. Indicates the beginning of diastole.
c. Coincides with the carotid artery pulse.
d. Is caused by the closure of the semilunar valves.
c. Coincides with the carotid artery pulse.
S1 coincides with the carotid artery pulse, is the start of systole, and is louder than S2 at the apex of the heart; S2 is louder than S1 at the base. The nurse should gently feel the carotid artery pulse while auscultating at the apex; the sound heard as each pulse is felt is S1.
During auscultation, the nurse hears a sound immediately occuring after S₂ at the second left intercostal space. To further assess this sound, what should the nurse do?
a. Have the patient turn to the left side while the nurse listens with the bell of the stethoscope.
b. Ask the patient to hold his or hear breath while the nurse listens again.
c. No further assessment is needed because the nurse knows this sound is S₃
d. Watch the patient’s respirations while listening for the effect of breathing on the sound.
d. Watch the patient’s respirations while listening for the effect of breathing on the sound.
Which of these findings would the nurse expect to notice during a cardiac assessment of a 4-year-old child?
a. S₃ when sitting up
b. Persistent tachycardia above 150 bpm
c. Murmur at the second left intercostal space when supine
d. Palpable apical impulse in the fifth left intercostal space lateral to midclavicular line.
c. Murmur at the second left intercostal space when supine
Some murmurs are common in healthy children or adolescents and are termed innocent of functional. 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.
While auscultating heart sounds on a 7-year-old child for routine physical examination, the nurse hears S₃, a soft murmur at the left midsternal border, and a venous hum when the child is standing. What would be a correct interpretation of these findings?
a. S₃ is indicative of heart disease in children
b. These findings can all be normal in a child.
c. These findings are indicative of congenital problems.
d. The venous hum most likely indicates an aneurysm.
b. These findings can all be normal in a child.
S₃ is common in children.
During the precordial assessment on a patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. This finding would indicate:
a. Right ventricular hypertrophy
b. Increased volume and size of the heart as a result of pregnancy.
c. Displacement of the heart from elevation of the diaphragm
d. Increased blood flow through the internal mammary artery.
c. Displacement of the heart from elevation of the diaphragm
In assessing for S₄ with a stethoscope, the nurse would listen with the:
a. Bell of the stethoscope at the base witht he patient leaning forward.
b. Bell of the stethoscope at the apex with the patient in the left lateral position.
c. Diaphragm of the stethoscope in the aortic area with the patient sitting
d. Diaphragm of the stethoscope in the pulmonic area with the patient supine.
b. Bell of the stethoscope at the apex with the patient in the left lateral position.
S4 is a ventricular filling sound that occurs when the atria contract late in diastole and is heard immediately before S1. S4 is a very soft sound with a very low pitch. The nurse needs a good bell adn must listen for this sound. S4 is heard best at teh apex, with the person in the left lateral position.
A 70-year-old patient with a hx of hypertension has a bp of 180/100 and a HR of 90. The nurse hears an extra sound at the apex immediately before S₁ . The sound is heard only with the bell of the stethoscope while the patient is in the left lateral position. With these findings and the patient’s hx, the nurse knows that this extra heart sound is most likely a(n):
a. split S₁
b. atrial gallop
c. diastolic murmur
d. summation sound
b. atrial gallop
Pathological S4 is termed the atrial gallop or S4 gallop. It occurs with decreased compliance of the ventricle and with systolic overload (afterload), including outflow obstruction to the ventricle (aortic stenosis) and systemic hypertension. Left-sided S4 occurs with these conditions and is heard best at the apex with the patient in the left lateral position.
The nurse is performing a cardiac assessment of a 65-year-old patient 3 days after her myocardial infarction. Heart sounds are normal when she is supine, but when she is sitting and leaning forward, the nurse hears a high pitched, scratchy sound with the diaphragm of the stethoscope at the apex. It disappears on inspiration. The nurse suspects:
a. Increased cardiac output
b. Another MI
c. Inflammation of the precordium
d. Ventricular hypertrophy resulting from muscle damage
c. Inflammation of the precordium
Inflammation of the precordium gives rise to a friction rub. The sound is high pitched and scratchy, similar to sandpaper being rubbed. A friction rub is best heard with the diaphragm of the stethoscope, with the person sitting up leaning forward, and with the breath held in expiration. A friction rub can be heard any place on the precordium. Usually however, the sound is best heard at the apex and left lower sternal border, which are places where the pericardium comes in close contact with the chest wall.
The mother of a 10 month old infant tells the nurse that she has noticed that her son becomes blue when he is crying and that the frequency of this is increasing. He is also not crawling yet. During the examination, the nurse palpates a vibration that feels like a purring cat at the left lower sternal border and auscultates a loud systolic murmur in the same area. What would be the most likely cause of these findings?
a. Tetralogy of Fallot
b. Atrial septal defect
c. Patent ductus arteriosus
d. Ventricular septal defect
a. Tetralogy of Fallot
A 30-year-old woman with a hx of mitral valve problems states that she had been “very tired.” She has started waking up at night and feels like her “heart is pounding.” During the assessment, the nurse palpates a thrill and forceful pushing of the ventricle at the fifth left intercostal space midclavicular line. In the same area, the nurse also auscultates a blowing, swishing sound right after S₁. These findings would be most consistent with:
a. Heart failure
b. Aortic stenosis
c. Pulmonary edema
d. Mitral regurgitation
d. Mitral regurgitation
During a cardiac assessment of a 38-year-old patient in the hospital for “chest pain,” the nurse finds the following: jugular vein pulsations 4 cm above the sternal angle when the patient is elevated at 45 degrees, BP 98/60 mm Hg, HR-130, ankle edema, difficulty breathing when supine, and S₃ on auscultation. Which of these conditions best explains the cause of these findings?
a. Fluid overload
b. Atrial septal defect
c. MI
d. Heart failure
d. Heart failure
The nurse knows that normal splitting of S₂ is associated with:
a. Expiration
b. Inspiration
c. Exercise state
d. Low resting heart rate.
b. Inspiration
During a cardiovascular assessment, the nurse knows that a thrill is:
a. A palpable vibration of rushing blood flow
b. Palpated in the right epigastric area
c. Associated with ventricular hypertrophy
d. A murmur auscultated at the third intercostal space.
a. A palpable vibration of rushing blood flow
During a cardiovascular assessment, the nurse knows that S₄ is:
a. Heard at the onset of atrial diastole
b. Usually a normal findings in the older adult
c. Heard at the end of ventricular diastole
d. Heard best over the second left intercostal space with the individual sitting upright.
c. Heard at the end of ventricular diastole
S4 is heard at the end of diastole when the atria contract and when the ventricles are resistant to filling. S4 occurs just before S1.
During assessment, the nurse notes that the patient’s apical impulse is laterally displaced and is palpable over a wide area. This finding indicates:
a. Systemic hypertension
b. Pulmonary hypertension
c. Pressure overload, as in aortic stenosis
d. Volume overload, as in heart failure
d. Volume overload, as in heart failure
With volume overload, as in heart failure and cardiomyopathy, cardiac enlargement laterally displaces the apical impulse and is palpable over a wider area when left ventricular hypertrophy and dilation are present.
When the nurse is auscultating the carotid artery for bruits, which of these statements reflects the correct technique?
a. While listening witht he bell of the stethoscope, the patient is asked to take a deep breath and hold it.
b. While auscultating one side with the bell of the stethoscope, the carotid artery is palpated on the other side to check pulsations.
c. While lightly applying the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.
d. While firmly placing the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.
c. While lightly applying the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.
The nurse is preparing for a class on risk factors for heart disease and identified the population with the highest prevalence of heart disease as people of:
a. African descent
b. European descent
c. Indigenous descent
d. South Asian descent
a. African descent
The nurse is assessing a patient with possible cardiomyopathy and assesses the hepatojugular reflux. If heart failure is present, then the nurse should recognize which findings?
a. The jugular veins will rise for a few seconds and then receded back to the previous level if the heart is properly working.
b. The jugular veins will remain elevated as long as pressure on the abdomen is maintained.
c. An impulse will be visible at the fourth or fifth intercostal space at or inside the midclavicular line.
d. The jugular veins will not be detected during this manoeuvre.
b. The jugular veins will remain elevated as long as pressure on the abdomen is maintained.
The nurse is assessing the apical pulse of a 3-month-old infant and finds that the heart rate is 125 beats per minute. The nurse interprets this result as:
a. Normal for this age
b. Lower than expected
c. Higher than expected, probably as a result of crying.
d. Higher than expected, reflecting a persistent tachycardia.
a. Normal for this age
