Chapter 20: Heart and Neck Vessels
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. What is the sac that surrounds and protects the heart is called?
a.
Myocardium
b.
Pericardium
c.
Endocardium
d.
Pleural space
2. The direction of blood flow through the heart is best described by which of these?
a.
Vena cava → right atrium → right ventricle → lungs → pulmonary artery → left
atrium → left ventricle
b.
Right atrium → right ventricle → pulmonary artery → lungs → pulmonary vein →
left atrium → left ventricle
c.
Aorta → right atrium → right ventricle → lungs → pulmonary vein → left atrium
→ left ventricle → vena cava
d.
Right atrium → right ventricle → pulmonary vein → lungs → pulmonary artery →
left atrium → left ventricle
3. The nurse is reviewing the anatomy and physiologic 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.
4. When listening to heart sounds, which valve closures are heard best at the base of the heart?
a.
Aortic and pulmonic
b.
Mitral and pulmonic
c.
Mitral and tricuspid
d.
Tricuspid and aortic
5. Which of these statements describes the closure of the valves in a normal cardiac cycle?
a.
The pulmonic valve closes slightly before the aortic valve.
b.
The aortic valve closes slightly before the tricuspid valve.
c.
Both the tricuspid and pulmonic valves close at the same time.
d.
The tricuspid valve closes slightly later than the mitral valve.
6. What component of the conduction system is referred to as the pacemaker of the heart?
a.
Bundle of His
b.
Bundle branches
c.
Sinoatrial (SA) node
d.
Atrioventricular (AV) node
7. Which sequence does the electrical stimulus of the cardiac cycle follow?
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
8. The findings from an assessment of a 70-year-old patient with swelling in his ankles include
jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45
degrees. What does this finding indicate?
a.
Decreased fluid volume
b.
Increased cardiac output
c.
Narrowing of jugular veins
d.
Elevated pressure r/t heart failure
9. 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, 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 vasodilatation 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.
10. In assessing a 70-year-old man, the nurse finds the following: blood pressure 140/100 mm Hg;
heart rate 104 beats per minute and slightly irregular; and the split S2 heart sound. Which of
these findings can be explained by the expected hemodynamic changes r/t age?
a.
Increase in resting heart rate
b.
Increase in systolic blood pressure
c.
Decrease in diastolic blood pressure
d.
Increase in diastolic blood pressure
11. A 45-year-old man is in the clinic for a routine physical examination. During the recording of
his health history, the patient states that he has been having difficulty sleeping. “I’ll be
sleeping great, and then I wake up and feel like I can’t get my breath.” Which is the best
response by the nurse?
a.
“When was your last electrocardiogram?”
b.
“It’s probably because it’s been so hot at night.”
c.
“Do you have any history of problems with your heart?”
d.
“Have you had a recent sinus infection or upper respiratory infection?”
12. In assessing a patient’s major risk factors for heart disease, which would the nurse want to
include when taking a history?
a.
Family history, hypertension, stress, 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
13. 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 want to have?
a.
Infant’s sleeping position
b.
Sibling history of eating disorders
c.
Amount of background noise when eating
d.
Presence of dyspnea or diaphoresis when sucking
14. What should the nurse do when assessing the carotid arteries of an older patient with
cardiovascular disease?
a.
Palpate the artery in the upper one-third of the neck.
b.
Simultaneously palpate both arteries to compare amplitude.
c.
Listen with the bell of the stethoscope to assess for bruits.
d.
Instruct the patient to take slow deep breaths during auscultation.
15. 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. What does this finding indicate?
a.
Valvular disorder
b.
Blood flow turbulence
c.
Fluid volume overload
d.
Ventricular hypertrophy
16. During an inspection of the precordium of an adult patient, the nurse notices the chest moving
in a forceful manner along the sternal border. What does this finding most likely indicate?
a.
Systolic murmur
b.
Diastolic murmur
c.
Enlargement of the left ventricle
d.
Enlargement of the right ventricle
17. During an assessment of a healthy adult, where would the nurse expect to palpate the apical
impulse?
a.
Third left intercostal space at the midclavicular line
b.
Fourth left intercostal space at the sternal border
c.
Fourth left intercostal space at the anterior axillary line
d.
Fifth left intercostal space at the midclavicular line
18. The nurse is examining a patient who has possible cardiac enlargement. Which statement
about percussion of the heart is true?
a.
Percussion is easier in patients who are obese.
b.
Percussion is a useful tool for outlining the heart’s borders.
c.
Only expert health care providers should attempt percussion of the heart.
d.
Studies show that percussed cardiac borders do not correlate well with the true
cardiac border.
19. The nurse is preparing to auscultate for heart sounds. Which technique is correct?
a.
Listening for all possible sounds at a time at each specified area.
b.
Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral areas.
c.
Listening to the sounds only at the site where the apical pulse is felt to be the
strongest.
d.
Listening by inching the stethoscope in a rough Z pattern, from the base of the
heart across and down, then over to the apex.
20. 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 should the nurse do?
a.
Document this as a normal finding.
b.
Talk with the patient about his intake of caffeine.
c.
Perform an electrocardiogram after the examination.
d.
Refer the patient to a cardiologist for further testing.
21. What is the best description of the S1 heart sound?
a.
Indicates the beginning of diastole.
b.
Coincides with the carotid artery pulse.
c.
Louder than the S2 at the base of the heart.
d.
Is caused by the closure of the semilunar valves.
22. During cardiac auscultation, the nurse hears a sound immediately occurring after the S2 at the
second left intercostal space. What should the nurse do to further assess this sound?
a.
Ask the patient to hold his or her breath while the nurse listens again.
b.
No further assessment is needed because the nurse knows this sound is an S3.
c.
Watch the patient’s respirations while listening for the effect on the sound.
d.
Have the patient turn to the left side while the nurse listens with the bell of the
stethoscope.
23. Which of these findings would the nurse expect to notice during a cardiac assessment on a
4-year-old child?
a.
S3 when sitting up
b.
Persistent tachycardia above 150 beats per minute
c.
Murmur at the second left intercostal space when supine
d.
Palpable apical impulse in the fifth left intercostal space lateral to midclavicular
line
24. While auscultating heart sounds on a 7-year-old child for a routine physical examination, the
nurse hears an 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.
These findings can all be normal in a child.
b.
An S3 is indicative of heart disease in children.
c.
The venous hum most likely indicates an aneurysm.
d.
These findings are indicative of congenital problems.
25. During the precordial assessment of a patient who is 8 months pregnant, the nurse palpates the
apical impulse at the fourth left intercostal space lateral to the midclavicular line. What does
this finding indicate?
a.
Right ventricular hypertrophy
b.
Increased blood flow through the internal mammary artery
c.
Displacement of the heart from elevation of the diaphragm
d.
Increased volume and size of the heart as a result of pregnancy
26. In assessing for an S4 heart sound, what part of the stethoscope should the nurse use and in
what location?
a.
Bell of the stethoscope at the base with the patient leaning forward
b.
Diaphragm of the stethoscope in the aortic area with the patient sitting
c.
Diaphragm of the stethoscope in the pulmonic area with the patient supine
d.
Bell of the stethoscope at the apex with the patient in the left lateral position
27. A 70-year-old patient with a history of hypertension has a blood pressure of 180/100 mm Hg
and a heart rate of 90 beats per minute. The nurse hears an extra heart sound at the apex
immediately before the S1. The sound is heard only with the bell of the stethoscope while the
patient is in the left lateral position. Based on these findings and the patient’s history, the
nurse should recognize this extra heart sound is most likely what?
a.
Split S1
b.
Atrial gallop
c.
Diastolic murmur
d.
Summation sound
28. The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her
myocardial infarction (MI). 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. What does the nurse suspect?
a.
Another MI
b.
Increased cardiac output
c.
Inflammation of the precordium
d.
Ventricular hypertrophy resulting from muscle damage
29. 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 thrill 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
30. A 30-year-old woman with a history of mitral valve problems states that she has been “very
tired.” She has started waking up at night and feels like her “heart is pounding.” During the
assessment, the nurse palpates a thrill and lift at the fifth left intercostal space midclavicular
line. In the same area, the nurse also auscultates a blowing, swishing sound right after the S1.
What do these findings most likely indicate?
a.
Heart failure
b.
Aortic stenosis
c.
Pulmonary edema
d.
Mitral regurgitation
31. During a cardiac assessment on a 38-year-old patient in the hospital for “chest pain,” the nurse
finds the following: jugular vein pulsations 4 cm above the sternal angle when the patient is
elevated at 45 degrees, blood pressure 98/60 mm Hg, heart rate 130 beats per minute, ankle
edema, difficulty breathing when supine, and an S3 on auscultation. Which of these conditions
best explains the cause of these findings?
a.
Heart failure
b.
Fluid overload
c.
Atrial septal defect
d.
Myocardial infarction
32. What is the normal splitting of the S2 is associated with?
a.
Expiration
b.
Inspiration
c.
Exercise state
d.
Low resting heart rate
33. The nurse is preparing to teach a class on cardiovascular assessment. When explaining a thrill,
what should the nurse include in the teaching?
a.
A vibration that is palpable
b.
Palpated in the right epigastric area
c.
Associated with ventricular hypertrophy
d.
A murmur auscultated at the third intercostal space
34. When performing a cardiovascular assessment, what should the nurse understand about an S4
heart sound?
a.
Heard at the onset of atrial diastole
b.
Often a normal finding 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
35. During an assessment, the nurse notes that the patient’s apical impulse is laterally displaced
and is palpable over a wide area. What does this finding indicate?
a.
Systemic hypertension
b.
Pulmonic hypertension
c.
Pressure overload, as in aortic stenosis
d.
Volume overload, as in heart failure
36. When the nurse is auscultating the carotid artery for bruits, which of these statements reflects
the correct technique?
a.
While listening with the 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.
37. The nurse is preparing for a class on risk factors for hypertension and reviews recent statistics.
Which racial group has the highest prevalence of hypertension in the world?
a.
Blacks
b.
Whites
c.
Hispanics
d.
American Indians
38. 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 finding while pushing
on the right upper quadrant of the patient’s abdomen, just below the rib cage?
a.
The jugular veins will not be detected during this maneuver.
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 rise for a few seconds and then recede back to the previous
level if the heart is properly working.
39. The nurse is assessing the apical pulse of a 3-month-old infant and finds that the heart rate is
135 beats per minute. How should the nurse interpret this finding?
a.
Normal for this age
b.
Lower than expected
c.
Higher than expected, probably as a result of crying
d.
Higher than expected, reflecting persistent tachycardia