Chapter 10: Cardiovascular Clinical Assessment and Diagnostic Procedures

Pulsus paradoxus may be noted on the bedside monitor when what is observed? A. A decrease of more than 10 mm Hg in the arterial waveform during inhalation B. A single, nonperfused beat on the ECG waveform C. Tall, tented T waves on the ECG waveform D. An increase in pulse pressure greater than 20 mm Hg on exhalation

A. A decrease of more than 10 mm Hg in the arterial waveform during inhalation

Which condition is usually associated with clubbing? A. Central cyanotic heart disease B. Carbon monoxide poisoning C. Peripheral cyanosis D. Decreased cardiac output

A. Central Cyanotic Heart disease

When assessing a patient with PVCs, the nurse knows that the ectopic beat is multifocal because it appears in what way? A. In various shapes in the same lead B. Wider than a normal QRS C. With increasing frequency D. On the T wave

A. In various shapes in the same lead

A patient is admitted with left-sided heart failure related to mitral stenosis. Physical assessment findings reveal an S3 and a 3/6 systolic murmur. The grading of a murmur as a 3/6 refers to which characteristics of the murmur? A. Intensity B. Tone C. Radiation D. Pitch

A. Intensity

Heart murmurs are characterized by which criteria? (Select all that apply.) A. Intensity B. Location C. Quality D. Pitch E. Pathologic cause

A. Intensity B. Location C. Quality D. Pitch

New-onset atrial fibrillation can be serious for which reason? A. It increases the risk of stroke and pulmonary embolism from atrial clots. B. It increases the patient's risk of deep venous thrombosis. C. It may increase cardiac output to dangerous levels. D. It indicates that the patient is about to have an MI.

A. It increases the risk of stroke and pulmonary embolism from atrial clots.

Which statements describe S1, the first heart sound? (Select all that apply.) A. It is associated with closure of the mitral and tricuspid valves. B. It is a high-pitched sound. C. It can be heard most clearly with the diaphragm of the stethoscope. D. The best listening point is in the aortic area. E. The "split" sound can best be detected in the tricuspid area.

A. It is associated with closure of the mitral and tricuspid valves. B. It is a high-pitched sound. C. It can be heard most clearly with the diaphragm of the stethoscope. E. The "split" sound can best be detected in the tricuspid area.

Which statement best describes the purpose of the modified Allen test? A. To assess the adequacy of blood flow through the ulnar artery B. To evaluate oxygen saturation in the brachial and ulnar artery C. To assess the patency of an internal arteriovenous (AV) graft D. To determine the size of needle to be used for venipuncture

A. To assess the adequacy of blood flow through the ulnar artery

The nurse assesses the dorsalis pedis and posterior tibialis pulses as weak and thready. What should the nurse document for the pulse volume? A. 0 B. 1+ C. 2+ D. 3+

B. 1+

A patient's blood pressure is 90/72 mm Hg. What is the patient's pulse pressure? A. 40 mm Hg B. 18 mm Hg C. 25 mm Hg D. 12 mm Hg

B. 18 mm Hg

A patient is admitted with a diagnosis of "rule out myocardial infarction." The patient reports midchest pressure radiating into the jaw and shortness of breath when walking up stairs. When inspecting the patient, the nurse notes that the patient needs to sit in a high Fowler position to breathe. The nurse suspects the patient may be experiencing what problem? A. Pericarditis B. Heart failure C. Anxiety D. Angina

B. Heart failure

Which criteria are representative of the patient in normal sinus rhythm? A. Heart rate, 64 beats/min; rhythm, regular; PR interval, 0.10 second; QRS, 0.04 second B. Heart rate, 88 beats/min; rhythm, regular; PR interval, 0.18 second; QRS, 0.06 second C. Heart rate, 54 beats/min; rhythm, regular; PR interval, 0.16 second; QRS, 0.08 second D. Heart rate, 92 beats/min; rhythm, irregular; PR interval, 0.16 second; QRS, 0.04 second

B. Heart rate, 88 beats/min; rhythm, regular; PR interval, 0.18 second; QRS, 0.06 second

An adult patient is admitted with left-sided heart failure related to mitral stenosis. Physical assessment findings reveal an S3 and a 3/6 systolic murmur. Which statement about an S3 is accurate? A. It is normal for a person this age. B. It is synonymous with a ventricular gallop. C. It is only heard during systole. D. It is best heard best with the diaphragm of the stethoscope.

B. It is synonymous with a ventricular gallop.

The nurse is questioning the accuracy of the arterial catheter readings. Which two actions should the nurse perform to ensure the accuracy of the transducer? A. Obtain a cuff blood pressure and adjust the monitor to match. B. Level the transducer to the phlebostatic axis and zero the transducer. C. Have the patient lay flat and closing the transducer to air. D. Obtain blood return on the arterial line and closing all the stopcocks.

B. Level the transducer to the phlebostatic axis and zero the transducer.

When checking the patient's back, the nurse pushes her thumb into the patient's sacrum. An indentation remains. What assessment finding should the nurse document? A. Sacral compromise B. Pitting edema C. Delayed skin turgor D. Dehydration

B. Pitting Edema

A patient is admitted with a diagnosis of "rule out myocardial infarction." The patient reports midchest pressure radiating into the jaw and shortness of breath when walking up stairs. What factor influences the amount of history obtained during the admission assessment? A. Presence of cardiovascular risk factors B. Presenting symptoms C. Prior medical history D. Current medications

B. Presenting symptoms

A patient presents with atrial flutter with an atrial rate of 280 beats/min and a ventricular rate of 70 beats/min. Which statement best explains this discrepancy in rates? A. The ventricles are too tired to respond to all the atrial signals. B. The AV node does not conduct all the atrial signals to the ventricles. C. Some of the atrial beats are blocked before reaching the AV node. D. The ventricles are responding to a ventricular ectopic pacemaker.

B. The AV node does not conduct all the atrial signals to the ventricles.

While preparing a patient for a cardiac catheterization, the patient asks why it is necessary to drink additional fluids after a cardiac catheterization. Which response by the nurse is the most accurate? A. "To keep the femoral vein from clotting at the puncture site after the procedure" B. "To make sure your electrolytes stay in balance and prevent dysrhythmias" C. "To protect your kidneys from the damaging effects of the contrast medium" D. "To increase your cardiac output so you will not feel dizzy after the procedure"

C. "To protect your kidneys from the damaging effects of the contrast medium"

What is the formula for calculating mean arterial pressure (MAP)? A. Averaging three of the patient's blood pressure readings over a 6-hour period B. Dividing the systolic pressure by the diastolic pressure C. Adding the systolic pressure and two diastolic pressures and then dividing by 3 D. Dividing the diastolic pressure by the pulse pressure

C. Adding the systolic pressure and two diastolic pressures and then dividing by 3

Why is the measurement of the QTc-interval important? A. It represents ventricular depolarization. B. It represents ventricular contraction. C. An increasing QT interval increases the risk of torsades de pointes. D. A decreasing QT interval increases the risk of torsades de pointes.

C. An increasing QT interval increases the risk of torsades de pointes.

Which event does the P wave on an ECG represent? A. Atrial contraction B. Sinus node discharge C. Atrial depolarization D. Ventricular contraction

C. Atrial depolarization

A patient with heart failure may be at risk for hypomagnesemia as a result of which factor? A. Pump failure B. Fluid overload C. Diuretic use D. Hemodilution

C. Diuretic use

Which serum lipid value is a significant predictor of future acute MI in persons with established coronary artery atherosclerosis? A. High-density lipoprotein (HDL) B. Triglycerides C. Low-density lipoprotein (LDL) D. Very-low-density lipoprotein

C. Low-density lipoprotein (LDL)

A patient becomes unresponsive. The patient's heart rate is 32 beats/min, idioventricular rhythm; blood pressure is 60/32 mm Hg; SpO2 is 90%; and respiratory rate is 14 breaths/min. Which intervention should the nurse do first? A. Notify the physician and hang normal saline wide open. B. Notify the physician and obtain the defibrillator. C. Notify the physician and obtain a temporary pacemaker. D. Notify the physician and obtain a 12-lead ECG.

C. Notify the physician and obtain a temporary pacemaker.

Which characteristic is associated with junctional escape rhythms? A. Irregular rhythm B. Rate greater than 100 beats/min C. P wave may be present or absent D. QRS greater than 0.10 seconds

C. P wave may be present or absent

Which portion of the ECG is most valuable in diagnosing atrioventricular (AV) conduction disturbances? A. P wave B. QRS complex C. PR interval D. QT interval

C. PR interval

A heart murmur is described as blowing, grating, or harsh. This description would fall under which criteria? A. Location B. Timing C. Quality D. Whisper

C. Quality

Which AV block can be described as a gradually lengthening PR interval until ultimately the final P wave in the group fails to conduct? A. First-degree AV block B. Second-degree AV block, type II C. Second-degree AV block, type I D. Third-degree AV block

C. Second-degree AV block, type I

A patient with a serum potassium level of 6.8 mEq/L may exhibit what type of electrocardiographic changes? A. A prominent U wave B. A narrowed QRS C. Tall and peaked T waves D. Sudden ventricular dysrhythmias

C. Tall and peaked T waves

To measure the heart rate of a patient in normal sinus rhythm, which technique would be the most accurate? A. The number of R waves in a 6-second strip B. The number of large boxes in a 6-second strip C. The number of small boxes between QRS complexes divided into 1500 D. The number of large boxes between consecutive P waves divided into 300

C. The number of small boxes between QRS complexes divided into 1500

Which cardiac biomarker is a highly specific for myocardial damage? A. BNP B. CK-MB C. Troponin I D. Total calcium

C. Troponin I

Which factor is a major influence in the patient's response to atrial flutter? A. Atrial rate B. PR interval C. Ventricular response rate D. QRS duration

C. Ventricular response rate

A patient has recently been started on anticoagulation therapy for atrial fibrillation. What would be the target range for the INR? A. 1.0 to 2.0 B. 1.5 to 2.5 C. 1.5 to 3.0 D. 2.0 to 3.0

D. 2.0 to 3.0

A nurse admits a patient with a diagnosis of syncope of unknown etiology. Orthostatic vital signs are lying: 120/80 mm/Hg; sitting: 100/74 mm/Hg; standing: 92/40 mm/Hg. Based on this information, what should the nurse monitor? A. Respirations B. Peripheral pulses C. Fluid intake D. Activity

D. Activity

A patient is reporting increased chest pain when coughing, swallowing, and changing positions. Upon auscultation, a scratching or grating sound is heard in the apical area. Based on the symptoms, the nurse suspects the patient may have which condition? A. Mitral regurgitation B. Tricuspid regurgitation C. Aortic insufficiency D. Acute pericarditis

D. Acute pericarditis

Which intervention should be strictly followed to ensure accurate cardiac output readings? A. Use 5 mL of iced injectate and average two measurements together. B. Inject the fluid into the pulmonary artery port. C. Ensure at least 5°C between the injectate and body temperature. D. Administer the injectate within 4 seconds.

D. Administer the injectate within 4 seconds.

Which assessment technique is used to evaluate arterial circulation to an extremity? A. Dorsiflexion of the foot B. Pressing a finger into the skin C. Pinching of the skin D. Compression of the nail bed

D. Compression of the nail bed

An older adult patient is admitted with a diagnosis of left-sided heart failure related to mitral stenosis. Physical assessment findings reveal tachycardia with an S3 and a 3/6 systolic murmur. In which location would this murmur best be heard? A. Fourth left ICS along the sternal border B. Second left ICS along the sternal border C. Second right ICS along the sternal border D. Fifth left ICS at MCL

D. Fifth left ICS at MCL

Abnormal heart sounds are labeled S3 and S4 and are referred to as what when auscultated during a tachycardic episode? A. Korotkoff sounds B. Blowing murmurs C. Grating murmurs D. Gallops

D. Gallops

Which major clinical finding is present in a patient with ventricular fibrillation (VF)? A. Hypertension B. Diaphoresis C. Bradycardia D. Pulselessness

D. Pulselessness