Chapter 14 Prep-U

A 68-year-old mechanic presents to the emergency room for shortness of breath. The examiner is concerned about a cardiac cause and measures the client's jugular venous pressure (JVP). It is elevated. Which of the following conditions is a potential cause of elevated JVP? - Left-sided heart failure - Mitral stenosis - Constrictive pericarditis - Aortic aneurysm

Constrictive pericarditis Explanation: One cause of increased jugular venous pressure is constrictive pericarditis. Others include right-sided heart failure, tricuspid stenosis and superior vena cava syndrome. The other noted pathologies are less likely to result in elevated JVP.

What is the normal peak pressure of the left ventricle? - 90 mm Hg - 100 mm Hg - 110 mm Hg - 120 mm Hg

120 mm Hg

The area known as Erb's point is the third site for auscultation on the precordium. Where is it located? - 4th left rib space - 3rd right rib space - 4th right rib space - 3rd left rib space

3rd left rib space Explanation: The 3rd left rib space is the third site for auscultation (Erb's point). The other options are distracters.

The nursing instructor is discussing assessment of the heart with students. A student states that he has a client with a rushing vibration in the precordium that the student could feel and that it was in the area of the pulmonic valve. What should the instructor explain that the student is feeling? - A thrill - A thrust - A heave - A normal finding

A thrill

When auscultating the heart sounds of a client, a nurse notes that the S2 is louder than the S1. How should the nurse describe S2? - Accentuated - Diminished - Normal split - Wide split

Accentuated Explanation: An accentuated S2 means that the S2 is louder than the S1. This occurs in conditions in which the aortic or pulmonic valve has a higher closing pressure. A diminished S2 means that the S2 is softer than the S1. This occurs in conditions in which the aortic or pulmonic valves have decreased mobility. Normal split S2 can be heard over the second or third left intercostal space; it is usually heard best during inspiration and disappears during expiration. Wide split S2 is an increase in the usual splitting that persists throughout the entire respiratory cycle, and widens on expiration.

A nurse experiences difficulty with palpation of the apical impulse on the precordium. What is an appropriate action by the nurse? - Try using one finger of the dominant hand to locate the pulse - Ask the client to assume the left lateral position - Instruct the client to cough and attempt again - Use the stethoscope to auscultate

Ask the client to assume the left lateral position

A nurse auscultates a client's heart rate and rhythm and finds the rhythm to be irregular. What would the nurse do next? - Inspect for a lift - Palpate for a thrill - Auscultate for pulse rate deficit - Listen for a ventricular gallop

Auscultate for pulse rate deficit Explanation: If the nurse detects an irregular rhythm, the nurse needs to auscultate for a pulse rate deficit, which may provide further evidence of atrial fibrillation, atrial flutter, premature ventricular contractions, and varying degrees of heart block. The client also should be referred for further evaluation because irregular rhythms may predispose the client to decreased cardiac output, heart failure, or emboli. It would not be necessary to inspect for a lift or palpate for a thrill. These would most likely have already been completed. Listening for a ventricular gallop would occur later, when the nurse is auscultating for normal and abnormal heart sounds.

Which statement describes the correct technique by a nurse for use of a stethoscope to auscultate the chest for heart sounds? - Listen with the bell for the high pitched sounds of normal S1S2 - Elevate the head of bed until the examiner can comfortably reach the client - Auscultate to determine the heart rate and if the rhythm is normal - Stand at the client's left side and perform the entire assessment from this position

Auscultate to determine the heart rate and if the rhythm is normal Explanation: The nurse should focus on one sound at a time when auscultating the precordium. Start by determining the rate and rhythm. The examiner should stand at the client's right side to perform the assessment. The client should be lying in the supine positions with the head of the bed elevated at 30 degrees. The diaphragm of the stethoscope is used to listen for the high pitched should of normal heart sounds.

The bicuspid, or mitral, valve is located - Between the left atrium and the left ventricle - Between the right atrium and the right ventricle - At the beginning of the ascending aorta - At the exit of each ventricle near the great vessels

Between the left atrium and the left ventricle Explanation: The bicuspid (mitral) valve is composed of two cusps and is located between the left atrium and the left ventricle.

A nurse auscultates a client's heart sounds and obtains a rate of 56 beats per minute. How should this rate be documented by the nurse? - Normal - Tachycardia - Bradycardia - Decreased

Bradycardia

A student is asked to define the continuous rhythmic movement of blood during contraction and relaxation of the heart. This best describes which of the following? - Cardiac circulation - Cardiac output - Cardiac cycle - Cardiac workload

Cardiac cycle Explanation: The continuous rhythmic movement of blood during contraction and relaxation of the heart is the cardiac cycle.

The nurse is preparing to assess a client's apical impulse. The nurse should palpate at which location? - Second intercostal space, left sternal border - Third intercostal space, left axillary line - Fourth intercostal space, left sternal border - Fifth intercostal space, left midclavicular line

Fifth intercostal space, left midclavicular line

A client with dehydration or volume depletion has barely visible neck veins, even when lying flat. These are described as what? - Flat neck veins - Round neck veins - Distended neck veins - Invisible neck veins

Flat neck veins Explanation: A client with dehydration or volume depletion have barely visible neck veins, even when lying flat. These are described as flat neck veins. Distended neck veins are used to describe engorged neck veins found in clients with fluid volume overload. Round and invisible neck veins are distracters to the question.

How does the nurse differentiate a pleural friction rub from a pericardial friction rub? - Have the client hold his or her breath; if the rub persists, it is pericardial - Turn the client on the right side; if the rub persists, it is pericardial - Auscultate the base of the heart; if a rub is present, it is pericardial - Auscultate the upper back; if a rub is present, it is pleural

Have the client hold his or her breath; if the rub persists, it is pericardial Explanation: Pericardial friction rubs can be differentiated from pleural friction rubs by having the client hold the breath. If present without breathing, the rub is pericardial. Turning the client to the right side and auscultating either the base of the heart or the upper back do not differentiate between pericardial and pleural friction rubs.

During the health history interview with a 40-year-old man, the nurse uses the genogram to specifically assess for major family risk for cardiovascular disease by asking about which of the following? - Hypertension in his grandparents - Weight patterns within his family -Diabetes mellitus in his extended family - Heart attacks in his father and siblings

Heart attacks in his father and siblings

The nurse assesses a hospitalized adult client and observes that the client's jugular veins are fully extended. The nurse contacts the client's physician because the client's signs are indicative of - Pulmonary emphysema - Diastolic murmurs - Patent ductus arteriosus - Increased central venous pressure

Increased central venous pressure

A nurse cares for a client who suffered a myocardial infarction two (2) days ago. A high pitched, scratchy, scraping sound is heard that increase with exhalation and when the client leans forward. The nurse recognizes this sound as a result of what process occurring within the pericardium? - Increased pressure within the ventricle - Inability of the atria to contract - Inflammation of the pericardial sac - Incompetent mitral valve

Inflammation of the pericardial sac Explanation: A high pitched, scratchy, scraping sound is heard that increase with exhalation and when the client leans forward is called a pericardial friction rub. This is caused by inflammation of the pericardial sac. Increased pressure within the ventricles may cause a decrease in cardiac output. Inability of the atria to contract can be caused by any problem that causes the sinoatrial node not to fire. An incompetent mitral valve would cause a systolic murmur.

Variations in the presentation of S1 are due to alterations in which heart valve? - Aortic - Pulmonic - Mitral - Tricuspid

Mitral Explanation: The sound of S1 is produced at the onset of systole, which is the closure of the mitral and tricuspid valves. The variations in the intensity of S1 are due to the position of the mitral valve at the start of systole and can cause the sound to be accentuated, diminished, or variable. The tricuspid valve is involved when there is a split S1, which causes the ventricles to contract at different times. The aortic and pulmonic valve closures produce the sound of S2.

A nurse is working with a client who recently suffered a heart attack. As a result, the client has experienced the death of the muscle tissues that make up the thickest layer of the heart. This layer of muscle is known as which of the following? - Myocardium - Epicardium - Endocardium - Pericardium

Myocardium

A 58-year-old teacher presents with breathlessness with activity. The client has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems? - Abdominal pain - Orthopnea - Hematochezia - Tenesmus

Orthopnea Explanation: Orthopnea, which is dyspnea that occurs when lying down and improves when sitting up, is part of the cardiovascular review of systems and, if positive, may indicate congestive heart failure.

The nurse is preparing to assess a client's carotid arteries. Which of the following would be most appropriate? - Palpate each artery individually to compare - Palpate the arteries before auscultating them - Use the diaphragm of the stethoscope - Ask the client to breathe in and out deeply

Palpate each artery individually to compare

While auscultating the heart at the third intercostal space, left sternal border, the nurse notes a high-pitched, scratchy sound that increases with exhalation with the client leaning forward. The nurse would document which of the following? - Pericardial friction rub - Midsystolic click - Summation gallop - Aortic ejection click

Pericardial friction rub

While performing an admission assessment, the nurse auscultates a high-pitched, scratching, and grating sound at the left lower sternal border. The nurse should know that this would be documented as what type of sound? - Paradoxical sound - Split sound - Pericardial murmur - Pericardial friction rub

Pericardial friction rub Explanation: The pericardial friction rub is the most important physical sign of acute pericarditis. It may have up to three components during the cardiac cycle and is high pitched, scratching, and grating. It can best be heard with the diaphragm of the stethoscope at the left lower sternal border. The pericardial friction rub is heard most frequently during expiration and increases when the client is upright and leaning forward. This is not a paradoxical sound, a split sound, or a murmur.

The anterior chest area that overlies the heart and great vessels is called the - Endocardium - Epicardium - Myocardium - Precordium

Precordium Explanation: The anterior chest area that overlies the heart and great vessels is called the precordium.

A client comes to the emergency department reporting a sudden onset of dyspnea. What finding is a manifestation of dyspnea? - Shortness of breath - Painful breathing - Rapid breathing - Inability to breathe

Shortness of breath Explanation: Clients with heart failure may be short of breath from fluid accumulation in the pulmonary bed. Onset may be sudden with acute or chronic pulmonary edema. It is important to assess how much activity brings on dyspnea, such as rest, walking on a flat surface, or climbing. The other options listed are distracters to the question.

The nurse notes that a client's heart rate speeds up with inspiration and slows down with expiration. What should the nurse suspect this client is demonstrating? - Atrial fibrillation - Sinus arrhythmia - Premature atrial contractions - Premature ventricular contractions

Sinus arrhythmia

A 52-year-old man is skeptical about the potentially harmful effect of his smoking on his heart, citing the fact that both his father and grandfather lived long lives despite being lifelong smokers. Which of the following facts would underlie the explanation that the nurse provides the client? - Smoking increases the heart's workload and contributes to atherosclerosis - Smoking decreases the contractility of the myocardium and contributes to valvular disorders - Smoking damages the cardiac conduction system, resulting in dysrhythmias that are entirely preventable - Smoking is a central component of metabolic syndrome

Smoking increases the heart's workload and contributes to atherosclerosis Explanation: Smoking increases cardiac workload and contributes to hypertension, plaque build-up, and blood clots. It does not directly affect contractility or cardiac conduction, and it is not a component of metabolic syndrome.

When, in the cardiac cycle, does blood pressure peak? - Preload - Systole - Diastole - Afterload

Systole Explanation: Blood pressure in the arterial system varies during the cardiac cycle, peaking in systole and falling to its lowest trough in diastole.

The nurse is assessing a client with a cardiac condition who complains of fatigue and nocturia. The nurse should recognize what implication of this statement? - The client may have developed a cardiac conduction problem. - The client may be experiencing symptoms of heart failure. - The client's cardiac problem is being adequately compensated for. - The client may be at increased risk for myocardial infarction.

The client may be experiencing symptoms of heart failure Explanation: The client may be experiencing symptoms of heart failure

The nurse auscultates the apical pulse and then palpates the PMI (point of maximal impulse). To best palpate the PMI, the nurse places two fingers at the left border of the heart in the 5th intercostal space. - True - False

True

A client might have an aortic regurgitation murmur. Which is the best position to accentuate the murmur? - Upright - Upright, but leaning forward - Supine - Left lateral decubitus

Upright, but leaning forward Explanation: Leaning forward slightly in the upright position brings the aortic valve and the left ventricular outflow tract closer to the chest wall, so it will be easier to hear the soft diastolic decrescendo murmur of aortic insufficiency (regurgitation). The examiner can further hear this soft murmur by having the client hold his or her breath in exhalation.

A client presents at the cardiology clinic for a checkup 6 months after a myocardial infarction. The client is known to have a bundle branch block that delays activation of the right ventricle. What would the nurse expect to hear when auscultating heart sounds? - Arrhythmia - Extra sound - Wide splitting - Delayed S1

Wide splitting