Ch 19: Heart & Neck Vessels

after, kentucky

S3 is heard ______ lub dub and is also known as _______

before, tennessee

S4 is heard _______ S1 and is also known as _______

Atrial systole occurs during ventricular diastole

Atrial/ventricular (systole/diastole) occurs during atrial/ventricular (systole/diastole)

a. a vibration that is palpable. A thrill is a palpable vibration. It signifies turbulent blood flow and accompanies loud murmurs. The absence of a thrill does not rule out the presence of a murmur.

During a cardiovascular assessment, the nurse knows that a "thrill" is: a. Vibration that is palpable. b. Palpated in the right epigastric area. c. Associated with ventricular hypertrophy. d. Murmur auscultated at the third intercostal space.

All People Eat Three Meals= Aorta(2nd IS), Pulmonary(2nd IS), Erbs Point(3rd IS), Tricuspid(4th IS), Mitral(5th IS)

5 Auscultation areas of the heart

a. This decline in blood pressure is the result of peripheral vasodilation and is an expected change Despite the increased cardiac output, arterial bp decreases in pregnancy because of peripheral vasodilation. The bp drops to it's lowest point during the second trimester and then rises after that.

A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous exam, 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

d. Mitral regurgitation Mitral regurgitation subjective findings include fatigue, palpitation, and orthopnea. Objective findings are (1) a thrill in systole at apex, (2) lift at apex, (3) apical impulse displaced down and to the left, (4) S1 diminished, S2 accentuated, S3 at apex often present, and (5) murmur: pansystolic, often loud, blowing, best heard at apex, radiating well to the left axilla.

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 S1. These findings would be most consistent with: a. Heart failure. b. Aortic stenosis. c. Pulmonary edema. d. Mitral regurgitation.

c. "Do you have any history of problems with your heart?" Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down increases volume intrathoracic blood, and the weakened heart can't accommodate for the increased load. Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the perception of needing fresh air.

A 45-year-old man is in the clinic for a routine physical. During the history the patient states he's been having difficulty sleeping. "I'll be sleeping great and then I wake up and feel like I can't get my breath." The nurse's best response to this would be: 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?"

c. heard at the end of ventricular diastole. An S4 heart sound is heard at the end of diastole when the atria contract (atrial systole) and when the ventricles are resistant to filling. The S4 occurs just before the S1.

During a cardiovascular assessment, the nurse knows that an S4 heart sound is: a. Heard at the onset of atrial diastole. b. Usually 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.

b. Atrial gallop A pathologic S4 is termed an atrial gallop or an 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. A left-sided S4 occurs with these conditions. It is heard best at the apex with the patient in the left lateral position.

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 S1. The sound is heard only with the bell while the patient is in the left lateral position. With these findings and the patient's history, 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.

Mitral or tricuspid valves

AV valves are also called

The left semilunar valve separating the left ventricle and aorta

Aortic Valve

Abnormal sound heard over an artery caused by turbulent blood flow

Bruits

Pitch, quality, location, radiation, and timing

Characteristics to explore when you listen for a murmur

Heart muscle relaxes; chambers fill with blood

Diastole

d. Heart Failure Heart failure causes decreased cardiac output when the heart fails as a pump and the circulation becomes backed up and congested. Signs and symptoms include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, decreased blood pressure, dependent and pitting edema; anxiety; confusion; jugular vein distention; and fatigue. The S3 is associated with heart failure and is always abnormal after age 35. The S3 may be the earliest sign of heart failure.

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 sternal angle when he is elevated at 45 degrees, blood pressure 98/60 mm Hg, heart rate 130 beats per minute, ankle edema, difficulty in breathing when supine, and an 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

b. Blood flow turbulence A bruit is a blowing, swishing sound indicating blood flow turbulence; normally none is present

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.

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.

During an assessment, the nurse notes that the patient's apical impulse is displaced laterally, and it is palpable over a wide area. This indicates: a. Systemic hypertension. b. Pulmonic hypertension. c. Pressure overload, as in aortic stenosis. d. Volume overload, as in heart failure.

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. 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.

During 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. Normal heart. b. Systolic murmur. c. Enlargement of the left ventricle. d. Enlargement of the right ventricle.

d. Watch the patient's respirations while listening for the effect on the sound. A split S2 is a normal phenomenon that occurs towards the end of inspiration in some people. A split S2 is heard only in the pulmonic valve area, the second left intercostal space. When the split S2 is first heard, the nurse should not be tempted to ask the patient to hold their breath; breath holding will only equalize ejection times in the right and left sides of the heart and cause the split to go away. Instead, the nurse should concentrate on the split while watching the person's chest rise up and down with breathing.

During the cardiac auscultation the nurse hears a sound occurring immediately 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 her breath while the nurse listens again. c. No further assessment is needed because the nurse knows this sound is an S3. d. Watch the patient's respirations while listening for the effect on the sound.

c. Displacement of the heart from elevation of the diaphragm Palpation of the apical impulse is higher and more 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.

During the precordial assessment on an 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.

layer of endothelial tissue that lines the inner surface of the heart chambers and valves

Endocardium

Sustained forceful thrusting of the ventricle during systole; occurs ventricular hypertrophy because of increased workload

Heave/lifts are:

b. Increase in systolic bp With aging, there is an increase in systolic blood pressure. No significant change in diastolic pressure occurs with age. No change in resting heart rate occurs with aging. Cardiac output at rest is not changed with aging.

In assessing a 70-year-old man, the nurse finds the following: blood pressure 140/100 mm Hg; heart rate 104 and slightly irregular; split S2. Which of these findings can be explained by expected hemodynamic changes related to 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

c. Smoking, hypertension, obesity, diabetes, and high cholesterol For major risk factors for coronary artery disease, collect data regarding elevated blood serum cholesterol, blood glucose levels above 130 mg/dL or known diabetes, obesity, cigarette smoking, low activity level.

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

b. Bell of the stethoscope at the apex with the patient in the left lateral position The S4 is a ventricular filling sound. It occurs when atria contract late in diastole. It is heard immediately before S1. This is a very soft sound with a very low pitch. The nurse needs a good bell and must listen for it. It is heard best at the apex, with the person in the left lateral position.

In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the: a. Bell of the stethoscope at the base with the 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. 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. The nurse should avoid compressing the artery because this could create an artificial bruit, and it could compromise circulation if the carotid artery is already narrowed by artherosclerosis. 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. Palpate only one carotid artery at a time to avoid compromising arterial blood to the brain.

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.

The left AV valve separating the left atria and ventricle

Mitral valve

Abnormal sound heard over heart caused by turbulent blood flow

Murmur

Muscular wall of the heart; it does the pumping

Myocardium

Aortic or pulmonic valves

Semilunar valves are also called

The right semilunar valve separating the right ventricle and pulmonary artery

Pulmonary valve

The difference between apical pulse and radial pulse (or other peripheral pulse)

Pulse deficit

Heart contracts; pumps blood from the chambers to the arteries

Systole

b. Automaticity The heart can contract by itself, independent of any signals or stimulation from the body; this property is termed automaticity. Depolarization is the reversal of the resting potential in excitable cardiac muscle cell membranes when stimulated. Conduction is the process by which an electrical impulse is transmitted through the heart. Repolarization is the process by which the membrane potential of a cardiac muscle cell is restored to the cell's resting potential.

The ability of the heart to contract independently of any signals or stimulation is due to: a. Depolarization b. Automaticity c. Conduction d. Repolarization

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 the "pacemaker."

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. Right atrium-->right ventricle-->pulmonary artery-->lungs-->pulmonary vein-->left atrium-->left ventricle Returning blood from the body empties into the right atrium and flows into the right ventricle and then goes to the lungs through the pulmonary artery. The lungs oxygenate the blood and it is then returned to the left atrium by the pulmonary vein. It goes from there to the left ventricle and then out to the body through the aorta.

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

d. AV node-->SA 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 so that the atria have time to contract before the ventricles are stimulated. Then the impulse travels to the bundle of His, the right and left bundle branches, and then through the ventricles.

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

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 activity on the right side of the heart. They reflect filling pressures and volume changes. Normal jugular venous pulsation is 2cm or less above the sternal angle. Elevated pressure is more than 3cm above the sternal angle at 45 degrees and occurs with heart failure.

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.

b. Closure of the AV valves S1 occurs with the closure of the AV valves. S2 occurs with the closure of the semilunar valves. A third heart sound (S3) can be heard when the ventricles are resistant to filling during the early rapid filling phase. S3 is heard when the AV valves open and atrial blood first pours into the ventricles.

The first heart sound (S1) is produced by the: a. Closure of the semilunar valves b. Closure of the AV valves c. Opening of the semilunar valves d. Opening of the AV valves

a. Heart's efficiency as a pump Jugular venous pressure is a reflection of the heart's ability to pump blood. If the pressure is elevated, heart failure is suspected.

The jugular venous pressure is an indirect reflection of the: a. Heart's efficiency as a pump b. Cardiac cycle c. Conduction effectiveness d. Synchronization of mechanical activity

c. Chordae tendineae; papillary muscles The valves are anchored by collagenous fibers (chordae tendineae) to the papillary muscles, which are embedded in the ventricle floor.

The leaflets of the tricuspid and mitral valves are anchored by ___________ to the _____________, which are embedded in the ventricular floor. a. Endocardial ligaments; mediastinal muscles b. AV tendons; pericardial bundles c. Chordae tendineae; papillary muscles d. Pericardial chords; ventricular sheaths

a. Body

The left side of the heart pumps blood to the: a. Body b. Lungs c. Lower extremities d. Brain

a. Tetralogy of Fallot Tetralogy of Fallot subjective findings include (1) severe cyanosis, not in the first months of life but developing as the infant grows, and right ventricle outflow (i.e., pulmonic) stenosis gets worse; (2) cyanosis with crying and exertion at first, then at rest; and (3) slowed development. Objective findings include (1) thrill palpable at left lower sternal border; (2) S1 normal, S2 has A2 loud and P2 diminished or absent; and (3) murmur is systolic, loud, crescendo-decrescendo.

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

d. Presence of dyspnea of diaphoresis when sucking To screen for heart disease in an infant, focus on feeding. Note fatigue during feeding. 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.

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 amount of 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

b. The jugular veins will remain elevated as long as pressure on the abdomen is maintained. When performing hepatojugular reflux, the jugular veins will rise for a few seconds and then recede back to the previous level if the heart is able to pump the additional volume created by the pushing; however, with heart failure, the jugular veins remain elevated as long as pressure on the abdomen is maintained.

The nurse is assessing a patient with possible cardiomyopathy and assesses the hepatojugular reflux. If heart failure is present, then the nurse should see which finding while pushing on the right upper quadrant of the patient's abdomen, just below the rib cage? a. The jugular veins will rise for a few seconds and then recede 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 maneuver.

13 The nurse should count a serial measurement (one after the other) of apical beat and then the radial pulse. Normally every beat heard at the apex should perfuse to the periphery and be palpable. The two counts should be identical. If different, the nurse should subtract the radial rate from the apical and record the remainder as the pulse deficit.

The nurse is assessing a patient's pulses and notices a difference between the patient's apical pulse and radial pulse. The apical pulse was 118 beats per minute, and the radial pulse was 105 beats per minute. What is the pulse deficit?

a. Normal for this age The heart rate may range from 100 to 180 beats per minute immediately after birth and then stabilize to an average of 120 to 140 beats per minute. Infants normally have wide fluctuations with activity, from 170 beats per minute or more with crying or being active to 70 to 90 beats per minute with sleeping. Persistent tachycardia is greater than 200 beats per minute in newborns or greater than 150 beats per minute in infants.

The nurse is assessing the apical pulse of a 3-month-old infant and finds that the heart rate is 135 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 persistent tachycardia.

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 border. Percussion is of limited usefulness with the female breast tissue or in an obese person, or a person with a muscular chest wall. Chest x-rays or echocardiogram examinations are more accurate in detecting heart enlargement.

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 heart's 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. Inflammation of the precordium Inflammation of the precordium gives rise to a friction rub. The sound is high pitched and scratchy, like sandpaper being rubbed. It is best heard with the diaphragm of the stethoscope, with the person sitting up and leaning forward, and with the breath held in expiration. A friction rub can be heard any place on the precordium but usually 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 nurse is performing a cardiac assessment on 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.

a. Blacks According to the American Heart Association, the prevalence of hypertension is higher among African-Americans than in other racial groups.

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. American Indians d. Hispanics

b. Listening by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex You can also start at the apex of the heart and work your way up to the base. Listen selectively to one sound at a time.

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 inching 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. Abnormal lipids C. Smoking E. Hypertension F. Diabetes Nine modifiable risk factors for MI, as identified by a recent study, include abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits and vegetables, alcohol use, and regular physical activity.

The nurse is presenting a class on risk factors for cardiovascular disease. Which of these are considered modifiable risk factors for myocardial infarction (MI)? Select all that apply. a. Ethnicity b. Abnormal lipids c. Smoking d. Gender e. Hypertension f. Diabetes g. Family history

d. The atria contract toward the end of diastole and push the remaining blood into the ventricles 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."

The nurse is reviewing anatomy and physiology 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.

b. Inspiration Normal or physiologic splitting of the second heart sound is associated with inspiration because of the increased blood return to the right side of the heart, delaying closure of the pulmonic valve.

The nurse knows that normal splitting of the second heart sound is associated with: a. Expiration. b. Inspiration. c. Exercise state. d. Low resting heart rate.

b. Lungs

The right side of the heart pumps blood to the: a. Body b. Lungs c. Lower extremities d. Brain

a. Pericardium Pericardium is a tough double-walled sac around the heart

The sac that surrounds and protects the heart is called the: a. Pericardium. b. Myocardium. c. Endocardium. d. Pleural space

c. Ventricles from the arteries The semilunar valves separate the ventricles from the arteries. The atrioventricular valves separate the atria and ventricles. The atrioventricular valves separate the atria and the ventricles. The septum separates the right atria from the left atria. The vena cava are not separated by a valve from the right atrium; the pulmonary veins are not separated by a valve from the left atrium.

The semilunar valves separate the: a. Atria from the ventricles b. Right atria from the left atria c. Ventricles from the arteries d. Atria from the veins

Benign sound like roaring water caused by turbulence of blood in the jugular veins

Venous Hum

b. 7

What age does the heart reach it's adult position? a. 12 b. 7 c. 5 d. 18

b. Increase in systole, but not in diastole

What is a normal change in bp in older adults? a. Decrease in systole, increase in diastole b. Increase in systole, but not in diastole c. Increase in systole and diastole d. Decrease in systole and diastole

c. Blood can flow into the left side of the heart through an opening in the atrial septum First, about two-thirds of the blood is shunted through an opening in the atrial septum, the formen ovale into the left side of the heart, where it is pumped out through the aorta. The foramen ovale closes within the first hour because the pressure in the right side of the heart is now lower than the left side.

When assessing a newborn infant who is 5 minutes old, the nurse knows that which of these statements would 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.

c. An expected sound caused by non-closure of the ductus arteriosus The murmur of a patent ductus arteriosus is a continuous machinery murmur, which disappears by 2 to 3 days.

When auscultating the heart of a newborn within 24 hours after birth, the examiner hears a continuous sound that mimics the sound of a machine. This finding most likely indicates: a. The presence of congenital heart disease b. A normal sound because of the thinner chest wall of the newborn c. An expected sound caused by non-closure of the ductus arteriosus d. Pathology only when accompanied by an increased heart rate

d. 10-15 hours after birth

When does the ductus arteriosis close? a. 24 hours after birth b. 3rd trimester c. Within the first 10 hours of birth d. 10-15 hours after birth

Within the first hour after birth

When does the foramen ovale close in newborns?

b. 2nd trimester

When is bp the lowest during pregnancy? a. 1st trimester b. 2nd trimester c. 3rd trimester

c. Aortic and pulmonic The second heart sound (S2) occurs with closure of the semilunar (aortic and pulmonic) valves and signals the end of systole. Although it is heard over all the precordium, S2 is loudest at the base of the heart.

When listening to heart sounds, the nurse knows that 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. 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 correct technique for auscultating the carotid artery for bruits involves the nurse lightly applying the bell of the stethoscope over the carotid artery at three levels. While listening, the nurse asks the patient take a breath, exhale, and briefly hold it. Holding the breath on inhalation will also tense the levator scapulae muscles, which makes it hard to hear the carotid arteries. Examining only one carotid artery at a time will avoid compromising arterial blood flow to the brain. Pressure over the carotid sinus, which may lead to decreased heart rate, decreased blood pressure, and cerebral ischemia with syncope, should be avoided.

When the nurse is auscultating the carotid artery for bruits, which of these statements reflects 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.

In the groove between the trachea and the sternomastoid muscle

Where is the carotid artery located?

a. between the aorta and pulmonary artery

Where is the ductus arteriosis? a. between the aorta and pulmonary artery b. between the left atrium and left ventricle c. between the aorta and pulmonary veins d. between the right atrium and right ventricle

Superficial, lateral to the sternomastoid muscle above the clavicle

Where is the external jugular vein?

Between the atria

Where is the foramen ovale?

b. An increase in cardiac volume and decrease in bp During pregnancy the blood volume increases by 30% to 40%; this creates an increase in stroke volume and cardiac output and an increased pulse rate of 10 to 15 beats per minute. The arterial blood pressure decreases in pregnancy as a result of peripheral vasodilation.

Which of the following cardiac alterations occurs during pregnancy? a. An increase in cardiac output and bp b. An increase in cardiac volume and decrease in bp c. An increased heart rate and increased bp d. An increased stroke volume and decreased cardiac output

c. S1 coincides with the carotid artery pulse S1 is loudest at the apex of the heart. S1 coincides with the C wave of the jugular venous pulse wave. S1 coincides with the R wave (the upstroke of the QRS complex).

Which of the following guidelines may be used to identify which heart sound is S1? a. S1 is louder than S2 at the base of the heart b. S1 coincides with the A wave of the jugular venous pulse wave c. S1 coincides with the carotid artery pulse d. S1 coincides with the Q wave of the QRS electrocardiogram complex

a. Roll toward the left side After auscultation in the supine position, the nurse should have the patient roll onto the left side; the examiner should listen at the apex with the bell for the presence of any diastolic filling sounds (i.e., S3 or S4) or murmurs that may be heard only in this position. The examiner should have the patient sit up and lean forward; the examiner should auscultate at the base with the diaphragm for a soft, high-pitched, early diastolic murmur of aortic or pulmonic regurgitation.

Which of the following is an appropriate position to have the patient assume when auscultating for extra heart sounds or murmurs? a. Roll towards the left side b. Roll towards the right side c. Trendelenburg position d. Recumbent position

c. Murmur at the second left intercostal space when supine Some murmurs are common in healthy children and adolescents and are termed innocent or 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

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

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. In the first heart sound, the mitral component (M1) closes just before the tricuspid component (T1).

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.

b. These findings can all be normal in a child Physiologic S3 is common in children. A venous hum, caused by a turbulence of blood flow in the jugular venous system is common in healthy children and has no pathologic significance. Heart murmurs that are innocent/functional in origin are very common through childhood.

While auscultating heart sounds on a 7-year-old child for a routine physical, the nurse hears an S3, a soft murmur at left midsternal border, and a venous hum when the child is standing. Which of these 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.

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 persons breathing, increasing at the peak of inspiration, and slowing with expiration.

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 an electrocardiogram 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.