Chapter 14: Heart Test Bank—Nursing

The heart sound that coincides with the carotid pulse is ________.

ANS: S1 S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole.

During the auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split. You should ask the patient to inhale deeply while listening at the ______ area.

ANS: pulmonic Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site

An example of a functional heart murmur is one that is caused by: a. anemia. b. a ventricular septal defect. c. an atrial septal defect. d. mitral valve prolapse.

ANS: A A functional heart murmur is a harmless heart murmur made by a healthy heart beating strongly. High-output demands that increase the speed of blood flow can cause murmurs. Anemia, pregnancy, and thyrotoxicosis can cause these functional heart murmurs.

In what age group are the right and left ventricles equal in weight and muscle mass? a. Newborns b. School-age children c. Adolescents d. Older adults

ANS: A At the time of birth, the right and left ventricles are equal in weight and muscle mass because they both pump blood into the systemic circulation. Within 24 to 48 hours, closure of the ductus arteriosus and interatrial foramen ovale causes pressure in the left atrium to increase. At this time, the right ventricles demand changes as the pulmonary circulation develops, and the left ventricle assumes total responsibility for providing systemic circulation. This results in an increase in the mass of the left ventricle. In older adults, the left ventricle wall thickens and the valves become fibrotic and calcified. The right and left ventricles are not equal in weight and muscle mass in school-age children, adolescents, or older adults.

Closure of the ductus arteriosus usually occurs: a. 24 to 48 hours after birth. b. after 7 days of life. c. between the second and third month. d. during the toddler period.

ANS: A Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth.

Which one of the following is a common symptom of cardiovascular disorders in the older adult? a. Fatigue b. Joint pain c. Poor night vision d. Weight gain

ANS: A Common symptoms of cardiovascular disorders in older adults include confusion, dizziness, blackouts, syncope, palpitations, coughs and wheezes, hemoptysis, shortness of breath, chest pains or tightness, impotence, fatigue, and leg edema.

To estimate heart size by percussion, you should begin tapping at the: a. anterior axillary line. b. left sternal border. c. midclavicular line. d. midsternal line.

ANS: A Estimating the size of the heart can be done by percussion. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border.

The earliest sign of heart failure in an infant is frequently: a. liver enlargement. b. fluid in the lungs. c. enlarged thyroid. d. clubbing of the fingers.

ANS: A If heart failure is suspected, note that the infant's liver may enlarge before there is any suggestion of fluid in the lungs and the left lobe of the liver may be more distinctly enlarged than the right.

If the apical impulse is more vigorous than expected, it is called a: a. lift. b. thrill. c. bruit. d. murmur.

ANS: A If the apical impulse is more vigorous than expected, it is referred to as a lift or heave. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated sound caused by turbulent blood flow into, through, or out of the heart.

The apex of a 2-month-old baby's heart typically lies closest to the: a. fourth left intercostal space. b. midsternal area. c. midthoracic spinal area. d. sixth left intercostal space.

ANS: A In infants and young children, the heart lies more horizontally in the chest. The apex of the heart is located higher, sometimes well out into the fourth left intercostal space.

A grade I or II murmur, without radiation and of medium pitch, is a common variation found in: a. school-age children. b. older women. c. middle-age men. d. older adults.

ANS: A Many murmurs, particularly in children and adolescents, and especially in young athletes, have no apparent cause. These are usually grade I or II murmurs that are usually midsystolic and without radiation, are medium pitched, and are blowing, brief, and often accompanied by a splitting of S2

Pleural pain differs from chest discomfort caused by other conditions in that it is: a. precipitated by coughing. b. eased with deep breathing. c. usually described as dull in nature. d. related to time of day.

ANS: A Pleural pain is precipitated by breathing and coughing and is usually described as a sharp pain that is present during respirations and absent during breath-holding.

Mr. Jones and his wife have brought in their infant daughter for a routine visit. A holosystolic murmur in an infant that is best heard along the left sternal border, is in the third to fifth intercostal spaces, and does not radiate to the neck is indicative of: a. a ventricular septal defect. b. patent ductus arteriosus. c. pulmonary stenosis. d. dextrocardia.

ANS: A Regurgitation through the ventricular septal defect results in a holosystolic murmur that is best heard along the left sternal border, is in the third to fifth intercostal spaces, and does not radiate to the neck.

Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the: a. P wave. b. PR interval. c. QRS complex. d. ST segment.

ANS: A The P wave represents the spread of a stimulus through the atria (atrial depolarization). The PR interval is the time from the initial stimulation of the atria to the initial stimulation of the ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment and T wave are the return of stimulated ventricular muscle to a resting state (ventricular repolarization).

The thin-walled reservoirs of the heart are the: a. atria. b. pericardium. c. sinuses. d. ventricles.

ANS: A The atria are small, thin-walled structures that act primarily as reservoirs for the blood returning to the heart from the venous system. The pericardium is a double-walled, , fibroserous sac enclosing the heart and the bases of the great vessels. A sinus is a dilated channel for venous blood. The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The ventricles are the primary muscle mass of the heart.

Which two structures together form the primary muscle mass of the heart? a. Right and left ventricles b. Left ventricle and the aorta c. Right and left atria d. Left atrium and the pulmonary vein

ANS: A The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The right and left ventricles together form the primary muscle mass of the heart. The left ventricle pumps blood through the aortic valve into the aorta, which provides blood to the rest of the body. The right and left atria pump blood through the tricuspid and mitral valves to the ventricles. The pulmonary vein pumps oxygenated blood from the lungs to the left atria.

Contraction of the ventricles causes: a. closure of the atrioventricular valves. b. closure of the pulmonic and aortic valves. c. opening of the auricular septa. d. opening of the mitral and tricuspid valves.

ANS: A When the ventricles contract the semilunar valves, the pulmonic and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles.

Your patient has been diagnosed with pericarditis. Which of the following are signs and symptoms, or a precipitating factor? (Select all that apply.) a. Sharp pain b. Pain relieved by sitting up c. Pain relieved by resting d. Friction rub heard to right of sternum e. History of kidney failure f. Result of viral infection g. Result of medications such as procainamide

ANS: A, B, E, F, G Pericarditis maybe seen with a viral infection, kidney failure, or medications such as procainamide. Symptoms include pain relieved by sitting up or leaning forward. A friction rub is heard at the left of the sternum, at the third or fourth intercostal space.

Ms. Sharpe is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She reports a recent severe sore throat. You suspect: a. angina. b. acute rheumatic fever. c. cardiac amyloidosis. d. aortic sclerosis.

ANS: B Acute rheumatic fever is a systemic connective tissue disease that occurs after a streptococcal pharyngitis or skin infection. It may result in serious cardiac valvular involvement of the mitral or aortic valve. Often, the valve becomes stenotic and regurgitant. Prevention is adequate treatment of the streptococcal pharyngitis or skin infection.

The major heart sounds are normally created by: a. valves opening. b. valves closing. c. the rapid movement of blood. d. rubbing together of the cardiac walls

ANS: B At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1, "lub." When the pressure in the ventricles falls, below that of the aorta and pulmonary artery, and when the ventricles are almost empty, the aortic and pulmonic valves close, producing the second heart sound S2, "dub." Valve opening is usually a silent event.

The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to suspect: a. congestive heart failure. b. pericarditis. c. endocarditis. d. cardiac tamponade.

ANS: B Chest pain is the usual initial symptom in acute pericarditis, which is the inflammation of the pericardium. The key physical finding is the triphasic friction rub, which is comprised of ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole. It is heard just to the left of the sternum in the third and fourth intercostal spaces and is characteristically scratchy. The auscultation of a triphasic friction rub in a patient with acute chest pain should not lead you to suspect congestive heart failure, endocarditis, or cardiac tamponade.

In the adult, the apical impulse should be most visible when the patient is in what position? a. Supine b. Upright c. Lithotomy d. Right lateral recumbent

ANS: B In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but it is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem. In most adults, the apical impulse will not be visible in the upright, lithotomy, or right lateral recumbent positions.

To hear diastolic heart sounds, you should ask patients to: a. lie on their back. b. lie on their left side. c. lie on their right side. d. sit up and lean forward.

ANS: B Left lateral recumbent is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position in which to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral recumbent position is the best position for evaluating the right rotated heart of dextrocardia.

Normal heart sounds are best heard: a. directly over the semilunar and bicuspid heart valves. b. over areas where blood flows after it passes through a valve. c. near the carotid vessels. d. over the central sternum.

ANS: B Normal heart sounds are best heard in areas where the blood flows after it passes through a valve in the direction of blood flow.

You are listening to a patient's heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound in this area is most likely: a. S1. b. S2. c. S3. d. S4.

ANS: B S2 marks the closure of the semilunar valves, which indicates the end of systole; it is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration.

An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an expected finding in: a. adults under stress. b. 4-year-old children. c. pregnant women. d. premature infants.

ANS: B Sinus arrhythmia is a physiologic event during childhood. The heart rate of a child (4 years old) varies in a cyclic pattern, usually faster on inspiration and slower on expiration.

A split second heart sound is: a. abnormal. b. greatest at the peak of inspiration. c. heard best after forceful expiration. d. supposed to disappear with deep inspiration.

ANS: B Splitting of S2 is an expected event because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear.

The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the: a. P wave. b. QRS complex. c. PR interval. d. T wave.

ANS: B The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to the initiation of stimulation of the ventricles. The T wave is the return of stimulated ventricular muscle to a resting state.

You are conducting an examination of Mr. Curtis's heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is: a. barely discernible. b. moderately loud. c. loud with palpable thrill. d. very loud without a stethoscope.

ANS: B The intensity of a grade III murmur is described as moderately loud. Barely discernible is a grade I murmur. Loud with a palpable thrill is a grade IV murmur. Very loud without a stethoscope is a grade VI murmur.

Normal cardiac changes that occur during pregnancy include: a. decreased cardiac output. b. increased thickness and mass of the left ventricle. c. decreased heart rate. d. dilation of the ventricles.

ANS: B The maternal blood volume increases by 40% to 50% because of an increase in plasma volume. The heart works harder to accommodate the increased heart rate and stroke volume (both equal cardiac output), thereby resulting in the increase in left ventricle wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally and there is a slight axis rotation.

Heart position can vary depending on body habitus. In a short stocky individual, you would expect the heart to be located: a. more to the right and hanging more vertically. b. more to the left and lying more horizontally. c. riding higher in the chest and pushed anteriorly. d. hanging lower in the chest and riding more vertically.

ANS: B The position of the heart varies depending on body build, configuration of the chest, and level of the diaphragm. A tall slender person's heart tends to hang vertically and is positioned centrally. A stocky short person's heart tends to lie more to the left and more horizontally.

In the fetus, the right ventricle pumps blood through the: a. left atrium. b. ductus arteriosus. c. lungs. d. foramen ovale.

ANS: B The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs, not through the left atrium, lungs, or foramen ovale.

Chest pain with an organic cause in a child is most likely the result of: a. cardiac disease. b. asthma. c. esophageal reflux. d. arthritis.

ANS: B Unlike chest pain in adults, chest pain in children and adolescents is seldom caused by a cardiac problem. More likely, the case is related to trauma, exercise-induced asthma, or cocaine use

Mr. O, age 50 years, comes for his annual health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O mentions that he routinely engages in light exercise. At this time, you should: a. ask if he makes his own bed daily. b. have the patient describe his exercise. c. make a note that he walks each day. d. record "light exercise" in the history.

ANS: B When Mr. O says that he engages in light exercise, have him describe his exercise. To qualify his use of the term light, ask him the type, length of time, frequency, and intensity of his activities.

A grade IV mitral regurgitation murmur would: a. be described as a diastolic murmur. b. not be expected to have a thrill. c. radiate to the axilla. d. be heard best at the base.

ANS: C A grade IV murmur would have a thrill; a mitral regurgitation murmur is best heard at the apex, is holosystolic, and would radiate to the axilla.

A palpable rushing vibration over the base of the heart at the second intercostal space is called a: a. heave. b. lift. c. thrill. d. thrust.

ANS: C A thrill is a fine, palpable, rushing vibration—a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A lift is another term for a heave, which is a more vigorous apical impulse. A thrust is sudden, forcible forward movement.

An apical PMI palpated beyond the fifth intercostal space may indicate: a. decreased cardiac output. b. obesity. c. left ventricular hypertrophy. d. hyperventilation.

ANS: C An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse

Fat deposits in the circulatory system of an older adult can lead to: a. diffuse conduction disturbances. b. exaggerated contractility. c. heart failure. d. thinning of the ventricles

ANS: C Atherosclerosis is a disease in which fat deposits (cholesterol) accumulate in the walls of the arteries, which can lead to heart failure or stroke.

The condition in which a patient's heart is rotated or displaced to the right or is situated as a mirror image of the expected position is called: a. amyloidosis. b. coarctation. c. dextrocardia. d. situs inversus.

ANS: C Dextrocardia occurs when the heart is displaced or rotated to the right or is a complete mirror image of the expected finding. Amyloidosis is a metabolic disorder marked by amyloid deposits in organs and tissues. Coarctation is the compression of the walls of a vessel, such as an aortic coarctation. Situs inversus occurs when the heart and stomach are displaced to the right and the liver is located to the left.

A third heart sound is created by: a. atrial contraction. b. ventricular contraction. c. diastolic filling. d. regurgitation between the right and left ventricles.

ANS: C Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria; the filling sometimes produces a third heart sound, S3.

The most helpful finding in determining left-sided heart failure is: a. dyspnea. b. orthopnea. c. jugular vein distention. d. an S3 heart sound

ANS: C Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention.

A condition that is likely to present with dizziness and syncope is: a. bacterial endocarditis. b. hypertension. c. sick sinus syndrome. d. pericarditis.

ANS: C Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes arrhythmias with subsequent syncope, transient dizzy spells, light-headedness, seizures, palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of neurologic dysfunction, and sudden onset of CHF. Chest pain is an initial symptom in acute pericarditis, along with a triphasic friction rub.

Purkinje fibers are located in the: a. sinoatrial node. b. atrioventricular node. c. myocardium. d. aortic arch.

ANS: C The Purkinje fibers are located in the ventricular myocardium.

Which two heart chambers are most anterior in the chest? a. Both atria b. Both ventricles c. The right atrium and ventricle d. The left atrium and ventricle

ANS: C The most anterior surface of the heart is formed by the right ventricle. The heart is turned ventrally on its axis, putting its right side more forward. The left atrium is above the left ventricle, forming the most posterior aspect of the heart.

Which cardiac structure is responsible for the heart's pumping action? a. Pericardium b. Epicardium c. Myocardium d. Endocardium

ANS: C The myocardium is the thick muscular middle layer responsible for the pumping action of the heart. The pericardium is the tough, double-walled, fibrous sac that protects the heart. The epicardium is the thin outermost muscle layer that covers the heart and extends onto the great vessels. The endocardium is the innermost layer that lines the chambers of the heart and covers heart valves.

The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing: a. a pericardial friction rub. b. high-pitched murmurs. c. presystolic gallops. d. systolic ejection sounds.

ANS: C Using the bell of the stethoscope at the apex is more useful for hearing low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position

A patient you are seeing in the emergency department for chest pain is believed to be having a myocardial infarction. During the health history interview of his family history, he relates that his father had died of "heart trouble." The most important follow-up question you should pose is which of the following? a. "Did your father have coronary bypass surgery?" b. "Did your father's father have heart trouble also?" c. "What were your father's usual dietary habits?" d. "What age was your father at the time of his death?"

ANS: D A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one's chance of a similar occurrence.

A lift along the left sternal border is most likely the result of: a. aortic stenosis. b. atrial septal defect. c. pulmonary hypertension. d. right ventricular hypertrophy.

ANS: D A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect.

The pacing structure of the heart's electrical activity is the: a. AV node. b. bundle of His. c. Purkinje fibers. d. sinoatrial (SA) node

ANS: D An electrical impulse stimulates each myocardial contraction; this impulse originates in and is paced by the SA node.

Which ECG change would not be expected as an age-related pattern? a. First-degree block b. Bundle branch block c. Left ventricular hypertrophy d. Ventricular fibrillation

ANS: D Common ECG changes in older adults include first-degree atrioventricular block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventricular hypertrophy, and atrial fibrillation.

Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of: a. rheumatic fever. b. cor pulmonale. c. pericarditis. d. endocarditis.

ANS: D Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and sudden onset of congestive heart symptoms. The lesions described are Janeway lesions. Osler nodes appear on the tips of fingers or toes are caused by septic emboli.

Which of the following information belongs in the past medical history section related to heart and blood vessel assessment? a. Adolescent inguinal hernia b. Childhood mumps c. History of bee stings d. Previous unexplained fever

ANS: D Previous unexplained fever should be included in the past medical history of a heart and blood vessel assessment. This incidence may be related to acute rheumatic fever, with potential heart valve damage.

Which dysrhythmia is a physiologic event during childhood? a. First-degree AV block b. Mobitz type II c. Multifocal PVCs d. Sinus arrhythmia

ANS: D Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension.