Chapter 20: Heart and Neck Vessels

A 45-year-old man is in the clinic for 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:

"Do you have any history of problems with your heart?"

The nurse is reviewing anatomy and physiology of the heart. Which statement best describes what is meant by atrial kick? A. The atria contract at systole and attempt to push against closed valves B. The atria contract towards the end of diastole and push the remaining blood into the ventricles

B. The atria contract towards the end of diastole and push the remaining blood into the ventricles

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 vein → lungs → pulmonary artery → left atrium → left ventricle C.Right atrium → right ventricle → pulmonary artery → lungs → pulmonary vein → left atrium → left ventricle

C.Right atrium → right ventricle → pulmonary artery → lungs → pulmonary vein → left atrium → left ventricle

In assessing a 70-year-old, 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?

Increase in systolic blood pressure

Briefly relate the route of a blood cell from the liver to tissue in the body.

Liver to right atrium via inferior vena cava, through tricuspid valve to right ventricle, through pulmonic valve to the pulmonary artery, picks up oxygen in the lungs, returns to left atrium, to left ventricle via mitral valve, through aortic valve to aorta, and out to the body.

Fourth heart sound (S4)

S4 gallop, atrial gallop; very soft, low-pitched ventricular filling sound that occurs in late diastole

assessing a patient's major risk factors for heart disease, which would the nurse want to include when taking a history?

Smoking, hypertension, obesity, diabetes, high cholesterol

List the major risk factors for heart disease and stroke in the text.

The major risk factors for heart disease and stroke are hypertension, smoking, high cholesterol levels, obesity, and diabetes. Physical inactivity, family history of heart disease, and age are other risk factors.

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

There is an opening in the atrial septum where blood can flow into the left side of the heart.

Endocardium

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

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?

This is a result of peripheral vasodilatation and is an expected change.

Select the statement that best differentiates a split S2 from S3. a) S3 is lower pitched and is heard at the apex. b) S2 is heard at the left lower sternal border. c) The timing of S2 varies with respirations. d) S3 is heard at the base; timing varies with respirations.

a

The examiner wishes to listen for a pericardial friction rub. Select the best method of listening. a) with the diaphragm, patient sitting up and leaning forward, breath held in expiration b) using the bell with the patient leaning forward c) at the base during normal respiration d) with the diaphragm, patient turned to the left side

a

When auscultating the heart, your first step is to: a) identify S1 and S2. b) listen for S3 and S4. c) listen for murmurs. d) identify all four sounds on the first round.

a

The electrical stimulus of the cardiac cycle follows which sequence? a. AV node → SA node → bundle of His → bundle branches b. AV node → SA node → bundle of his

a. AV node → SA node → bundle of His → bundle branches

Summation gallop

abnormal mid-diastolic heart sound heard when both the pathologic S3 and S4 are present

When listening to heart sounds, the nurse knows that the valve closures that can be heard best at the base of the heart are:

aortic and pulmonic

Fill in the following blanks: S1 is best heard at the ____ of the heart, whereas S2 is loudest at the ____ of the heart. S1 coincides with the pulse in the ______________ and coincides with the ___ wave if the patient is on an ECG monitor.

apex; base; carotid artery; R.

Precordium

area of the chest wall overlying the heart and great vessels

Atrial systole occurs: a) during ventricular systole. b) during ventricular diastole c) concurrently with ventricular systole d) independently of ventricular function.

b

Select the best description of the tricuspid valve. a) left semilunar valve b) right atrioventricular valve. c) left atrioventricular valve. d) right semilunar valve.

b

The examiner is palpating the apical impulse. The normal size of this impulse: a) is less than 1cm b) is about 2 cm c) is 3 cm d) varies depending on the size of the person

b

The examiner wishes to listen in the pulmonic valve area. To do this, the stethoscope would be placed at the: a) second right interspace b) second left interspace c) left lower sternal border d) fifth interspace, left midclavicular line

b

When assessing the carotid artery, the examiner should palpate: a) bilaterally at the same time, while standing behind the patient. b) medial to the sternomastoid muscle, one side at a time. c) for a bruit while asking the patient to hold his or her breath briefly. d) for unilateral distention while turning the patient's head to one side.

b

You will hear a split S2 most clearly in what area? a) apical b) pulmonic c) tricuspid d) aortic

b

Clubbing

bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic cyanotic heart and lung conditions

A murmur heard after S1 and before S2 is classified as: a) diastolic (possibly benign). b) diastolic (always pathologic). c) systolic (possibly benign). d) systolic (always pathologic).

c

The function of the pulmonic valve is to: a) divide the left atrium and left ventricle. b) guard the opening between the right atrium and right ventricle. c) protect the orifice between the right ventricle and the pulmonary artery. d) guard the entrance to the aorta from the left ventricle.

c

The precordium is: a) a synonym for the mediastinum. b) the area on the chest where the apical impulse is felt. c) the area on the anterior chest overlying the heart and great vessels. d) a synonym for the area where the superior and inferior venae cavae return unoxygenated venous blood to the right side of the heart.

c

The stethoscope bell should be pressed lightly against the skin so that: a) chest hair doesn't stimulate crackles. b) high-pitched sounds can be heard better. c) it does not act as a diaphragm d) it does not interfere with amplification of heart sounds

c

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 valves 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

c

which of the following positions is best to have the client in while aucultating for a S3 and S4 murmur, of mitral stenosis? a. supine b. sitting up and leaning ofrward c. left lateral

c. left lateral

Pulmonic stenosis

calcification of pulmonic valve that restricts forward flow of blood during systole

Mitral stenosis

calcified mitral valve impedes forward flow of blood into left ventricle during diastole

Bell (of the stethoscope)

cup-shaped endpiece used for soft, low-pitched heart sounds

The examiner has estimated the jugular venous pressure. Identify the finding that is abnormal. a) patient elevated to 30 degrees, internal jugular vein pulsation at 1cm above sternal angle b) patient elevated to 30 degrees, internal jugular vein pulsation at 2cm above sternal angle c) patient elevated to 40 degrees, internal jugular vein pulsation at 1cm above sternal angle d) patient elevated to 45 degrees, internal jugular vein pulsation at 4cm above sternal angle

d

The second heart sound is the result of: a) opening of the mitral and tricuspid valves b) closing of the mitral and tricuspid valves c) opening of the aortic and pulmonic valves d) closing of the aortic and pulmonic valves.

d

Dyspnea

difficult, labored breathing

Cyanosis

dusky blue mottling of the skin and mucous membranes due to excessive amount of reduced hemoglobin in the blood

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:

elevated pressure related to heart failure

Pericardial fluid

ensures smooth, friction-free movement of the heart muscle

Which of the following heart sounds would be expected with someone with mitral insufficiency? a. varying intensity of s1 b. loud accentuated s1 c. faint diminished s1

faint diminished s1

Diaphragm (of the stethoscope)

flat endpiece of the stethoscope used for hearing relatively high-pitched heart sounds

Systole

he heart's pumping phase

Pericardial friction rub

high-pitched, scratchy extra cardiac sound heard when the precordium is inflamed

Midclavicular line (MCL)

imaginary vertical line bisecting the middle of the clavicle in each hemithorax

Left ventricular hypertrophy (LVH)

increase in thickness of myocardial wall that occurs when the heart pumps against chronic outflow obstruction (e.g., aortic stenosis)

Mitral valve

left atrioventricular valve separating the left atrium and ventricle

Mitral regurgitation

mitral insufficiency; incompetent mitral valve allows regurgitation of blood back into left atrium during systole

Ventricle

muscular pumping chamber

Myocardium

muscular wall of the heart

Physiologic splitting

normal variation in S2 inspiration 165 heard as two separate components during

First heart sound (S1)

occurs with closure of the atrioventricular valves signaling the beginning of systole

Second heart sound (S2)

occurs with closure of the semilunar valves, aortic and pulmonic; signals the end of systole

Paradoxical splitting

opposite of a normal split S2 so that the split is heard in expiration, and in inspiration the sounds fuse to one sound

Thrill

palpable vibration on the chest wall accompanying severe heart murmur

The sac that surrounds and protects the heart is called the

pericardium

Pulmonic regurgitation

pulmonic insufficiency; backflow of blood through incompetent pul-monic valve into the right ventricle

Tachycardia

rapid heart rate, greater than 95 beats per minute in the adult

Atrium

reservoir for holding blood

Tricuspid valve

right atrioventricular valve separating the right atrium and ventricle

Pulmonic valve

right semilunar valve separating the right ventricle and pulmonary artery

Cor pulmonale

right ventricular hypertrophy and heart failure due to pulmonary hypertension

Coarctation of aorta

severe narrowing of the descending aorta, a congenital heart defect

The component of the conduction system referred to as the pacemaker of the heart is the:

sinoatrial (SA) node

Bradycardia

slow heart rate, less than 50 beats per minute in the adult

Third heart sound (S3)

soft, low-pitched ventricular filling sound that occurs in early diastole (S3 gallop) and may be an early sign of heart failure

Edema

swelling of legs or dependent body part due to increased interstitial fluid

Inching

technique of moving the stethoscope incrementally across the precordium through the auscultatory areas while listening to the heart sounds

Syncope

temporary loss of consciousness due to decreased cerebral blood flow (fainting); caused by ventricular asystole, pronounced bradycardia, or ven-tricular fibrillation

Gallop rhythm

the addition of a 3rd or a 4th heart sound; makes the rhythm sound like the cadence of a galloping horse

Diastole

the heart's filling phase

Pericardium

tough, fibrous, double-walled sac that surrounds and protects the heart

Erb's point

traditional auscultatory area in the 3rd left intercostal space

Palpitation

uncomfortable awareness of rapid or irregular heart rate