Chapter 19 &20 HA

Question 1

How long should the patient rest before performing a ankle-brachial index test?

Answer 1

5-10 minutes

Question 2

What device do you use detect a weak peripheral pulse, to monitor blood pressure in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity.

Answer 2

Doppler probe

Question 3

A highly specific, noninvasive and readily available way to determine the extent of peripheral arterial disease

Answer 3

Doppler stethoscope

Question 4

Which way are you going to measure a doppler probe?

Answer 4

counterclockwise

Question 5

An ABI between 0.91 and 1 is…..

Answer 5

borderline cardiovascular risk

Question 6

ABI Scores:

0. 90-0.71
1. 70-0.41
2. 40-0.30

Answer 6

A)Mild PAD
B) Moderate PAD
C) Severe PAD, usually with rest pain except in the presence of diabetic neuropathy

Question 7

An ABI less than 30 means……

Answer 7

Ischemia, with impending loss of tissue

Question 8

This valve is located in the 2nd right interspace

Answer 8

Aortic Valve

Question 9

What valve is located in the 2nd left interspace?

Answer 9

Pulmonic valve area

Question 10

What valve is located in the left lower sternal border?

Answer 10

Tricuspid valve area

Question 11

Fifth interspace at around left midclavicular line is located where?

Answer 11

Mitral valve area

Question 12

What pattern should you inch your stethoscope

Answer 12

Z pattern, from the base of the heart across and down and over to the apex

Question 13

What does a normal heart rate range from…….

Answer 13

50-95

Question 14

The rhythm varies with the person’s breathing, increasing at the peak of inspiration and slowing with expiration

Answer 14

Sinus arrhythmias

Question 15

When you notice any irregularities in rate or rhythm what should you check?

Answer 15

Pulse deficit by auscultating apical beat while palpating the radial pulse

Question 16

Start of systole and thus serves as the reference point for the timing of all other cardiac sounds.

Answer 16

S1

Question 17

Signals a weak contraction of the ventricles; it occurs with afib, premature beats, and heart failure

Answer 17

pulse deficit

Question 18

Congenital cyanotic heart disease can cause what finding when examining the patients nails?

Answer 18

Clubbing

Question 19

Clubbing of fingers and toes usually does not appear until when, if with severe cyanotic defects.

Answer 19

late in the first year

Question 20

Palpate the apical impulse in the fourth interspace to the left of the midclavicular line until what age?

Answer 20

4 years old
4th interspace at midclavicular space (4-6)
5th interspace to right of midclavicular line (7)

Question 21

A precordial bulge to the left of the sternum with a hyperdynamic precordium signals

Answer 21

Cardiac enlargement

Question 22

What congenital defects does cyanosis occur in?

Answer 22

tetralogy of Fallots or transposition of the great arteries

Question 23

When palpating the apical impulse what should the nurse ask the patient to do?

Answer 23

Exhale and hold their breath

Question 24

How do you localize the apical impulse precisely?

Answer 24

by using one finger pad

Question 25

What might you have the patient do to find the apical impulse

Answer 25

roll the person midway to the left

Question 26

A sustained forceful thrusting of the ventricle during systole. Occurs with ventricular hypertrophy as a result of increased workload.

Answer 26

heave or lift

Question 27

Increased force and duration but no change in location occurs with left ventricular hypertrophy and no dialtion

Answer 27

sustained impulse

Question 28

Not palpable with ______ ______ because of overriding lungs.

Answer 28

pulmonary emphysema

Question 29

Where can you feel apical impulse best?

Answer 29

at the end of expiration

Question 30

What states the apical impulse increases in amplitude and duration

Answer 30

high cardiac output (anxiety, fever, hyperthyroidism, anemia)

Question 31

Which lymphatic duct empties into the left subclavian vein?

Answer 31

Thoracic Duct (drains rest of body)

Question 32

Which lymphatic duct empties into the right subclavian vein?

Answer 32

Right lymphatic duct (drains right side of body)

Question 33

How does lymph flow?

Answer 33

contractions of the skeletal muscles

Question 34

Filters the fluid before it is returned to the bloodstream and filter out microorgansims that could be harmful to the body.

Answer 34

Lymph nodes

Question 35

Destroys RBC to produce antibodies, store RBC and to filter microorganisms from the blood

Answer 35

spleen

Question 36

Located at the entrance to the respiratory and GI tracts and respond to local inflammation

Answer 36

tonsils

Question 37

Is important in developing the L lymphocytes of the immune system in children, and located in the superior mediastinum behind the sternum and in front of the aorta

Answer 37

Thymus

Question 38

Where is the SA node?

Answer 38

near the superior vena cava

Question 39

Specialized cells in SA node near the superior vena cava initiate an......

Answer 39

electrical impulse

Question 40

What is another name for the SA node

Answer 40

pacemaker

Question 41

How many L of blood per minute does the heart normally pump?

Answer 41

4-6L

Question 42

What position should the patient be in to listen to the S3 and S4 heart sounds?

Answer 42

Left lateral

Question 43

What position should the patient be in to to listen to a soft diastolic murmur of aortic regurgitation

Answer 43

leaning forward in the sitting position

Question 44

When doing a pulse assessment on a patient with anxiety, how might you characterize your findings?

Answer 44

+3

Question 45

What force of pulse occurs with shock and peripheral artery disease?

Answer 45

weak, "thready", pulse

Question 46

Which test has replaced percussion to outline the borders of the heart?

Answer 46

chest xray or echocardiogram

Question 47

What are chest xray's and echoes are more accurate at detecting.....

Answer 47

heart enlargement

Question 48

What non-invasive test is performed to check for valvular incompetency?

Answer 48

Doppler ultrasound

Question 49

A split S2 sound is heard only in the _______ valve area

Answer 49

pulmonic (2nd left interspace)

Question 50

A split S2 is a normal phenomenon that occurs towards......

Answer 50

then end of inspiration in some people

Question 51

When S2 splits, what sound will you hear?

Answer 51

T-DUP

Question 52

During _______, synchrony returns and the aortic and pulmonic components fuse together.

Answer 52

Expiration

Question 53

Unaffected by respiration; the split is always there

Answer 53

fixed split

Question 54

The opposite of what you would expect; the sounds fuse on inspiration and split on expiration.

Answer 54

Paradoxical split

Question 55

During systole, happens during mitral valve prolapse, and is the most common extra sounds.

Answer 55

midsystolic click

Question 56

This is the muscle wall of the heart?

Answer 56

Myocardium

Question 57

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

Answer 57

pericardium

Question 58

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

Answer 58

endocardium

Question 59

A thin-walled reservoir for holding blood, and the thick walled ventricles is the muscular pumping chamber.

Answer 59

Atrium

Question 60

What is the main purpose of valves?

Answer 60

to prevent backflow of blood

Question 61

Semilunar valves are the pulmonic valves in the _____ side of the hear

Answer 61

Right

Question 62

When do the semilunar valves open?

Answer 62

During systole

Question 63

Deficiency in which vitamin may increase the risk of cardiovascular disease?

Answer 63

Vitamin D

Question 64

Encourage men ages 45 to 79 years and women age 55 to 79 years to use what if potential benefit of preventing MI outweighs the potential risk of GI bleeding?

Answer 64

Aspirin

Question 65

Vitamin D deficiency can be associated with what medical conditions?

Answer 65

HTN, diabetes, metabolic syndrome, left ventricular hypertrophy, and chronic vascular inflammation

Question 66

To screen for heart disease in infant, what should we observe?

Answer 66

fatigue during feeding

Question 67

Which node is in the antecubital fossa and drains the hand and lower arm?

Answer 67

Epitrochlear Node

Question 68

In the groin drain most of the lymph of the lower extremity, the external genitalia, and the anterior abdominal wall.

Answer 68

Inguinal nodes

Question 69

How do you check the epitrochlear nodes?

Answer 69

shake the patient's hand and reach your other hand under their elbow to the groove between the biceps and triceps muscles

Question 70

Epitrochlear node occurs in what condition?

Answer 70

generalized lymphadenopathy

Question 71

When auscultating the carotid artery, you hear a blowing, swishing sound. What is this called?

Answer 71

Bruit

Question 72

Bruit increases risk of.....

Answer 72

transient ischemic attack and ischemic stroke

Question 73

Radiate tot he neck and must be distinguished from a local bruit

Answer 73

aortic valve murmurs (aortic stenosis)

Question 74

A bruit indicates turbulence from a local vascular cause and is a marker for.....

Answer 74

atherosclerotic disease

Question 75

A carotid bruit is audible when the lumen is occluded by

Answer 75

1/2 to 2/3

Question 76

Auscultate the Carotid Artery using the ____ of the stethoscope.

Answer 76

bell

Question 77

Where is S1 heard the loudest at?

Answer 77

the apex

Question 78

Occurs with closure of the semilunar valves and signals the end of systole.

Answer 78

S2

Question 79

Where is S2 is loudest over?

Answer 79

Base of the heart

Question 80

The QRS complex occurs during which part of the cardiac cycle?

Answer 80

Depolarization of the ventricle

Question 81

The P wave occurs during which part of the cardiac cycle

Answer 81

Depolarization of the atria

Question 82

the time necessary for atrial depolarization plus time for the impulse to travel through the AV node to the ventricles

Answer 82

PR inerval

Question 83

A thrill in the 2nd and 3rd RIGHT interspaces occurs with what condition?

Answer 83

Aortic stenosis and systemic hypertension

Question 84

A thrill in the 2nd and 3rd LEFT interspaces occurs with what condition?

Answer 84

pulmonic stenosis, pulmonic hypertension

Question 85

Pressure overload is found in what conditions?

Answer 85

aortic stenosis or systemic hypertension

Question 86

Which artery travels behind the medial malleolus and forms the plantar arteries?

Answer 86

posterior tibial artery

Question 87

Major artery of the leg, passes under the inguinal ligament. Travels down the thigh.

Answer 87

Femoral artery

Question 88

Deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel

Answer 88

Ischemia

Question 89

Below the knees what artery is divided

Answer 89

popliteal artery

Question 90

Travels down the front of the leg on the dorsum of the foot, where it becomes the dorsalis pedis

Answer 90

anterior tibial artery

Question 91

What cardiac sound is best characterized as sounding like sandpaper?

Answer 91

Pericardial friction rub

Question 92

What position is the patient in to best hear pericardial friction rub.

Answer 92

sitting up and leaning forward and the breath held in expiration.

Question 93

What is claudification?

Answer 93

Pain when walking

Question 94

The number of blocks walked or stairs climbed to produce pain.

Answer 94

Claudification distance

Question 95

What type of occlusion is associated with erectile dysfunction (Leriche Syndrome)

Answer 95

Aortoiliac occlusion

Question 96

Risk factors for Peripheral Vascular Disease (PVD)

Answer 96

Diabetes and smoking

Question 97

PND is short for what condition?

Answer 97

Paraoxsmal Nocturnal Disorder

Question 98

What does PND occur with?

Answer 98

Heart failure

Question 99

A pulmonary disorder but also occurs with mitral stenosis

Answer 99

Hemoptysis

Question 100

What increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically the person awakens after 2 hours of sleep with the perception of needing fresh air

Answer 100

Lying down

Question 101

Arteries carry freshly oxygenated blood to all body tissues

Answer 101

High pressure system

Question 102

Veins drain the deoxygenated blood with its waste products from the tissues and return it to the heart

Answer 102

Low pressure system

Question 103

Engorged pulsating neck veins and liver enlargement can be seen with what cardiac condition?

Answer 103

Tricuspid regurgitation

Question 104

Stream of blood regurgitates back into LA during systole through incompetent mitral valve. Fatigue, palpitation, orthopnea, PND. Thrill in systole at apex.

Answer 104

Mitral Regurgitation

Question 105

Calcification of pulmonic valve restricts forward flow of blood. Thrill in systole at 2nd and 3rd left interspace

Answer 105

Pulmonic Stenosis

Question 106

What are the names of the semilunar valves?

Answer 106

Aortic and Pulmonic

Question 107

Sudden sharp and stabbing pain relieved often by sitting or leaning forward and worsens by lying down or with inspiration

Answer 107

Pericarditis

Question 108

Sharp or stabbing pain worsening with deep breaths.

Answer 108

Pulmonary embolism

Question 109

Occurs early in systole at the start of ejection because it results from opening of the SL valves. Open silently, but in the presence of stenosis

Answer 109

Ejection Click

Question 110

Severe narrowing of teh descending aorta, usually at the junction of the ductus arteriosus and the aortic arch, just distal to the origin of the left subclavian artery.

Answer 110

Coarctation of the Aorta

Question 111

Occurs with occlusion of a deep ven. Occurs with lympatic obstruction.

Answer 111

Unilateral edema

Question 112

Occurs with arterial deficit, especially......

Answer 112

diabetes

Question 113

Episodes of abrupt, progressive tricolor change of the fingers in response to cold, vibration, or stress

Answer 113

Raynaud Phenomenon

Question 114

Buildup of fatty plaques on intima (atherosclerosis) plus hardening, calcification of arterial wall (arteriosclerosis).

Answer 114

Arterial (Ischemic) Ulcer

Question 115

After acute DVT or chronic incompetent valves in deep veins. Account for 80% of lower leg ulcers.

Answer 115

Venous (Stasis) Ulcer

Question 116

Normal leg veins have dilated as a result of chronic increased venous pressure (obesity, multiple pregnancies) and incompetent valves that permit reflux of blood back toward leg instead of forward toward heart.

Answer 116

Superficial Varicose Veins