Jarvis Ch-20 Heart & Neck Vessels Flashcards
(40 cards)
When assessing a patient’s cardiovascular system, the nurse notes a high pitched scratchy sound at the apex of the heart. The nurse recognizes this as rubbing between two walls of the sac surrounding and protecting the heart, called the:
a. Pericardium
b. Myocardium
c. Endocardium
d. Pleural space
a. Pericardium
What’s rubbing?
The pericardium.
It’s a double-walled sac that surrounds and protects your heart. Normally, it contains a teensy bit of fluid so your heart can beat in peace, free from friction and drama.
But when it’s inflamed (pericarditis), those two layers get irritated and start rubbing—creating the famous pericardial friction rub. That’s what you’re hearing through the stethoscope. It’s not cute. It’s not subtle. It’s like your heart is filing a complaint.
⸻
Wrong answer breakdown
• b. Myocardium – That’s the actual heart muscle. • c. Endocardium – Inner lining of the heart chambers. • d. Pleural space – That’s in your lungs.
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
b. Right atrium > right ventricle > pulmonary artery > lungs > pulmonary vein > left atrium > left ventricle
1. Vena Cava (where deoxygenated blood enters from the body) 2. Right Atrium 3. Right Ventricle 4. Pulmonary Artery (blood leaves heart to the lungs—yes, artery goes away even though it’s deoxygenated here) 5. Lungs (where the magic happens—oxygen added, CO2 dumped) 6. Pulmonary Vein (returns oxygenated blood to heart) 7. Left Atrium 8. Left Ventricle 9. Aorta (blood pumped out to the rest of the body to deliver that sweet, sweet oxygen
The nurse is reviewing the anatomy and physiological functioning 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.
d. The atria contract toward the end of diastole and push the remaining blood into the ventricles.
Towards the end of diastole, the atria contract and push the last amount of blood (approximately 25% of stroke volume) into the ventricles. This active filling phase is called presytole, or atrial systole, or sometimes the atrial kick.
When listening to heart sounds, the nurse knows 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. Aortic and pulmonic
The second heart sound (S2) occurs with the closure of the semilunar (aortic & pulmonic) valves and signals the end of systole. Although it is heard over all the precordium, the S2 is loudest at the base of the heart.
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.
c. The tricuspid valve closes slightly later than the mitral valve.
Due to the way electrical impulses travel through the heart (thanks to myocardial depolarization), the right side lags just a touch.
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. Sinoatrial (SA) node
• SA node = Sinoatrial node.
• It’s found chilling in the right atrium of your heart, near where the superior vena cava enters.
• Its job? Start the electrical signal that tells your heart to beat. It’s the original influencer. The Beyoncé of heart cells.
• That’s why it’s called the pacemaker of the heart—it sets the pace, like a Fitbit with authority issues.
How it works (like, basically):
1. SA Node fires an impulse (like, “Hey, time to beat!”).
2. The signal spreads across the atria, making them contract. So the top chambers go squish.
3. Then it hits the AV node (atrioventricular node), which delays it slightly to let the ventricles fill. Very considerate.
4. From there it goes down the Bundle of His, into the bundle branches, and finally to the Purkinje fibers, causing the ventricles to contract like champs.
Why this matters:
Without the SA node, your heart would be confused and sad, possibly beating like a toddler on a drum kit—erratically and with poor rhythm. Nobody wants that. Not you, not your ventricles, not the ER staff
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
c. SA node > AV 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, allowing the atria the time to contract before the ventricles are stimulated. Then the impulses travels to the bundle of His, to the right and left bundle branches, and then through the ventricles.
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
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 the activity on the right side of the heart. They reflect filling pressures and volume changes. Normal jugular venous pulsation is 2 cm or less above the sternal angle. Elevated pressure is a level of pulsation of more than 3 cm above the sternal angle at 45 degrees and occurs with heart failure.
When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to 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.
About two-thirds of the freshly oxygenated blood from the placenta is shunted through an opening in the atrial septum, the foramen ovale, into the left side of the heart, where it is pumped out through the aorta. The foramen ovale closes within the first hour after birth because the pressure in the right side of the heart is now lower than in the left side.
A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous examination findings, 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 vasodilation 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.
a. This decline in blood pressure is the result of peripheral vasodilation and is an expected change.
Despite the increased cardiac output, arterial blood pressure decreases in pregnancy because of peripheral vasodilation. The blood pressure drops to its lowest point during the second trimester and then rises after that.
In assessing a 70-year-old man, the nurse finds the following: BP of 140/100 mm Hg; HR of 104 and slightly irregular; and split S₂. Which of these findings is an expected hemodynamic change related to age?
a. Increase in resting HR
b. Increase in systolic BP
c. Decrease in diastolic BP
d. Increase in diastolic BP
b. Increase in systolic BP
With aging, an increase in systolic BP occurs.
A 45-year-old man is in the clinic for a routine physical examination. During the recoding of his health hx, the patient states that he has been having difficulty sleeping. “I’ll be sleeping great, and then I wake up and feel I can’t get my breath.” The nurses best response to this would be:
a. “when was your last electrocardiography done?”
b. “it’s probably because it’s been so hot at night.”
c. “Do you have any hx of problems with your heart?”
d. “Have you had a recent sinus infection or upper respiratory infection?”
c. “Do you have any hx of problems with your heart?”
Paroxysmal nocturnal dyspnea (SOB generally occurring at night_ occurs with heart failure. Lying down increases the volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and fligs open a window with the perception of needing fresh air.
In assessing a patient’s major risk factors for heart disease, which would the nurse want to include when taking a hx?
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
c. smoking, hypertension, obesity, diabetes, and high cholesterol
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 time, hungry again. What other information would the nurse need?
a. Infants sleeping position
b. Sibling hx of eating disorders
c. Amount of background noise when eating
d. Presence of dyspnea or diaphoresis when sucking.
d. Presence of dyspnea or diaphoresis when sucking.
To screen for heart disease in an infant, the focus should be on feeding. Fatigue during feeding should be noted. 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.
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.
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 by using the bell of the stethoscope. The nurse should avoid compressing the artery, which would create an artificial bruit and compromise circulation if the carotid artery is already narrowed by atherosclerosis. Excessive pressure on the carotid sinus area high in the next should be avoided, and excessive vagal stimulation could slow down the heart rate, especially in older adults. Palpating only one carotid artery at a time will avoid compromising arterial blood to the brain.
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
b. Blood flow turbulence
A bruit is an blowing, swishing sound indicating blood flow turbulence; normally, none is present.
During an 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. A normal heart
b. Systolic murmur
c. Enlargement of the left ventricle
d. Enlargement of the right ventricle
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 (MCL). 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.
Before administering certain cardiovascular medications, the nurse needs to check the rate of the apical impulse at the:
a. Third intercostal space at the midclavicular line
b. Fourth left intercostal space at the sternal border
c. Fourth left intercostal space at the anterior axillary line.
d. Fifth left intercostal space at the midclavicular line.
d. Fifth left intercostal space at the midclavicular line.
The apical impulse should occupy only one intercostal space, the fourth or fifth, and it should be at or medial to the midclavicular line.
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 hearts 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. 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 borer. Percussion is of limited usefulness in the female breast tissue, in a person who is obese, or in a person with a muscular chest wall. Chest radiography and echocardiography are significantly more accurate in detecting heart enlargement.
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 including 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. Listening by including the stethoscope in a rough “Z” pattern, from the base of the heart across and down, then over to the apex.
Auscultation of breath sounds should not be limited to only four locations. Sounds produced by the valves may be heard all over the precordium. The stethoscope should be inched in a rough “Z” pattern from the base of the heart, across and down, and then over to the apex; or, starting at the apex, it should be slowly worked up.
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 ECG 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.
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 person’s breathing, increasing at the peak of inspiration and slowing with expiration.
When listening to heart sounds, the nurse knows that S₁:
a. Is louder than S₂ at the base of the heart.
b. Indicates the beginning of diastole.
c. Coincides with the carotid artery pulse.
d. Is caused by the closure of the semilunar valves.
c. Coincides with the carotid artery pulse.
S1 coincides with the carotid artery pulse, is the start of systole, and is louder than S2 at the apex of the heart; S2 is louder than S1 at the base. The nurse should gently feel the carotid artery pulse while auscultating at the apex; the sound heard as each pulse is felt is S1.
During auscultation, the nurse hears a sound immediately occuring 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 hear breath while the nurse listens again.
c. No further assessment is needed because the nurse knows this sound is S₃
d. Watch the patient’s respirations while listening for the effect of breathing on the sound.
d. Watch the patient’s respirations while listening for the effect of breathing on the sound.
Which of these findings would the nurse expect to notice during a cardiac assessment of a 4-year-old child?
a. S₃ when sitting up
b. Persistent tachycardia above 150 bpm
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. Murmur at the second left intercostal space when supine
Some murmurs are common in healthy children or adolescents and are termed innocent of 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.
