PHYSICAL EXAMINATION AND HEALTH ASSESSMENT TESTBANK BY JARVIS:Chapter 20: Heart and Neck Vessels

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1. The sac that surrounds and protects the heart is called the: a. Pericardium. b. Myocardium. c. Endocardium. d. Pleural space. ANS: A The pericardium is a tough, fibr... ous double-walled sac that surrounds and protects the heart. It has two layers that contain a few milliliters of serous pericardial fluid. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 460 MSC: Client Needs: General 2. The direction of blood flow through the heart is best described by which of these? Vena cava right atrium right ventricle lungs pulmonary artery left atrium a. left ventricle Right atrium right ventricle pulmonary artery lungs pulmonary vein left b. atrium left ventricle Aorta right atrium right ventricle lungs pulmonary vein left atrium left c. ventricle vena cava Right atrium right ventricle pulmonary vein lungs pulmonary artery left d. atrium left ventricle ANS: B 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 through the pulmonary vein. The blood goes from there to the left ventricle and then out to the body through the aorta. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 461|p. 463 MSC: Client Needs: General 3. The nurse is reviewing the anatomy and physiologic 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. ANS: D Toward 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 presystole, or atrial systole, or sometimes theatrial kick. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 463 MSC: Client Needs: General 4. 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. ANS: C The second heart sound (S2) occurs with the closure of the semilunar (aortic and 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. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 464 MSC: Client Needs: General 5. 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. ANS: C 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). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 463 MSC: Client Needs: General 6. 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. ANS: B 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 called the pacemaker of the heart. 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 ANS: D 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 impulse travels to the bundle of His, the right and left bundle branches, and then through the ventricles. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 464 MSC: Client Needs: General 8. 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. ANS: D 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 more than 3 cm above the sternal angle at 45 degrees and occurs with heart failure. DIF: Cognitive Level: Analyzing (Analysis) REF: pp. 466-467 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. ANS: C First, approximately two thirds of the blood 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. DIF: Cognitive Level: Applying (Application) REF: p. 467 MSC: Client Needs: Health Promotion and Maintenance 10. 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, 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 decline in blood pressure is the result of peripheral vasodilatation and is an expected a. change. b. Because of increased cardiac output, the blood pressure should be higher at this time. This change in blood pressure is not an expected finding because it means a decrease in c. cardiac output. This decline in blood pressure means a decrease in circulating blood volume, which is d. dangerous for the fetus. ANS: A Despite the increased cardiac output, arterial blood pressure decreases in pregnancy because of peripheral vasodilatation. The blood pressure drops to its lowest point during the second trimester and then rises after that. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 467 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 ANS: B With aging, an increase in systolic blood pressure occurs. No significant change in diastolic pressure and no change in the resting heart rate occur with aging. Cardiac output at rest is does not changed with aging. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 469 MSC: Client Needs: Health Promotion and Maintenance [Show More]

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