Chapter 19

Front 1

The nurse is caring for a patient who reports lower-extremity cramping during exercise. The nurse records the blood pressure in the upper extremities at 20 mm Hg greater than that of the lower extremities. The nurse also notices diminished femoral pulses in the patient. Which complication should the nurse expect to find in the patient?

Back 1

Coarctation of the aorta

Front 2

While auscultating an infant’s heart sounds, the nurse notices that the infant has a fixed split S2, P2 louder than A2, and a medium-pitched systolic murmur, which is clearly heard in the second left interspace. What is the most likely reason for this condition in the infant?

Back 2

Abnormal opening in the atrial septum

Front 3

Which heart rate would be found in an infant with bradycardia?

Back 3

50 beats/minute

Front 4

After reviewing the medical record for a pregnant patient, the nurse determines that the patient has normal fetal development. Which finding supports this conclusion? Select all that apply.

Back 4

Apical impulse sits higher

Increase in loudness of S1

A slight left axis deviation

Front 5

Which component of the jugular venous pulse corresponds to the opening of the tricuspid valve?

Back 5

Y descent

Front 6

The nurse is caring for a child who often has cyanotic episodes while crying. The nurse notices that the child uses the squatting posture during exertion. While assessing the child, the nurse finds that the sound A2 is louder than P2. Which complication would the nurse expect in the child?

Back 6

Tetralogy of Fallot

Front 7

After assessing the pulse rate of a child, the nurse declares the presence of sinus arrhythmia. Which statement, if made by the nurse, best describes sinus arrhythmia?

Back 7

"Sinus arrhythmia indicates a pulse rate that varies with respiration."

Front 8

Which sign would be present in a patient with atherosclerosis?

Back 8

Presence of bruit sound

Front 9

What can cause a wide split in the second heart sound?

Back 9

Right bundle branch block

Front 10

The nurse instructs a student nurse to palpate the carotid artery of a patient. Which action made by the student nurse needs correction?

Back 10

Palpating both carotid arteries at once

Front 11

Which statement best describes the semilunar valves?

Back 11

Semilunar valves lie between the ventricles and the great vessels.

Front 12

The nurse is caring for an infant who has frequent respiratory infections. While assessing the infant, the nurse hears a loud and harsh holosystolic murmur at the left lower sternal border. What should the nurse infer from these findings?

Back 12

The infant has a ventricular septal defect.

Front 13

While assessing a patient, the nurse finds that the liver and the jugular vein have become enlarged. The nurse could best hear the soft and pansystolic heart murmur at the lower right and left sternal borders. Which disorder does the nurse suspect?

Back 13

Tricuspid regurgitation

Front 14

While assessing a patient, the nurse finds elevated jugular venous pressure, ventricular gallop, and a pulse deficit. The diagnostic results of the patient indicate that the diameter of heart is 5 cm. Which complication does the nurse suspect in the patient?

Back 14

Heart Failure

Front 15

The nurse is taking care of a patient with visible apical impulse in the sixth left intercostal space lateral to the midclavicular line. On palpation, the nurse finds that the impulse is approximately 4 cm in diameter and is more forceful than usual. Which disorder does the nurse suspect?

Back 15

Left ventricular hypertrophy

Front 16

Which statement describes a thrill?

Back 16

A thrill is a palpation of the chest.

Front 17

Which conditions may cause a pathologic S3, or a ventricular gallop? Select all that apply.

Back 17

Anemia

Pregnancy

Hyperthyroidism

Front 18

What is the thin layer of endothelial tissue that lines the inner surface of the heart and the valves called?

Back 18

Endocardium

Front 19

While assessing a patient with cyanosis, the nurse hears a loud murmur that lasts throughout systole. A thrill is also palpable. Which classification best describes the murmur?

Back 19

Grade 4 holosystolic

Front 20

The nurse is planning the cardiac assessment of a patient. Which patient positions are necessary during this assessment? Select all that apply.

Back 20

Sitting

Supine

Left lateral recumbent

Front 21

A patient presents with complaints of chest pain. The nurse identifies a heart murmur in the patient. Which pathologic conditions can cause heart murmurs? Select all that apply.

Back 21

Septal defect

Regurgitant valve

Increased blood flow

Front 22

Which blood vessel drains the blood from the head and upper extremities?

Back 22

Superior vena cava

Front 23

Which condition would cause a patient to have a diminished first heart sound of S1 due to more forceful atrial contractions?

Back 23

Severe hypertension

Front 24

How would the nurse describe an innocent murmur?

Back 24

Grade 2, midsystolic, musical

Front 25

While assessing a patient who has fever, cough, and myalgia, the nurse confirms that the patient has pneumonia. Which other symptom would the nurse expect to find in the patient?

Back 25

Stabbing pain located in the chest with a cough on one side

Front 26

Which patients are at highest risk for developing cardiac disease? Select all that apply.

Back 26

The patient with diabetes mellitus

The patient with vitamin D deficiency3

The patient with increased body weight

Front 27

While assessing the cardiac health of a middle-aged patient, which finding would the nurse consider abnormal?

Back 27

Presence of a third heart sound

Front 28

Which murmurs are caused by an obstruction of the flow of blood into the ventricles?

Back 28

Diastolic rumbles

Front 29

What is the characteristic of the first heart sound in the patient who has a complete heart block?

Back 29

Varied intensity

Front 30

What is the pericardium?

Back 30

The pericardium is the tough, fibrous sac surrounding the heart.

Front 31

Which term can be used to describe the pacemaker of the heart?

Back 31

Sinoatrial node

Front 32

What are chordae tendineae?

Back 32

These are collagenous fibers that anchor the leaflets of the atrioventricular valves.

Front 33

When would the nurse perform the abdominojugular test?

Back 33

When the nurse suspects heart failure

Front 34

The nurse is going through the electrocardiogram (ECG) report of a patient complaining of chest pain. Which section of the electrocardiograph indicates atrial depolarization?

Back 34

P wave

Front 35

A patient with an enlarged left atrium reports fatigue and orthopnea. While examining the patient, the nurse hears a low-pitched diastolic rumble when the patient is in the left lateral position. The nurse observes a palpable thrill at the apex. Which extra sound should the nurse expect to hear upon auscultating the heart?

Back 35

Opening snap

Front 36

What should the nurse assess first in the patient while doing a regional cardiovascular assessment?

Back 36

Pulse and blood pressure

Front 37

The nurse is caring for a patient who reports pain in the right side of the abdomen and right shoulder. The patient reports that the pain is most severe after eating a fatty meal. What should the nurse infer from these findings?

Back 37

The patient has cholecystitis.

Front 38

The parent of a child worries about the humming sound heard in the child’s chest. After assessing the child, the nurse informs the parents that the child is healthy. Which finding does the nurse observe in the child to support this conclusion?

Back 38

A continuous, low-pitched, soft sound at the medial third of the clavicle

Front 39

The patient reports having a sudden stabbing pain below the sternum, in the upper back, and in the neck. During the assessment, the nurse also finds that the patient has a fever, joint pains, and a dry cough. What condition is most consistent with these findings?

Back 39

Pericarditis

Front 40

What method should the nurse use to detect a pericardial friction rub?

Back 40

Auscultate with the diaphragm of a stethoscope

Front 41

Which clinical findings does the nurse observe in the patient with mitral regurgitation? Select all that apply.

Back 41

S1 is diminished.

S2 is accentuated.

Apical impulse is heard lower.

Front 42

What is the characteristic feature of the third heart sound, S3?

Back 42

The sound occurs at the left lower sternal border.

Front 43

The nurse is caring for a patient who has pain in the substernal region. The patients states, "I feel like some object is blocking my throat." After doing an assessment, the nurse finds that the pain may be caused by gastrointestinal complications. What condition may be causing the patient’s symptoms?

Back 43

The patient may have esophageal spasms.

Front 44

While assessing a patient with pulmonic stenosis, the nurse hears medium pitched murmurs in the left second intercostal space. Which finding does the nurse observe in the patient?

Back 44

Pathologic S4

Front 45

The nurse determines that a patient has an increased risk for having a myocardial infarction. Which medication would be beneficial for the patient?

Back 45

Aspirin (Ecotrin)

Front 46

A patient reports pain and discomfort in the chest. After assessing the patient, the nurse determines that the pain is of pulmonary origin. Which characteristics in the patient enabled the nurse to make this conclusion?

Back 46

Sharp stabbing pain that worsens with deep breathing and a cough with hemoptysis

Front 47

Which extra sounds may occur in early diastole? Select all that apply.

Back 47

Opening snap

Mitral prosthetic valve sound

Front 48

The nurse is assessing the jugular pulse of a patient. Which jugular pulse component reflects ventricular contraction?

Back 48

C Wave

Front 49

Which findings should the nurse observe in a patient with left ventricular hypertrophy? Select all that apply.

Back 49

Visible apical heave

Diameter of the heart 3.5 cm

Front 50

What is indicated in a patient with pathologic S3?

Back 50

Decreased compliance of the ventricles