Question 1

In assessing a 70-year-old man, the nurse finds the following: blood pressure 140/100 mm Hg; heart rate 104 beats per minute and slightly irregular; and the split S2 heart sound. Which of these findings can be explained by the expected hemodynamic changes r/t age?

Accepted Answer

A)  Increase in resting heart rate 
B)  Increase in systolic blood pressure 
C)  Decrease in diastolic blood pressure 
D)  Increase in diastolic blood pressure

Question 2

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 should the nurse do?

Accepted Answer

A)  Document this as a normal finding. 
B)  Talk with the patient about his intake of caffeine. 
C)  Perform an electrocardiogram after the examination. 
D)  Refer the patient to a cardiologist for further testing.

Question 3

When listening to heart sounds, which valve closures are heard best at the base of the heart?

Accepted Answer

A)  Aortic and pulmonic 
B)  Mitral and pulmonic 
C)  Mitral and tricuspid 
D)  Tricuspid and aortic

Question 4

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. What does this finding indicate?

Accepted Answer

A)  Valvular disorder 
B)  Blood flow turbulence 
C)  Fluid volume overload 
D)  Ventricular hypertrophy

Question 5

The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her myocardial infarction (MI). Heart sounds are normal when she is supine, but when she is sitting and leaning forward, the nurse hears a high-pitched, scratchy sound with the diaphragm of the stethoscope at the apex. It disappears on inspiration. What does the nurse suspect?

Accepted Answer

A)  Another MI 
B)  Increased cardiac output 
C)  Inflammation of the precordium 
D)  Ventricular hypertrophy resulting from muscle damage

Question 6

The nurse is preparing to auscultate for heart sounds. Which technique is correct?

Accepted Answer

A)  Listening for all possible sounds at a time at each specified area. 
B)  Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral areas. 
C)  Listening to the sounds only at the site where the apical pulse is felt to be the strongest. 
D)  Listening by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex.

Question 7

When the nurse is auscultating the carotid artery for bruits, which of these statements reflects the correct technique?

Accepted Answer

A)  While listening with the bell of the stethoscope, the patient is asked to take a deep breath and hold it. 
B)  While auscultating one side with the bell of the stethoscope, the carotid artery is palpated on the other side to check pulsations. 
C)  While lightly applying the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it. 
D)  While firmly placing the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.

Question 8

Which of these findings would the nurse expect to notice during a cardiac assessment on a 4-year-old child?

Accepted Answer

A)  S3 when sitting up 
B)  Persistent tachycardia above 150 beats per minute 
C)  Murmur at the second left intercostal space when supine 
D)  Palpable apical impulse in the fifth left intercostal space lateral to midclavicular line

Question 9

The nurse is reviewing the anatomy and physiologic functioning of the heart. Which statement best describes what is meant by atrial kick?

Accepted Answer

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.

Question 10

A 45-year-old man is in the clinic for a routine physical examination. During the recording of his health history, the patient states that he has been having difficulty sleeping. "I'll be sleeping great, and then I wake up and feel like I can't get my breath." Which is the best response by the nurse?

Accepted Answer

A)  "When was your last electrocardiogram?" 
B)  "It's probably because it's been so hot at night." 
C)  "Do you have any history of problems with your heart?" 
D)  "Have you had a recent sinus infection or upper respiratory infection?"

Question 11

While auscultating heart sounds on a 7-year-old child for a routine physical examination, the nurse hears an S3, a soft murmur at the left midsternal border, and a venous hum when the child is standing. What would be a correct interpretation of these findings?

Accepted Answer

A)  These findings can all be normal in a child. 
B)  An S3 is indicative of heart disease in children. 
C)  The venous hum most likely indicates an aneurysm. 
D)  These findings are indicative of congenital problems.

Question 12

The nurse is preparing to teach a class on cardiovascular assessment. When explaining a thrill, what should the nurse include in the teaching?

Accepted Answer

A)  A vibration that is palpable 
B)  Palpated in the right epigastric area 
C)  Associated with ventricular hypertrophy 
D)  A murmur auscultated at the third intercostal space

Question 13

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?

Accepted Answer

A)  This decline in blood pressure is the result of peripheral vasodilatation 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.

Question 14

The nurse is assessing the apical pulse of a 3-month-old infant and finds that the heart rate is 135 beats per minute. How should the nurse interpret this finding?

Accepted Answer

A)  Normal for this age 
B)  Lower than expected 
C)  Higher than expected, probably as a result of crying 
D)  Higher than expected, reflecting persistent tachycardia

Question 15

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. What does this finding indicate?

Accepted Answer

A)  Decreased fluid volume 
B)  Increased cardiac output 
C)  Narrowing of jugular veins 
D)  Elevated pressure r/t heart failure

Question 16

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 want to have?

Accepted Answer

A)  Infant's sleeping position 
B)  Sibling history of eating disorders 
C)  Amount of background noise when eating 
D)  Presence of dyspnea or diaphoresis when sucking

Question 17

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

Accepted Answer

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

Question 18

During the precordial assessment of a patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. What does this finding indicate?

Accepted Answer

A)  Right ventricular hypertrophy 
B)  Increased blood flow through the internal mammary artery 
C)  Displacement of the heart from elevation of the diaphragm 
D)  Increased volume and size of the heart as a result of pregnancy

Question 19

During an assessment, the nurse notes that the patient's apical impulse is laterally displaced and is palpable over a wide area. What does this finding indicate?

Accepted Answer

A)  Systemic hypertension 
B)  Pulmonic hypertension 
C)  Pressure overload, as in aortic stenosis 
D)  Volume overload, as in heart failure

Exam 20: Heart and Neck Vessels

In assessing a 70-year-old man, the nurse finds the following: blood pressure 140/100 mm Hg; heart rate 104 beats per minute and slightly irregular; and the split S₂ heart sound. Which of these findings can be explained by the expected hemodynamic changes r/t age?