C HAPTER 9: T HE C ARDIOVASCULAR S YSTEM
MULTIPLE CHOICE
1. 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 find ing would indicate:
a. Valvular disorder.
b. Blood flow turbulence.
c. Fluid volume overload.
d. Ventricular hypertrophy.
ANS: B
A bruit is a blowing, swishing sound indicating blood flow turbulence;
normall y, none is present.
DIF: Cognitive Level: Anal yzing (A nal ysis) REF: p. 476
MSC: Client Needs: Safe and Effective Care Environment:
Management of Care
2. 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 mo st likel y suggests a(n):
a. Normal heart.
b. Systolic murmur.
c. Enlargement of the left ventricle.
d. Enlargement of the right ventricle.
, ANS: D
Normall y, the examiner may or may not see an apical impulse; when
visible, it occupies the fourth or fifth intercost al space at or inside the
midclavicular line. 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 bord er; a left ventricular heave is seen at the apex.
DIF: Cognitive Level: Appl ying (Application) REF: p. 479 MSC:
Client Needs: Safe and Effective Care Environment: Management of
Care
3. During an assessment of a healthy adult, where would the nurse expect t o
palpate the apical impulse?
a. Third left 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
ANS: D
The apical impulse should occupy onl y one intercostal space, the fourth
or fifth, and it should be at or medial to the midclavicular line.
DIF: Cognitive Level: Remembering (Knowledge) REF: p.
479 MSC: Client Needs: Safe and Effective Care Envi ronment:
Management of Care
, 4. 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. Onl y expert health care providers should attempt percussion of the
heart.
ANS: C
Numerous comparison studies have shown that the percussed cardia c
border correlates only moderatel y with the true cardiac border.
Percussion is of limited usefulness with the female breast tissue, in a
person who is obese, or in a person with a muscular chest wall. Chest
x-ray images or echocardiographic examinations a re significantl y more
accurate in detecting heart enlargement.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 480
MSC: Client Needs: Safe and Effective Care Environment:
Management of Care
5. The nurse is preparing to auscultate for heart soun ds. Which technique is
correct?
a. Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral
areas
b. Listening by inching the stethoscope in a rough Z pattern, from the
base of the heart across and down, then over to the apex
MULTIPLE CHOICE
1. 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 find ing would indicate:
a. Valvular disorder.
b. Blood flow turbulence.
c. Fluid volume overload.
d. Ventricular hypertrophy.
ANS: B
A bruit is a blowing, swishing sound indicating blood flow turbulence;
normall y, none is present.
DIF: Cognitive Level: Anal yzing (A nal ysis) REF: p. 476
MSC: Client Needs: Safe and Effective Care Environment:
Management of Care
2. 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 mo st likel y suggests a(n):
a. Normal heart.
b. Systolic murmur.
c. Enlargement of the left ventricle.
d. Enlargement of the right ventricle.
, ANS: D
Normall y, the examiner may or may not see an apical impulse; when
visible, it occupies the fourth or fifth intercost al space at or inside the
midclavicular line. 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 bord er; a left ventricular heave is seen at the apex.
DIF: Cognitive Level: Appl ying (Application) REF: p. 479 MSC:
Client Needs: Safe and Effective Care Environment: Management of
Care
3. During an assessment of a healthy adult, where would the nurse expect t o
palpate the apical impulse?
a. Third left 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
ANS: D
The apical impulse should occupy onl y one intercostal space, the fourth
or fifth, and it should be at or medial to the midclavicular line.
DIF: Cognitive Level: Remembering (Knowledge) REF: p.
479 MSC: Client Needs: Safe and Effective Care Envi ronment:
Management of Care
, 4. 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. Onl y expert health care providers should attempt percussion of the
heart.
ANS: C
Numerous comparison studies have shown that the percussed cardia c
border correlates only moderatel y with the true cardiac border.
Percussion is of limited usefulness with the female breast tissue, in a
person who is obese, or in a person with a muscular chest wall. Chest
x-ray images or echocardiographic examinations a re significantl y more
accurate in detecting heart enlargement.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 480
MSC: Client Needs: Safe and Effective Care Environment:
Management of Care
5. The nurse is preparing to auscultate for heart soun ds. Which technique is
correct?
a. Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral
areas
b. Listening by inching the stethoscope in a rough Z pattern, from the
base of the heart across and down, then over to the apex
