/ NR 509 Jarvis: Physical Examination and Health Assessment, 5th edition Chapter 19: Heart and Neck Vessels - $15.49   Add to cart

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/ NR 509 Jarvis: Physical Examination and Health Assessment, 5th edition Chapter 19: Heart and Neck Vessels

Jarvis: Physical Examination and Health Assessment, 5th edition Chapter 19: Heart and Neck Vessels Text Bank MULTIPLE CHOICE 1. The sac that surrounds and protects the heart is called the: 1. pericardium. 2. myocardium. 3. endocardium. 4. pleural space. ANS: 1 The pericardium is a tough fibrous double-walled sac that surrounds and protects the heart. It has two layers that contain a few milliliters of serous pericardial fluid. DIF: Knowledge REF: Page: 484 MSC: NCLEX: General 2. The direction of blood flow through the heart is best described by which of the following? 1. Vena cava—right atrium—right ventricle—lungs—pulmonary artery—left atrium—left ventricle 2. Right atrium—right ventricle—pulmonary artery—lungs—pulmonary vein—left atrium—left ventricle 3. Aorta—right atrium—right ventricle—lungs—pulmonary vein—left atrium—left ventricle—vena cava 4. Right atrium—right ventricle—pulmonary vein—lungs—pulmonary artery—left atrium—left ventricle ANS: 2 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 by the pulmonary vein. It goes from there to the left ventricle and then out to the body through the aorta. DIF: Knowledge REF: Page: 485 MSC: NCLEX: General 3. Which of the following best describes what is meant by atrial kick? 1. The atria contract during systole and attempt to push against closed valves. 2. The contraction of the atria at the beginning of diastole can be felt as a palpitation. 3. This is the pressure exerted against the atria as the ventricles contract during systole. 4. The atria contract toward the end of diastole and push the remaining blood into the ventricles. ANS: 4 Toward the end of diastole, the atria contract and push the last amount of blood (about 25% of stroke volume) into the ventricles. This active filling phase is called presystole, or atrial systole, or sometimes the “atrial kick.” DIF: Knowledge REF: Page: 487 MSC: NCLEX: General 4. When listening to heart sounds, the nurse knows that the valve closures that can be heard best at the base of the heart are: 1. mitral, tricuspid. 2. tricuspid, aortic. 3. aortic, pulmonic. 4. mitral, pulmonic. ANS: 3 The second heart sound (S2) occurs with closure of the semilunar valves and signals the end of systole. Although it is heard over all the precordium, S2 is loudest at the base. DIF: Comprehension REF: Page: 487 MSC: NCLEX: General 5. Which of the following describes the closure of the valves in a normal cardiac cycle? 1. The aortic valve closes slightly before the tricuspid valve. 2. The pulmonic valve closes slightly before the aortic valve. 3. The tricuspid valve closes slightly later than the mitral valve. 4. Both the tricuspid and pulmonic valves close at the same time. ANS: 3 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 you can hear them separately. In the first heart sound, the mitral component (M1) closes just before the tricuspid component (T1). DIF: Comprehension REF: Page: 487 MSC: NCLEX: General 6. The component of the conduction system referred to as the pacemaker of the heart is the: 1. atrioventricular (AV) node. 2. sinoatrial (SA) node. 3. bundle of His. 4. bundle branches. ANS: 2 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 the “pacemaker.”) DIF: Knowledge REF: Page: 488 MSC: NCLEX: General 7. The electrical stimulus of the cardiac cycle follows which sequence? 1. AV node—SA node—bundle of His 2. Bundle of His—AV node—SA node 3. SA node—AV node—bundle of His—bundle branches 4. AV node—SA node—bundle of His—bundle branches ANS: 3 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 so that the atria have 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: Comprehension REF: Page: 488 MSC: NCLEX: 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: 1. decreased fluid volume. 2. increased cardiac output. 3. narrowing of jugular veins. 4. increased pressure in the right side of his heart. ANS: 4 Because no cardiac valve exists to separate the superior vena cava from the right atrium, the jugular veins give information about 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 right-sided heart failure. DIF: Analysis REF: Page: 500 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. When assessing a newborn infant who is just 5 minutes old, the nurse knows that which of the following would be true? 1. The left ventricle is larger and weighs more than the right. 2. The circulation of a newborn is identical to that of an adult. 3. There is an opening in the atrial septum where blood can flow into the left side of the heart. 4. The foramen ovale closes just minutes before birth and the ductus arteriosus closes immediately after. ANS: 3 First, about 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 because the pressure in the right side of the heart is now lower than in the left side. DIF: Application REF: Page: 491 MSC: NCLEX: 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 exam, 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? 1. This is the result of peripheral vasodilatation and is an expected change. 2. Because of increased cardiac output, the blood pressure should be higher this time. 3. This is not an expected finding because it would mean a decreased cardiac output. 4. This would mean a decrease in circulating blood volume, which is dangerous for the fetus.

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