NURS 487 Midterm Exam 1 UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
Inspect, palpate, auscultate, percuss, smell - CORRECT ANSWER IPAP-S
Jugular vein distention (JVD) - CORRECT ANSWER - increased right side heart
pressure
Cardiovascular objective assessment - CORRECT ANSWER - IPAP-S
- neck vessels
- blood pressure
- pulse
- precordium (heart sounds)
Pallor - CORRECT ANSWER - grey/white appearance
Cyanosis - CORRECT ANSWER - blue
- lack of oxygen
Mottling - CORRECT ANSWER - sign of poor perfusion
Clubbing - CORRECT ANSWER - sign of chronic hypoximia
Splinter hemorrhages - CORRECT ANSWER - sign of infective endocarditis
Heave or lift - CORRECT ANSWER - sustains thrusting of ventricle during systole
- appears on the 4th or 5th IC space
Thrill - CORRECT ANSWER - palpable
- associated with murmurs and extra heart sounds
S1 - CORRECT ANSWER - loudest at apex of heart
- best heard with diaphragm
- first heart sound
- closure of tricuspid and mitral valves
- beginning of systole
S2 - CORRECT ANSWER - loudest at base of heart
- best heard with diaphragm
- second heart sound
- closure of aortic and pulmonic valves
,- beginning of diastole
Aortic valve - CORRECT ANSWER - best heart with diaphragm
- between aorta and left ventricle
Pulmonic valve - CORRECT ANSWER - best heard with diaphragm
- between pulmonary artery and right ventricle
Tricuspid valve - CORRECT ANSWER - best heard with diaphragm
- between right atrium and right ventricle
Mitral valve - CORRECT ANSWER - best heard with diaphragm
- between left atrium and left ventricle
- more likely to have a murmur as it is on the bigger side of the heart
S3 - CORRECT ANSWER - caused by ventricular filling
- associated with volume and heart failure
- occurs when ventricles are resistant to filling during rapid phase
- immediately after S2
- ventricular gallop
- "Kentucky," low intense vibrations
- most common
S4 - CORRECT ANSWER - caused by atrial contraction
- before S1
- atrial gallop
- "Tennessee," low frequency vibrations
- associated with CAD, after load, ventricular obstruction, HTN
Innocent murmur - CORRECT ANSWER - no valve problems, or a pathological cause
Functional murmur - CORRECT ANSWER - due to increased blood flow in heart
- causes: anemia, fever, pregnancy
Pregnancy induced hypertension - CORRECT ANSWER - murmur with a high BP
- increased in BP of 30/15mmhg
- systolic murmurs usually go away after delivery
Dextrocardia - CORRECT ANSWER - heart is on the right side
100-180 - CORRECT ANSWER newborn heart rate
,50-100 - CORRECT ANSWER 10 yo to adult heart rate
1+ Pitting Edema - CORRECT ANSWER - mild pitting, slight indentation, no
perceptible swelling of the leg
2+ Pitting Edema - CORRECT ANSWER - moderate pitting, indentation subsides
rapidly
3+ Pitting Edema - CORRECT ANSWER - deep pitting, indentation remains for a
short time, leg looks swollen
4+ Pitting Edema - CORRECT ANSWER - very deep pitting, indentation lasts a long
time, leg is very swollen
Cardiac Output - CORRECT ANSWER - the amount of blood pumped by each
ventricle per minute
Variable of Cardiac Output - CORRECT ANSWER - heart rate
- stroke volume (preload, after load, an contractility)
- metabolic rate and O2 demand
- females < males (females have smaller heart)
- larger body
- decreases with age
- decreased from supine to upright
CO = HR x SV - CORRECT ANSWER Cardiac Output equation
Chemoreceptors - CORRECT ANSWER - respond to heart rate, O2 levels, ph levels
- recognize levels of gases in blood: ph, paco2, pao2
Alpha Receptors - CORRECT ANSWER - in periphery
- vasocontrict when stimulated
- dilate when inhibited
Beta 1 Receptors - CORRECT ANSWER - in heart
- increase SNS and heart rate when stimulated
- decrease stimulation from SA to AV nodes when inhibited
Beta 2 Receptors - CORRECT ANSWER - in lungs
- vasodilator when stimulated
- Ventolin is an agonist
, Less than 60bpm - CORRECT ANSWER Bradycardia heart rate
Above 100bpm - CORRECT ANSWER Tachycardia heart rate
Heart Rate - CORRECT ANSWER - controlled by autonomic nervous system, neural
reflexes, atrial receptors and hormones
Centres of the Brain - CORRECT ANSWER - control heart rate
- medulla and pons areas of the brainstem
- hypothalmus
- cerebral cortex
- thalamus
Neural Reflexes - CORRECT ANSWER - control heart rate
- baroreceptors respond to BP and HR
- tissue receptors found in aortic arch and carotid sinus
Baroreceptors - CORRECT ANSWER - very receptive to stretch and stimulation
Heart Rate Hormones - CORRECT ANSWER - adrenocortical hormones
- thyroid hormones
- decrease in growth hormones
Heart Rate Neurotransmitters - CORRECT ANSWER - norepinephrine
- epinephrine
Norepinephrine - CORRECT ANSWER - increases HR
- causes vasoconstriction
Epinephrine - CORRECT ANSWER - dilates muscles and liver
- increases contractility
Stroke Volume - CORRECT ANSWER - the volume of blood ejected per beat during
systole
Preload - CORRECT ANSWER - only in the heart
- the amount of STRETCH on the myocardial fibres at the end of diastole (filling)
Factors in Preload - CORRECT ANSWER - slower HR prolongs diastole which
increases filling time
QUESTIONS AND CORRECT ANSWERS
Inspect, palpate, auscultate, percuss, smell - CORRECT ANSWER IPAP-S
Jugular vein distention (JVD) - CORRECT ANSWER - increased right side heart
pressure
Cardiovascular objective assessment - CORRECT ANSWER - IPAP-S
- neck vessels
- blood pressure
- pulse
- precordium (heart sounds)
Pallor - CORRECT ANSWER - grey/white appearance
Cyanosis - CORRECT ANSWER - blue
- lack of oxygen
Mottling - CORRECT ANSWER - sign of poor perfusion
Clubbing - CORRECT ANSWER - sign of chronic hypoximia
Splinter hemorrhages - CORRECT ANSWER - sign of infective endocarditis
Heave or lift - CORRECT ANSWER - sustains thrusting of ventricle during systole
- appears on the 4th or 5th IC space
Thrill - CORRECT ANSWER - palpable
- associated with murmurs and extra heart sounds
S1 - CORRECT ANSWER - loudest at apex of heart
- best heard with diaphragm
- first heart sound
- closure of tricuspid and mitral valves
- beginning of systole
S2 - CORRECT ANSWER - loudest at base of heart
- best heard with diaphragm
- second heart sound
- closure of aortic and pulmonic valves
,- beginning of diastole
Aortic valve - CORRECT ANSWER - best heart with diaphragm
- between aorta and left ventricle
Pulmonic valve - CORRECT ANSWER - best heard with diaphragm
- between pulmonary artery and right ventricle
Tricuspid valve - CORRECT ANSWER - best heard with diaphragm
- between right atrium and right ventricle
Mitral valve - CORRECT ANSWER - best heard with diaphragm
- between left atrium and left ventricle
- more likely to have a murmur as it is on the bigger side of the heart
S3 - CORRECT ANSWER - caused by ventricular filling
- associated with volume and heart failure
- occurs when ventricles are resistant to filling during rapid phase
- immediately after S2
- ventricular gallop
- "Kentucky," low intense vibrations
- most common
S4 - CORRECT ANSWER - caused by atrial contraction
- before S1
- atrial gallop
- "Tennessee," low frequency vibrations
- associated with CAD, after load, ventricular obstruction, HTN
Innocent murmur - CORRECT ANSWER - no valve problems, or a pathological cause
Functional murmur - CORRECT ANSWER - due to increased blood flow in heart
- causes: anemia, fever, pregnancy
Pregnancy induced hypertension - CORRECT ANSWER - murmur with a high BP
- increased in BP of 30/15mmhg
- systolic murmurs usually go away after delivery
Dextrocardia - CORRECT ANSWER - heart is on the right side
100-180 - CORRECT ANSWER newborn heart rate
,50-100 - CORRECT ANSWER 10 yo to adult heart rate
1+ Pitting Edema - CORRECT ANSWER - mild pitting, slight indentation, no
perceptible swelling of the leg
2+ Pitting Edema - CORRECT ANSWER - moderate pitting, indentation subsides
rapidly
3+ Pitting Edema - CORRECT ANSWER - deep pitting, indentation remains for a
short time, leg looks swollen
4+ Pitting Edema - CORRECT ANSWER - very deep pitting, indentation lasts a long
time, leg is very swollen
Cardiac Output - CORRECT ANSWER - the amount of blood pumped by each
ventricle per minute
Variable of Cardiac Output - CORRECT ANSWER - heart rate
- stroke volume (preload, after load, an contractility)
- metabolic rate and O2 demand
- females < males (females have smaller heart)
- larger body
- decreases with age
- decreased from supine to upright
CO = HR x SV - CORRECT ANSWER Cardiac Output equation
Chemoreceptors - CORRECT ANSWER - respond to heart rate, O2 levels, ph levels
- recognize levels of gases in blood: ph, paco2, pao2
Alpha Receptors - CORRECT ANSWER - in periphery
- vasocontrict when stimulated
- dilate when inhibited
Beta 1 Receptors - CORRECT ANSWER - in heart
- increase SNS and heart rate when stimulated
- decrease stimulation from SA to AV nodes when inhibited
Beta 2 Receptors - CORRECT ANSWER - in lungs
- vasodilator when stimulated
- Ventolin is an agonist
, Less than 60bpm - CORRECT ANSWER Bradycardia heart rate
Above 100bpm - CORRECT ANSWER Tachycardia heart rate
Heart Rate - CORRECT ANSWER - controlled by autonomic nervous system, neural
reflexes, atrial receptors and hormones
Centres of the Brain - CORRECT ANSWER - control heart rate
- medulla and pons areas of the brainstem
- hypothalmus
- cerebral cortex
- thalamus
Neural Reflexes - CORRECT ANSWER - control heart rate
- baroreceptors respond to BP and HR
- tissue receptors found in aortic arch and carotid sinus
Baroreceptors - CORRECT ANSWER - very receptive to stretch and stimulation
Heart Rate Hormones - CORRECT ANSWER - adrenocortical hormones
- thyroid hormones
- decrease in growth hormones
Heart Rate Neurotransmitters - CORRECT ANSWER - norepinephrine
- epinephrine
Norepinephrine - CORRECT ANSWER - increases HR
- causes vasoconstriction
Epinephrine - CORRECT ANSWER - dilates muscles and liver
- increases contractility
Stroke Volume - CORRECT ANSWER - the volume of blood ejected per beat during
systole
Preload - CORRECT ANSWER - only in the heart
- the amount of STRETCH on the myocardial fibres at the end of diastole (filling)
Factors in Preload - CORRECT ANSWER - slower HR prolongs diastole which
increases filling time
