NR 509 Exam Test Questions and Answers
ANS: A
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.
The sac that surrounds and protects the heart is called the:
a.Pericardium.
b.Myocardium.
c.Endocardium.
d.Pleural space.
ANS: B
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 through the pulmonary vein. The blood goes from there to the left ventricle and then
out to the body through the aorta.
2. The direction of blood flow through the heart is best described by which of these?
a.Vena cava right atrium right ventricle lungs pulmonary artery left atrium left ventricle
b.Right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle
c.Aorta right atrium right ventricle lungs pulmonary vein left atrium left ventricle vena cava
d.Right atrium right ventricle pulmonary vein lungs pulmonary artery left atrium left ventricle
ANS: D
Toward the end of diastole, the atria contract and push the last amount of blood (approximately 25% of
stroke volume) into the ventricles. This active filling phase is called presystole, or atrial systole, or
sometimes the atrial kick.
3. The nurse is reviewing the anatomy and physiologic functioning of the heart. Which statement best
describes what is meant by atrial kick?
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.
ANS: C
,The second heart sound (S2) occurs with the closure of the semilunar (aortic and pulmonic) valves and
signals the end of systole. Although it is heard over all the precordium, the S2 is loudest at the base of
the heart.
4. When listening to heart sounds, the nurse knows the valve closures that can be heard best at the base
of the heart are:
a.
Mitral and tricuspid.
b.
Tricuspid and aortic.
c.
Aortic and pulmonic.
d.
Mitral and pulmonic.
ANS: C
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
they can be heard separately. In the first heart sound, the mitral component (M1) closes just before the
tricuspid component (T1).
5. Which of these statements describes the closure of the valves in a normal cardiac cycle?
a.
The aortic valve closes slightly before the tricuspid valve.
b.
The pulmonic valve closes slightly before the aortic valve.
c.
The tricuspid valve closes slightly later than the mitral valve.
d.
Both the tricuspid and pulmonic valves close at the same time.
ANS: B
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 called the pacemaker of the heart.
6. The component of the conduction system referred to as the pacemaker of the heart is the:
a.
Atrioventricular (AV) node.
b.
Sinoatrial (SA) node.
c.
Bundle of His.
d.
Bundle branches.
ANS: D
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, allowing the atria the 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.
7. The electrical stimulus of the cardiac cycle follows which sequence?
a.
AV node SA node bundle of His
b.
Bundle of His AV node SA node
c.
SA node AV node bundle of His bundle branches
d.
AV node SA node bundle of His bundle branches
ANS: D
Because no cardiac valve exists to separate the superior vena cava from the right atrium, the jugular
veins give information about the 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 heart failure.
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:
a.
Decreased fluid volume.
b.
Increased cardiac output.
c.
Narrowing of jugular veins.
d.
Elevated pressure related to heart failure.
ANS: C
First, approximately 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 after birth because the pressure in the right side of the heart is now
lower than in the left side.
9. When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to
be true?
a.
The left ventricle is larger and weighs more than the right ventricle.
b.
The circulation of a newborn is identical to that of an adult.
c.
Blood can flow into the left side of the heart through an opening in the atrial septum.
d.
The foramen ovale closes just minutes before birth, and the ductus arteriosus closes immediately after.
, ANS: A
Despite the increased cardiac output, arterial blood pressure decreases in pregnancy because of
peripheral vasodilatation. The blood pressure drops to its lowest point during the second trimester and
then rises after that.
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 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?
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.
ANS: B
With aging, an increase in systolic blood pressure occurs. No significant change in diastolic pressure and
no change in the resting heart rate occur with aging. Cardiac output at rest is does not changed with
aging.
11. 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 expected hemodynamic changes related to age?
a.
Increase in resting heart rate
b.
Increase in systolic blood pressure
c.
Decrease in diastolic blood pressure
d.
Increase in diastolic blood pressure
ANS: C
Paroxysmal nocturnal dyspnea (shortness of breath generally occurring at night) occurs with heart
failure. Lying down increases the volume of intrathoracic blood, and the weakened heart cannot
accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and
flings open a window with the perception of needing fresh air.
12. 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." The nurse's best response to this would be:
a.
"When was your last electrocardiogram?"
b.
"It's probably because it's been so hot at night."
ANS: A
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.
The sac that surrounds and protects the heart is called the:
a.Pericardium.
b.Myocardium.
c.Endocardium.
d.Pleural space.
ANS: B
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 through the pulmonary vein. The blood goes from there to the left ventricle and then
out to the body through the aorta.
2. The direction of blood flow through the heart is best described by which of these?
a.Vena cava right atrium right ventricle lungs pulmonary artery left atrium left ventricle
b.Right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle
c.Aorta right atrium right ventricle lungs pulmonary vein left atrium left ventricle vena cava
d.Right atrium right ventricle pulmonary vein lungs pulmonary artery left atrium left ventricle
ANS: D
Toward the end of diastole, the atria contract and push the last amount of blood (approximately 25% of
stroke volume) into the ventricles. This active filling phase is called presystole, or atrial systole, or
sometimes the atrial kick.
3. The nurse is reviewing the anatomy and physiologic functioning of the heart. Which statement best
describes what is meant by atrial kick?
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.
ANS: C
,The second heart sound (S2) occurs with the closure of the semilunar (aortic and pulmonic) valves and
signals the end of systole. Although it is heard over all the precordium, the S2 is loudest at the base of
the heart.
4. When listening to heart sounds, the nurse knows the valve closures that can be heard best at the base
of the heart are:
a.
Mitral and tricuspid.
b.
Tricuspid and aortic.
c.
Aortic and pulmonic.
d.
Mitral and pulmonic.
ANS: C
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
they can be heard separately. In the first heart sound, the mitral component (M1) closes just before the
tricuspid component (T1).
5. Which of these statements describes the closure of the valves in a normal cardiac cycle?
a.
The aortic valve closes slightly before the tricuspid valve.
b.
The pulmonic valve closes slightly before the aortic valve.
c.
The tricuspid valve closes slightly later than the mitral valve.
d.
Both the tricuspid and pulmonic valves close at the same time.
ANS: B
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 called the pacemaker of the heart.
6. The component of the conduction system referred to as the pacemaker of the heart is the:
a.
Atrioventricular (AV) node.
b.
Sinoatrial (SA) node.
c.
Bundle of His.
d.
Bundle branches.
ANS: D
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, allowing the atria the 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.
7. The electrical stimulus of the cardiac cycle follows which sequence?
a.
AV node SA node bundle of His
b.
Bundle of His AV node SA node
c.
SA node AV node bundle of His bundle branches
d.
AV node SA node bundle of His bundle branches
ANS: D
Because no cardiac valve exists to separate the superior vena cava from the right atrium, the jugular
veins give information about the 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 heart failure.
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:
a.
Decreased fluid volume.
b.
Increased cardiac output.
c.
Narrowing of jugular veins.
d.
Elevated pressure related to heart failure.
ANS: C
First, approximately 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 after birth because the pressure in the right side of the heart is now
lower than in the left side.
9. When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to
be true?
a.
The left ventricle is larger and weighs more than the right ventricle.
b.
The circulation of a newborn is identical to that of an adult.
c.
Blood can flow into the left side of the heart through an opening in the atrial septum.
d.
The foramen ovale closes just minutes before birth, and the ductus arteriosus closes immediately after.
, ANS: A
Despite the increased cardiac output, arterial blood pressure decreases in pregnancy because of
peripheral vasodilatation. The blood pressure drops to its lowest point during the second trimester and
then rises after that.
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 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?
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.
ANS: B
With aging, an increase in systolic blood pressure occurs. No significant change in diastolic pressure and
no change in the resting heart rate occur with aging. Cardiac output at rest is does not changed with
aging.
11. 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 expected hemodynamic changes related to age?
a.
Increase in resting heart rate
b.
Increase in systolic blood pressure
c.
Decrease in diastolic blood pressure
d.
Increase in diastolic blood pressure
ANS: C
Paroxysmal nocturnal dyspnea (shortness of breath generally occurring at night) occurs with heart
failure. Lying down increases the volume of intrathoracic blood, and the weakened heart cannot
accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and
flings open a window with the perception of needing fresh air.
12. 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." The nurse's best response to this would be:
a.
"When was your last electrocardiogram?"
b.
"It's probably because it's been so hot at night."
