ECG WORKOUT
EXERCISES IN ARRHYTHMIA
INTERPRETATION
8TH EDITION
• AUTHOR(S)JANE HUFF
TEST BANK
1
Reference
Ch. 1 — Anatomy and Physiology of the Heart — Description
and Location of the Heart
Question Stem
A nurse palpates the point of maximal impulse (PMI) during a
cardiovascular assessment and finds it at the left 5th intercostal
space at the mid-clavicular line. Which statement best explains
,the significance of that PMI location? Analyze cardiac anatomy
and surface landmarks to support your answer.
Options
A. The PMI at this location indicates left ventricular apex is
displaced laterally, suggesting pericardial effusion.
B. This PMI location corresponds to the normal anatomic
position of the left ventricle apex in adults.
C. The PMI at the left 5th intercostal space, MCL, indicates the
heart is rotated posteriorly into the mediastinum.
D. The PMI at this site implies enlargement of the right
ventricle.
Correct Answer
B
Rationales
• Correct (B): The left ventricular apex normally lies near the
5th intercostal space at the mid-clavicular line; palpating
the PMI here reflects normal anatomic position. It matches
surface anatomy for a normally sized heart.
• Incorrect (A): Pericardial effusion tends to produce more
diffuse, muffled impulses rather than a discrete PMI
displaced laterally.
• Incorrect (C): Posterior rotation would not localize a
discrete PMI at the left 5th intercostal MCL; that statement
misinterprets rotation effects.
, • Incorrect (D): Right ventricular enlargement usually shifts
impulse more medially or inferiorly and is not localized to
the left 5th intercostal MCL as a sign of right ventricular
hypertrophy.
Teaching Point
PMI at 5th ICS MCL = typical left ventricular apex location.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
2
Reference
Ch. 1 — Anatomy and Physiology of the Heart — Description
and Location of the Heart
Question Stem
During bedside teaching, a student asks why the heart sits
obliquely in the thorax with right border more anterior than left
border. Which anatomical explanation best accounts for this
orientation?
Options
A. The left lung is larger so it pushes the heart to the right,
rotating it.
B. The asymmetry is due to sternum curvature forcing the heart
posteriorly and medially.
C. The heart’s oblique position arises because the left ventricle
, forms the posterior surface of the heart.
D. The apex points leftward and anteriorly because the left
ventricle is larger and more muscular than the right.
Correct Answer
D
Rationales
• Correct (D): The left ventricle is thicker and produces the
apex beat that projects leftward and anteriorly, producing
the heart’s oblique orientation with the right border more
anterior.
• Incorrect (A): The left lung is not larger in a way that
pushes the heart to the right; lung asymmetry does not
explain cardiac leftward apex.
• Incorrect (B): Sternum curvature does not primarily
determine the oblique left-pointing apex; ventricular mass
distribution does.
• Incorrect (C): The left ventricle does not form the posterior
surface — the left atrium and parts of the ventricles
contribute posteriorly; the statement is inaccurate.
Teaching Point
Left ventricle mass creates apex that points left and anterior.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
EXERCISES IN ARRHYTHMIA
INTERPRETATION
8TH EDITION
• AUTHOR(S)JANE HUFF
TEST BANK
1
Reference
Ch. 1 — Anatomy and Physiology of the Heart — Description
and Location of the Heart
Question Stem
A nurse palpates the point of maximal impulse (PMI) during a
cardiovascular assessment and finds it at the left 5th intercostal
space at the mid-clavicular line. Which statement best explains
,the significance of that PMI location? Analyze cardiac anatomy
and surface landmarks to support your answer.
Options
A. The PMI at this location indicates left ventricular apex is
displaced laterally, suggesting pericardial effusion.
B. This PMI location corresponds to the normal anatomic
position of the left ventricle apex in adults.
C. The PMI at the left 5th intercostal space, MCL, indicates the
heart is rotated posteriorly into the mediastinum.
D. The PMI at this site implies enlargement of the right
ventricle.
Correct Answer
B
Rationales
• Correct (B): The left ventricular apex normally lies near the
5th intercostal space at the mid-clavicular line; palpating
the PMI here reflects normal anatomic position. It matches
surface anatomy for a normally sized heart.
• Incorrect (A): Pericardial effusion tends to produce more
diffuse, muffled impulses rather than a discrete PMI
displaced laterally.
• Incorrect (C): Posterior rotation would not localize a
discrete PMI at the left 5th intercostal MCL; that statement
misinterprets rotation effects.
, • Incorrect (D): Right ventricular enlargement usually shifts
impulse more medially or inferiorly and is not localized to
the left 5th intercostal MCL as a sign of right ventricular
hypertrophy.
Teaching Point
PMI at 5th ICS MCL = typical left ventricular apex location.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
2
Reference
Ch. 1 — Anatomy and Physiology of the Heart — Description
and Location of the Heart
Question Stem
During bedside teaching, a student asks why the heart sits
obliquely in the thorax with right border more anterior than left
border. Which anatomical explanation best accounts for this
orientation?
Options
A. The left lung is larger so it pushes the heart to the right,
rotating it.
B. The asymmetry is due to sternum curvature forcing the heart
posteriorly and medially.
C. The heart’s oblique position arises because the left ventricle
, forms the posterior surface of the heart.
D. The apex points leftward and anteriorly because the left
ventricle is larger and more muscular than the right.
Correct Answer
D
Rationales
• Correct (D): The left ventricle is thicker and produces the
apex beat that projects leftward and anteriorly, producing
the heart’s oblique orientation with the right border more
anterior.
• Incorrect (A): The left lung is not larger in a way that
pushes the heart to the right; lung asymmetry does not
explain cardiac leftward apex.
• Incorrect (B): Sternum curvature does not primarily
determine the oblique left-pointing apex; ventricular mass
distribution does.
• Incorrect (C): The left ventricle does not form the posterior
surface — the left atrium and parts of the ventricles
contribute posteriorly; the statement is inaccurate.
Teaching Point
Left ventricle mass creates apex that points left and anterior.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
