TB-Chapter 20 Heart and Neck Vessels PDF

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK

TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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Chapter20:HeartandNeckVessels MULTIPLECHOICE 1.Thesacthatsurroundsandprotectstheheartiscalledthe: a.

Pericardium.

b.

Myocardium.

c.

Endocardium.

d.

Pleuralspace.

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. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 2.Thedirectionofbloodflowthroughtheheartisbestdescribedbywhichofthese? a.

NURSINGTB.COM 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: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. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 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.

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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.

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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 theatrialkick. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 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. NURSINGTB.COM

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. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:General 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: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).

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DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:General 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: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. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 7.Theelectricalstimulusofthecardiaccyclefollowswhichsequence? a.

AVnodeSAnodebundleofHis NURSINGTB.COM

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 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. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds: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: a.

Decreasedfluidvolume.

b.

Increasedcardiacoutput.

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

c.

Narrowingofjugularveins.

d.

Elevatedpressurerelatedtoheartfailure.

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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. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 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.

NURSINGTB.COM

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. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds: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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.

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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. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 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:B NURSINGTB.COM 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.

DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 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.Illbesleepinggreat,andthenIwakeup andfeellikeIcantgetmybreath.Thenursesbestresponsetothiswouldbe: a.

Whenwasyourlastelectrocardiogram?

b.

Itsprobablybecauseitsbeensohotatnight.

c.

Doyouhaveanyhistoryofproblemswithyourheart?

d.

Haveyouhadarecentsinusinfectionorupperrespiratoryinfection?

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.

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289

DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 13.Inassessingapatientsmajorriskfactorsforheartdisease,whichwouldthenursewanttoincludewhen takingahistory? a.

Familyhistory,hypertension,stress,andage

b.

Personalitytype,highcholesterol,diabetes,andsmoking

c.

Smoking,hypertension,obesity,diabetes,andhighcholesterol

d.

Alcoholconsumption,obesity,diabetes,stress,andhighcholesterol

ANS:C Toassessformajorriskfactorsofcoronaryarterydisease,thenurseshouldcollectdataregardingelevated serumcholesterol,elevatedbloodpressure,bloodglucoselevelsabove100mg/dLorknowndiabetesmellitus, obesity,anylengthofhormonereplacementtherapyforpostmenopausalwomen,cigarettesmoking,andlow activitylevel. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential NURSINGTB.COM 14.Themotherofa3-month-oldinfantstatesthatherbabyhasnotbeengainingweight.Withfurther questioning,thenursefindsthattheinfantfallsasleepafternursingandwakesupafterashorttime,hungry again.Whatotherinformationwouldthenursewanttohave?

a.

Infantssleepingposition

b.

Siblinghistoryofeatingdisorders

c.

Amountofbackgroundnoisewheneating

d.

Presenceofdyspneaordiaphoresiswhensucking

ANS:D Toscreenforheartdiseaseinaninfant,thefocusshouldbeonfeeding.Fatigueduringfeedingshouldbe noted.Aninfantwithheartfailuretakesfewerounceseachfeeding,becomesdyspneicwithsucking,maybe diaphoretic,andthenfallsintoexhaustedsleepandawakensafterashorttimehungryagain. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 15.Inassessingthecarotidarteriesofanolderpatientwithcardiovasculardisease,thenursewould: a.

Palpatethearteryintheupperonethirdoftheneck.

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b.

Listenwiththebellofthestethoscopetoassessforbruits.

c.

Simultaneouslypalpatebotharteriestocompareamplitude.

d.

Instructthepatienttotakeslowdeepbreathsduringauscultation.

290

ANS:B Ifcardiovasculardiseaseissuspected,thenthenurseshouldauscultateeachcarotidarteryforthepresenceofa bruit.Thenurseshouldavoidcompressingtheartery,whichcouldcreateanartificialbruitandcompromise circulationifthecarotidarteryisalreadynarrowedbyatherosclerosis.Excessivepressureonthecarotidsinus areahighintheneckshouldbeavoided,andexcessivevagalstimulationcouldslowdowntheheartrate, especiallyinolderadults.Palpatingonlyonecarotidarteryatatimewillavoidcompromisingarterialbloodto thebrain. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 16.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findingwould indicate: a.

Valvulardisorder.

b.

Bloodflowturbulence.

c.

Fluidvolumeoverload.

d.

Ventricularhypertrophy.

NURSINGTB.COM

ANS:B Abruitisablowing,swishingsoundindicatingbloodflowturbulence;normally,noneispresent. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 17.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mostlikelysuggestsa(n): a.

Normalheart.

b.

Systolicmurmur.

c.

Enlargementoftheleftventricle.

d.

Enlargementoftherightventricle.

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

291

ANS:D Normally,theexaminermayormaynotseeanapicalimpulse;whenvisible,itoccupiesthefourthorfifth intercostal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border;aleftventricularheaveisseenattheapex. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 18.Duringanassessmentofahealthyadult,wherewouldthenurseexpectto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onlyoneintercostalspace,thefourthorfifth,anditshouldbeatormedial tothemidclavicularline. NURSINGTB.COM DIF:CognitiveLevel:Remembering(Knowledge)

MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 19.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.

Onlyexperthealthcareprovidersshouldattemptpercussionoftheheart.

ANS:C Numerouscomparisonstudieshaveshownthatthepercussedcardiacbordercorrelatesonlymoderately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are significantlymoreaccurateindetectingheartenlargement. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

292

20.Thenurseispreparingtoauscultateforheartsounds.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

c.

Listeningtothesoundsonlyatthesitewheretheapicalpulseisfelttobethestrongest

d.

Listeningforallpossiblesoundsatatimeateachspecifiedarea

ANS:B Auscultationofbreathsoundsshouldnotbelimitedtoonlyfourlocations.Soundsproducedbythevalvesmay beheardallovertheprecordium.ThestethoscopeshouldbeinchedinaroughZpatternfromthebaseofthe heartacrossanddown,thenovertotheapex;or,startingattheapex,itshouldbeslowlyworkedup.Listening selectivelytoonesoundatatimeisbest. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 21.Whilecountingtheapicalpulseona16-year-oldpatient,thenursenoticesanirregularrhythm.Hisrate speedsuponinspirationandslowsonexpiration.Whatwouldbethenursesresponse? a.

NURSINGTB.COM Talkwiththepatientabouthisintakeofcaffeine.

b.

Performanelectrocardiogramaftertheexamination.

c.

Nofurtherresponseisneededbecausesinusarrhythmiacanoccurnormally.

d.

Referthepatienttoacardiologistforfurthertest...