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NUR 614 EXAM 2024/2025 QUESTIONS AND ANSWERS GRADED A+ Where is the heart in the body? In the mediastinum, behind and left of the sternum, above the diaphragm between the lungs and the Upper portion of heart called what? Base Lower portion of heart called what? Apex What are the layers of the heart? pericardium, epicardium(outer), myocardium (heart muscle), endocardium (inner layer) What are the two atrioventricular valves? Tricuspid and mitral
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Where is the heart in the body?
In the mediastinum, behind and left of the sternum, above the diaphragm between the lungs and the
Upper portion of heart called what?
Base
Lower portion of heart called what?
Apex
What are the layers of the heart?
pericardium, epicardium(outer), myocardium (heart muscle), endocardium (inner layer)
What are the two atrioventricular valves?
Tricuspid and mitral
What are the two semilunar valves?
Pulmonic and aortic valves
What is the electrical activation cycle?
Sa node, AV node, Bundle of HIS, Left and right bundle branches, Purkinje fibers
What does P-wave stand for?
Atrial depolarization
What does PR interval?
Atrioventricular conduction
What is QRS complex
Ventricular depolarization
What is ST segment and T wave
blood volume increases, heart works harder (HR, BP ankle edema)
special considerations for geriatrics
heart size decreases as we age
LV thickens
valve calcification
decrease in pacemaker
delayed myocardium contactility
Birth through first few months or no anxiety whats the assessment order?
inspection, palpation, auscultation,
older infant- 3 years or fearful/anxious, what's the assessment order?
inspection, auscultation, palpation
3 years- adolescent or cooperative, whats the assessment order?
inspection, palpation, and auscultation
For CV assessment what are some things we inspect for?
apical impulse, nail beds, respiration and effort, skin
expected findings for percussing precordium
-no change in tone before right sternal border
-loss of resonance close to PMI at 5th ICS
-loss of resonance may outline left border of heart at 2th to 5th ICS
ventricular gallop
normally quiet, if heard can indicate increased filling pressures, best heard at apex
NORMAL in children
PATHOLOGIC in >40 years of age
atrial gallop
quiet, pathologic if hear
best heard at apex
12-14 hours after birth
Why does the interatrial foramen ovale close?
due to shifting pressures in right and left side of the heart
special consideration of aging of the ateries
arterial walls thicken and elasticity is lost, they are stiffer and less resilient
signs of venous insufficiency
changes in skin color (blue, pale), ulcers, varicosity
signs of arterial insufficiency
shiny skin on legs, skin color changes, slower growth of nails, hair loss or slower hair growth on the legs, wounds that won't heal
Cap refil in NB-7 days old and in children
<2 sec
Cap refill in adults
<3secs
Cap refil in older adults
3 secs but <5 seconds
Special consideration in pediatrics of ausculation
venous hum is often heard, nonpathological if low pitched, continuous, and louder during diastole
How to check for JVD
recline patient at 45-degree angle
observe both jugular veins
measure vertical distance between midaxillary line and highest level of JVD
What is the expected finding of JVD?
What are some characteristics of a murmur in pediatrics that indicate structural heart disease?
normally holosystolic, diastolic, grade 3+, associated with systolic click, increased intensity when standing and harsh quality
Ventricle Septal Defect
opening between L and R ventricles
arterial pulse is small and JVD not affected
Holosystolic murmur in pediatric patients
loud, coarse, high pitched
Tetralogy of Fallot
Four defects: VSD, pulmonic stenosis, dextroposition of the aorta, R ventricular hypertrophy
Systolic ejection murmur
3rd intercostal space, can radiate to L neck, S
Patent ductus arteriosus
when the heart's foramen ovale and ductus arteriosus do not close, common in < weeks
large PDA
"machine like murmur" very harsh and 1-2 intercostal space/lower sternal border
Atrial Septal Defect (ASD)
congenital defect in septum between L and R atria
Rheumatic fever
fever, inflamed swollen joints, erythema marginatum, chorea, small painless nodules under the skin, CP, palpitations, fatigue, SOB, murmurs of mitral regurg and aortic insufficiency, cardiomegaly, pericarditis friction rub, signs of CHF
Kawasaki Disease
costovertebral angle
GI assessment- on the back
What does McBurney's point indicate?
appendicitis
How long is it ok for a child's stomach to protrude?
until 5 years old
Pyloric stenosis what and where is is noted in pediatrics?
olive shaped mass, RUQ
projectile vomiting, eager feeding after, failure to gain weight, peristalsis wave (L to R), need for ultrasound and surgical consult
Intussusception
sausage shaped mass, RUQ
Hischsprung
midline, suprapubic mass
most common cause of lower intestinal obstruction in newborns
megacolon
failure to pass meconium in 24-48 hours, absence of peristalsis, constipation, distension, bilious vomiting, diarrhea
older infant/child: constipation
Constipation
soft mass is LLQ
Meconium Ileus
failure to pass meconium in the first 24 hours, can be first sign of CF, vomiting, abdominal distension, if with volvulus (can be present in shock), hyperosmolar enemas under fluoroscopic guidance,
Biliary Atresia
postnatal-usually viral
Embryonic-genetic mutation
clay colored stools, dark urine
may have failure to gain weight
Jaundice
firm, fixed, nontender, irregular, nodular, crosses midline, imaging: calcified mass with hemorrhaging
Wilms Tumor
painless mass in abdomen often found while bathing child
abd pain, vomiting, hematuria
firm nontender, deep, does not cross midline, may be bilateral, HTN may be present
spurling test
tests cervical spine, identify if nerve root is being compressed. Passively extend and rotate patients neck to affected side, apply axial pressure, pain radiating to arm on same side of test is positive, dont preform in acute trauma
extension-rotation test
used to eliminate facet joint etiology, move patient into cervical extension, then laterally flex, and rotate to same side, considered positive if maneuver increases pain or causes numbness or tingling on side of neck being tested
Straight leg raise
test identified lumbar radiculopathy, patient lies supine, lift one leg at a time to 90 degrees, test positive if pain between 30 and 70 degrees of hip flexion that radiates below the knee
Valsalva maneuver
test identifies pain coming from cervical canal, patient sitting, take deep breath and bear down, localized or radioulnar pain is postive test
Shoulder tests
Hawkins-kennedy test
Neer test
Empty can test
drop arm test
external rotation resistance test
Hawkins Kennedy test
test identify shoulder impingement, while holding elbow at 90 degrees with one hand and wrist in other flex shoulder to 90 degrees then internally rotate, pain and apprehension is positive
test identify lateral epicondylitis or tennis elbow, with elbow stabilized and hand pronated and in a fist, have patient extend their wrist against resistance, pain over lateral epicondyle is considered postive
Golder elbow test
identify medial epicondylitis, with elbow stabilized, have patient supinate their hand and close their fist. next have patient flex their wrist against resistance, pain over epicondyle is considered positive test
Varus stress test
test identify injury to radial(lateral) collateral ligament of the elbow, with wrist stabilized, apply a varus force to medial side of elbow while flexed to 20 or 30 degrees, pain or excess motion compared to contralateral side is positive
valgus stress test
test identify ulnar (medial) collateral ligament injury of the elbow, with elbow flexed to 20 or 30 degrees and wrist stabilized, apply valgus force to lateral elbow, pain or excess motion compared to contralateral side is positive
Tinel's sign
test identify compression of the ulnar nerve. with elbow relaxed and the wrist supported, tap the ulnar nerve as it courses through the ulnar notch. tingling or pain along ulnar distribution is postive
Phalen's test
test for hands and wrist, can detect carpal tunnel syndrome , have patient sit with dorsum of their hand touching in maximal wrist flexion for one minute, numbness or tingling in median nerve distribution is postive
Hip tests
FABER test, log roll, thomas test, trendelenburg test
FABER test
test identifies hip, stands for flexion, abduction, and external rotation
Log roll
test looks at hip but particularly symptomatic arthritis, with patient supine, hold the ankle or knee and passively internally and externally rotate leg, pain in groin is positive test
