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NURS 623 : HEALTH ASSESSMENT : MODULE 6 TEST
QUESTIONS WITH COMPLETE SOLUTIONS
the percentage of ventricular volume ejected during each heartbeat -- Answer โโ Ejection Fraction what is a normal EF? -- Answer โโ 60% the load the stretches the cardiac muscle before contraction -- Answer โโ preload 3 causes of decreased right ventricular preload -- Answer โโ 1. exhalation
- dehydration
- pooling of blood in the capillary bed or venous system the ability of the cardiac muscle, when given a load, to shorten -- Answer โโ myocardial contractility the degree of vascular resistance to ventricular contraction -- Answer โโ afterload jugular veins provide an important index of what two things? -- Answer โโ 1. right heart pressures
- cardiac function
what do absent a waves signal? -- Answer โโ atrial fibrillation what three questions relate to the most common manifestations of cardiac disease -- Answer โโ 1. is the blood supply to the heart adequate?
- is the electrical system of the heart functioning normally
- is the heart adequately moving blood through the circulation and supplying the organs 5 common or concerning symptoms of the heart -- Answer โโ 1. chest pain
- palpitations
- shortness of breath
- swelling (edema)
- fainting (syncope) a connective tissue-lined compartment located centrally in the thoracic cavity -- Answer โโ mediastinum 4 great vessels -- Answer โโ 1. aorta
- pulmonary artery
- superior vena cava
- inferior vena cava the most anterior structure of the heart -- Answer โโ right ventricle the point where the apex of the heart touches the anterior chest wall and heart movements are most easily observed and palpated -- Answer โโ point of maximal impulse (PMI) displacement of the heart to the right -- Answer โโ dextrocardia
when do right-sided cardiac events usually occur compared to those on the left -- Answer โโ slightly later splitting of S1 can vary with respiration (yes/no) -- Answer โโ no distinct heart sounds distinguished by their pitch and their longer duration -- Answer โโ heart murmurs what do heart murmurs usually indicate? -- Answer โโ valvular heart disease if you hear a murmur at the right second intercostal space or cardiac apex it is likely originating at the: -- Answer โโ aortic valve if you hear a murmur at the left second and third intercostal spaces close to the sternum, but also at higher or lower levels it is likely originating at the: -- Answer โโ pulmonic valve if you hear a murmur at or near the lower left sternal border it is likely originating at the: -- Answer โโ tricuspid valve if you hear a murmur at and around the cardiac apex it is likely originating at the: -- Answer โโ mitral valve normally, maximal left ventricular pressure corresponds to: -- Answer โโ systolic blood pressure where do electrical impulses in the heart originate? -- Answer โโ SA node
what is the SA node also known as? -- Answer โโ pacemaker of the heart The volume of blood ejected from the left side of the heart in one minute. -- Answer โโ cardiac output how do. you calculate cardiac output? -- Answer โโ HR x stroke volume the volume of blood ejected with each heartbeat -- Answer โโ stroke volume stroke volume depends on what 3 things? -- Answer โโ 1. preload
- myocardial contractility
- afterload what is the most common symptom in coronary heart disease (CHD) -- Answer โโ chest pain anterior chest pain, often tearing or ripping and radiating into the back or neck occurs in: -- Answer โโ acute aortic dissection an unpleasant awareness of the heartbeat -- Answer โโ palpitations sudden dyspnea can occur in what three cases? -- Answer โโ 1. pulmonary embolus
- spontaneous pneumothorax
- anxiety how is orthopnea classically quantified -- Answer โโ the number of pillows the patient uses for sleeping
the rhythm of the pulse remains regular, but the force of the arterial pulse alternates because. of alternating strong and weak ventricular contractions -- Answer โโ pulsus alternans pulsus alternans almost always indicates what? -- Answer โโ severe left ventricular dysfunction where is pulsus alternans best felt? -- Answer โโ radial or femoral arteries greater-than-normal drop in systolic blood pressure during inspiration -- Answer โโ pulsus paradoxus in what life threatening condition do you have paradoxical pulse? -- Answer โโ pericardial tamponade what abnormal finding. can you hear. in the left lateral decubitus position? -- Answer โโ mitral stenosis what abnormal finding can you hear when the patient is sitting, leaning forward? -- Answer โโ aortic regurgitation when is S1 diminished? -- Answer โโ first-degree heart block when is S2 diminished? -- Answer โโ aortic stenosis sound or murmurs coinciding with the carotid upstroke are (systolic/diastolic) -- Answer โโ systolic sounds or murmurs following the carotid upstroke are (systolic/diastolic) -- Answer โโ diastolic
where can you palpate impulses from the right ventricle? -- Answer โโ the lower left sternal border and in the subxiphoid area it is always best to describe the apical impulse in relation to what? -- Answer โโ midsternal or midclavicular line what may have a hypokinetic apical impulse displaced far to the left? -- Answer โโ markedly dilated failing heart what may make the apical impulse undetectable? -- Answer โโ a large pericardial effusion is the diaphragm of the stethoscope better for high pitched or low-pitched sounds? -- Answer โโ high-pitched what does expiratory splitting suggest? -- Answer โโ valvular abnormality what does a loud P2 point to? -- Answer โโ pulmonary hypertension how is the intensity of a murmur typically expressed? -- Answer โโ fraction what the does the numerator represent? -- Answer โโ the intensity of the murmur wherever it is loudest what does. the denominator represent? -- Answer โโ the scare you are using a six point scale used to grade systolic murmurs -- Answer โโ Levine grading system
what is a principal determinant of systemic vascular resistance? -- Answer โโ the smooth muscle tone of arterioles what delivers blood to the esophagus, stomach, duodenum, liver, gallbladder, pancreas, and spleen? -- Answer โโ celiac trunk what delivers blood to the small intestine, ascending and transverse colon and right splenic flexure -- Answer โโ superior mesenteric artery what delivers blood to the descending. and sigmoid colon and proximal rectum -- Answer โโ inferior mesenteric artery vein that originates on the dorsum of the foot, passes just anterior to the medial malleolus, continues up the medial aspect of the leg, and joins the femoral vein of the deep venous system below the inguinal ligament -- Answer โโ great saphenous vein vein that begins on the lateral side of the foot, passes upward along the posterior calf, and joins the deep venous system in the popliteal fossa -- Answer โโ small saphenous vein is lymphedema usually compressible? -- Answer โโ no enlarged lymph nodes, with. or without tenderness -- Answer โโ lymphadenopathy what should be your goal when approaching a person presenting with signs and symptoms relating. to the peripheral vascular system -- Answer โโ determining the integrity of the system atherosclerotic disease distal to the aortic bifurcation -- Answer โโ peripheral arterial disease (PAD)
3 common presenting symptoms of PAD -- Answer โโ 1. pain
- swelling
- discoloration in the area of arterial distribution pain relived by resting up to 10 minutes -- Answer โโ intermittent claudication hair loss over the anterior tibiae points to what? -- Answer โโ decreased arterial perfusion 5 PAD warning signs -- Answer โโ 1. fatigue, aching, numbness or pain that limits walking or exertion. in the legs
- any poorly healing or nonhealing wounds of the legs or feet
- any pain present when at rest in the lower leg or foot and changes when standing or supine
- abdominal pain after meals and associated food fear and weight loss
- any first-degree relatives with an abdominal aortic aneurysm the acute onset of symptoms in the abdomen should raise the concern of what? -- Answer โโ arterial thrombosis if abdomen pain is relieved by sitting and bending forward, or if there is bilateral buttock or leg pain, the etiology is more likely to be: -- Answer โโ spinal stenosis what does food fear. and weight loss suggest? -- Answer โโ chronic intestinal ischemia of the celiac or superior or inferior mesenteric arteries what do visible venous collaterals, swelling, edema, and discoloration signal? -- Answer โโ upper extremity DVT
the relative hypothermia of one extremity as compared with another -- Answer โโ poikilothermia 3 places to palpate for pitting edema in the feet -- Answer โโ 1. over the dorsum of each foot
- behind each medial malleolus
- over the shins Comparison of the blood pressure in the leg vs. the arm; normal ratio is greater than 1 -
- Answer โโ ankle-brachial index what does an ABI >1.40 suggest -- Answer โโ a noncompressible calcified vessel what does an ABI <0.90 suggest? -- Answer โโ diagnostic of PAD how to calculate ABI -- Answer โโ highest pressure in foot/highest pressure. in both arms what test compares patency of the ulnar and radial arteries? -- Answer โโ Allen test if present, where do ulcers occur with chronic arterial insufficiency? -- Answer โโ toes or point of trauma on feet if present. where do ulcers occur with chronic venous insufficiency? -- Answer โโ side of ankle, especially medially does gangrene develop with chronic venous insufficiency? -- Answer โโ no
what two valves make up. the atrioventricular valves? -- Answer โโ 1. mitral valve
- tricuspid valve what two valves make up the semilunar valves -- Answer โโ 1. aortic
- pulmonic which S sound is low pitched and heard best at the apex or left sternal border with the bell of the stethoscope -- Answer โโ physiological S Which S sound is also called a ventricular gallop and is associated with decreased myocardial contractility, HF, and volume overload conditions -- Answer โโ pathological S which S sound is also called an atrial gallop and is usually due to increased resistance to filling of the ventricle -- Answer โโ S Grating sound heard throughout the respiratory cycle as inflamed pleural spaces rubs together -- Answer โโ friction rubs which screening tool is designed for primary prevention for CVD -- Answer โโ Atherosclerotic coronary artery disease (ASCVD) 10-year risk estimator soft, raised yellow plaques occurring on the skin at the inner corners of the eyes often seen in dyslipidemia -- Answer โโ xanthelasma an enzyme released when organ. or tissue is destroyed, particularly myocardial tissue. Can also be elevated in hemolytic states, hyperthyroidism, kidney disease, gastric malignancy, and megaloblastic anemia. -- Answer โโ lactate dehydrogenase (LDH)
7 red flags for chest pain/pressure -- Answer โโ 1. sudden onset
- severe, "crushing" chest pain/pressure
- lasting more than 15 minutes
- worsening with exertion
- accompanied by shortness of breath, diaphoresis, N/V
- radiating to the left arm, neck, or jaw
- accompanied by change. in vital signs (tachycardia, bradycardia, hypotension) what is often termed the widow maker? -- Answer โโ highly stenotic LCA or proximal LAD a serious complication of pericarditis -- Answer โโ cardiac tamponade cardiac tamponade requires immediate: -- Answer โโ pericardiocentesis unlike the symptoms associated with ACS, the pain accompanying pericarditis is: -- Answer โโ sharp and stabbing what is a way to help differentiate GERD from cardiac symptoms? -- Answer โโ symptoms tend to be worse at night when the patient. is lying down the pain of ________ is generally colicky in nature and localized to. the right upper quadrant -- Answer โโ cholecystitis with cholecystitis, Murphy's sign is (positive/negative) -- Answer โโ positive what history do you want. to ask about with pancreatitis -- Answer โโ alcohol abuse
the pain of _____ is severe, steady, and "boring" -- Answer โโ pancreatitis 3 categories of systolic murmurs -- Answer โโ 1. pathological
- functional
- innocent what is one of the first questions. to ask when a murmur is heard? -- Answer โโ whether the patient has ever been told that. he or she has a murmur and if any diagnostic testing has been done, particularly an echocardiogram 6 ways to describe murmurs -- Answer โโ 1. grade (intensity)
- location
- radiation
- pitch (high, medium, low)
- quality (blowing, rumbling, harsh, musical)
- where they occur in the cardiac cycle the most common type of systolic murmurs and are associated with forward flow through the semilunar valves -- Answer โโ ejection murmurs what type of pattern do ejection murmurs have? -- Answer โโ crescendo-decrescendo pattern where. is aortic stenosis heard best? -- Answer โโ second right intercostal space with the client leaning forward what are the three classic symptoms of aortic stenosis -- Answer โโ 1. syncope
- angina
- dyspnea on exertion
what is the most common cause of aortic insufficiency? -- Answer โโ infective endocarditis associated with rheumatic fever what is typically the first sign of an atrial septal defect -- Answer โโ HF what is the aim for primary prevention of dyslipidemia? -- Answer โโ keep LDL-C levels below 130 4 main determinants of systolic function -- Answer โโ 1. myocardial contractility
- heart rate
- preload
- afterload class of heart failure with no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea, palpitation or anginal discomfort -- Answer โโ class I class of heart failure with slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of fatigue, dyspnea, palpitation, or anginal discomfort -- Answer โโ class II class of heart failure with marked limitation of physical activity. comfortable at rest, but less than ordinary activity causes symptoms of fatigue, dyspnea, palpitation or anginal discomfort -- Answer โโ class III class of heart failure unable to engage in any physical activity without discomfort, and symptoms of cardiac insufficiency are present at rest. If any physical activity is undertaken, symptoms increase. -- Answer โโ class IV
3 most common symptoms. of heart failure -- Answer โโ 1. dyspnea with exertion or rest
- orthopnea
- edema what test will confirm diagnosis of bacterial endocarditis? -- Answer โโ blood cultures describe the differences in pulses between arterial and venous insufficiency -- Answer โโ arterial insufficiency: decreased/absent venous insufficiency: normal describe the differences in edema between arterial and venous insufficiency -- Answer โโ arterial: absent or mild venous: significant describe the differences in pain between arterial and venous insufficiency -- Answer โโ arterial: severe venous: absent/mild describe the differences in temperature between arterial and venous insufficiency -- Answer โโ arterial: cool venous: normal describe the differences in color between arterial and venous insufficiency -- Answer โโ arterial: pallor with elevation; dusky red on dependency
