Chapter 20: Heart and Neck Vessels
Physical Examination and Health Assessment, 8th Edition by
Carolyn Jarvis
MULTIPLE CHOICE
1. The sac that surrounds and protects theheart is called the:
a. Pericardium.
b. Myocardium.
c. Endocardium.
d. Pleuralspace.
ANS: A
The pericardium is a tough, fibrous double-walled sac that surrounds and protects
theheart. 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 theheart 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: B
Returning blood from thebody empties into theright atrium and flows into theright
ventricle and then goes to thelungs through thepulmonary artery. thelungs
oxygenate theblood, and it is then returned to theleft atrium through thepulmonary
vein. theblood goes from there to theleft ventricle and then out to thebody through
theaorta.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
3. The nurse is reviewing theanatomy and physiologic functioning of theheart. 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 theatria at thebeginning of diastole can be felt as a palpitation.
, c. Atrial kick is thepressure exerted against theatria as theventricles contract during
systole.
d. The atria contract toward theend of diastole and push theremaining blood into
theventricles.
ANS: D
Toward theend of diastole, theatria contract and push thelast amount of blood
(approximately 25% of stroke volume) into theventricles. 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.
ANS: C
The second heart sound (S2) occurs with theclosure of thesemilunar (aortic and
pulmonic) valves and signals theend of systole. Although it is heard over all
theprecordium, theS2 is loudest at thebase of theheart.
DIF: Cognitive Level: Understanding (Comprehension)
MSC: Client Needs: General
5. Which of these statements describes theclosure of thevalves in a normal cardiac cycle?
a. The aortic valve closes slightly before thetricuspid valve.
b. The pulmonic valve closes slightly before theaortic valve.
c. The tricuspid valve closes slightly later than themitralvalve.
d. Both thetricuspid and pulmonic valves close at thesametime.
ANS: C
Events occur just slightly later in theright side of theheart because of theroute of
myocardial depolarization. As a result, two distinct components to each of
theheart sounds exist, and sometimes they can be heard separately. In thefirst heart
sound, themitral component (M1) closes just before thetricuspid component (T1).
DIF: Cognitive Level: Understanding (Comprehension)
MSC: Client Needs: General
6. The component of theconduction system referred to as thepacemaker of theheart is the:
a. Atrioventricular (AV) node.
b. Sinoatrial (SA) node.
c. Bundle of His.
, d. Bundle branches.
ANS: B
Specialized cells in theSA node near thesuperior vena cava initiate an electrical
impulse. Because theSA node has an intrinsic rhythm, it is called thepacemaker of
theheart.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
7. The electrical stimulus of thecardiac 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
Specialized cells in theSA node near thesuperior vena cava initiate an electrical
impulse. thecurrent flows in an orderly sequence, first across theatria to theAV
node low in theatrial septum. There it is delayed slightly, allowing theatria thetime
to contract before theventricles are stimulated. Then theimpulse travels to
thebundle of His, theright and left bundle branches, and then through
theventricles.
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 thesternal angle when thehead of his bed
is elevated 45 degrees. thenurse 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: D
Because no cardiac valve exists to separate thesuperior vena cava from theright
atrium, thejugular veins give information about theactivity on theright side of
theheart. They reflect filling pressures and volume changes. Normal jugular
venous pulsation is 2 cm or less above thesternal angle. Elevated pressure is more
than 3 cm above thesternal 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, thenurse knows which of these
statements to be true?
Physical Examination and Health Assessment, 8th Edition by
Carolyn Jarvis
MULTIPLE CHOICE
1. The sac that surrounds and protects theheart is called the:
a. Pericardium.
b. Myocardium.
c. Endocardium.
d. Pleuralspace.
ANS: A
The pericardium is a tough, fibrous double-walled sac that surrounds and protects
theheart. 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 theheart 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: B
Returning blood from thebody empties into theright atrium and flows into theright
ventricle and then goes to thelungs through thepulmonary artery. thelungs
oxygenate theblood, and it is then returned to theleft atrium through thepulmonary
vein. theblood goes from there to theleft ventricle and then out to thebody through
theaorta.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
3. The nurse is reviewing theanatomy and physiologic functioning of theheart. 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 theatria at thebeginning of diastole can be felt as a palpitation.
, c. Atrial kick is thepressure exerted against theatria as theventricles contract during
systole.
d. The atria contract toward theend of diastole and push theremaining blood into
theventricles.
ANS: D
Toward theend of diastole, theatria contract and push thelast amount of blood
(approximately 25% of stroke volume) into theventricles. 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.
ANS: C
The second heart sound (S2) occurs with theclosure of thesemilunar (aortic and
pulmonic) valves and signals theend of systole. Although it is heard over all
theprecordium, theS2 is loudest at thebase of theheart.
DIF: Cognitive Level: Understanding (Comprehension)
MSC: Client Needs: General
5. Which of these statements describes theclosure of thevalves in a normal cardiac cycle?
a. The aortic valve closes slightly before thetricuspid valve.
b. The pulmonic valve closes slightly before theaortic valve.
c. The tricuspid valve closes slightly later than themitralvalve.
d. Both thetricuspid and pulmonic valves close at thesametime.
ANS: C
Events occur just slightly later in theright side of theheart because of theroute of
myocardial depolarization. As a result, two distinct components to each of
theheart sounds exist, and sometimes they can be heard separately. In thefirst heart
sound, themitral component (M1) closes just before thetricuspid component (T1).
DIF: Cognitive Level: Understanding (Comprehension)
MSC: Client Needs: General
6. The component of theconduction system referred to as thepacemaker of theheart is the:
a. Atrioventricular (AV) node.
b. Sinoatrial (SA) node.
c. Bundle of His.
, d. Bundle branches.
ANS: B
Specialized cells in theSA node near thesuperior vena cava initiate an electrical
impulse. Because theSA node has an intrinsic rhythm, it is called thepacemaker of
theheart.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
7. The electrical stimulus of thecardiac 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
Specialized cells in theSA node near thesuperior vena cava initiate an electrical
impulse. thecurrent flows in an orderly sequence, first across theatria to theAV
node low in theatrial septum. There it is delayed slightly, allowing theatria thetime
to contract before theventricles are stimulated. Then theimpulse travels to
thebundle of His, theright and left bundle branches, and then through
theventricles.
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 thesternal angle when thehead of his bed
is elevated 45 degrees. thenurse 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: D
Because no cardiac valve exists to separate thesuperior vena cava from theright
atrium, thejugular veins give information about theactivity on theright side of
theheart. They reflect filling pressures and volume changes. Normal jugular
venous pulsation is 2 cm or less above thesternal angle. Elevated pressure is more
than 3 cm above thesternal 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, thenurse knows which of these
statements to be true?
