Cardiac and Vascular Assessment Quiz

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Questions and Answers

What is the normal time for the hand to return to its color after releasing pressure on the ulnar artery while maintaining pressure on the radial artery?

7 seconds (correct)

3 seconds

5 seconds

10 seconds

Which leg inspection findings are considered abnormal?

Visible, dilated tortuous veins (correct)

Flat venous pattern

Normal hair distribution

Symmetric size without swelling

When assessing the venous system, what should be noted if the client has varicose veins?

They appear only during the night

They are only visible while sitting

They are dilated and tortuous (correct)

They disappear when the legs are elevated

What is the normal appearance of the feet after raising the legs for 30 seconds?

Both should be pale but still pink Signup and view all the answers

What does bilateral edema that worsens in the evening and improves in the morning typically indicate?

Heart failure Signup and view all the answers

Which part of the heart is responsible for the pumping action?

Myocardium Signup and view all the answers

What prevents the backflow of blood in the heart?

Atrioventricular and semilunar valves Signup and view all the answers

During which phase of the cardiac cycle is the first heart sound (S1) produced?

Beginning of systole Signup and view all the answers

What characterizes a third heart sound (S3)?

Occurs during early rapid filling phase Signup and view all the answers

What describes the function of valves in the heart?

They operate based on pressure gradients. Signup and view all the answers

What is the role of the pericardium?

To provide a fibrous protective layer around the heart Signup and view all the answers

Which of the following is associated with turbulent blood flow?

Murmurs Signup and view all the answers

Which condition can lead to an increase in blood flow velocity?

Exercise Signup and view all the answers

What is the primary function of the peripheral vascular system?

To deliver blood to all areas of the body Signup and view all the answers

Which statement accurately describes the internal jugular vein?

It lies deep and medial to the sternomastoid muscle Signup and view all the answers

Which symptom is typically associated with orthopnea?

Shortness of breath when lying flat Signup and view all the answers

What can structural defects in heart valves lead to?

Impaired delivery of oxygen and nutrients Signup and view all the answers

Which of the following is a potential symptom of dyspnea?

Shortness of breath Signup and view all the answers

What does the term 'retards' refer to in the context of vascular diseases?

Delays the delivery of nutrients and oxygen Signup and view all the answers

Which type of cough is typically characterized as 'barky'?

Dry cough Signup and view all the answers

What condition is indicated by the need to assume a more upright position to breathe?

Orthopnea Signup and view all the answers

What should be performed to determine pulse deficit?

Subtract radial rate from apical rate Signup and view all the answers

Which heart sound is louder at the apex of the heart?

S1 Signup and view all the answers

What is S3 and S4 indicative of in adults?

Abnormal heart sounds Signup and view all the answers

How should a client be positioned to best auscultate for S3 and S4 heart sounds?

Supine and rolled to the left side Signup and view all the answers

What does a profile sign assess?

Nail bed angle and curvature Signup and view all the answers

Which pulse rate is classified as bradycardia?

Below 50 beats/min Signup and view all the answers

What does the Modified Allen test evaluate?

Adequacy of collateral circulation Signup and view all the answers

What finding indicates an increased pulse force?

3+ Signup and view all the answers

What is the expected temperature of skin upon inspection in a healthy individual?

Warm to the touch Signup and view all the answers

Which pulse rhythm is classified as irregular?

Varying intervals between beats Signup and view all the answers

What is indicated by no pulsations being felt during examination?

Normal physiological state Signup and view all the answers

Which method has replaced percussion for outlining the heart's borders?

Chest x-ray or echocardiogram Signup and view all the answers

What is the normal range for a healthy heart rate in beats per minute?

50 to 95 Signup and view all the answers

Where is the auscultation area for the Aortic valve located?

2nd right interspace Signup and view all the answers

What should be noted during auscultation for an irregularity in heart rhythm?

Check for pulse deficit Signup and view all the answers

What type of heart sounds are considered 'extra' during auscultation?

S3, S4, and murmurs Signup and view all the answers

How should the diaphragm of the stethoscope be used during auscultation?

In a zigzag pattern Signup and view all the answers

Which area is the location for auscultating the Mitral valve?

5th interspace midclavicular line Signup and view all the answers

What does a pulse deficit indicate when auscultating the apical beat and palpating the radial pulse?

Only some beats are perfused to the periphery Signup and view all the answers

What is the primary benefit of using a chest x-ray or echocardiogram over percussion?

It can detect heart enlargement more accurately Signup and view all the answers

Study Notes

Learning Objectives

Identify pertinent cardiovascular and peripheral-vascular history questions
Obtain a cardiovascular and peripheral-vascular history
Perform a cardiovascular and peripheral-vascular physical assessment
Document cardiovascular and peripheral-vascular findings
Differentiate between normal and abnormal findings

Heart

Cardiovascular system consists of the heart (muscular pump) and blood vessels (arteries and veins)
Precordium: area on the anterior chest that overlays the heart and great vessels
Heart and great vessels are located between the lungs in the middle third of the thoracic cage (mediastinum)
Heart extends from the 2nd to 5th intercostal space and from the right border of the sternum to the left midclavicular line
Base (top): widest point
Apex (bottom): narrow point

Vessels

Great vessels: superior and inferior vena cava, pulmonary artery, pulmonary veins, and aorta
Blood vessels are arranged in two continuous loops: pulmonary circulation and systemic circulation

Heart Wall

Heart wall has numerous layers:
- Pericardium: tough, fibrous, double-walled sac that surrounds and protects the heart.
- Myocardium: muscular wall of the heart; it pumps blood.
- Endocardium: thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves.

Heart Chambers and Valves

Four chambers: left atrium, right atrium, left ventricle, and right ventricle
Valves are unidirectional (can only open one way) to prevent backflow of blood.
Valves open and close passively in response to pressure gradients in moving blood
Two atrioventricular (AV) valves (tricuspid and mitral)
Two semilunar (SL) valves (pulmonic and aortic)

Heart Sounds

Cardiac cycle generates heart sounds (heard through a stethoscope)
Include:
- Normal heart sounds (S1 and S2)
- Extra heart sounds (S3 and S4)
- Murmurs
First heart sound (S1, “lub”): occurs with closure of AV valves and signals the beginning of systole. Heard over all precordium, loudest at apex
Second heart sound (S2, “dub”): occurs with closure of SL valves and signals the end of systole. Heard over all precordium, loudest at base

2) Extra heart sounds

Third heart sound (S3): occurs when ventricles are resistant to filling during early rapid filling phase. Occurs immediately after S2
Fourth heart sound (S4): occurs at end of diastole, at presystole when ventricle is resistant to filling. Occurs just before S1

3) Murmurs

Blood circulating through normal chambers and valves makes no noise
Some conditions create turbulent blood flow, producing a murmur (blowing, swooshing sound).
Associated with:
- Increased blood flow velocity (exercise)
- Decreased blood viscosity (anemia)
- Structural defects in valves or unusual openings in the chambers

Neck Vessels

Carotid artery (central): located in the groove between the trachea and sternomastoid muscle, medial to and alongside that muscle
Jugular veins (JV): empty un-oxygenated blood directly into the superior vena cava
- Internal JV: deep, not visible, lies deep and medial to sternomastoid muscle
- External JV: more superficial, lies lateral to sternomastoid muscle, above clavicle

Peripheral Vascular System

Primary function is to deliver blood to all areas of the body
Vascular system consists of vessels for transporting fluid
Any disease in the vascular system leads to:
- Impairs delivery of oxygen and nutrients to target cells
- Retards elimination of carbon dioxide and waste products from cellular metabolism
Arteries: common carotid, subclavian, axillary, brachial, radial, deep palmar arch, ulnar, arteries in the arm and leg
Veins: cephalic, accessory cephalic, intermediate (median), basilic, veins in the arms and legs

Subjective Data: Heart & Neck Vessels

1- Chest Pain: provocation, quality, region/location, severity, timing, understanding, associated symptoms (sweating, ashen skin, palpitations, SOB, nausea/vomiting, fatigue, tachycardia)
2- Dyspnea (difficulty breathing): any SOB, onset/when, type, duration, affected by position (lying down), awaken from sleep, interferes with daily activity
3- Orthopnea (SOB when lying flat): how many pillows used
4- Cough: do you have a cough, duration, frequency, type, cough up mucus, relieved by rest/medication
5- Fatigue: do you seem to tire easily, able to keep up with family/co-workers, onset, related to time of day
6- Cyanosis or Pallor: decreased tissue perfusion, low cardiac output, myocardial infarction
7- Edema: any swelling in feet or legs, onset, equally swollen, does swelling go away
8- Nocturia (urinating at night): awaken at night, how long has this been occurring
9- Cardiac History: any past history of hypertension, elevated cholesterol/triglycerides, congenital heart disease, rheumatic fever, unexplained joint pains, or recurrent tonsillitis. Ever had heart disease, treated by medications/surgery, past ECGs, serum cholesterol measurements, other heart tests
10- Family Cardiac History: any family history of hypertension, obesity, diabetes, coronary artery disease (CAD)
11- Cardiac Risk Factors: nutrition, smoking, alcohol, exercise
Subjective Data: Peripheral Vascular System: leg pain/cramps, skin changes, temperature change, leg veins, leg sores/ulcers, swelling in the arms or legs, smoking history

Objective Data: Neck Vessels

Palpate the carotid artery: palpate each carotid artery medial to sternomastoid muscle, avoid excessive pressure, palpate gently and only one carotid artery at a time. Feel contour and amplitude of pulse. Findings should be the same bilaterally
Auscultate the carotid artery: performed for who shows symptom or signs of cardiovascular disease. Auscultate for presence of a bruit (blowing, swishing sound indicating blood flow disorder). Keep neck in neutral position, lightly apply bell of stethoscope on 3 levels: angle of jaw, midcervical area, base of neck.
Inspect jugular venous pulse: stand on patient's right side, position patient supine from 30-45°, remove pillow to avoid flexing neck, turn head slightly away from examiner side, direct strong light onto the neck. Note external jugular vein overlying sternomastoid muscle. Observe bilaterally.

Objective Data: Heart

1. Inspection: Pulsations (You may or may not see apical impulse. If visible, it occupies the 4th-5th intercostal space. It is easier to see in children and those with thinner chest walls)
1. Palpate apical impulse: Locate apical impulse area by using one finger pad. Ask client to exhale and hold. Not palpable in obese persons or persons with thick chest wall. Note location, size, amplitude and duration.
1. Palpate across the precordium: Use palmar aspect of four fingers. Gently palpate apex, left sternal border, and base. Search for any other pulsations (thrills).
1. Percussion: Percussion to outline the heart's borders has been replaced by Chest X-ray image or echocardiogram. More accurate in detecting heart enlargement.
1. Auscultation: Use the diaphragm & a zigzag pattern. Four traditional valve “areas”. Note rate and rhythm. When you notice any irregularity check for a pulse deficit.

Objective Data: Peripheral Vascular System

Inspect the arms: Lift both hands, inspect hands while turning them over. Note skin color, nail beds, temperature, texture, turgor of skin, presence of any lesions, edema, or clubbing. Check profile sign and capillary refill. Two arms should be symmetrical in size.
Palpate the arms: Pulse and note the following: Rate (Beats/min), Tachycardia: above 95, Bradycardia: below 50, Rhythm (Regular/ irregular). Elasticity: elastic and smooth contour. Equal force: grade force on a 3-point scale. Modified allen test used to evaluate adequacy of collateral circulation before cannulating radial artery.
Inspect the leg: Uncover legs while keeping genitalia draped. Inspect both legs together, noting the following: Skin color and discoloration, skin lesion or ulcers, Hair distribution, Venous pattern (flat, barely visible), Leg size (swelling or atrophy).
Palpate the leg (Femoral, distal pulses and use graded scale for pulses equal bilaterally.)
Palpate the legs; Assess venous system. Note any visible, dilated tortuous veins.
Color changes: Raise legs 30 cm for 30 seconds; Now have client sit up with legs over side of table. Compare color of both feet. Note the time it takes for color to return to the feet.

Abnormalities : Heart & Neck Vessels & Peripheral Vascular System

Edema
Thrill
Full distended external jugular vein

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Description

Test your knowledge on cardiac and vascular assessments, covering topics such as arterial pressure observations, venous conditions, and heart sounds. This quiz is perfect for nursing or medical students looking to deepen their understanding of cardiovascular health.