Questions and Answers
What is the correct order of cardiac examination?
Systematically listen to the entire precordium, use the bell and diaphragm, and inspect and palpate beforehand
A client presents to the emergency department complaining of chest pain. The nurse conducts a pain assessment and discovers the client's chest pain has lasted more than 20 minutes and is accompanied by nausea and diaphoresis. The nurse should prepare for which treatment?
What is stroke volume?
The amount of blood pumped from the heart with each contraction
When evaluating the jugular venous pressure in a patient with known coronary artery disease, the nurse should explain to the patient that the JVP measures the pressure in the:
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What does engorged jugular veins suggest?
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Where are the semilunar valves located?
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What is the myocardium?
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What does a split S1 indicate?
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What does a thrill indicate?
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What is an accentuated first heart sound associated with?
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What is the pattern of a murmur that is initially loud and then gets softer?
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Do the heart valves need to open simultaneously to function adequately?
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Which valvular defect is best heard in the left lateral decubitus position?
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What does the T wave indicate on an electrocardiogram?
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What do elevated cholesterol and C-reactive protein levels indicate?
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What action should the nurse take if there is difficulty with palpation of the apical impulse on the precordium?
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Where should the nurse palpate to assess the apical impulse?
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What event in the cardiac cycle corresponds with the first heart sound?
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What instructions should the nurse provide to the client in preparation for a cardiovascular examination?
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Which of the following indicate cardiac pain?
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What valve is involved in variations of S1?
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When assessing a client's carotid arteries, which of the following would be most appropriate?
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Where are the semilunar valves located?
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Which of the following cardiac outputs is within the normal range?
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Which statement describes the correct technique for a nurse using a stethoscope to auscultate the chest for heart sounds?
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A nurse auscultates a client's carotid arteries, finding the strength of the pulse to be bounding. Which score should the nurse record?
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A client is experiencing decreased cardiac output. Which vital sign is a priority for the nurse to monitor frequently?
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A client reports difficulty falling asleep unless she is in an upright position. Which potential problem should the nurse further investigate?
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When addressing the relationship between coronary artery disease (CAD) and culture, which information would the nurse include?
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What event does the PR interval on an electrocardiogram represent?
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A client with a cardiac condition complains of not sleeping well and having to get up frequently at night to urinate. What should the nurse suspect?
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The nurse notes that a client's heart rate speeds up with inspiration and slows down with expiration. What should the nurse suspect?
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The nurse's assessment of a client reveals jugular venous distention. What health problem should the nurse suspect?
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The nurse auscultates a client's heart sounds and obtains a rate of 56 beats per minute. How should this rate be documented?
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When conducting a workshop on the measurement of jugular venous pulsation, the nurse tells the students to distinguish between the jugular venous pulsation and carotid pulse. Which characteristic is typical of the carotid pulse?
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A nurse recognizes that the second heart sound, S2, is produced by which cardiac action?
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When auscultating a client's heart, the nurse hears both S3 and S4. What is this known as?
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A nurse suspects that a client may have a pericardial friction rub. To ensure that the nurse hears this, the nurse would place the client in which position?
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A nurse auscultates a very loud murmur that occurs throughout systole and can be heard with the stethoscope partly off the chest. How should the nurse grade this murmur?
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Which statement describes the correct technique by a nurse for use of a stethoscope to auscultate the chest for heart sounds?
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During a cardiac examination, the nurse can best hear the S1 heart sound by placing the stethoscope at the client's
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Temporary heart pain, resolving in less than 20 minutes, aggravated by physical activity and stress is known as what?
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The client asks the nurse what the small P wave on her ECG indicates. What would the nurse answer?
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The nurse is assessing a client diagnosed with mitral stenosis. Which technique should the nurse use to listen to this condition?
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A nurse is assessing a client for possible dehydration. Which of the following should the nurse do?
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A client complains of palpitations and a feeling of anxiety. Which of the following would be most appropriate for the nurse to keep in mind?
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Which is true of a third heart sound (S3)?
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While assessing an adult client, the nurse detects opening snaps early in diastole during auscultation of the heart. The nurse should refer the client to a physician because this is usually indicative of
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A nurse is having trouble finding the apical pulse on an obese person. What is the most likely reason for this?
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After teaching a group of students about the great vessels, the instructor determines that the students need additional teaching when they identify which of the following as a great vessel?
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A nurse auscultates the heart rate of a young male and notices that the rate speeds with inspiration and slows with exhalation. S1 and S2 are normal. The nurse recognizes this as what dysrhythmia?
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By what percent can clients reduce their risk of cardiac events the first year after quitting smoking?
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When auscultating a client diagnosed with aortic stenosis, the nurse should place the stethoscope at what location on the client's chest?
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The nurse is assessing the jugular venous pressure (JVP) of a 72-year-old client with recent complaints of fatigue, shortness of breath, and swollen ankles. What cardiac phenomena are represented by the oscillations that the nurse observes in the client's internal jugular veins?
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A nurse is having difficulty identifying a client's heart sounds, specifically S1 and S2. Which of the following would be most appropriate for the nurse to do?
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A nurse understands that the cardiac event that signals the beginning of systole and produces the first heart sound is what?
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A nurse is assessing a client for the presence of stenosis in the carotid arteries. Which of the following should the nurse do?
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A nurse cares for a client who suffered a myocardial infarction 2 days ago. A high-pitched, scratchy, scraping sound is heard that increases with exhalation and when the client leans forward. The nurse recognizes this sound as a result of what process occurring within the pericardium?
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The nurse is assessing the carotid arteries of a client with a history of heart disease. What action should the nurse perform during this assessment?
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When auscultating the left carotid artery, the nurse notes a swishing sound. The nurse interprets this finding as suggesting which of the following?
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In order for the nurse to assess jugular venous pressure (JVP), the client should be in which of the following positions?
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A client might have an aortic regurgitation murmur. Which is the best position to accentuate the murmur?
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Upon assessment of a client's pulse, a nurse notices that the amplitude of the pulse varies between beats. Which other finding should the nurse assess for in this client?
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Study Notes
Assessment Techniques
- Palpate carotid arteries individually to avoid reducing cerebral blood flow; auscultate before palpation.
- Auscultate heart sounds while determining heart rate and rhythm; use the diaphragm for high-pitched sounds.
- Modify client positioning to enhance auscultation and ensure accurate readings.
Cardiac Anatomy
- Semilunar valves are located at the exit of each ventricle, beginning the great vessels.
- The bicuspid (mitral) valve is between the left atrium and left ventricle.
- Aortic and pulmonic valves closure creates the second heart sound (S2).
Cardiac Output Norms
- Normal cardiac output ranges from 5-8 L/min; 6 L/min is considered within this range.
- Bradycardia is defined as a heart rate lower than 60 beats per minute; tachycardia is above 100 beats per minute.
Heart Sounds and Abnormalities
- First heart sound (S1) results from closure of the atrioventricular valves, while the second (S2) from semilunar valves closure.
- S3 and S4 heart sounds together create a summation gallop, indicating heart failure or volume overload.
- Abnormal findings like a bruit indicate occlusive arterial disease; jugular venous distention suggests heart failure.
Risk Factors and Health Education
- Hypertension is more prevalent in African Americans; high serum levels of low-density lipoproteins increase coronary heart disease risk.
- Lifestyle measures for reducing coronary artery disease risk include stress management, regular walking, and low-sodium diets.
Monitoring and Intervention
- Frequent blood pressure monitoring is paramount with decreased cardiac output.
- Signs such as nocturia in clients can indicate heart failure due to increased renal perfusion during rest periods.
EKG Waveform Understanding
- The T wave signifies ventricular repolarization while the PR interval indicates the time from SA node firing to the onset of ventricular depolarization.
Client Interaction and Resources
- Encourage clients to keep food and activity logs to better manage hypertension and lifestyle choices.
- Provide resources for smoking cessation as a part of risk factor modification.
Physical Examination Techniques
- To hear a suspected pericardial friction rub, position the client upright and leaning forward.
- Engage in thorough assessments to understand signs like jugular vein distention thoroughly, indicating possible heart failure.
Overall Cardiac Health
- Educate clients about symptoms like dyspnea and nocturia as indicators of potential heart conditions.
- Reinforce the importance of maintaining regular health check-ups to monitor for cardiovascular risks and conditions.### Heart Sounds and Assessment
- Best position for auscultating a client's heart sounds is sitting up, leaning forward, exhaling, and holding breath.
- Left lateral position may be used to hear an S3 or S4 heart sound or a murmur of mitral stenosis not detected in supine position.
Grading Murmurs
- Grade 5 murmur: very loud, can be heard with stethoscope partly off chest.
- Grade 1 murmur: very faint.
- Grade 6 murmur: can be heard with stethoscope entirely off chest.
- Grade 2 murmur: quiet, heard immediately on placing stethoscope on chest.
Auscultation Technique
- Focus on one sound at a time when auscultating the precordium.
- Start by determining rate and rhythm.
- Stand at client's right side to perform assessment.
- Client should be lying in supine position with head of bed elevated at 30 degrees.
- Diaphragm of stethoscope used to listen for high-pitched sounds of normal heart sounds.
Heart Sounds Location
- S1 heart sound best heard at the apex (left MCL, fifth ICS).
- Pulmonic valve sounds heard best at second left interspace.
Angina
- Temporary heart pain, resolving in less than 20 minutes, aggravated by physical activity and stress.
ECG
- P wave indicates atrial depolarization (duration up to 80 msec; PR interval 120 to 200 msec).
Mitral Stenosis
- Listen with bell of stethoscope over apex with client on left side.
- Murmur has low-pitched, rumbling quality.
Heart Failure
- Edema in both lower extremities at night is seen in heart failure.
- Due to reduction of blood flow out of heart, causing blood to back up in organs and dependent areas of body.
Point of Maximum Impulse (PMI)
- If unable to identify PMI with client supine, assist client to roll partly onto left side or left lateral decubitus position.
Mitral Insufficiency
- S1 sound is diminished.
Lifestyle Modifications
- Regular exercise provides many benefits, including lowering risk of hypertension.
Dehydration
- Decrease in jugular venous pressure occurs with dehydration secondary to decrease in total blood volume.
Palpitations
- Palpitations may occur with abnormality of heart's conduction system or during heart's attempt to increase cardiac output by increasing heart rate.
S3 Heart Sound
- Caused by rapid deceleration of blood against the ventricular wall.
Accentuated S2
- S2 is louder than S1, occurring in conditions where aortic or pulmonic valve has higher closing pressure.
Ineffective Tissue Perfusion
- Characterized by weak radial pulse and decreased carotid pulses.
Mitral Valve Prolapse
- Midsystolic click is heard on auscultation.
Murmur Location
- Mitral valve sounds are usually heard best at and around cardiac apex.
ECG Waveforms
- T wave indicates ventricular repolarization.
- P wave indicates atrial depolarization.
- QRS complex indicates ventricular depolarization.
- ST segment indicates period between ventricular depolarization and beginning of ventricular repolarization.
Electrical Conduction System
- Electrical signal originates in sinoatrial node.
Precordium
- Anterior chest area that overlies heart and great vessels.
Semilunar Valves
- Located at exit of each ventricle at beginning of great vessels.
Murmur
- Swooshing or blowing sound caused by turbulent blood flow in heart.
Auscultation Technique
- Systematically listen to entire precordium, using diaphragm and bell.
Myocardial Infarction
- Treatment includes nitroglycerin, bedrest, thrombolytics, or angioplasty.
Stroke Volume
- Decreased left ventricular compliance causes decrease in stroke volume.
Jugular Venous Pressure
- Measures pressure in right atrium.
Right Atrial Pressure
- Engorged jugular veins are seen in right or left heart failure, pulmonary hypertension, tricuspid stenosis, and pericardial compression or tamponade.
Cardiac Structure and Function
- The semilunar valves are located at the exit of each ventricle at the beginning of the great vessels.
- The myocardium is the thickest layer of the heart, made up of contractile cardiac muscle cells.
Heart Sounds
- A split S1 occurs when the left and right ventricles contract at different times (asynchronous ventricular contraction).
- A thrill or pulsation is usually associated with a grade IV or higher murmur.
- An accentuated S1 sound is louder than an S2 sound, which occurs when the mitral valve is wide open and closes quickly (e.g., in hyperkinetic states or mitral stenosis).
- Crescendo-decrescendo murmur grows louder and then softer.
- The first heart sound corresponds to the closure of the atrioventricular valves.
- The second heart sound corresponds to the closure of the semilunar valves.
Electrocardiogram (ECG)
- The P wave indicates atrial depolarization and conduction of the impulse throughout the atria.
- The T wave indicates ventricular repolarization, when the ventricles return to a resting state.
Cardiac Examination
- When performing a cardiac examination, the nurse should:
- Instruct the client to wear the examination gown with the opening in the front.
- Have the client sit and lean forward for part of the examination.
- Have the client lay on their left side for part of the examination.
- The left lateral decubitus position brings the left ventricle closer to the chest wall, allowing mitral valve murmurs to be better heard.
Cardiac Pain
- Angina (cardiac chest pain) is usually described as a sensation of squeezing around the heart; a steady, severe pain; and a sense of pressure.
- It may radiate to the left shoulder and down the left arm or to the jaw.
- Cardiac pain may occur at any time, is not relieved with antacids, and worsens with activity.
Great Vessels
- The great vessels include the superior and inferior vena cava, the pulmonary artery and vein, and the aorta.
- The femoral artery is not a great vessel.
Dysrhythmias
- Sinus arrhythmia is a heart rate that speeds with inspiration and slows with exhalation.
- Atrial fibrillation causes the ventricles to beat irregularly.
- Premature ventricular contractions and premature atrial contractions occur earlier than expected.
Risk Reduction
- Quitting smoking can reduce the risk of cardiac events by 50% after the first year.
Auscultation
- Aortic stenosis is a midsystolic ejection murmur that begins after S1, crescendos, and then decrescendos before S2.
- It is best heard over the 2nd or 3rd right intercostal space.
- Jugular venous pressure (JVP) is a visible manifestation of the varying pressures in the right atrium.
- Palpating the carotid pulse while auscultating the heart can help distinguish S1 and S2 sounds.
Cardiovascular Assessment
- To assess for stenosis in the carotid arteries, the nurse should check for pulse inequality between the right and left carotid arteries.
- Differences in the amplitude or rate of the carotid pulse may indicate stenosis.
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Test your knowledge with the PrepU Chapter 17 questions focused on nursing assessments, specifically related to the carotid arteries. This quiz will enhance your understanding of proper assessment techniques and procedures. Ideal for nursing students looking to reinforce their practical skills.
