c (When auscultating the heart of a newborn, you should expect to hear a continuous sound that mimics the sound of a machine, which is due to nonclosure of the ductus arteriosus. This sound should change to the familiar lub dup within 10-15 hours after bi
Mrs. Black brings her newborn infant into the ambulatory health center for a health assessment. When auscultating the heart of a newborn, you hear a continuous sound that mimics the sound of a machine. Based on your knowledge of newborn cardiac physiology
b ( An exaggerated splitting of the S1 and increased loudness of the S1 is commonly associated with the pregnant woman.)
Mrs. Marks is a 27-year-old pregnant woman who goes to the clinic for general prenatal care. On examination, which of the following cardiac assessment findings are commonly associated with the pregnant woman?
A) A loud, diastolic murmur that disappears sh
a ( The presence of an S4 would be an expected finding when performing a cardiac assessment on this 86-year-old patient, as this extra heart sound often occurs in older people who have no known cardiac disease.)
Mrs. Cousins is an 86-year-old woman who comes to the ambulatory clinic for a routine health assessment. On examination, which of the following cardiac assessment findings would be expected?
A) The presence of an S4
B) The presence of an S3
C) A diastolic
b ( The top of the heart is the broader part termed the base.)
The top of the heart, as it is positioned in the chest, is anatomically identified as the:
A) apex.
B) base.
C) crux.
D) integrant.
a ( The pulmonary artery leaves the right ventricle and bifurcates into the right and left branches, which carry the deoxygenated venous blood to the lungs.)
Which blood vessel(s) is/are responsible for carrying the deoxygenated blood away from the heart?
A) Pulmonary artery
B) Pulmonary veins
C) Mediastinal arteries
D) Pericardial veins
c ( The leaflets of the tricuspid and mitral valves are anchored by chordae tendineae to the papillary muscles, which are embedded in the ventricular floor.)
The leaflets of the tricuspid and mitral valves are anchored by __________________ to the _________________, which are embedded in the ventricular floor.
A) endocardial ligaments; mediastinal muscles
B) AV tendon of Todaro; pericardial bundles
C) chordae
c ( There are no valves between the right atrium and both the superior and inferior vena cava. In addition, there are no valves between the pulmonary veins and the left atrium.)
Which of the following structures of the heart are not separated by valves?
A) The left ventricle and the aorta
B) The left atrium and the left ventricle
C) The right atrium and the vena cava
D) The right ventricle and the pulmonary artery
c (During ventricular diastole, the ventricles relax and blood rapidly fills the ventricles.)
During ventricular diastole, which of the following activities takes place?
A) Blood is ejected from the ventricles.
B) Blood is emptied into the atria.
C) Blood pours rapidly into the ventricles.
D) Blood travels from the atria to the pulmonary circulati
a ( During isometric or isovolumic relaxation of the ventricles, all four heart valves are closed for a very brief moment.)
During isometric or isovolumic relaxation of the ventricles, which of the following takes place?
A) All four valves are closed.
B) Pulmonary circulation occurs.
C) The atria and ventricles fill with blood simultaneously.
D) The volume of blood on the righ
b ( A diastolic murmur always indicates heart disease.)
Which of the following statements is true regarding murmurs?
A) All systolic murmurs are generally considered functional or innocent.
B) Diastolic murmurs always indicate heart disease.
C) A murmur graded V can be heard with the stethoscope that is lifted
b (During inspiration, intrathoracic pressure is decreased. This pushes more blood into the vena cava, increasing venous return to the right side of the heart, which increases right ventricular stroke volume. The increased volume prolongs right ventricula
During inspiration, intrathoracic pressure is decreased and causes which of the following to occur?
A) An increase in blood return to the left side of the heart
B) An increase in blood return to the right side of the heart
C) A greater pressure is needed
b (Automaticity in the heart is the unique ability to contract by itself, independent of any signals or stimulation from the body.)
The ability of the heart to contract independently of any signals or stimulation is due to which of the following characteristics?
A) Autonomy
B) Automaticity
C) Autocracy
D) Authenticity
c (The acronym ECG stands for the term electrocardiogram.)
ECG is an abbreviation for which of the following?
A) Electroconductogram
B) Echoconductogram
C) Electrocardiogram
D) Eclecticardiogram
d (The ability of the heart to increase cardiac output is affected by preload and afterload.)
The ability of the heart to increase cardiac output is affected by:
A) preload and postload.
B) frontload and afterload.
C) foreload and hindload.
D) preload and afterload.
c (Blood is rerouted in the fetal heart by the ductus arteriosus.)
In the fetal circulation, which of the following structures is responsible for rerouting the blood in the heart?
A) Ductus venosus
B) Foramen ellipse
C) Ductus arteriosus
D) Foramen mitrale
c ( Peripheral vasodilation in pregnancy causes a decrease in arterial blood pressure despite the increased cardiac output associated with this condition.)
Mrs. Green is 30 years old and pregnant. She comes to the office during the second trimester for a routine follow-up health assessment. As the health care provider, which of the following does not increase in the pregnant woman?
A) Heart rate
B) Blood vol
b (Paroxysmal nocturnal dyspnea (PND) occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep with the perception o
Mr. Noble is a 57-year-old patient who comes to the ambulatory health center, describing symptoms that include waking up in the middle of the night with difficulty breathing and then opening a window because he felt a need for fresh air. Your assessment m
c (Hemoptysis (coughing up blood) is often caused by a pulmonary disorder and can also occur with mitral stenosis, not coronary artery disease. (CAD))
Mr. James is a 48-year-old patient who comes to the clinic for a cardiac risk assessment. Which of the following is not considered a risk factor for the development of CAD?
A) Smoking
B) Elevated blood pressure
C) Hemoptysis
D) Obesity
b (The apical impulse, palpable in most people, is normally at the fifth intercostal space, 7 to 9 cm from the midsternal line. However, you may need to roll the person midway to the left to find it; note that this also displaces the apical impulse farthe
Mrs. Whitlock is a 45-year-old patient who comes to the health center for a cardiac health assessment. On examination, which of the following maneuvers will you possibly have to perform to palpate the apical impulse?
A) Have the individual inhale deeply a
c (Left ventricular dilatation (volume overload) displaces the impulse down and to the left, and increases size more than one space.)
Displacement of the apical impulse down and toward the left, with an increased size that occupies more than one interspace, occurs with:
A) left ventricular hypertrophy without dilatation.
B) pulmonary emphysema.
C) left ventricular dilatation.
D) left at
c (S1 coincides with the carotid artery pulse. Feel the carotid gently as you auscultate at the apex; the sound you hear as you feel each pulse is S1.)
Which of the following guidelines may be used to identify which heart sound is S1?
A) S1 is louder than S2 at the base of the heart.
B) S1 coincides with the A wave of the jugular venous pulse wave.
C) S1 coincides with the carotid artery pulse.
D) S1 coi
a (A fixed split is unaffected by respiration; the split is always there.)
Ms. Kelson is a 26-year-old patient who comes to the clinic for a routine health assessment. On examination, you note a fixed split. Which of the following is a characteristic of this finding?
A) It is unaffected by respiration.
B) It generally only occur
a (S3 and S4, and the murmur of mitral stenosis sometimes may be heard only when on the left side.)
Which of the following is an appropriate position to have the patient assume when auscultating the heart sounds?
A) Rolled toward the left side
B) Rolled toward the right side
C) Trendelenburg position
D) Recumbent position
b (Cyanosis at or just after birth signals oxygen desaturation of congenital heart disease.)
Cyanosis in the infant is of greatest significance when it occurs:
A) after 2 hours of life.
B) at or just after delivery.
C) in the presence of an audible murmur.
D) in the presence of an increased heart rate.
d (The S3 is found in high cardiac output states in the absence of heart disease, such as pregnancy. When the primary condition is corrected, the gallop disappears.)
An increase in blood volume and workload in the pregnant woman results in the development of:
A) orthostatic hypotension.
B) a venous hum.
C) a sustained rise of 30 mm Hg or greater in the systolic blood pressure.
D) a loud and easily heard S3.
c ( The pulmonary veins return oxygenated blood to the left atrium.)
In regard to blood circulation, which of the following is a correct statement?
A) The inferior and superior pulmonary arteries return oxygenated blood to the left side of the heart.
B) The pulmonary veins return unoxygenated blood to the left atrium.
C) T
b (The heart wall has numerous layers. The pericardium is a tough, fibrous, double-walled sac that surrounds and protects the heart. The myocardium is the muscular wall of the heart; it does the pumping. The endocardium is the thin layer of endothelial ti
The heart wall is made up of three layers of muscle that are identified as the:
A) myocardium, endocardium, and precardium.
B) pericardium, myocardium, and endocardium.
C) mesocardium, endocardium, and pericardium.
D) myocardium, ectocardium, and endocard
c (The semilunar (SL) valves are set between the ventricles and the arteries.)
The semilunar valves separate the:
A) atria from the ventricles.
B) right atria from the left atria.
C) ventricles from the arteries.
D) atria from the veins.
a (The blood flows from an area of higher pressure to one of lower pressure and is kept moving along by continually shifting pressure gradients.)
Which of the following principles governs the direction of blood flow?
A) Blood flows from an area of high pressure to an area of low pressure.
B) Blood flows from an unoxygenated area into an oxygenated area.
C) Blood flows from a superior position to an
b (The closure of the AV valves contributes to the first heart sound.)
The first heart sound is caused by closure of the:
A) semilunar valves.
B) AV valves.
C) right-sided valves.
D) left-sided valves.
b (A split S2 is directly related to the effects of respiration and changes in intrathoracic pressure.)
Which of the following heart sounds is directly related to the effects of respiration and changes in intrathoracic pressure?
A) A split S1
B) A split S2
C) An S3
D) An S4
b (All heart sounds are described by frequency (pitch), intensity (loudness), duration, and timing.)
Characteristics of sound that are used to describe heart sounds include which of the following?
A) Frequency, intensity, and quality
B) Duration, frequency, intensity, and timing
C) Timing, synchrony, intensity, and strength
D) Duration, tone, frequency,
c (Automaticity is the heart's unique ability to independently contract and pump blood.)
The unique characteristic of the heart is its ability to independently contract and pump blood, which is identified as:
A) depolarization.
B) conduction.
C) automaticity.
D) syncopation.
d (The QRS complex of the ECG represents depolarization of the ventricles.)
The QRS complex of the ECG represents:
A) atrial depolarization.
B) an impulse passing through the AV node.
C) ventricular repolarization.
D) ventricular depolarization.
c (Cardiac output equals the volume of blood in each systole (called the stroke volume) times the number of beats per minute (rate).)
The cardiac output is defined as the:
A) ability of the heart to pump blood.
B) amount of blood ejected with each contraction.
C) amount of blood pumped by the heart in 1 minute.
D) amount of blood returned to the heart.
b (The jugular pulse results from a backwash, a waveform moving backward caused by events upstream.)
Which of the following is true regarding the venous pulse wave?
A) It is characterized by a rapid upstroke and a gradual downstroke with a dicrotic notch.
B) It results from a backwash of pressure from events that occur in the heart.
C) Its timing closely
a (Blood in the fetal circulation is shunted around the lungs by way of the foramen ovale and ductus arteriosus.)
Blood in the fetal circulation is shunted around the lungs by way of two bypasses, which are identified as the:
A) foramen ovale and ductus arteriosus.
B) placenta and umbilicus arteriosus.
C) foramen magnum and ductus venosus.
D) ductus arteriosus and fo
b (Peripheral vasodilation in pregnancy causes a decrease in arterial blood pressure despite the increased cardiac output (from the increased blood volume) associated with this condition.)
Which of the following cardiac alterations occurs in the pregnant woman?
A) An increase in cardiac output and blood pressure
B) An increase in cardiac volume and a decrease in blood pressure
C) An increased heart rate and increased blood pressure
D) An in
b (Between the ages of 60 and 80 years, the systolic blood pressure rises due to stiffening of the large arteries which, in turn, is due to calcification of vessel walls (arteriosclerosis). This stiffening creates an increase in pulse wave velocity becaus
As individuals age, the arterial walls become stiffer and less compliant. Which of the following can be attributed to this age-related change?
A) Decreased cardiac output
B) Rising systolic blood pressure
C) Decreasing diastolic blood pressure
D) Decrease
d (Blacks have a higher incidence of hypertension than other racial groups, at 42.6% for men and 46.6% for women.)
Studies have shown that individuals in which of the following ethnic groups are most likely to have high blood pressure?
A) Native Americans
B) Japanese
C) Whites
D) Blacks
c (Recumbency at night promotes fluid reabsorption and excretion (nocturia), which occurs with heart failure in the person who is ambulatory during the day.)
Mr. Walker, who is 56 years of age, goes to the clinic for a follow-up examination. While you take his health history, he indicates that he has just begun to notice the need to get up in the middle of the night to urinate. This causes you concern because
b (A bruit indicates turbulence due to a local vascular cause, such as atherosclerotic narrowing.)
Mrs. Branson is a 65-year-old patient who comes to your office for a follow-up health assessment after being discharged from the emergency department. On examination, you hear a bruit while auscultating the carotid artery. This is caused by which of the f
c (The apical impulse is palpable in about half of adults. It is not palpable in obese persons or in persons with thick chest walls, like a body builder.)
Mr. Kleiner is a 24-year-old body builder who comes to the clinic for a health assessment. When palpating the chest wall, you note that he has well-developed chest muscles. Because of this, which of the following would you expect to find?
A) Precordial he
d (The sound radiates with the direction of blood flow.)
Which of the following statements regarding the sound produced by heart valves is true?
A) Heart valve sounds are best heard over the exact anatomic location of the valves.
B) The intensity of the sound produced is directly related to the stroke volume.
C
a (S2 is louder at the base than S1 (option a). Option b is incorrect, as S1, not S2, coincides with the carotid artery pulse. Option c is incorrect, as S1 is louder at the apex. Option d is incorrect, as S1 coincides with the R wave on the ECG.)
Mrs. Brown is a 43-year-old patient who goes to the emergency room with complaints of chest pain. When auscultating the heart, which of the following guidelines may be used to identify S2?
A) S2 is louder at the base than S1.
B) S2 coincides with the caro
b (The closure of the AV valves contributes to the first heart sound (S1) and signals the beginning of systole.)
The first heart sound is produced by:
A) closure of the semilunar valves.
B) closure of the AV valves.
C) opening of the semilunar valves.
D) opening of the AV valves.
c (A split S2 is a normal phenomenon that occurs toward the end of inspiration in some people.)
Mr. Jones is a 46-year-old patient who comes to your office for a follow-up health assessment after his hospitalization. On examination, you note a split S2. A split S2 heart sound is generally best heard:
A) when the individual is holding his/her breath.