1. During systole, the ventricles contract. This causes
a. all four heart valves to close.
b. all four heart valves to open.
c. the atrioventricular (AV) valves to close and the semilunar valves to open.
d. the AV valves to open and the semilunar valves to close.
2. The normal pacemaker of the heart is the
a. sinoatrial (SA) node.
b. AV node.
c. bundle of His.
d. ventricles.
3. The pressure the ventricle must generate to overcome the higher pressure in the aorta refers to
a. stroke volume.
b. contractility.
c. preload.
d. afterload.
4. The layer of the heart responsible for contraction is the
a. myocardium.
c. endocardium.
b. pericardium.
d. epicardium.
5. When listening to heart sounds, you can best hear S1 at the
a. base of the heart.
b. apex of the heart.
c. aortic area.
d. second intercostal space to the right of the sternum.
6. You're auscultating for heart sounds in a 3-year-old girl and hear an S3. You assess the sound to be a
a. normal finding.
b. probable sign of heart failure.
c. possible sign of arterial septal defect.
d. probable sign of mitral stenosis.
7. When grading arterial pulses, a 1+ grade indicates
a. bounding pulse.
c. weak pulse.
b. increased pulse.
d. absent pulse.
8. When assessing a patient for jugular vein distension, you should position him
a. sitting upright.
b. lying flat on his back.
c. lying on his back, with the head of his bed elevated 30 to 45 degrees.
d. lying on his left side.
9. Capillary refill time is normally
a. 15 seconds.
b. 7 to 10 seconds.
c. 4 to 6 seconds.
d. 1 to 3 seconds.
10. Which test provides the best means of standardizing measurement of prothrombin time (PT) to monitor oral anticoagulant therapy?
a. plasma thrombin time
b. International Normalized Ratio (INR)
c. partial thromboplastin time
d. activated bleeding time
11. The test that's most specific for myocardial damage is
a. CK.
c. troponin I.
b. CK-MB.
d. myoglobin.
12. Serial serum cardiac markers are monitored in the patient with chest pain for which reason?
a. Cardiac markers help determine if cardiac damage is occurring.
b. Cardiac markers help identify the area of myocardial damage.
c. Decreasing cardiac marker levels help clinicians estimate the recovery time for the patient with myocardial damage.
d. Cardiac marker results reveal whether the patient is truly having chest pain.
13. Transesophageal echocardiography (TEE) combines ultrasonography with which other procedure?
a. electrocardiography
b. endoscopic retrograde cholangiopancreatography
c. endoscopy
d. sigmoidoscopy
14. A noninvasive method of evaluating blood flow is
a. Doppler ultrasonography.
b. venography.
c. angiography.
d. cardiac catheterization.
15. What's an important teaching point for the patient receiving a heart transplant?
a. He'll need to stay indoors during the winter months.
b. He'll need to take immunosuppressants for at least 6 months following surgery.
c. He'll be at risk for life-threatening infections because of the medications he'll be taking.
d. After 6 weeks, he'll no longer be at risk for rejection.
16. For a patient with symptomatic bradycardia, appropriate nursing interventions include establishing I.V. access to administer
a. atropine.
b. anticoagulants.
c. a calcium channel blocker.
d. digoxin.
17. The treatment of choice for a patient with ventricular fibrillation is
a. defibrillation.
b. transesophageal pacing.
c. synchronized cardioversion.
d. digoxin administration.
18. In second-degree AV block type I, the PR interval
a. varies according to the ventricular response rate.
b. progressively lengthens until a QRS complex is dropped.
c. remains constant despite an irregular ventricular rhythm.
d. can't be determined.
19. In atrial flutter, the key consideration in determining treatment is the
a. atrial rate.
b. ventricular rate.
c. configuration of the flutter waves.
d. PR interval.
20. Vegetation on the heart valve results from
a. bacterial invasion.
c. hypertension.
b. poor diet.
d. diabetes mellitus.
21. Chest pain is described as pleuritic when it
a. resolves with sublingual nitroglycerin.
b. occurs only during sleep.
c. increases with deep inspiration and decreases with expiration.
d. resolves with a deep breath.
Answers
1. cRationale: During systole, the pressure is greater in the ventricles than in the atria, causing the AV valves (the tricuspid and mitral valves) to close. The pressure in the ventricles is also greater than the pressure in the aorta and pulmonary artery, forcing the semilunar valves (the pulmonic and aortic valves) to open.
2. aRationale: Normally, the SA node is the heart's pacemaker, generating 60 to 100 impulses/minute. The AV node is the heart's secondary pacemaker (40 to 60 beats/minute). The ventricles are the last line of defense (20 to 40 beats/minute).
3. dRationale: Afterload is the pressure the ventricle must generate to overcome the higher pressure in the aorta to eject blood out of the heart.
4. aRationale: The myocardium has specialized cardiac muscle cells that not only contract but also transmit action potentials.
5. bRationale: S1 is best heard at the apex of the heart.
6. aRationale: Although an S3 can indicate heart failure in an adult, it's normal in a child.
7. cRationale: A 1+ pulse indicates weak pulses and can be associated with diminished cardiac perfusion.
8. cRationale: Assess jugular vein distension with the patient in semi-Fowler's position (head of the bed elevated 30 to 45 degrees). If he lies flat, his veins will be more distended; if he sits upright, his veins will be flat.
9. dRationale: Capillary refill time that lasts longer than 3 seconds is considered delayed and indicates decreased perfusion.
10. bRationale: The INR is the best means of standardized measurement of PT to monitor anticoagulant therapy.
11. cRationale: Troponin I is found only in the myocardium; it's more specific to myocardial damage than the other choices.
12. aRationale: Serial serum cardiac markers help indicate whether cardiac damage is occurring.
13. cRationale: In TEE, ultrasonography is combined with endoscopy to provide a better view of the heart's structures.
14. aRationale: Doppler ultrasonography evaluates blood flow in the arms' and legs' major blood vessels and in the extracranial cerebrovascular system using a handheld transducer.
15. cRationale: After a heart transplant, the patient is treated with potent immunosuppressants. The resulting immunosuppression puts him at risk for life-threatening infection.
16. aRationale: Atropine is standard drug therapy for symptomatic bradycardia.
17. aRationale: Patients with ventricular fibrillation are in cardiac arrest and require defibrillation.
18. bRationale: Progressive lengthening of the PR interval creates an irregular ventricular rhythm with a repeating pattern of groups of QRS complexes. Those groups are followed by a dropped beat in which the P wave isn't followed by a QRS complex.
19. bRationale: If the ventricular rate is too fast or too slow, cardiac output will be compromised. A rapid ventricular rate may require immediate cardioversion.
20. aRationale: Bacterial invasion produces vegetative growths on the heart valves. These growths may embolize to the spleen, kidneys, central nervous system, extremities, and lungs.
21. cRationale: Pleuritic pain increases with deep inspiration and decreases with expiration.
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