Chapter 32: Nursing Assessment: Cardiovascular System

Chapter 32: Nursing Assessment: Cardiovascular System

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE
1. After noting a pulse deficit when assessing a patient who has just arrived in the
emergency department, the nurse will anticipate that the patient may require
a. a 2-D echocardiogram.
b. a cardiac catheterization.
c. hourly blood pressure (BP) checks.
d. electrocardiographic (ECG) monitoring.
ANS: D
Pulse deficit is a difference between simultaneously obtained apical and radial pulses and
indicates that there may be a cardiac dysrhythmia that would be detected with ECG
monitoring. Frequent BP monitoring, cardiac catheterization, and echocardiograms are
used for diagnosis of other cardiovascular disorders but would not be as helpful in
determining the immediate reason for the pulse deficit.
DIF: Cognitive Level: Application REF: 726 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
2. When reviewing the 12-lead electrocardiograph (ECG) for a healthy 86-year-old patient
who is having an annual physical examination, which of the following will be of most
concern to the nurse?
a. The heart rate (HR) is 43 beats/minute.
b. The PR interval is 0.21 seconds.
c. There is a right bundle-branch block.
d. The QRS duration is 0.13 seconds.
ANS: A
The resting HR does not change with aging, so the decrease in HR requires further
investigation. Bundle-branch block and slight increases in PR interval or QRS duration
are common in older individuals because of increases in conduction time through the AV
node, the bundle of His, and the bundle branches.
DIF: Cognitive Level: Application REF: 719-720
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
3. During a physical examination of a patient, the nurse palpates the point of maximal
impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The
most appropriate action for the nurse to take next will be to
a. document that the PMI is in the normal anatomic location.
b. ask the patient about risk factors for coronary artery disease.
Test Bank 32-2
c. auscultate both the carotid arteries for the presence of a bruit.
d. assess the patient for symptoms of left ventricular hypertrophy.
ANS: D
The PMI should be felt at the intersection of the 5th intercostal space and the left
midclavicular line. A PMI located outside these landmarks indicates possible cardiac
enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not
necessarily associated with coronary or carotid artery disease.
DIF: Cognitive Level: Application REF: 724 | 726
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
4. To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the
a. bell of the stethoscope with the patient in the left lateral position.
b. bell of the stethoscope with the patient sitting and leaning forward.
c. diaphragm of the stethoscope with the patient in a reclining position.
d. diaphragm of the stethoscope with the patient lying flat on the left side.
ANS: A
Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of
the stethoscope. Sounds associated with the mitral valve are accentuated by turning the
patient to the left side, which brings the heart closer to the chest wall. The diaphragm of
the stethoscope is best to use for the higher-pitched sounds such as S1 and S2.
DIF: Cognitive Level: Application REF: 726
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance