Great cardiac vein Left atrium
Left coronary artery Left marginal artery Left ventricle Middle cardiac vein
Posterior descending artery Posterior vein
Pulmonary trunk Right atrium
Right coronary artery Right marginal artery Right ventricle Small cardiac vein Superior vena cava
a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
e. _____________________________________
f. _____________________________________
g. _____________________________________
h. _____________________________________
i. _____________________________________
j. _____________________________________
k. _____________________________________
l. _____________________________________
m. _____________________________________
n. _____________________________________
o. _____________________________________
p. _____________________________________
q. _____________________________________
r. _____________________________________
s. _____________________________________
t. _____________________________________
u. _____________________________________
v. _____________________________________
w. _____________________________________
x. _____________________________________
y. _____________________________________
z. _____________________________________
3. Which arteries are the major providers of coronary circulation (select all that apply)?
a. Left marginal artery b. Right marginal artery c. Left circumflex artery d. Right coronary artery e. Posterior descending artery f. Left anterior descending artery
4. Number in sequence the path of the action potential along the conduction system of the heart.
_____ a. Atrioventricular (AV) node _____ b. Purkinje fibers
_____ c. Internodal pathways _____ d. Bundle of His _____ e. Ventricular cells _____ f. Sinoatrial (SA) node _____ g. Right and left atrial cells _____ h. Right and left bundle branches
5. On the following illustration, locate and letter the following normal electrocardiographic (ECG) pattern deflections and indicate where to locate and measure the intervals.
P
PR interval Q
QRS interval QT interval R
S T U
a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
e. _____________________________________
f. _____________________________________
g. _____________________________________
h. _____________________________________
i. _____________________________________
6. Match the cardiac activity and time frames characteristic of the waveforms of the ECG (answers may be used more than once).
_____ a. Measured from beginning of P wave to beginning of QRS complex _____ b. Repolarization of the ventricles
_____ c. 0.12 to 0.20 sec _____ d. 0.16 sec
_____ e. Time of depolarization and repolarization of ventricles _____ f. <0.12 sec
_____ g. Depolarization from the AV node throughout ventricles _____ h. 0.06 to 0.12 sec
1. P wave 2. PR interval 3. QRS interval 4. T wave 5. QT interval
7. Indicate what factor of stroke volume (i.e., preload, afterload, or contractility) is primarily affected (i.e., increased or decreased) by the following situations and whether cardiac output (CO) is increased or decreased by the factor.
Situation Stroke Volume Factor Cardiac Output Valsalva maneuver
Venous dilation Hypertension
Administration of epinephrine Obstruction of pulmonary artery Hemorrhage
8. Which effects result from sympathetic nervous system stimulation of β-adrenergic receptors (select all that apply)?
a. Vasoconstriction b. Increased heart rate c. Decreased heart rate
d. Increased rate of impulse conduction e. Decreased rate of impulse conduction f. Increased force of cardiac contraction
9. What are the age-related physiologic changes that occur in the older adult that result in the following cardiovascular problems?
Cardiovascular Problem Physiologic Change Widened pulse pressure
Decreased cardiac reserve Increased cardiac dysrhythmias
Decreased response to sympathetic stimulation Aortic or mitral valve murmurs
10. What is a significant finding in the health history of a patient during an assessment of the cardiovascular system?
a. Metastatic cancer
b. Calcium supplementation c. Frequent viral pharyngitis
d. Frequent use of recreational drugs
11. Identify one specific finding identified by the nurse during assessment of each of the patient's functional health patterns that indicates a risk factor for cardiovascular disease or a patient response to an actual cardiovascular problem.
Functional Health Pattern Risk Factor for or Response to Cardiovascular Problem Health perception–health management
Nutritional-metabolic Elimination Activity-exercise Sleep-rest Cognitive-perceptual Self-perception–self-concept Role-relationship Sexuality-reproductive Coping–stress tolerance Value-belief
12. When palpating the patient's popliteal pulse, the nurse feels a vibration at the site. How should the nurse record this finding?
a. Thready, weak pulse b. Bruit at the artery site c. Bounding pulse volume d. Thrill of the popliteal artery
13. Locate the following points or locations that are inspected and palpated on the chest wall.
Angle of Louis Aortic area Erb's point
Mitral area (apex) and point of maximal impulse (PMI) Pulmonic area
Tricuspid area
a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
e. _____________________________________
f. _____________________________________
14. Indicate whether the following are characteristic of the first heart sound (S1) or the second heart sound (S2).
_____ a. Soft lub sound _____ b. Sharp dub sound
_____ c. Indicates beginning of systole _____ d. Indicates the onset of diastole _____ e. Loudest at pulmonic and aortic areas _____ f. Loudest at tricuspid and mitral areas
15. What can be auscultated in a patient with cardiac valve problems (select all that apply)?
a. Arterial bruit b. Heart murmurs c. Pulsus alternans d. Third heart sound (S3) e. Pericardial friction rub f. Fourth heart sound (S4)
16. The nursing student is seeking assistance in hearing the patient's abnormal heart sounds. What should the nurse tell the student to do for a more effective assessment?
a. Use the diaphragm of the stethoscope with the patient prone.
b. Use the diaphragm of the stethoscope with the patient supine.
c. Use the bell of the stethoscope with the patient leaning forward.
d. Use the bell of the stethoscope with the patient on the right side.
17. Which finding is associated with a blue tinge around the lips and conjunctiva?
a. Finger clubbing b. Central cyanosis c. Peripheral cyanosis
d. Delayed capillary filling time
18. A patient is scheduled for exercise nuclear imaging stress testing. The nurse explains to the patient that this test involves
a. IV administration of a radioisotope at the maximum heart rate during exercise to identify the heart's response to physical stress.
b. placement of electrodes inside the right-sided heart chambers through a vein to record the electrical activity of the heart directly.
c. exercising on a treadmill or stationary bicycle with continuous ECG monitoring to detect ischemic changes in the heart during exercise.
d. placement of a small transducer in four positions on the chest to record the direction and flow of blood through the heart by the reflection of sound waves.
19. Priority Decision: The nurse caring for a patient immediately following a transesophageal echocardiogram (TEE) should consider which action the highest priority?
a. Monitor the ECG.
b. Monitor pulse oximetry.
c. Assess vital signs (BP, HR, RR, temperature).
d. Maintain NPO status until gag reflex has returned.
20. Which method is used to evaluate the ECG responses to normal activity over a period of 1 or 2 days?
a. Serial ECGs b. Holter monitoring c. 6-minute walk test
d. Event monitor or loop recorder
21. When caring for a patient after a cardiac catheterization with coronary angiography, which finding should be of most concern to the nurse?
a. Swelling at the catheter insertion site
b. Development of raised wheals on the patient's trunk c. Absence of pulses distal to the catheter insertion site d. Patient pain at the insertion site at 4 on a scale of 0 to 10
22. A female patient has a total cholesterol level of 232 mg/dL (6.0 mmol/L) and a high-density lipoprotein (HDL) of 65 mg/dL (1.68 mmol/L). A male patient has a total cholesterol level of 200 mg/dL (5.172 mmol/L) and an HDL of 32 mg/dL (0.83 mmol/L). Based on these findings, which patient has the highest cardiac risk?
a. The man, because his HDL is lower b. The woman, because her HDL is higher c. The woman, because her cholesterol is higher
d. The man, because his cholesterol-to-HDL ratio is higher
23. Increases in which blood studies are diagnostic for acute coronary syndrome (ACS) (select all that apply)?
a. Copeptin
b. Creatine kinase (CK-MM) c. Cardiac troponin T (cTnT) d. B-type natriuretic peptide (BNP)
e. High-sensitivity C-reactive protein (hs-CRP) f. Lipoprotein-associated phospholipase A2 (Lp-PLA2)