NR302 EXAM 3 STUDY GUIDE HEALTH ASSESSMENT I WITH
COMPLETE SOLUTION 2026
1
Chapter 19 Heart
and Neck Vessels
Position and Surface
Landmarks
o Precordium: area on anterior chest overlying heart and great vessels
o During contraction, apex beats against chest wall, producing an apical impulse
o Heart has four chambers: atria and ventricles
o Great vessels lie bunched above base of heart
o Pulmonary veins return freshly oxygenated blood to left side of
heart, and aorta carries it out to body
Heart Wall, Chambers, and Valves
o Heart wall has numerous layers
➢ Pericardium: tough, fibrous, double-walled sac that
surrounds and protects heart
➢ Myocardium: muscular wall of heart; it does pumping
➢ Endocardium: thin layer of endothelial tissue that lines
inner surface of heart chambers and valves
o Heart has two pump systems
o Each side of the heart has an atrium and ventricle
➢ Atrium: thin-walled reservoir for holding blood
➢ Ventricle: thick-walled, muscular pumping chamber
➢ Heart Chambers and Valves
o Four chambers separated by valves, whose main purpose is to prevent
backflow of blood
➢ Valves are unidirectional: can only open one way
➢ Valves open and close passively in response to pressure
gradients in moving blood
o Four valves in heart
➢ Two atrioventricular (AV) valves
➢ Two semilunar (SL) valves
AV Valves
o Two AV valves separate atria and ventricles
➢ Tricuspid valve: right AV valve
➢ Bicuspid, or mitral valve: left AV valve
• Valves’ thin leaflets are anchored by collagenous
fibers (chordae tendineae) to papillary muscles
, embedded in ventricle floor
➢ AV valves open during heart’s filling phase, or diastole, to
allow ventricles to fill with blood
➢ During pumping phase, or systole, AV valves close to
prevent regurgitation of blood back up into atria
SL Valves
o SL valves are set between ventricles and arteries
➢ Each valve has three cusps that look like half moons
➢ Pulmonic valve: SL valve in right side of heart
➢ Aortic valve: SL valve in left side of heart
, 2
• Open during pumping, or systole, to allow blood to
be ejected from heart
➢ No valves are present between vena cava and right
atrium, or between pulmonary veins and left atrium,
for this reason
• Abnormally high pressure in left side of heart gives a
person symptoms of pulmonary congestion
• Abnormally high pressure in right side of heart shows
in neck veins and abdomen
• Chambers and Valves
Direction of Blood Flow I
Unoxygenated red blood drains into vena cava, follows route of venous blood
o From liver to right atrium (RA) through inferior vena cava
➢ Superior vena cava drains venous blood from the head and upper
extremities
➢ From RA, venous blood travels through tricuspid valve to right ventricle
(RV)
o From RV, venous blood flows through pulmonic valve to pulmonary artery
➢ Pulmonary artery delivers unoxygenated blood to lungs
Direction of Blood Flow II
➢ Lungs oxygenate blood
• Pulmonary veins return fresh blood to LA
➢ From LA, arterial blood travels through mitral valve to LV
• LV ejects blood through aortic valve into aorta
➢ Aorta delivers oxygenated blood to body
o Circulation is continuous loop; blood is kept moving by
continually shifting pressure gradients
➢ Blood flows from area of higher pressure to area of lower pressure
Cardiac Cycle
o Rhythmic flow of blood through heart is cardiac cycle
➢ Has two phases, diastole and systole
➢ Diastole: ventricles relax and fill with blood; this takes up
two thirds of cardiac cycle
➢ Systole: heart’s contraction, blood pumped from ventricles
fills pulmonary and systemic arteries; this is one third of
cardiac cycle
Cardiac Cycle: Diastole
➢ Ventricles relaxed, and AV valves, tricuspid and mitral, are
open; opening of normal valve is silent
➢ Pressure in atria higher than that in ventricles, so blood
, pours rapidly into ventricles
• This first passive filling phase called protodiastolic filling
➢ Toward end of diastole, atria contract and push last
amount of blood into ventricles
• This active filling phase called presystole, or atrial systole
o Note that atrial systole occurs during ventricular diastole, a
confusing but important point
COMPLETE SOLUTION 2026
1
Chapter 19 Heart
and Neck Vessels
Position and Surface
Landmarks
o Precordium: area on anterior chest overlying heart and great vessels
o During contraction, apex beats against chest wall, producing an apical impulse
o Heart has four chambers: atria and ventricles
o Great vessels lie bunched above base of heart
o Pulmonary veins return freshly oxygenated blood to left side of
heart, and aorta carries it out to body
Heart Wall, Chambers, and Valves
o Heart wall has numerous layers
➢ Pericardium: tough, fibrous, double-walled sac that
surrounds and protects heart
➢ Myocardium: muscular wall of heart; it does pumping
➢ Endocardium: thin layer of endothelial tissue that lines
inner surface of heart chambers and valves
o Heart has two pump systems
o Each side of the heart has an atrium and ventricle
➢ Atrium: thin-walled reservoir for holding blood
➢ Ventricle: thick-walled, muscular pumping chamber
➢ Heart Chambers and Valves
o Four chambers separated by valves, whose main purpose is to prevent
backflow of blood
➢ Valves are unidirectional: can only open one way
➢ Valves open and close passively in response to pressure
gradients in moving blood
o Four valves in heart
➢ Two atrioventricular (AV) valves
➢ Two semilunar (SL) valves
AV Valves
o Two AV valves separate atria and ventricles
➢ Tricuspid valve: right AV valve
➢ Bicuspid, or mitral valve: left AV valve
• Valves’ thin leaflets are anchored by collagenous
fibers (chordae tendineae) to papillary muscles
, embedded in ventricle floor
➢ AV valves open during heart’s filling phase, or diastole, to
allow ventricles to fill with blood
➢ During pumping phase, or systole, AV valves close to
prevent regurgitation of blood back up into atria
SL Valves
o SL valves are set between ventricles and arteries
➢ Each valve has three cusps that look like half moons
➢ Pulmonic valve: SL valve in right side of heart
➢ Aortic valve: SL valve in left side of heart
, 2
• Open during pumping, or systole, to allow blood to
be ejected from heart
➢ No valves are present between vena cava and right
atrium, or between pulmonary veins and left atrium,
for this reason
• Abnormally high pressure in left side of heart gives a
person symptoms of pulmonary congestion
• Abnormally high pressure in right side of heart shows
in neck veins and abdomen
• Chambers and Valves
Direction of Blood Flow I
Unoxygenated red blood drains into vena cava, follows route of venous blood
o From liver to right atrium (RA) through inferior vena cava
➢ Superior vena cava drains venous blood from the head and upper
extremities
➢ From RA, venous blood travels through tricuspid valve to right ventricle
(RV)
o From RV, venous blood flows through pulmonic valve to pulmonary artery
➢ Pulmonary artery delivers unoxygenated blood to lungs
Direction of Blood Flow II
➢ Lungs oxygenate blood
• Pulmonary veins return fresh blood to LA
➢ From LA, arterial blood travels through mitral valve to LV
• LV ejects blood through aortic valve into aorta
➢ Aorta delivers oxygenated blood to body
o Circulation is continuous loop; blood is kept moving by
continually shifting pressure gradients
➢ Blood flows from area of higher pressure to area of lower pressure
Cardiac Cycle
o Rhythmic flow of blood through heart is cardiac cycle
➢ Has two phases, diastole and systole
➢ Diastole: ventricles relax and fill with blood; this takes up
two thirds of cardiac cycle
➢ Systole: heart’s contraction, blood pumped from ventricles
fills pulmonary and systemic arteries; this is one third of
cardiac cycle
Cardiac Cycle: Diastole
➢ Ventricles relaxed, and AV valves, tricuspid and mitral, are
open; opening of normal valve is silent
➢ Pressure in atria higher than that in ventricles, so blood
, pours rapidly into ventricles
• This first passive filling phase called protodiastolic filling
➢ Toward end of diastole, atria contract and push last
amount of blood into ventricles
• This active filling phase called presystole, or atrial systole
o Note that atrial systole occurs during ventricular diastole, a
confusing but important point
