Quiz 4 V2: NURS190 / NURS 190 (Latest 2026 / 2027 Update) Physical Assessment | Questions & Answers | Grade A | 100% Correct – WCU

Quiz 4 V2: NURS190 / NURS 190 (Latest 2026 / 2027 Update) Physical Assessment | Questions & Answers | Grade A | 100% Correct – WCU Q: What are the two atrioventricular valves? Answer Tricuspid and Mitral Q: What are the two semilunar valves? Answer pulmonic and aortic Q: What is the period between AV valves closing and semilunar valves closing- ejection of blood, blood pushed out Answer Systole Q: What is the relaxing, filling period of blood Answer Diastole Q: In what part of the mechanical cycle of the heart does ventricular depolarization (contracting) happen? Answer QRS complex Q: In what part of the mechanical cycle of the heart does atrial depolarization (atria are contracting) happen? Answer P wave Q: In what part of the mechanical cycle of the heart does repolarizing (refilling with blood) happen? Answer T wave Q: What structure of the heart closes and makes the S1 (lub) sound? Answer AV valves Q: What structure of the heart closes and makes the S2 (dub) sound? Answer SL valves Q: What assessment tool is needed to assess JVD? Answer penlight Q: I we are unable to palpate a pulse, what assessment too do we need to use? Answer doppler, place tip at 90 degrees Q: What is the best angle for the patient for a cardiovascular assessment? Answer 30-40 degrees Q: What are we looking for when inspecting neck vessels? Answer tone, symmetry, veins, pulsations Q: What are we looking for when inspecting the anterior chest? Answer symmetry, pulsations Q: What are we looking for when inspecting the extremities? Answer skin tone, symmetry of size, hair, texture, fingernails Q: What are we looking for when palpating the carotid arteries? Answer individually for strength Q: What are we looking for when palpating the anterior chest? Answer advanced provider skill looking for PMI, lifts, heaves, thrills Q: What are we looking for when palpating the skin? Answer temp, texture, turgor, moisture, cap refill, edema, arterial pulses Q: What are we looking for when palpating the pulses? Answer rate, rhythm, strength Q: What are we looking for when auscultating the heart sounds? Answer Rate, rhythm, & pitch of apical pulse Q: When assessing the JVD what angle should the clients head be leaned back? Answer 45 degree Q: Presence of extended JVD is a good indication of Answer Fluid volume excess Q: What auscultation point is located on the right of the sternal border in the second intercostal space Answer Aortic Q: What auscultation point is located on the left of the sternal border in the second intercostal space? Answer pulmonic Q: What auscultation point is located on the right of the sternal border in the third intercostal space? Answer Erb's point Q: What auscultation point is located on the left of the sternal border in the fourth intercostal space? Answer tricuspid Q: What auscultation point is located midclavicular on the left side of the chest in the fifth intercostal space? Answer Mitral Q: What as a yellowish cholesterol deposit on the eyelids, that can indicate premature atherosclerosis Answer Xanthelasma Q: 1+ pitting edema= Answer 2mm Q: 2+ pitting edema= Answer 4mm 3+ pitting edema= Answer 6mm 4+ pitting edema= Answer 8mm What are the 5 hallmark signs of a DVT? Answer Unilateral Erythema Edema Warm hot to touch Tenderness/ Pain What is the widening/ballooning of the arterial walls? Answer aneurysm What is a dilated vein that causes abnormal blood flow? Varicose veins What type of ulcer is located around the ankle (medial or lateral) has an irregular wound border, the wound bed is usually pink, no report of pain at rest, and pulses are present? Venous What type of ulcer is located at a more distal part of the extremities (toes), the wound bed is necrosed, the patient reports pain and pedal pulses are absent? Arterial Blood Pressure, glucose & cholesterol tests should be monitored every year How much exercise and how many times a week should patients be exercising? 150 minutes/wk moderate activity, muscle strengthening 2x/wk Why is it important to use stress reduction techniques? prevent the release of chemicals leading to heart disease, HTN, improve sleep, decrease anxiety What dietary changes are needed to reduce heart and vascular disease? Increase fruits, vegetables, whole grains, & low-fat dairy products & meats Limit fats, sugar, carbs, sodium What is an expected variation for a cardiovascular assessment? murmur in children, S3 sound S3 sound= ventricular gallop S4 sound= atrial gallop (unexpected finding) precordium area of the chest where you listen to heart sounds what occurs when cardiac valves are pathologic? forward blood flow becomes restricted, results in regurgitation and cardiac murmurs. cardiac murmurs (5) associated with the following: tricuspid regurgitation tricuspid stenosis mitral regurgitation mitral stenosis aortic regurgitation cardiac murmur grading can be graded 1-6 grade 1/6 being barely audible grade 6-6 being loudest sound heard S1 heart sound aka "lub" sound first heartbeat heard d/t closure of the tricuspid/mitral valves this is when ventricles are filled w/ blood atrioventricular valves aka mitral (left) and tricuspid (right) valves valves between atria and ventricles where is S1 loudest? at the apex (bottom) of the heart S2 heart sound aka "dub" 2nd heartbeat d/t closure of semilunar valves occurs when ventricles empty blood to pulmonic arteries and aorta (rest of periphery) semilunar valves pulmonic artery valves aortic valve where is S2 heard loudest? at the base of the heart (aka top of the heart) interatrial septum separates left and right atrium interventricular septum separates right and left ventricles pulse grading graded 0-4+ 0 = no pulse 1+ = weak and thready 2+ = normal 3+ = brisk 4+ = bounding 5 landmarks of the heart aortic landmark pulmonic landmark Erb's point tricuspid landmark mitral landmark aortic landmark 2nd ICS right sternal border S2 S1 pulmonic landmark 2nd ICS left sternal border S2 S1 Erb's point 3rd ICS left sternal border S1 = S2 tricuspid landmark 4th ICS left sternal border S1 S2 mitral landmark 5th ICS left midclavicular line apex of the heart S1 S2 5 major risk factors of heart diseases hypertension smoking obesity diabetes high cholesterol 4 mechanisms to interpret heart sounds? pitch duration intensity phase sympathetic cardiac nerves responsible for stimulation of the heart increases HR increases dilation of coronary arteries parasympathetic cardiac nerves responsible for decreases stimulation of heart decreases HR decreases dilation of the coronary arteries does opposite of sympathetic point of maximum impulse (PMI) in adults heard loudest in the 5th ICS, left midclavicular line can be palpated and auscultated PMI in infants loudest in the 4th ICS d/t infants' hearts being horizontally positioned newborn HR very rapid at birth 160-180 bpm reduces 6-8 hrs. after birth to 112-120 bpm anticipated sound on percussion of the heart dull sound normal BP 120/80 mmHg prehypertension Systolic: 120-139 Diastolic: 80-89 hypertension 140/90 or above racial group w/ highest incidence of hypertension African Americans 6 pulse locations dorsalis pedis popliteal femoral posterior tibialis radial ulnar dorsalis pedis top of feet lateral to big toe popliteal pulse behind the knees, medially femoral pulse inguinal area radial pulse lateral wrists, in line w/ thumb ulnar pulse medial to wrists, in line with the small fingers ECG electrical representation of cardiac cycles documented by deflection on recording paper electrical ionization of the heart aka the start of the heart occurs in the SA node SA node pacemaker of the heart fires 60-100 joules/min. (the same as adult HR [60-100 bpm]) AV node fires at 60 joules/min. bundle branches fires at 40-60 joules/min. cardiac depolarization occurs when cardiac current from SA node spreads to the atria, causing contraction cardiac cells are positively charged depolarization contraction repolarization cardiac cells are relaxed cardiac cells are now negatively charged imbalance in electrolytes and their effect on the heart electrolytes: sodium, calcium, potassium can result in dysregulation of conduction system aka arrythmias P wave atrial depolarization atrial repolarization hidden behind PQRS complex QRS complex ventricular depolarization T wave ventricular repolarization (relaxation) ventricular fibrillation total absence of regular heart rhythm ventricular tachycardia rapid heartbeat HR is still regular bpm can be as high as 200 heart block slow HR as low as 20-40 bpm conduction between atria and ventricles is disrupted 8 s/sx of congestive heart failure 3 cm JVD at 45-degree angle low BP fatigue HR 120 bpm weak peripheral pulses S3 SOB ankle edema sign of severe aortic regurgitation patient's head will be bobbing at the same rhythm of their heart thin red lines on the nails aka splinters/hemorrhages indication of infective endocarditis arterial vs. venous insufficiency arterial = cold legs, lack of leg hair growth venous = warm legs, pain w/ prolonged sitting/standing Raynaud's syndrome fingers and hands have intermittent pallor, cyanosis, and rubor rubor redness Allen's test determines patency of the radial and ulnar pulses varicosities aka varicose veins don't disappear when legs are elevated 4 causes of JVD over 3 cm increased central venous pressure fluid volume overload pressure of the superior vena cava (SVC) smoking sex at higher risk for cardiovascular disease? males d/t smoking showing higher risk of disease use of cocaine attributed to hypertension, MI, and ruptured aorta S3 and S4 common comorbidities (4) MI congestive heart failure angina ventricular hypertrophy (more common in pts. w/ these comorbidities) S3 aka ventricular gallop occurs when a vibration in AV valve causes blood to go ventricles heard after S2 also heard in healthy children/young adults, and 3rd tri. pregnancy S4 aka atrial gallop occurs when atrial contraction is late to fill ventricles, causing late ventricular ejection. heard before S1 also heard in healthy children/elderly, fit ppl 4 defects of Tetralogy of Fallot dextroposition of the aorta pulmonary stenosis right ventricular hypertrophy ventricular septal defect patent foramen ovale passage between left and right atria should close shortly after birth sometimes doesn't, which can cause cardiac murmurs on auscultation patent ductus arteriosus opening between the pulmonary artery and descending aorta should close 24-48 hours after birth if it doesn't close, murmurs can be heard on auscultation number of heartbeats in 24 hours in adults 100,000 bpm examples of therapeutic communication (5) open-ended questions active listening leaning towards patient eye contact open posture examples of nontherapeutic communication (5) why questions giving opinion giving advice close-ended questions false reassurance S1 sound is __ sound lub S1 sound caused by AV valves closing S2 sound is ____ sound dub S2 sound caused by aortic and pulmonary semilunar valves closing atria is the filling of chambers ventricles cause pumping of the chambers vessels of the heart superior and inferior vena cava superior and inferior vena cava in charge of returning deoxygenated blood valves help control blood flow coronary = crown surrounding the heart S1 is ___ valves closing at ___ AV valves closing at the end of systole S2 is ____ valves closing at ____ SL valves closing at the end of systole mechanical and electrical = blood flow throughout the body CO = amount of blood pumped by the heart in 1 minute heart should pump_____ per minute 4-6 L/min flow of the heart Inferior/Superior vena cava right atrium tricuspid valve right ventricle pulmonary semi lunar valve pulmonary arteries (deox) lungs pulmonary veins left atrium mitral valve left ventricle aortic semi lunar valve aorta (oxy) the vascular system provides O2 and removes waste products arterial system is made of strong elastic fibers connection between arteries and veins capillaries venous system is low pressure valves contractions of skeletal muscle if you are unable to palpate pulse use doppler penlight used for JVD for cardiovascular and peripheral vascular assessment it is better to have the patient supine 30-40 degrees Heart sounds mnemonic APETM APETM Aortic Pulmonic Erb's point Tricuspid Mitral Aortic is in the right 2nd intercostal space pulmonic heart sound is in the. left 2nd intercostal spce erb's point is in the left 3rd intercostal space tricuspid heart sound is in the lower left sternal border 4th intercostal space mitral heart sound is in the left 5th intercostal space medial to the midclavicular line at the aortic point you can hear S2 dub at the pulmonic point you can hear S2 dub at erb's point you can hear S1 and S2 equally at the tricuspid point you can hear S1 lub at the mitral point you can hear S1 lub when auscultating heart sounds use the Z pattern diaphragm heart sounds are made by the closing of vavles Lub sound is the force of blood against closed AV valves Lub sound signifies beginning of systole Dub sound is the force of blood against semilunar valves Dub sound will ____ at the close at the beginning of ventricular diastole time between S1 and S2 is systole when contracting time between S2 and S1 is diastole when relaxing and filling Pulses can be scored on a scale of 0-4 0 pulse amplitude absent, unable to palpate +1 pulse amplitude weak thready diminished pulse +2 pulse amplitude normal brisk pulse +3 pulse amplitude increase strong pulse +4 pulse amplitude bounding full volume pulse S1 is best heard over the apex S2 is best heard over the base Expected variations: elderly be careful with palpation of palpation of carotid ---- syncope Expected variations: anterior chest no visualization of PMI in patients with obesity or very muscular Expected variations: S3 sounds in children adolescents pregnancy Expected variations: S3 sounds are aka ventricular gallop Expected variations: S3 sounds are due to vibration due to rapid filling of the ventricles due to a lot of blood volume Expected variations: S4 found in children athletes Expected variations: S4 caused by atrial contraction and ejection of blood into ventricles in late diastole S4 sounds aka atrial gallop Elderly can have _____ heart rhythms and irregular increase BP orthostatic hypotension Expected variations: hair hair can vary elderly less hairy unexpected findings: full bulging and bounding jugulars on 1 or both sides right sided HF unexpected findings: absence of pulsation in carotid artery decline in force of blood flow unexpected findings: bounding very strong pulse with carotid fluid overload unexpected findings: diminished weak pulse blockage narrowing of artery hypovolemia (Shock) unexpected findings: prominent forceful thrusting in PMI area lift or heave unexpected findings: abnormal HR or irregular rhythm heart disease valve malfunction unexpected findings: tachycardia bradycardia heart disease valve malfunction unexpected findings: extra heart sounds (clicks rubs murmurs S3 S4) heart disease valve malfunction unexpected findings: murmur regurgitation - backflow of blood into chambers stenosis - narrowed opening with valve unexpected findings: area of the heart is inflamed hear sandpaper scratching pericardial friction rub unexpected findings: asymmetry edema atrophy unexpected findings: pale or darker skin tone decline circulation cardiovascular condition unexpected findings: lack of ahir thin shiny skin thickened skin ulceration decreased circulation to extremity unexpected findings: dilated twisted veins weakened valve unexpected findings: nails are pale or blue low O2 levels unexpected findings: swelling at the nail base nail angle greater than 160 clubbing chronic O2 level low unexpected findings: skin tenting dehydration FVD unexpected findings: delayed cap refill decreased oxygenation and perfusion unexpected findings: excessively hot or cool temp texture rough or scaly circulation disorder unexpected findings: diaphoretic for no reason cardiac event HF unexpected findings: pulse absent weak bounding or asymmetrical bilaterally edema of the skin cardiac event HF xanthelasma yellowish cholesterol deposits on the eyelids can be premature atherosclerosis thrills are felt bruits are heard the nail should be at an angle of 160 clubbing the nail angle will be greater than 160 venous ulcer location medial or lateral ankle venous ulcer wound border irregular flat venous ulcer color pink venous ulcer edema ankle or leg venous ulcer ankle will be discolored venous ulcer pain? no pain at rest venous ulcer pedal pulses? present arterial ulcer location end of toes arterial ulcer wound border regular even arterial ulcer wound color pale arterial ulcer foot temp cool arterial ulcer hair loss? yes arterial ulcer pain? reported at rest arterial ulcer pedal pulses? absent with arterial ulcer blood is not reaching the toes health promotion cardiovascular exercise stress reduction dietary changes reduce ETOH tobacco cessation