Quiz 4 V1: NURS190 / NURS 190 (Latest 2026 / 2027 Update) Physical Assessment | Questions & Answers | Grade A | 100% Correct – WCU

Quiz 4 V1: NURS190 / NURS 190 (Latest 2026 / 2027 Update) Physical Assessment | Questions & Answers | Grade A | 100% Correct – WCU Q: What size is the heart? Answer length: 5" diameter: 3.5" thickness: 2.5" female heart is smaller and less in weight compared to male Q: What technique is used to measure heart rate? Answer auscultation & palpation Q: What is another name for PMI (point of maximal impulse)? Answer heartbeat Q: What way does the blood flow in a healthy individual? Answer unidirectionally Q: What sound is heard when blood back flows? Answer regurgitation/cardiac murmur Q: What is precordium? Answer area of the chest where the heart sounds are assessed Q: What is pericardium? Answer a double layered sac that encloses the heart Q: When cardiac valves are pathologic... Answer forward back flow is restricted resulting in regurgitation/cardiac murmurs Q: S1 (LUB) Answer 1st heartbeat heard due to the closure of the AV valves when ventricles are filled (loudest at the apex of the heart, heard better in tricuspid/mitral area) Q: S2 (DUB) Answer 2nd heartbeat heard due to the closure of the SEMILUNAR valves when ventricles empty blood to the pulmonic area and aorta (heard loudest at the base [top] of heart) Q: S3 Answer vibration when AV valves open and blood goes to the ventricles (ventricular gallop) (may be heard in HEALTHY children & adults, pregnant woman: 3rd trimester) Answer Q: S4 Answer atrial contraction and ejection of blood to the ventricles in late diastole (atrial gallop) (may be heard in HEALTHY children WELL FIT adult, & HEALTHY elderly) Q: Interatrial septum Answer separates the left and right atrium Q: Interventricular septum Answer separates the left and right ventricles Q: Heart sounds Answer 1+ faint 2+ normal 3+ brisk 4+ bounding Q: What are the cardiac murmurs associated with? Answer tricuspid regurgitation tricuspid stenosis mitral regurgitation mitral stenosis aortic regurgitation Q: How are cardiac murmurs graded? Answer 1/6 barely audible 6/6 loudest sound, thrills can be seen Q: What are the major risk factors of heart disease? Answer hypertension smoking diabetes obesity high cholesterol Q: How are the pitch sounds interpreted? Answer pitch duration intensity base Q: Where is the angle of louis? Answer in line with the second rib Q: What are the nerves that supplies the heart? Answer SYMPATHETIC NERVE: cardiac nerve responsible for increased stimulation of the heart, HR, & dilation of the coronary arteries PARASYMPATHETIC NERVE: cardiac nerve responsible for decreased stimulation of the heart, HR, & dilation of coronary arteries. Q: What is the heart rate of a newborn? Answer high/irregular, ranges from 160-180, gradually reduces to 112-120 after 6-8 hours after birth Q: What sounds are heard on percussion of the heart? Answer dullness Q: Blood pressure Answer normal: 120/80 prehypertension: 120/80-139/89 hypertension: 140/90+ (African Americans have higher incidents of hypertension) Q: Where does electrical initiation of the heart occur? Answer SA node: pacemaker of the heart, 60-100 j/min AV node: 60j/min Bundle Branches: 40-60j/min When does cardiac depolarization occur? Answer When a current SA node spreads across the atria causing cardiac contraction, + charged When does repolarization occur? Answer the cardiac cells are relaxed, - charged What imbalance of Na, Ca, K can result in? Answer dysregulation of cardiac conduction systems What is the P wave? Answer atrial depolarization (contraction) What is the QRS wave? Answer ventricular depolarization (contraction) What is the T wave? Answer ventricular repolarization (relaxation) What is ventricular fibrillation? Answer the total absence of regular heart rhythm What is ventricular tachycardia? Answer rhythm is rapid, regular heartbeat (as high as 200 bpm) What is heart block? Answer slow HR (20-40 bpm) conduction between the atria and ventricles are disrupted S&S of heart failure? Answer jugular vein pulsation over 3cm at 45 degrees, low BP, HR over 120/min, edema, SOB, presence of S3 What is severe aortic regurgitation? Answer synchronous head bobbing synchronous with heartbeat Findings for infective endocarditis? Answer thin red lines on the nail beds What is the difference between atrial and venous insufficiency? atrial: legs cold, no hair growth on legs venous: legs warm, pain from prolonged sitting or standing What is reynaud's syndrome? fingers and hands have intermittent skin pallor, cyanosis, numbness and tingling in hands What are varicosities? incompetent valves of the veins, do not disappear when legs are elevated What are the causes of JVD over 3 cm? increase in venous pressure, fluid overload, pressure at the vena cava female patients 65-74 yr have higher incidents of cardiovascular disease native americans under 35 yr have 2x more incidents of cardiovascular death What is the cocaine attributed to? hypertension, MI, ruptured aorta What are S3 and S4 more common in? patients with cardiac disease such MI, CHF, angina, ventricular hypertrophy What is the difference between foramen ovale and pectic ductus arteriosis? pectic ductus arteriosis: the pulmonary artery in descending aorta and should close 24-48 hrs after birth foramen ovale: passage of blood between right and left atria **if both don't close, cardiac murmurs can be heard on ausculation 70% of children will have innocent cardiac murmurs What is the heartbeat in 24 hrs? 100,000 bpm/24 hrs 60-100 bpm/min Pericardium Tougher outer layer (protects the heart & anchors it to the adjacent structures-diaphragm & great vessels) Myocardium thick, muscular layer (called the fibrous skeleton of the heart-Smoking leads to damage) Endocardium The inner most layer; provides an inner lining for the chambers of the heart. The health of the cardiovascular system gets promoted by means of self-care habits through the life span: Eating a low-fat diet, exercising & notsmoking! point of maximal impulse left 5th intercostal space midclavicular The Apex heartbeat more easily palpated here thus this point is referred as: -Apical impulse: It is the point of maximum impulse (intensity) (PMI) -Apical pulse heard the best here Left ventricle (LV) ▪Egg-shaped and most muscular chamber ▪Permits pumping of blood through aortic semilunar valve into aorta ▪The LV of a female has 10 % mass than that of a males systole contraction phase of the heartbeat Diastole relaxation phase of the heartbeat Valves of the heart Permit the flow of blood between chambers and into blood vessels Atrioventricular valves (AV) located between atria and ventricles -Tricuspid- separate the atrium from the ventricle (tricuspid lies between the R atrium & R ventricle) -Mitral (bicuspid)- It's thicker & separates the L atrium & L ventricle) (Its closure produces S1) Semilunar valves -Separates the ventricles from the vascular system -Pulmonary-valve separate the R ventricle from the trunk of pulmonary arteries -Aortic- Separates the L ventricle from the aorta The blood flow of an individual with competent valves is mostly... unidirectional If valves are diseased: It results in... regurgitation (backflow) Closure of the valves increases/allows for heart sounds the heart sounds are associated with the contraction & relaxation phases of the heart Normal heart sounds include: •S1-Lub: AV valves closes (ventricle have been filled) •S2-Dub- Occurs when aortic & pulmonic valve close •S3 and S4- Usually abnormal sounds; may be present in some healthy individuals. •Systole: Phase of ventricular contraction •Diastole: Phase of ventricular relaxation S3 is heard... after S2 and is termed a ventricular gallop (Low frequency brief vibration) S3 occurs... when the ventricle reaches its elastic limit, rapidly causing the blood flow from the atrium to slow The S4 sound may also be heard... in children, well-conditioned athletes, and even healthy elderly individuals without cardiac disease. S4 is heard... before S1 and is termed an atrial gallop S4 sounds are associated with active atrial contractions that cause late ventricular filling Although S3 and S4 sounds are sometimes heard in healthy individuals, they are more commonly associated with pathological conditions such as myocardial infarction (MI) or heart failure (HF). Clicks and snaps may be heard in patients with valvular disease. An opening snap may be heard in mitral stenosis Ejection clicks occur in damaged pulmonic and aortic valves. Nonejection clicks are heard in prolapse of the mitral valve. Clicks and snaps: Abnormal sounds; heard with pt.'s with valvular disease Friction rubs Results from inflammation of the pericardial sac & produce a rubbing grating sound Heart murmurs Are harsh, blowing sounds caused by disruption of blood flow from: The heart, between the chambers of the heart:into the pulmonary or aortic systems Murmurs are described by Their timing in the cardiac cycle, intensity, shape, pitch, location, radiation &: -Response to dynamic maneuvers •The timing is crucial to accurate diagnosis. Stenosis of the aortic or pulmonic valves will result in A systolic murmur, as blood is ejected through the narrowed orifice regurgitation of the same valves will result in diastolic murmur Diastolic murmurs examples Aortic regurgitation Pulmonic regurgitation Mitral stenosis Tricuspid stenosis Systolic Murmurs examples Aortic stenosis Pulmonic stenosis Mitral regurgitation Tricuspid regurgitation Hypertrophic cardiomyopathy coronary arteries Transport blood bringing nutrients & oxygen to the myocardial muscle Atherosclerotic plaque in these arteries as well as in their branches contributes significantly to the development of Ischemic and injury processes and the potential for death Sinoatrial (SA) node Pacemaker-Initiates electrical impulse throughout the right and left atria Atrioventricular (AV) node and Bundle of His Receive current that has finished spreading throughout atria The A V node is also capable of initiating electrical impulses in the event of event of S A node failure. -The intrinsic rate of firing is slower and averages about 60 per minute (Bradycardia) - the further down the electrical current the slower the heart beats are The sympathetic fibers stimulate the heart, increasing the heart rate, force of contraction, and dilation of the coronary arteries The parasympathetic fibers, such as the vagus nerve... decreases heart rate Pulmonary artery is the only artery to carry unoxygenated blood Pulmonary veins are the only veins to carry oxygenated blood Landmarks for assessing the cardiovascular system include The sternum, clavicles, ribs, and intercostal spaces During cardiovascular assessment, the sternum is used as a vertical landmark, and the angle of Louis is used to locate the second intercostal space The cardiac cycle describes the events of one complete heartbeat which is the contraction and relaxation of the atria and ventricles Any interruption in this balance affects the ability of the heart to provide oxygen and nutrients to the body. Significant disruptions in synchrony can be fatal The cardiac cycle can be divided into three periods the period of ventricular filling, ventricular systole (S1), and isovolumetric relaxation (S2) The QRS complex represents ventricular depolarization (Spread of electric current) The T represents ventricular repolarization (change in polarity) The P represents atrial depolarization STEMI ST elevation myocardial infarction "Widow maker" (Anterior MI) The terms that describe the effectiveness of the action of the cardiac cycle are stroke volume, cardiac output, and cardiac index Cardiac output (CO) Amount of blood ejected from the left ventricle over 1 minute Normal CO 4-8 L/min There are two strong influences on the heart's pumping action -Preload -Afterload Preload Is related to the amount of blood in the ventricles & the stretching of the ventricular myocardial fibers (Sterling Law) Sterling Law Greater the stretch, the greater the contractile force= to the greater the volume of blood ejected with each contraction at the end of diastole Afterload Is the pressure that the ventricles must overcome in order to open the aortic and pulmonic valvular cusps Higher risk of cardiovascular disease than Caucasians are Hispanics and Latinos But Hispanics and Latinos are... 25% less likely to die from cardiovascular disease than Caucasians are The chemicals inhaled in cigarette smoke alter and injure... the linings of the arteries, especially in areas of bifurcation (division into branches) Physical assessment of the cardiovascular system requires the use of inspection, palpation, and auscultation, & B/P The earlobes should be smooth and without creases: Document data S2 is louder than S1 at the aortic and pulmonic auscultatory areas S1 and S2 are heard equally at Erb's point (third left I C S) S1 is louder than S2 at the tricuspid and apical areas Assessment of Central Venous Pressure: (CVP) Provides information about the pt.'s central venous pressure & the heart's pumping efficiency Splinter Hemorrhage Associate with infective endocarditis (caused by bacterial infiltration of the heart chamber) A heave or lift in the LSB, 3rd to 5th ICS may indicate right ventricular hypertrophy or resp. disease such as pulmonary hypertension Landmarks in precordial assessments "All Pigs Eat Too Much" Aortic Pulmonic Erb's Point Tricuspid Mitral An apical pulse greater than the carotid pulse indicates a pulse deficit Mitral stenosis narrowing of left mitral valve caused by rheumatic fever or cardiac infection findings: murmur heard at the apical area w/ the pt in left lateral position mitral regurgitation back flow of blood from left ventricle into left atrium caused by rheumatic fever, MI, rupture of chord tendinae findings: murmur at apex transmitted to left axillae tricuspid stenosis narrowing or stricture of the tricuspid valve of the heart caused by rheumatic heart disease, congenital defect, R atrial myxoma (tumor) findings: murmur heard with the bell of the stethoscope over the tricuspid area. peripheral vascular system function - Deliver oxygen and nutrients to tissues - Transport carbon dioxide andwaste from tissues for excretion - Remove pathogens by filteringlymph Arteries Receive oxygenated blood from the heart and carry it to organs and tissues Problems with the lumen or valves of the leg veins can lead to stasis (stagnation of flow) or pooling of blood in the veins of the lower extremities. examples of lymphoid organs spleen, tonsils, and thymus gland Lymph nodes are clumps of tissue located along the lymphatic vessels and are either deep or superficial in the body The lymph nodes usually are covered and protected by connective tissue and are, therefore not palpable The lymph nodes filter lymph fluid, removing any pathogens before the fluid is returned to the bloodstream. epitrochlear node located on the medial surface of the arm above the elbow drains the ulnar surface of the forearm and the third, fourth, and fifth digits. There is a greater incidence of hypertension in African Americans than in Caucasians or Hispanics Smoking is a risk factor for hypertension and peripheral vascular disease Risk factors for varicose veins include Irish and German descent Family history of varicosities A sedentary lifestyle Obesity Multiple pregnancies. Patients whose jobs require them to stand for most of the day are at greater risk for developing varicose veins Physical assessment of the peripheral vascular and lymphatic systems requires the use of Inspection, palpation, auscultation, and assessment of blood pressure Taking blood pressure palpate the brachial pulse- place diaphragm of the stethoscope An adult younger than age 60 or an adult older than age 60 with diabetes should have a normal systolic blood pressure of less than 140 and normal diastolic blood pressure below 90. Assessing Peripheral Pulses Rate- # of beats per min Rhythm- regularity of beats Symmetry- pulses on both sides of body should be similar Amplitude- strength of the beat on a scale of 0-4 1= weak 2= normal 3= increased 4= bounding Edema grading scale Ulcer Because of Arterial Insufficiency diminished pulses. Cool, shiny skin; absence of hair on toes. Pallor on elevation, red color when dependent; & deep muscle pain. Ulcers due to arterial insufficiency are usually seen on toes or areas of trauma of the feet. The ulcer is pale in color with well defined edges & no bleeding Arterial Aneurysm It's a bulging or dilation caused by weakness in the wall of an artery. It can occur in the aorta & the abdominal, renal or femoral arteries. Detected by a characteristic bruit over the artery, but difficult to discover. Some are not discovered before rupturing. Varicose Veins Are veins that have become dilated & have a diminished rate of blood flow & increased intravenous pressure. The condition may be the result of incompetent valves that permit the reflux of blood or an obstruction of a proximal vein. Findings: Distended, twisted vein near the skin's surface; bleeding after minor trauma; skin changes including discoloration, dryness or scaling. Skin ulceration. Raynaud disease Condition in which the arterioles in the fingers develop spams, causing intermittent skin pallor & then rubor (red color). Spams may last minutes to hours, occurring bilaterally. S & S: Numbness or pain during the pallor or cyanotic state & burning/throbbing during the rubor. Condition is commonly seen in the young, otherwise healthy females. The condition is due to 2nd connective tissue disease, drug intoxication, pulmonary hypertension or trauma. Deep Vein Thrombosis (DVT) Occlusion of a deep vein-femoral or pelvic circulation by a blood clot. S & S: None or intense sharp pain along the iliac vessels, in the popliteal space, or in the calf muscle. Pain may increase with application Homan's sign (not reliable) for DX. There may be unilateral edema, low grade fever, & tachycardia. It requires immediate TX, because of the danger of the clot migrating to the lung, resulting in pulmonary embolism. Flushed skin may indicate rheumatic heart disease or presence of a fever Grayish undertones are often seen in clients with coronary artery disease or shock A ruddy color may indicate polycythemia (increase in RBCs) or Cushing's syndrome Obvious pulsations that are present during both inspiration and expiration and coincide with the arterial pulse are commonly seen with severe congestive heart failure Distention of the neck veins indicates elevation of central venous pressure commonly seen with congestive heart failure, fluid overload or pressure on superior vena cava Bounding pulses may indicate fever The presence of heaves of thrills may be reflective of a... cardiac or respiratory alterations Thrills soft vibratory sensations best assessed with either the fingertips or the palm flattened on the chest Diminished or absent carotid pulses may be found in patients with... carotid disease or dissecting ascending aneurysm Absence of both pulses indicates... asystole (absent of HR) A difference of 10 mmHg or more between the arms may indicate an obstruction of arterial flow to one arm A systolic reading below 90 or a diastolic reading under 60 may indicate shock