NR 509 APEA Cardio
NR 509 Advanced physical assessment
,NR 509 APEA Cardio
Question 1:
The lymphatic ducts drain into the:
arterial system.
venous system. Correct
arteriovenous system.
capillary bed. Incorrect
Explanation:
The lymphatic ducts drain into the venous system.
Question 2:
While auscultating the patient's heart, a medium, soft murmur is audible.
It is pansystolic and heard loudest at the apex with radiation to the left
axilla. These findings are consistent with:
tricuspidregurgitation.mitral regurgitation. Correcta ventricular septal
defect.an innocent murmur. Incorrect
Explanation:
Mitral regurgitation produces a pansystolic, harsh murmur heard loudest
at the apex with radiation toward the left axilla. The intensity of the
murmur can be soft or if there is an atrial thrill, it can be loud. With
,tricuspid regurgitation, the murmur is audible loudest at the left sternal
border with radiation to the right sternal border, xiphoid area, or to the
left midclavicular line. It produces a blowing sound and is pansystolic.
The murmur of an uncomplicated ventricular septal defect has a high
pitch and is usually heard throughout systole. An innocent murmur is
heard loudest at mid systole near the second to fourth intercostal spaces
between the left sternal border and the apex. It usually decreases or
disappears when sitting.
Question 3:
Which of the following group of symptoms would be suggestive of an
infant experiencing a congenital heart defect associated with a decreased
pulmonary blood flow pattern?
Tissue perfusion greater than 3 seconds, bluish colored skin, and poor
feeding Correct
Abnormal heart sounds, capillary refill less than 2 seconds, and oxygen
saturation less than 95%
Capillary refill less than 2 seconds, tissue perfusion less than 3 seconds,
and oxygen saturation greater than 95%
Poor feeding, audible heart murmur, and oxygen saturation greater than
95%
Explanation:
Infants with defects resulting from decreased pulmonary blood flow
have cyanosis because of desaturated blood entering systemic circulation
and/or because of the inability to get blood to the lungs. Tetralogy of
Fallot (TOF), pulmonary atresia and tricuspid atresia all fall in this
category and are considered cyanotic defects. Due to the ventricular
, septal defect in TOF, the absence of the tricuspid valve or pulmonary
valve in tricuspid and pulmonary atresia, one should hear abnormal heart
sounds either due to the murmur in TOF or single heart sounds of S1 or
S2 in pulmonary atresia or tricuspid atresia. Usually these infants have
activity intolerance and therefore, experience failure to thrive because of
their inability to consume enough formula to gain weight appropriately.
Capillary refill is usually prolonged due to poor oxygenation and poor
perfusion secondary to the defect as well as the O2 sats being lower than
normal, sometimes even in the 80% range.
Question 4:
Right atrial pressure can be determined by:
palpating the carotid pulse. Incorrect
identifying the pulsations of the right jugular vein. Correct
analyzing the arterial blood gases.
assessing for dependent edema.
Explanation:
Jugular venous pressure reflects pressure in the right atrium and is best
assessed from pulsations in the right internal jugular vein. This is an
indicator of cardiac function and right heart hemodynamics. Palpating
the carotid artery denotes arterial pressure; analyzing blood gases
reflects the status of the arterial blood. Assessing for dependent edema is
a reflection of heart failure and poor venous return and not atrial
pressure.
Question 5:
When assessing the heart rate of a healthy 13-month-old child, which
one of the following sites is the most appropriate for this child?
NR 509 Advanced physical assessment
,NR 509 APEA Cardio
Question 1:
The lymphatic ducts drain into the:
arterial system.
venous system. Correct
arteriovenous system.
capillary bed. Incorrect
Explanation:
The lymphatic ducts drain into the venous system.
Question 2:
While auscultating the patient's heart, a medium, soft murmur is audible.
It is pansystolic and heard loudest at the apex with radiation to the left
axilla. These findings are consistent with:
tricuspidregurgitation.mitral regurgitation. Correcta ventricular septal
defect.an innocent murmur. Incorrect
Explanation:
Mitral regurgitation produces a pansystolic, harsh murmur heard loudest
at the apex with radiation toward the left axilla. The intensity of the
murmur can be soft or if there is an atrial thrill, it can be loud. With
,tricuspid regurgitation, the murmur is audible loudest at the left sternal
border with radiation to the right sternal border, xiphoid area, or to the
left midclavicular line. It produces a blowing sound and is pansystolic.
The murmur of an uncomplicated ventricular septal defect has a high
pitch and is usually heard throughout systole. An innocent murmur is
heard loudest at mid systole near the second to fourth intercostal spaces
between the left sternal border and the apex. It usually decreases or
disappears when sitting.
Question 3:
Which of the following group of symptoms would be suggestive of an
infant experiencing a congenital heart defect associated with a decreased
pulmonary blood flow pattern?
Tissue perfusion greater than 3 seconds, bluish colored skin, and poor
feeding Correct
Abnormal heart sounds, capillary refill less than 2 seconds, and oxygen
saturation less than 95%
Capillary refill less than 2 seconds, tissue perfusion less than 3 seconds,
and oxygen saturation greater than 95%
Poor feeding, audible heart murmur, and oxygen saturation greater than
95%
Explanation:
Infants with defects resulting from decreased pulmonary blood flow
have cyanosis because of desaturated blood entering systemic circulation
and/or because of the inability to get blood to the lungs. Tetralogy of
Fallot (TOF), pulmonary atresia and tricuspid atresia all fall in this
category and are considered cyanotic defects. Due to the ventricular
, septal defect in TOF, the absence of the tricuspid valve or pulmonary
valve in tricuspid and pulmonary atresia, one should hear abnormal heart
sounds either due to the murmur in TOF or single heart sounds of S1 or
S2 in pulmonary atresia or tricuspid atresia. Usually these infants have
activity intolerance and therefore, experience failure to thrive because of
their inability to consume enough formula to gain weight appropriately.
Capillary refill is usually prolonged due to poor oxygenation and poor
perfusion secondary to the defect as well as the O2 sats being lower than
normal, sometimes even in the 80% range.
Question 4:
Right atrial pressure can be determined by:
palpating the carotid pulse. Incorrect
identifying the pulsations of the right jugular vein. Correct
analyzing the arterial blood gases.
assessing for dependent edema.
Explanation:
Jugular venous pressure reflects pressure in the right atrium and is best
assessed from pulsations in the right internal jugular vein. This is an
indicator of cardiac function and right heart hemodynamics. Palpating
the carotid artery denotes arterial pressure; analyzing blood gases
reflects the status of the arterial blood. Assessing for dependent edema is
a reflection of heart failure and poor venous return and not atrial
pressure.
Question 5:
When assessing the heart rate of a healthy 13-month-old child, which
one of the following sites is the most appropriate for this child?
