Heart Activitiesto Accompany Delmar’s Heart & Lung Sounds for Nurses CD-ROM
Directions:
- Read the section on the Cardiac Cycle on pages 487-488 in Health Assessment & Physical Examination, third edition.
- Listen to Heart Sounds, Cardiac cycle on Delmar’s Heart & Lung Sounds CD-ROM.
- In the normal cardiac cycle:
(a)systole is when the ventricles are contracting and diastole is when the ventricles are relaxing.
(b)systole is when the ventricles are relaxing and diastole is when the ventricles are contracting.
(c)systole is when the right ventricle is contracting and the left ventricle is relaxing.
(d)systole is when the right ventricle is relaxing and the left ventricle is contracting.
Answer: a
Rationale: The ventricles work together, and systole is when they are contracting and producing the greatest force.
- Cardiac muscle must recover from each contraction.This means that:
(a)systole is generally half as long as diastole.
(b)systole takes the same amount of time as diastole.
(c)systole takes twice as long as diastole.
(d)systole takes three times as long as diastole.
Answer: a
Rationale: The recovery takes about twice as long as the contraction.
- During systole in the normal cardiac cycle, the S1 sound is produced by closure of which valves?
(a)pulmonic and aortic
(b)pulmonic and tricuspid
(c)mitral and aortic
(d)mitral and tricuspid
Answer: d
Rationale: The mitral and tricuspid valves are pushed closed with increasing pressure in the ventricles.
- All of the following are stages or phases of systole except:
(a)the isovolumic or isometric stage.
(b)early systole.
(c)mid systole.
(d)late systole.
Answer: c
Rationale: Systole is divided into three stages or phases, in the order (a), (b), and (d) above.
- During diastole in the normal cardiac cycle, the S2 sound is produced by closure of which valves?
(a)pulmonic and tricuspid
(b)pulmonic and aortic
(c)mitral and aortic
(d)mitral and tricuspid
Answer: b
Rationale: Pressures in the aortic and pulmonic valves are higher than in the ventricles, closing the pulmonic and aortic valves.
- The stages or phases of diastole in the normal cardiac cycle are called:
(a)isovolumic or isometric phase.
(b)early, mid, and late diastole.
(c)late diastole.
(d)all of the above
Answer: d
Rationale: Diastole is divided into four phases or stages in this order: isovolumic or isometric phase, early diastole, mid diastole, late diastole.
- Ventricles begin filling with blood during which stage of diastole?
(a)isovolumic or isometric stage
(b)early diastole
(c)mid diastole
(d)late diastole
Answer: b
Rationale: During early diastole, atrial pressures exceed ventricular pressures, pushing the mitral and tricuspid valves open, and blood begins to flow into the ventricles.
Directions:
- Read Assessment of the Precordium, pages 507-508, and Auscultation, pages 513 and 817-818 in Health Assessment & Physical Examination, third edition.
- Listen to Heart Sounds, Auscultation on Delmar’s Heart & Lung Sounds CD-ROM.
- When auscultating heart sounds (choose two):
(a)use the diaphragm to listen to high-pitched sounds, like S1 or S2.
(b)use the diaphragm to listen to low-pitched sounds, like S3orS4.
(c)use the bell to listen to high-pitched sounds, like S1 or S2.
(d)use the bell to listen to low-pitched sounds, like S3 or S4.
Answer: a, d
Rationale: The diaphragm is used for high-pitched sounds and the bell is used for low-pitched sounds.
- When auscultating heart sounds:
(a)it is acceptable to listen through clothing.
(b)the patient should be supine or sitting.
(c)the aortic and pulmonary areas may be heard better if the patient is in the left lateral decubitus position.
(d)when using the bell, press it tightly on the skin.
Answer: b
Rationale: Never auscultate through clothing.The left lateral decubitus position may be better for hearing the mitral and tricuspid areas.
- The area in the second intercostal space to the right of the sternum is the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: a
Rationale: This is where the aortic valve is best heard.
- The area in the second intercostal space to the left of the sternum is the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: b
Rationale: This is where the pulmonic valve is best heard.
- The area over the fifth intercostal space to the left of the sternum is the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: c
Rationale: This is where the tricuspid valve is best heard.
- The area over the fifth intercostal space at the left midclavicular line is the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: d
Rationale: This is where the mitral valve is best heard.
Directions:
- Read the sections on Auscultation, pages 513-515 and817-818in Health Assessment & Physical Examination, third edition.
- Listen to Heart Sounds, S1S2 on Delmar’s Heart & Lung Sounds CD-ROM.
- An abnormally loud aortic portion of the S2, called intensified A2, could indicate:
(a)aortic stenosis.
(b)a thickened or calcified aortic valve.
(c)arterial hypertension.
(d)pulmonary hypertension.
Answer: c
Rationale: Intense A2 is caused by increased pressure in the aorta.
- Intense A2 is best heard:
(a)over the aortic auscultation site using the bell of the stethoscope.
(b)over the tricuspid auscultation site using the diaphragm of the stethoscope.
(c)over the mitral auscultation site using the bell of the stethoscope.
(d)over the aortic auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched sounds better.
- An abnormally soft portion of S2, called diminished A2, could indicate (choose two):
(a)aortic stenosis.
(b)a thickened or calcified aortic valve.
(c)arterial hypertension.
(d)pulmonary hypertension.
Answer: a, b
Rationale: When the aortic valve is less pliable, as with stenosis, calcification, or thickening, it could produce a diminished sound.
- Diminished A2 is best heard:
(a)over the aortic auscultation site using the bell of the stethoscope.
(b)over the tricuspid auscultation site using the diaphragm of the stethoscope.
(c)over the mitral auscultation site using the bell of the stethoscope.
(d)over the aortic auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched sounds better.
- An abnormally loud pulmonic portion of the S2, called intensified P2, could indicate:
(a)aortic stenosis.
(b)a thickened or calcified aortic valve.
(c)arterial hypertension.
(d)pulmonary hypertension.
Answer: d
Rationale: Intensified P2 is caused by increased pressure in the pulmonary artery.
- Intense P2 is best heard:
(a)over the aortic auscultation site using the bell of the stethoscope.
(b)over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c)over the mitral auscultation site using the bell of the stethoscope.
(d)over the aortic auscultation site using the diaphragm of the stethoscope.
Answer: b
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched sounds better.
- An abnormally soft portion of S2, called diminished P2, could indicate:
(a)stenosis of the pulmonic valve.
(b)a thickened or calcified aortic valve.
(c)arterial hypertension.
(d)pulmonary hypertension.
Answer: a
Rationale: When the pulmonic valve is less pliable, as with stenosis, calcification, or thickening, it could produce a diminished sound.
- Diminished P2 is best heard:
(a)over the aortic auscultation site using the bell of the stethoscope.
(b)over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c)over the mitral auscultation site using the bell of the stethoscope.
(d)over the aortic auscultation site using the diaphragm of the stethoscope.
Answer: b
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched sounds better.
- An abnormally loud S1 can be caused by (choose two):
(a)mitral stenosis.
(b)short PR interval syndrome.
(c)rheumatic fever.
(d)atrial fibrillation.
Answer: a, b
Rationale: A loud S1 occurs when the mitral valve is wide open when systolic contraction begins, and then slams shut.
- Loud S1 is best heard:
(a)over the aortic auscultation site using the bell of the stethoscope.
(b)over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c)over the mitral auscultation site using the bell of the stethoscope.
(d)over the mitral auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched sounds better.
- An abnormally soft S1 can be caused by any of the following except:
(a)mitral stenosis.
(b)first degree heart block.
(c)rheumatic fever.
(d)atrial fibrillation.
Answer: d
Rationale: A soft S1 occurs when the mitral valve has only limited motion.
- Soft S1 is best heard:
(a)over the aortic auscultation site using the bell of the stethoscope.
(b)over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c)over the mitral auscultation site using the bell of the stethoscope.
(d)over the mitral auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched sounds better.
- A variable S1 can be caused by (choose two):
(a)mitral stenosis.
(b)complete heart block.
(c)rheumatic fever.
(d)atrial fibrillation.
Answer: b, d
Rationale: A variable S1 occurs when the atria and ventricles are beating independently or when the ventricles are beating irregularly.
- Variable S1 is best heard:
(a)over the aortic auscultation site using the bell of the stethoscope.
(b)over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c)over the mitral auscultation site using the bell of the stethoscope.
(d)over the mitral auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched sounds better.
- Due to higher pressures on the left side of the heart, S2 is loudest over the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: a
Rationale: The pressures in the left side of the heart are higher than on the right side.
- The best site to auscultate the normal physiologic split S2 sound is the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: b
Rationale: During inspiration, venous return to the right side of the heart increases because of the more negative intrathoracic pressure. Pulmonic closure is delayed because of the extra time needed for the increased blood volume to pass through the valve.The split disappears if the patient holds his breath.
- The best site to auscultate the normal physiologic split S1 sound is the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
Answer: c
Rationale: The mitral valve closes slightly before the tricuspid due to greater pressures in the left side of the heart.The split disappears if the patient holds his breath.
- The S1 sound is loudest over the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: d
Rationale: The S1 sound is caused by the closure of the mitral and tricuspid valves.
Directions:
- Read the sections on Auscultation, pages 513-515, 746, and 818 in Health Assessment & Physical Examination, third edition.
- Listen to Heart Sounds, Splits on Delmar’s Heart & Lung Sounds CD-ROM.
- An abnormal split S1 can be caused by (choose two):
(a)a diseased aortic valve.
(b)a diseased mitral valve.
(c)a diseased pulmonic valve.
(d)an electrical malfunction, such as a bundle branch block.
Answer: b, d
Rationale: The aortic and pulmonic valves are involved in the S2 sound.
- A wide split S2 (choose two):
(a)is heard only on inspiration.
(b)is heard throughout the respiratory cycle.
(c)is heard only with expiration.
(d)is wider with inspiration than with expiration.
Answer: b, d
Rationale: It is heard throughout the respiratory cycle but varies with inspiration and expiration.
- A wide split S2 may be caused by any of the following except:
(a)pulmonic stenosis.
(b)a right bundle branch block.
(c)mitral regurgitation.
(d)a left bundle branch block.
Answer: d
Rationale: The wide split is caused by the aortic valve closing early and the pulmonic valve closing late, indicating delayed electrical stimulation or damage to a valve.
- A fixed split S2 may be caused by (choose two):
(a)left ventricular heart failure.
(b)right ventricular heart failure.
(c)an atrial septal defect.
(d)a ventral septal defect.
Answer: b, c
Rationale: Right ventricular failure can result in prolonged right ventricular systole.
- A fixed split S2 is heard best with the diaphragm of the stethoscope in this area:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: b
Rationale: It is best heard in the pulmonic area.
- A fixed split S2 is:
(a)longer with inspiration than with expiration.
(b)longer with expiration than with inspiration.
(c)the same length during inspiration and expiration.
(d)of variable lengths during inspiration and expiration.
Answer: c
Rationale: The adjective “fixed” refers to the length being unchanged throughout the respiratory cycle.
- A paradoxical split S2(choose two):
(a)occurs during expiration and disappears during inspiration.
(b)occurs during inspiration and disappears during expiration.
(c)occurs when the aortic valve closes after the pulmonic valve.
(d)occurs when the pulmonic valve closes after the aortic valve.
Answer: a, c
Rationale: Normally, the aortic valve closes before the pulmonic valve.
- A paradoxical split S2 is best heard with the diaphragm of the stethoscope over the:
(a)aortic area.
(b)pulmonic area.
(c)tricuspid area.
(d)mitral area.
Answer: b
Rationale: It is best heard over the pulmonic area.
- Split sounds are best heard with the diaphragm of the stethoscope over the (choose two):
(a)valve sites that close first during each sound.
(b)valve sites that close last during each sound.
(c)tricuspid and pulmonic valves.
(d)aortic and mitral valves.
Answer: b, c
Rationale: Split sounds are best heard over the valves that close last, the tricuspid and pulmonic.
Directions:
- Read the section on Auscultation, pages 513-515 in Health Assessment & Physical Examination, third edition.
- Listen to Heart Sounds, Systolic Sounds (Clicks) on Delmar’s Heart & Lung Sounds CD-ROM.
- Ejection clicks are (choose two):
(a)high-pitched sounds heard during systole.
(b)low-pitched sounds heard during diastole.
(c)caused by the closing of a diseased heart valve.
(d)caused by the opening of a diseased heart valve.
Answer: a, d
Rationale: Ejection clicks are high-pitched, as the name indicates, and are caused by the opening of a diseased valve.
- A midsystolic click is formed by:
(a)the aortic valve opening.
(b)the pulmonic valve opening.
(c)the tricuspid valve reopening.
(d)the mitral valve reopening.
Answer: d
Rationale: The midsystolic click is heard halfway between the S1 and S2 sounds, as the mitral valve fails.
- Early ejection clicks are caused by a diseased (choose two):
(a)aortic valve.
(b)mitral valve.
(c)pulmonic valve.
(d)tricuspid valve.
Answer: a, c
Rationale: Early ejection clicks are caused by diseased aortic and pulmonic valves.
- An aortic ejection click (choose two):
(a)is low-pitched and does not radiate into the chest wall.
(b)is high-pitched and can radiate into the chest wall.
(c)varies with the respiratory cycle.
(d)does not vary with the respiratory cycle.
Answer: b, d
Rationale: It is high-pitched, can radiate, and does not vary with respiration.
- An aortic ejection click is best heard with the diaphragm of the stethoscope over the:
(a)aortic area.
(b)pulmonic area.
(c)mitral area.
(d)tricuspid area.
Answer: a
Rationale: An aortic sound is best heard over the aortic area.
- A pulmonic ejection click (choose two):
(a)does not vary with the respiratory cycle.
(b)varies markedly with the respiratory cycle.
(c)may indicate pulmonary stenosis or hypertension.
(d)is heard late in the systolic cycle.
Answer: b, c
Rationale: It is heard early in the systolic cycle, is louder on expiration than on inspiration, and may indicate pulmonary stenosis or hypertension.
- A pulmonic ejection click:
(a)is best heard with the bell of the stethoscope.
(b)is best heard over the pulmonic site.
(c)can radiate through the chest wall.
(d)is louder on inspiration.
Answer: b
Rationale: A pulmonic ejection click is best heard with the diaphragm, does not radiate, and is louder during expiration.
- The midsystolic click is (choose two):
(a)early in systole.
(b)diagnosticfor mitral valve prolapse.
(c)caused by failure of the aortic valve.
(d)often accompanied by a murmur.
Answer: b, d
Rationale: As the name suggests, it occurs in midsystole, and it is caused by a diseased mitral, not aortic, valve.
- The midsystolic click is best heard using the diaphragm of the stethoscope over the:
(a)aortic site.
(b)pulmonic site.
(c)mitral site.
(d)tricuspid site.
Answer: c
Rationale: Because it is caused by the mitral valve, it is logical to listen at that site.
Directions:
- Read the sections on Auscultation, Mitral Area and Mitral and Tricuspid Area (S3) on pages 515-516, Heart and Peripheral Vasculature, page 746, and Auscultation, Heart Sounds, page 818 in Health Assessment & Physical Examination, third edition.
- Listento Heart Sounds, Diastolic Sounds, Gallops on Delmar’s Heart & Lung Sounds CD-ROM.
- Gallops are caused by:
(a)opening of diseased valves.
(b)closing of diseased valves.
(c)turbulence in blood flow.
(d)smooth passage of blood flow.
Answer: c
Rationale: Gallops sound like a horse’s gallop and are due to turbulent blood flow.
- The S3 sound, or ventricular gallop, is (choose two):
(a)caused by rapid filling and over-distension of the ventricle.
(b)always normal.
(c)normal in children and during the third trimester of pregnancy.
(d)often indicative of congestive heart failure and fluid overload in adults over 40.