Question

be, some kedy es The with the hem e with hy habh ary Atrial de d. Peripheral 14. While performing a car de rected wwwcoder which of the following over the second third intercostale s al board e de at the left midlavicularline c eat the left we s and head over the boarder Activities the and third BA -pitched, ping heard in the third A brief thythmic in the theo d. A washing or wishing sound head 1This is the correct order for sculation of heart som Mitral, Tricuspid Apical, Pulmonic b. Apical, Palmonic, Tricuspid, Mil Apical Tricuspid, Palm , M d. Mitml Apical Palio, Tripid for which of the following 10. A heart murmur should be used a. Location b. Timing c. Radiation d. Intensity e, Pitch sessed for which of the following select all that apply 17. A nurse is performing a Performing a cardiac assesment and auscultates an S4 heart sound. The mure should recognize that this mostly likely indicates a Mitral valve stenosis b. Left sided heart failure c. Ischemic heart disease d. Pulmonic valve insufficiency 18. When the sinoatrial node is working appropriately the heart is in sinus rate. This is expected to be a. 40-50 bpm b. 60-80 bpm c. 60-100 bpm d. 100-120 bpm 19. When performing a peripheral vascular assessment of the lower extremities, a nurse should place the fingertips just posterior to the medial malleolus in order to assess for which of the following periphera pulses?

Answer 1

Q:13 - Answer - b

Explanation

The clinical feature of heart failure are

1. chest pain - it is caused due to myocardial ischemia
2. Jugular venous pulsation above 4cm - Normally the JVP is < 4cm above the sternal angle. The JVP is raised due to systemic venous congestion.
3. Bilateral ankle edema - As the failing heart is unable to accommodate the venous return, this increases the pressure in the veins downstream (backpressure changes). This leads to edema.
4. Difficulty breathing in the supine position ( orthopnea) - In the supine position, there is a movement of blood from the lower limbs into the thorax. The failing heart is unable to accommodate this extra volume. Therefore, there is breathlessness in the supine position.
5. Tachycardia - it is a response to low cardiac output
   1. Heart failure causes low cardiac output
   2. Cardiac output is the product of Stroke volume and Heart rate (CO = SV * HR)
   3. As the heart is unable to increase the stroke volume, there is an increase in the heart rate to maintain cardiac output.
6. Low blood pressure - Due to low circulating volume and low cardiac output.
7. S3 - it is produced in systolic heart failure.
   1. it occurs due to passive ventricular filling when the mitral valve opens
   2. It can only be heard of the left ventricle is compliant.
   3. In heart failure the left ventricle is compliant.
8. Capillary refill >
   1. normal capillary time is less than 2 sec
   2. An increase in capillary refill suggests poor peripheral circulation.
   3. This occurs in heart failure, as the body tries to shunt blood to the vital organs (brain, kidney)

Q:14 - Answer - c

1. These are the features of normal cardiac impulse
2. It is the outermost and lateral most area of the chest where a definitive cardiac impulse is seen.
3. It is located in the 5th intercostal area in the mid-clavicular line.

Q:15- Answer - b

Q-16 - Answer - a,b,c,d,e

Q:17 - Answer - b

Explanation

1. The 4th heart sound is always abnormal.
2. It is produced in the late diastolic phase of the ventricles
3. When the atria contract, the blood moves to the ventricles.
4. If the ventricles are stiff ( non-compliant), the S4 is produced
5. It is usually produced in left-sided heart disease like systemic hypertension, aortic stenosis, hypertrophic cardiomyopathy.

Q:18 - Answer - c

Explanation

1. SA node is a group of specialized myocytes
2. It has the property of automaticity. Pacemaker cells for the SA node
3. It is situated at the junction of the Superior vena cava and Right Atrium ( crista terminalis)
4. The transitional cells spread the electrical impulse from the SA node to the rest of the atria.
5. Cells in the SA node have no resting action potential
6. Depolarization is carried out by Calcium rather than sodium

Q:19 - Answer - Posterior Tibial artery

1. Posterior Tibial artery arises from the Popliteal artery ( the tibiofibular trunk)
2. It is the artery of the posterior compartment of the leg.
3. The posterior tibial artery at level of the ankle lies between the medial malleolus and medial process of the calcaneum.
4. Under the adductor hallucis, it ends by dividing into medial and lateral plantar arteries