1. During systole, the ventricles contract.This causesa. all four heart valves to close.b. all four heart valves to open.c. the atrioventricular (AV) valves to close and the semilunar valves to open.d. the AV valves to open and the semilunar valves to close.2. The normal pacemaker of the heart is thea. sinoatrial (SA) node.b. AV node.c. bundle of His.d. ventricles.3. The pressure the ventricle must generate to overcome the higher pressure in the aorta refers toa. stroke volume. b. contractilityc. preload.d. afterload.4. The layer of the heart responsible for contraction is thea. myocardium. b. pericardium. c. endocardium.d. epicardium.5. When listening to heart sounds, you can best hear S1 at thea. base of the heart.b. apex of the heart.c. aortic area.d. second intercostal space to the right of the sternum.6. Youre auscultating for heart sounds in a 3-year-old girl and hear an S3. You assess the sound to be aa. normal finding.b. probable sign of heart failure.c. possible sign of arterial septal defect.d. probable sign of mitral stenosis.7. When grading arterial pulses, a 1+ grade indicatesa. bounding pulse. b. increased pulse. c. weak pulse.d. absent pulse.8. When assessing a patient for jugular vein distension, you should position hima. sitting upright.b. lying flat on his back.c. lying on his back, with the head of his bed elevated 30 to 45 degrees.d. lying on his left side.9. Capillary refill time is normallya. 15 seconds.b. 7 to 10 seconds.c. 4 to 6 seconds.d. 1 to 3 seconds.10. Which test provides the best means of standardizing measurement of prothrombin time (PT) to monitor oral anticoagulant therapy?a. plasma thrombin timeb. International Normalized Ratio (INR)c. partial thromboplastin timed. activated bleeding time11. The test thats most specific for myocardialdamage isa. CK. c. troponin I.b. CK-MB. d. myoglobin.12. Serial serum cardiac markers are monitored in the patient with chest pain for which reason?a. Cardiac markers help determine if cardiac damage is occurring.b. Cardiac markers help identify the area of myocardial damage.c. Decreasing cardiac marker levels help clinicians estimate the recovery time for the patient with myocardial damage.d. Cardiac marker results reveal whether the patient is truly having chest pain.13. Transesophageal chocardiography (TEE) combines ultrasonography with which other procedure?a. electrocardiographyb. endoscopic retrograde cholangiopancreatographyc. endoscopyd. sigmoidoscopy14. A noninvasive method of valuating blood flow isa. Doppler ultrasonography.b. venography.c. angiography.d. cardiac catheterization.15. Whats an important teaching point for the patient receiving a heart transplant?a. Hell need to stay indoors during the winter months.b. Hell need to take immunosuppressants for at least 6 months following surgery.c. Hell be at risk for life-threatening infections because of the medications hell be taking.d. After 6 weeks, hell no longer be at risk for rejection.16. For a patient with symptomatic bradycardia, appropriate nursing interventions include establishing I.V. access to administera. atropine.b. anticoagulants.c. a calcium channel blocker.d. digoxin.17. The treatment of choice for a patient with ventricular fibrillation isa. defibrillation.b. transesophageal pacing.c. synchronized cardioversion.d. digoxin administration.18. In second-degree AV block type I, the PR intervala. varies according to the ventricular response rate.b. progressively lengthens until a QRS complex is dropped.c. remains constant despite an irregular ventricular rhythm.d. cant be determined.19. In atrial flutter, the key consideration in determining treatment is thea. atrial rate.b. ventricular rate.c. configuration of the flutter waves.d. PR interval.20. Vegetation on the heart valve resultsfroma. bacterial invasionb. poor diet. c. hypertension.d. diabetes mellitus.21. Chest pain is described as pleuritic when ita. resolves with sublingual nitroglycerin.b. occurs only during sleep.c. increases with deep inspiration and decreases with expiration.d. resolves with a deep breath.

Answers1. c Rationale: During systole, the pressure is greater in the ventricles than in the atria, causing the AV valves (the tricuspidand mitral valves) to close. The pressure in the ventricles is also greater than the pressure in the aorta and pulmonary artery, forcing the semilunar valves (the pulmonic and aortic valves) to open.2. a Rationale: Normally, the SA node is the hearts pacemaker, generating 60 to100 impulses/minute. The AV node is thehearts secondary pacemaker (40 to 60 beats/minute). The ventricles are the last line of defense (20 to 40 beats/minute).3. d Rationale: Afterload is the pressure the ventricle must generate to overcome the higher pressure in the aorta to ejectblood out of the heart.4. a Rationale: The myocardium has specialized cardiac muscle cells that not only contract but also transmit action potentials.5. b Rationale: S1 is best heard at the apex of the heart. 6. a Rationale: Although an S3 can indicate heart failure in an adult, its normal in a child.7. c Rationale: A 1+ pulse indicates weak pulses and can be associated with diminished cardiac perfusion.8. c Rationale: Assess jugular vein distension with the patient in semi-Fowlers position (head of the bed elevated 30 to 45 degrees). If he lies flat, his veins will be more distended; if he sits upright, his veins will be flat.9. d Rationale: Capillary refill time that lasts longer than 3 seconds is considered delayed and indicates decreased perfusion.10. b Rationale: The INR is the best means of standardized measurement of PT to monitor anticoagulant therapy.11. c Rationale: Troponin I is found only in the myocardium; its more specific to myocardial damage than the other choices.12. a Rationale: Serial serum cardiac markers help indicate whether cardiac damage is occurring.13. c Rationale: In TEE, ultrasonography is combined with endoscopy to provide a better view of the hearts structures.14. a Rationale: Doppler ultrasonography evaluates blood flow in the arms and legs major blood vessels and in the extracranial cerebrovascular system using a handheld transducer.15. c Rationale: After a heart transplant, the patient is treated with potent immunosuppressants. The resulting immunosuppression puts him at risk for life-threatening infection.16. a Rationale: Atropine is standard drug therapy for symptomatic bradycardia.17. a Rationale: Patients with ventricular fibrillation are in cardiac arrest and require defibrillation.18. b Rationale: Progressive lengthening of the PR interval creates an irregular ventricular rhythm with a repeating pattern ofgroups of QRS complexes. Those groups are followed by a dropped beat in which the P wave isnt followed by a QRS complex.19. b Rationale: If the ventricular rate is too fast or too slow, cardiac output will be compromised. A rapid ventricular ratemay require immediate cardioversion.20. a Rationale: Bacterial invasion produces vegetative growths on the heart valves. These growths may embolize to the spleen, kidneys, central nervous system, extremities, and lungs.21. c Rationale: Pleuritic pain increases with deep inspiration and decreases with expiration.