1. During systole, the ventricles contract.

This causes
a. 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 the
a. 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 to
a. stroke volume.
b. contractility
c. preload.
d. afterload.
4. The layer of the heart responsible for contraction is the
a. myocardium.
b. pericardium.
c. endocardium.
d. epicardium.
5. When listening to heart sounds, you can best hear S1 at the
a. 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 a
a. 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 indicates
a. bounding pulse.
b. increased pulse.
c. weak pulse.
d. absent pulse.
8. When assessing a patient for jugular vein distension, you
should position him
a. 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 normally
a. 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 time
b. International Normalized Ratio (INR)
c. partial thromboplastin time
d. activated bleeding time
11. The test thats most specific for myocardial
damage is
a. 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. electrocardiography
b. endoscopic retrograde cholangiopancreatography
c. endoscopy
d. sigmoidoscopy
14. A noninvasive method of valuating blood flow is
a. 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
administer
a. atropine.
b. anticoagulants.
c. a calcium channel blocker.
d. digoxin.
17. The treatment of choice for a patient with ventricular
fibrillation is
a. defibrillation.
b. transesophageal pacing.
c. synchronized cardioversion.
d. digoxin administration.
18. In second-degree AV block type I, the PR interval
a. 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 the
a. atrial rate.
b. ventricular rate.
c. configuration of the flutter waves.
d. PR interval.
20. Vegetation on the heart valve results
from
a. bacterial invasion
b. poor diet.
c. hypertension.
d. diabetes mellitus.
21. Chest pain is described as pleuritic when it
a. resolves with sublingual nitroglycerin.
b. occurs only during sleep.
c. increases with deep inspiration and decreases with expiration.
d. resolves with a deep breath.

Answers
1. c Rationale: During systole, the pressure is greater in the
ventricles than in the atria, causing the AV valves (the tricuspid
and 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 the
hearts 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 eject
blood 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 of
groups 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 rate
may 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.