Review Practice Exercise 2

Pediatric anatomy and physiology of the cardiac system, tests of cardiac function, and common cardiac treatments. > Child Health

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Practice Exercise 2

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Total Questions : 5

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Question 1:

The nurse auscultates the first heart sound, interpreting this sound as occurring:

A. late in diastole. B. early in diastole. C. with closure of the mitral and tricuspid valves. D. with closure of the aortic and pulmonic of the aortic and pulmonic valves.

Answer and Explanation

Choice A:

Late diastole is characterized by atrial contraction and ventricular filling. The AV valves are still open at this time, so no S1 occurs yet.

Choice B:

Early diastole begins after ventricular relaxation, when the semilunar valves close (aortic and pulmonic valves), producing S2, not SA.

Choice C:

S1 is directly caused by AV valve closure. It signifies the beginning of ventricular systole. This sound is best heard at the apex of the heart, where the mitral valve is located. Clinically, S1 coincides with the carotid pulse, ventricular contraction, and rising ventricular pressure.

Choice D:

Closure of the aortic and pulmonic (semilunar) valves generates the second heart sound (S2), which marks the end of systole and beginning of diastole.

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Question 2:

A nurse is performing a physical assessment of a pediatric client. While auscultating the heart, the nurse hears physiological splitting of S2 when the child takes a deep breath. Which action should be taken by the nurse?

A. Notify the provider of suspected atrial-septal defect. B. Notify the provider of suspected pulmonary stenosis. C. Follow institutional policy for initiating an emergency response. D. Document the findings as a normal finding.

Answer and Explanation

Choice A:

Notify the provider of suspected atrial-septal defect (ASD): ASD can cause fixed splitting of S2, which is present in both inspiration and expiration. Physiological splitting is variable with respiration and does not indicate a septal defect.

Choice B:

Notify the provider of suspected pulmonary stenosis: Pulmonary stenosis may produce a loud systolic ejection murmur with fixed splitting, not normal physiological splitting. The described finding does not suggest pathology.

Choice C:

Follow institutional policy for initiating an emergency response: This is unnecessary because physiological splitting of S2 is a normal, nonemergent finding.

Choice D:

Document the findings as a normal finding: Physiological splitting is most prominent during deep inspiration and is considered normal, especially in children, adolescents, and young adults. No intervention or provider notification is required unless other abnormal findings are present such as cyanosis, murmurs, or signs of heart failure. Accurate documentation ensures continuity of care and reflects the child’s normal cardiac physiology.

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Question 3:

A nurse is using a picture to educate the parents of a child with a congenital murmur about the etiology

of the condition. Which of the following sites demonstrate the location of the tricuspid valve?

A. 1 B. 2 C. 3 D. 4

Answer and Explanation

Choice A:

The pulmonic valve is located between the right ventricle and pulmonary artery. It is a semilunar valve, not an atrioventricular valve.

Choice B:

The tricuspid valve is located between the right atrium and the right ventricle. It allows blood to flow from the right atrium into the right ventricle and prevents backflow during ventricular contraction. Murmurs related to the tricuspid valve are typically heard along the left lower sternal border.

Choice C:

The aortic valve is located between the left ventricle and the aorta. It is also a semilunar valve, associated with systemic outflow.

Choice D:

The mitral valve is located between the left atrium and left ventricle. This is the left-sided AV valve, not the tricuspid valve.

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Question 4:

A nurse is performing a cardiac assessment on a child. Which characteristic would indicate a diagnosis of a grade 1 heart murmur?

A. The murmur is equal to the heart sounds. B. The murmur is softer than the heart sounds. C. The murmur can be heard with the naked ear. D. The murmur is associated with a precordial thrill.

Answer and Explanation

Choice A:

A murmur that is equal to the heart sounds describes a grade 3 murmur, not grade A. Grade 1 is softer, not equal in intensity.

Choice B:

A grade 1 murmur is very faint, requiring focused auscultation. It is softer than the normal S1 and S2 sounds. Often, these murmurs are innocent or functional and not indicative of significant heart disease.

Choice C:

This describes grade 6 murmurs which can be heard with the naked ear.

Choice D:

A precordial thrill indicates a grade 4 or higher murmur, which is louder and more significant than grade A.

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Question 5:

A nurse is performing a cardiac assessment on a 2-year-old. The first heart sound (S1) can best be heard at which location?

A. Third or fourth intercostal space. B. The apex with the stethoscope bell. C. Second intercostal space, midclavicular line. D. Fifth intercostal space, left midclavicular line.

Answer and Explanation

Choice A:

Third or fourth intercostal space: These locations are closer to the base of the heart, where S2, the closure of aortic and pulmonic valves is louder than SA.

Choice B:

The apex with the stethoscope bell: Using the bell is better for low-pitched sounds, like S3 or S4, not the high-pitched SA.

Choice C:

Second intercostal space, midclavicular line: The second intercostal space corresponds to the aortic and pulmonic areas, where S2 is best heard, not SA.

Choice D:

Fifth intercostal space, left midclavicular line: The first heart sound (S1) is produced by the closure of the atrioventricular (AV) valves, the mitral and tricuspid valves, at the beginning of ventricular systole. S1 is loudest at the apical area. In clinical testing, the apex is classically identified as the 5th intercostal space at the left midclavicular line, which is considered the standard landmark for auscultating SA. The diaphragm of the stethoscope is preferred because S1 is a high-pitched sound.

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Practice Exercise 2

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