MULTIPLE CHOICE 1. When assessing a patient’s cardiovascular system, the nurse notes a high pitched scratchy sound at the apex of the heart. The nurse recognizes this as rubbing between the two walls of the sac surrounding and protecting the heart, called the: a. Pericardium b. Myocardium c. Endocardium d. Pleural space ANS: A The pericardium is a tough, fibrous, double-walled sac that surrounds and protects the heart. It has two layers that contain a few millilitres of serous pericardial fluid. Inflammation of the precordium gives rise to a friction rub. The sound is high pitched and scratchy, like sandpaper being rubbed. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: General 2. The direction of blood flow through the heart is best described by which of these? a. Vena cava  right atrium  right ventricle  lungs  pulmonary artery  left atrium  left ventricle b. Right atrium  right ventricle  pulmonary artery  lungs  pulmonary vein  left atrium  left ventricle c. Aorta  right atrium  right ventricle  lungs  pulmonary vein  left atrium  left ventricle  vena cava d. Right atrium  right ventricle  pulmonary vein  lungs  pulmonary artery  left atrium  left ventricle ANS: B Returning blood from the body empties into the right atrium, flows into the right ventricle, and then goes to the lungs through the pulmonary artery. The lungs oxygenate blood, and it is then returned to the left atrium through the pulmonary vein. Blood goes from there to the left ventricle and then to the aorta and out to other areas of the body. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: General 3. The nurse is reviewing the anatomy and physiological functioning of the heart. Which statement best describes what is meant by atrial kick? a. The atria contract during systole and attempt to push against closed valves. b. Contraction of the atria at the beginning of diastole can be felt as a palpitation. c. Atrial kick is the pressure exerted against the atria as the ventricles contract during systole. d. The atria contract toward the end of diastole and push the remaining blood into the ventricles. ANS: D