Fundamentals of Respiratory care 10th edition by Albert , James test bank

Fundamentals of Respiratory care  10th edition by Albert , James  test bank
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Chapter 09: The Cardiovascular System
Test Bank

MULTIPLE CHOICE

1. The apex of the heart (tip of the left ventricle) lies just above the diaphragm at a level corresponding to which intercostal space?
a. fourth
b. fifth
c. sixth
d. seventh

ANS: B
The apex of the heart is formed by the tip of the left ventricle and lies just above the diaphragm at the level of the fifth intercostal space.

DIF: Application REF: p. 204 OBJ: 1

2. What is the loose membranous sac that encloses the heart?
a. endocardium
b. mesothelium
c. myocardium
d. pericardium

ANS: D
The heart resides within a loose, membranous sac called the parietal pericardium.

DIF: Recall REF: p. 205 OBJ: 1

3. Tissue layers making up the heart wall include which of the following?
1. endocardium
2. epicardium
3. myocardium
a. 1, 2, and 3
b. 2 and 3
c. 2 only
d. 1 and 3

ANS: A
The heart wall consists of three layers: (1) the outer epicardium, (2) the middle myocardium, and (3) the inner endocardium.

DIF: Application REF: p. 205 OBJ: 1

4. Most of the muscle mass of the heart is located in which chamber?
a. left atrium (LA)
b. left ventricle (LV)
c. right atrium (RA)
d. right ventricle (RV)

ANS: B
The two lower heart chambers, or ventricles, make up the bulk of the hearts muscle mass and do most of the pumping that circulates the blood (Figure 9-2). The mass of the left ventricle is approximately two thirds larger than that of the right ventricle and has a spherical appearance when viewed in anteroposterior cross section.

DIF: Application REF: p. 205 OBJ: 2

5. The mitral (bicuspid) valve does which of the following?
a. prevents atrial backflow during ventricular contraction
b. separates the right atrium and the left atrium
c. separates the right atrium and the right ventricle
d. separates the right ventricle and the pulmonary artery

ANS: A
The valve between the left atrium and ventricle is the bicuspid, or mitral, valve. The AV valves close during systole (contraction of the ventricles), thereby preventing backflow of blood into the atria.

DIF: Application REF: p. 208 OBJ: 1

6. Narrowing of the mitral valve (mitral stenosis) results in which of the following?
a. increased afterload on left ventricle
b. increased preload on right ventricle
c. increased pulmonary congestion
d. systemic hypertension

ANS: C
Stenosis is a pathologic narrowing or constriction of a valve outlet, which causes increased pressure in the affected chamber and vessels. Both conditions affect cardiac performance. For example, in mitral stenosis, high pressures in the left atrium back up into the pulmonary circulation. This can cause pulmonary edema.

DIF: Application REF: p. 208 OBJ: 1

7. The semilunar (pulmonary and aortic) valves do which of the following?
a. cause almost the entire afterload for the ventricles
b. consist of two half-moon or crescent-shaped cusps
c. prevent arterial backflow during ventricular relaxation
d. separate the ventricles from their arterial outflow tracts

ANS: D
A set of semilunar valves separates the ventricles from their arterial outflow tracts (Figure 9-3). Consisting of three half-moonshaped cusps attached to the arterial wall, these valves prevent backflow of blood into the ventricles during diastole (or when the hearts chambers fill with blood).

DIF: Application REF: p. 208 OBJ: 1

8. What are the first arteries to branch off the ascending aorta?
a. brachiocephalic
b. carotid
c. coronary
d. subclavian

ANS: C
Two main coronary arteries, a left and a right, arise from the root of the aorta.

DIF: Recall REF: p. 208 OBJ: 1

9. What are the major branches of the left coronary artery?
1. anterior descending
2. circumflex
3. coronary sinus
4. posterior descending
a. 1, 2, and 3
b. 2 and 4
c. 1 and 2
d. 2 and 3

ANS: C
An anterior descending branch courses down the anterior sulcus to the apex of the heart. A circumflex branch moves along the coronary sulcus toward the back and around the left atrial appendage.

DIF: Recall REF: p. 208 OBJ: 1

10. The branches of the left coronary artery DO NOT supply which area of the heart?
a. majority of the interventricular septum
b. majority of the left ventricle
c. majority of the left atrium
d. sinus node

ANS: D
In combination, the branches of the left coronary artery normally supply most of the left ventricle, the left atrium, and the anterior two thirds of the interventricular septum.

DIF: Application REF: p. 208 OBJ: 1

11. Before draining into the right atrium, where do the large veins of the coronary circulation gather together?
a. coronary sinus
b. left posterior coronary vein
c. right coronary sulcus
d. thebesian veins

ANS: A
These veins gather together into a large vessel called the coronary sinus, which passes left to right across the posterior surface of the heart. The coronary sinus empties into the right atrium.

DIF: Application REF: p. 208 OBJ: 1

12. Mixing of venous blood with arterial blood (a right-to-left shunt) occurs normally because of which of the following?
1. congenital cardiac defects
2. bronchial venous drainage
3. thebesian venous drainage in the heart
a. 1, 2, and 3
b. 2 and 3
c. 1 only
d. 2 only

ANS: B
Because the thebesian veins bypass, or shunt, around the pulmonary circulation, this phenomenon is called an anatomical shunt. When combined with a similar bypass in the bronchial circulation (see Chapter 7), these normal anatomical shunts account for approximately 2% to 3% of the total cardiac output.

DIF: Application REF: p. 208-209 OBJ: 1

13. What is the ability of myocardial tissue to propagate electrical impulses?
a. automaticity
b. conductivity
c. contractility
d. excitability

ANS: A
Inherent rhythmicity or automaticity is the unique ability of the cardiac muscle to initiate a spontaneous electrical impulse.

DIF: Application REF: p. 209 OBJ: 2

14. What makes it impossible for the myocardium to go into tetany?
a. absolute refractory period
b. automaticity
c. cardiac myofibrils
d. intercalated discs

ANS: A
Unlike those of other muscle tissues, however, cardiac contractions cannot be sustained or tetanized because myocardial tissue exhibits a prolonged period of inexcitability after contraction. The period during which the myocardium cannot be stimulated is called the refractory period.

DIF: Application REF: p. 209 OBJ: 2

15. Intercalated disks in the myocardium perform a very important function. Which of the following describes that function?
a. absolute refractory period
b. automaticity
c. contractility
d. electrical conduction

ANS: D
Cardiac fibers are separated by irregular transverse thickenings of the sarcolemma called intercalated discs. These discs provide structural support and aid in electrical conduction between fibers.

DIF: Recall REF: p. 209 OBJ: 2

16. What in essence is Frank-Starlings law of the heart?
a. the greater the stretch, the stronger the contraction.
b. the less the afterload, the greater the ejection fraction
c. describes the inverse relationship between diameter and resistance to flow
d. curves show the hysteresis variations between systole and diastole

ANS: A
According to Frank-Starling law, the more a cardiac fiber is stretched, the greater the tension it generates when contracted.

DIF: Recall REF: p. 209 OBJ: 2

17. Which vessels in the body act like faucets, controlling the flow of blood into the capillary beds?
a. arteries
b. arterioles
c. veins
d. venules

ANS: B
Just as faucets control the flow of water into a sink, the smaller arterioles control blood flow into the capillaries. Arterioles provide this control by varying their flow resistance. For this reason, arterioles are often referred to as resistance vessels.

DIF: Recall REF: p. 211 OBJ: 1

18. Why are the vessels of the venous system, particularly the small venules and veins, termed capacitance vessels?
a. They transmit and maintain the head of perfusion pressure.
b. They can alter their capacity to maintain adequate perfusion.
c. They determine the afterload on the left ventricle.
d. They maintain a constant environment for the bodys cells.

ANS: B
By quickly changing its holding capacity, the venous system can match the volume of circulating blood to that needed to maintain adequate perfusion. Accordingly, the components of the venous system, especially the small, expandable venules and veins, are termed capacitance vessels.

DIF: Application REF: p. 211 OBJ: 1

19. Which of the following mechanisms facilitates venous return to the heart?
1. sodium/potassium pump
2. sympathetic venomotor tone
3. cardiac suction
4. skeletal muscle contraction
a. 1 and 2
b. 2, 3, and 4
c. 1, 2, 3, and 4
d. 3 and 4

ANS: B
The following four mechanisms combine to aid venous return to the heart: (1) sympathetic venous tone, (2) skeletal muscle pumping, or milking (combined with venous one-way valves), (3) cardiac suction, and (4) thoracic pressure differences caused by respiratory efforts.

DIF: Application REF: p. 211 OBJ: 1

20. What circulatory system is referred to as a low-pressure, low-resistance system?
a. left heart
b. pulmonary vascular bed
c. right heart
d. systemic vascular bed

ANS: B
The right side of the heart provides the pressures needed to drive blood through the low-resistance, low-pressure pulmonary circulation.

DIF: Application REF: p. 211 OBJ: 1

21. Which of the following equations would you use to compute total peripheral resistance (CO = cardiac output)?
a. (mean aortic pressure right atrial pressure) CO
b. (mean aortic pressure/right atrial pressure) CO
c. (mean aortic pressure right atrial pressure) CO
d. (right atrial pressure mean aortic pressure) CO

ANS: C
SVR = (mean aortic pressure right atrial pressure)/CO

DIF: Analysis REF: p. 212 OBJ: 3

22. Which of the following statements is true?
a. Pulmonary vascular resistance (PVR) is equal to systemic resistance.
b. Pulmonary vasculature is a high-pressure, high-resistance circulation.
c. Systemic vascular resistance (SVR) is less than PVR.
d. SVR is normally approximately 10 times higher than PVR.

ANS: D DIF: Analysis REF: p. 212 OBJ: 3

23. Which of the following equations best portrays the factors determining mean arterial blood pressure?
a. mean arterial pressure = cardiac output vascular resistance
b. mean arterial pressure = cardiac output vascular resistance
c. mean arterial pressure = right atrial pressure aortic pressure
d. mean arterial pressure = vascular resistance cardiac output

ANS: B
Average blood pressure in the circulation is directly related to both cardiac output and flow resistance.
Mean arterial pressure = cardiac output vascular resistance

DIF: Analysis REF: p. 212 OBJ: 3

24. Mean arterial blood pressure can be regulated by changing which of the following?
1. capacity of the circulatory system
2. effective volume of circulating blood
3. tone of the capacitance vessels (veins)
a. 1 and 2
b. 2
c. 1, 2, and 3
d. 3

ANS: C
All else being constant, mean arterial pressure is directly related to the volume of blood in the vascular system and inversely related to its capacity. A change in the tone of the capacitance vessels alters their capacity.
Mean arterial pressure = volume/capacity

DIF: Application REF: p. 212 OBJ: 4

25. During exercise, cardiac output increases dramatically, but mean arterial blood pressure rises very little. Why is this so?
a. Venules constrict, increasing vascular resistance.
b. Arterioles dilate, decreasing vascular capacity.
c. Arterioles constrict, increasing vascular resistance.
d. Muscle vessels dilate, increasing vascular capacity.

ANS: D
For example, when exercising, the circulating blood volume undergoes a relative increase, but blood pressure remains near normal. This is because the skeletal muscle vascular beds dilate, causing a large increase in system capacity.

DIF: Application REF: p. 212 OBJ: 4

26. During blood loss due to hemorrhage, perfusing pressures can be kept near normal until the volume loss overwhelms the system. Why is this so?
a. Arteries constrict, increasing vascular resistance.
b. Arterioles dilate, decreasing vascular capacity.
c. Muscle vessels dilate, increasing vascular capacity.
d. Venules constrict, decreasing vascular capacity.

ANS: D
When blood loss occurs, as with hemorrhage, system capacity is decreased by constricting the venous vessels. Thus, perfusing pressures can be kept near normal until the volume loss overwhelms the system.

DIF: Application REF: p. 212 OBJ: 6

27. The underlying goal of the bodys cardiovascular control mechanisms is to ensure that all tissues receive which of the following?
a. blood flow according to their mass
b. blood flow according to their size
c. equivalent amounts of blood flow
d. perfusion according to their metabolic needs

ANS: D
The goal is to maintain adequate perfusion to all tissues according to their needs.

DIF: Application REF: p. 212 OBJ: 4

28. The cardiovascular system regulates perfusion mainly by altering which of the following?
a. capacity and resistance of blood vessels
b. rate of cardiac contractions
c. strength of cardiac contractions
d. volume of cardiac contractions

ANS: A
The cardiovascular system regulates blood flow mainly by altering the capacity of the vasculature and the volume of blood it holds.

DIF: Application REF: p. 212 OBJ: 4

29. What is the primary function of local or intrinsic cardiovascular control mechanisms?
a. alter local blood flow according to tissue needs
b. alter the rate of cardiac contractions
c. maintain a basal level of systemic vascular tone
d. control the capacity of the venous reservoir

ANS: A
Local, or intrinsic, controls operate independently, without central nervous control. Intrinsic control alters perfusion under normal conditions to meet metabolic needs.

DIF: Application REF: p. 213 OBJ: 4

30. Central, or extrinsic, control of the cardiovascular system occurs through the action of which of the following?
1. autonomic nervous system
2. circulating humoral agents
3. local metabolites
a. 1, 2, and 3
b. 2 and 3
c. 3
d. 1 and 2

ANS: D
Central, or extrinsic, control involves both the central nervous system and circulating humoral agents.

DIF: Application REF: p. 213 OBJ: 4

31. Central control of vasomotor tone has its greatest impact on which of the following vessels?
1. arterioles (resistance vessels)
2. veins (capacitance vessels)
3. microcirculation (exchange vessels)
a. 2 and 3
b. 1 and 2
c. 3 only
d. 1, 2, and 3

ANS: B
Central control mainly affects the high-resistance arterioles and capacitance veins.

DIF: Application REF: p. 213 OBJ: 4

32. Variations in blood flow to the brain are governed primarily by which of the following?
a. central neural innervation
b. circulation of humoral agents
c. local metabolic control mechanisms
d. local myogenic control mechanisms

ANS: C
Metabolic control involves the relationship between vascular smooth muscle tone and the level of local cellular metabolites. The vascular tone in the brain is the most sensitive to changes in the local metabolite levels, particularly those of CO2 and pH.

DIF: Application REF: p. 213 OBJ: 4

33. Variations in blood flow to the heart are governed primarily by which of the following?
1. local metabolic control mechanisms
2. local myogenic control mechanisms
3. central neural innervation
a. 1, 2, and 3
b. 2 and 3
c. 1 only
d. 1 and 3

ANS: B
The vasculature of the heart shows a strong response to both myogenic and metabolic factors.

DIF: Application REF: p. 213 OBJ: 4

34. Which portion of the nervous system is mainly responsible for the central control of the blood flow?
a. higher brain centers
b. parasympathetic nervous system
c. somatic (voluntary) nervous system
d. sympathetic nervous system

ANS: D
Central control of blood flow is achieved primarily by the sympathetic division of the autonomic nervous system

DIF: Application REF: p. 213 OBJ: 4

35. Central mechanisms cause contraction and increased resistance to blood flow mainly through which of the following?
a. adrenergic stimulation and the release of norepinephrine
b. cholinergic stimulation and the release of acetylcholine
c. cholinergic stimulation and the release of norepinephrine
d. stimulation of specialized -adrenergic receptors

ANS: A
Smooth muscle contraction and increased flow resistance are mostly caused by adrenergic stimulation and the release of norepinephrine.

DIF: Application REF: p. 213 OBJ: 4

36. Smooth muscle relaxation and vessel dilation are caused mainly by which of the following?
1. action of local metabolites
2. cholinergic stimulation
3. stimulation of -adrenergic receptors
a. 1 and 3
b. 2 and 3
c. 1 and 2
d. 1, 2, and 3

ANS: B
Smooth muscle relaxation and vessel dilation occur as a result of stimulation of cholinergic or specialized -adrenergic receptors.

DIF: Application REF: p. 213 OBJ: 4

37. Which of the following formulas is used to calculate the total amount of blood pumped by the heart per minute, or cardiac output?
a. blood pressure SV
b. rate SV
c. SV rate
d. SV vascular resistance

ANS: B
Cardiac output = heart rate stroke volume

DIF: Analysis REF: p. 213 OBJ: 6

38. What is an approximate normal resting cardiac output for a healthy adult?
a. 75 ml/min
b. 500 ml/min
c. 2000 ml/min
d. 5000 ml/min

ANS: D
A normal resting cardiac output of approximately 5 L/min can be calculated by substituting a normal heart rate (70 contractions/min) and stroke volume (75 ml, or 0.075 L, per contraction).
Cardiac output = 70 beats/min 0.075 L/beat = 5.25 L/min

DIF: Analysis REF: p. 213 OBJ: 6

39. Which of the following factors determine cardiac stroke volume?
1. ventricular preload
2. ventricular afterload
3. ventricular contractility
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: D
Stroke volume is affected chiefly by intrinsic control of three factors: (1) preload, (2) afterload, and (3) contractility.

DIF: Application REF: p. 214 OBJ: 5

40. Stroke volume can be calculated using which formula?
a. ejection fraction heart rate
b. end-diastolic volume end-systolic volume
c. ejection fraction end-systolic volume
d. cardiac output end-diastolic volume

ANS: B
Stroke volume = EDV ESV

DIF: Application REF: p. 214 OBJ: 7

41. Given a stroke volume of 40 ml and an end-diastolic volume (EDV) of 70 ml, what is the patients ejection fraction (EF)?
a. 0.57
b. 1.75
c. 67
d. 2800

ANS: A
Given a stroke volume of approximately 40 ml, and a EDV of 70 ml, the ejection fraction can be calculated as follows:
EF = SV/EDV= 40 ml/70 ml = 0.57, or 57%

DIF: Analysis REF: p. 214 OBJ: 7

42. What is a normal cardiac ejection fraction?
a.
b.
c.
d.

ANS: D
Thus, on each contraction, the normal heart ejects approximately two thirds of its stored volume. Decreases in ejection fraction are normally associated with a weakened myocardium and decreased contractility.

DIF: Application REF: p. 214 OBJ: 7

43. The hearts ability to vary stroke volume based solely on changes in end-diastolic volume is based on what mechanism?
a. automaticity
b. autoregulation
c. Bohr equation
d. Frank-Starling law

ANS: D
The hearts ability to change stroke volume solely according to the EDV is an intrinsic regulatory mechanism based on the Frank-Starling law.

DIF: Application REF: p. 214 OBJ: 5

44. What does the Frank-Starling law of the heart state?
a. The less cardiac fibers stretch, the greater is the stroke volume.
b. The more cardiac fibers stretch, the greater the stroke volume.
c. The more cardiac fibers stretch, the greater the heart rate.
d. The more cardiac fibers stretch, the less the stroke volume.

ANS: B
Because the EDV corresponds to the initial stretch, or tension, placed on the ventricle, the greater the EDV (up to a point), the greater is the tension developed on contraction, and vice versa.

DIF: Application REF: p. 214 OBJ: 5

45. Which of the following are true of the force against which the left ventricle must pump?
1. referred to as left ventricular afterload
2. equivalent to systemic vascular resistance
3. helps to determine left ventricular stroke volume
a. 1 and 3
b. 1 and 2
c. 1, 2, and 3
d. 2 and 3

ANS: C
A major factor affecting stroke volume is the force against which the heart must pump. This is called afterload. In clinical practice, left ventricular afterload equals the SVR. In other words, the greater the resistance to blood flow, the greater is the afterload.

DIF: Application REF: p. 214 OBJ: 8

46. Which of the following would have a negative impact on cardiac contractility?
1. acidosis
2. digitalis
3. hypoxia
4. norepinephrine
a. 1, 2, and 3
b. 2 and 4
c. 4 only
d. 1 and 3

ANS: D
Profound hypoxia and acidosis impair myocardial metabolism and decrease cardiac contractility.

DIF: Application REF: p. 215 OBJ: 5

47. Changes in the rate of cardiac contractions are affected primarily by changes in which of the following?
a. sympathetic or parasympathetic tone
b. ventricular afterload
c. ventricular contractility
d. ventricular preload

ANS: A
Those factors affecting heart rate are mainly of central origin (i.e., neural or hormonal).

DIF: Application REF: p. 215 OBJ: 4

48. Where are the central centers responsible for regulating the cardiovascular system located?
a. aortic bodies
b. brainstem
c. carotid arteries
d. cerebral hemispheres

ANS: B
Central control of cardiovascular function occurs via interaction between the brainstem and selected peripheral receptors.

DIF: Application REF: p. 216 OBJ: 4

49. What is the affect on the cardiovascular medullary centers when the cerebral carbon dioxide is low?
a. excitatory
b. inhibitory
c. no affect
d. increased vascular tone

ANS: B
The cardiovascular centers also are affected by local chemical changes in the surrounding blood and cerebrospinal fluid. For example, decreased levels of carbon dioxide tend to inhibit the medullary centers.

DIF: Application REF: p. 216 OBJ: 5

50. In order to function effectively, the central cardiovascular control center must receive signals regarding changes in blood volume or pressure. From where do these signals come?
a. central chemoreceptors
b. hypothalamus
c. peripheral baroreceptors
d. skeletal muscles

ANS: C
The greater the blood pressure, the greater is the stretch and the higher is the rate of neural discharge from the peripheral baroreceptors to the cardiovascular centers in the medulla.

DIF: Application REF: p. 216 OBJ: 4

51. Considering the negative feedback system for the control of blood pressure, when a blood pressure rise is noted in the arterial receptors, what is the expected response?
a. arterial vasoconstriction
b. decreased inotropic state
c. increased heart rate
d. venoconstriction

ANS: B
In the case of the arterial receptors, a rise in blood pressure increases aortic and carotid receptor stretch, and thus the discharge rate. The increased discharge rate causes an opposite response by the medullary centers (i.e., a depressor response). Venomotor tone decreases, blood vessels dilate, and heart rate and contractility both decrease.

DIF: Application REF: p. 218 OBJ: 5

52. Vascular low-pressure baroreceptors have their greatest impact on which system?
a. central chemoreceptors
b. endocrine
c. exocrine
d. renin-angiotensin

ANS: D
The low-pressure atrial and venous baroreceptors regulate plasma volume mainly through their effects on the following:
renal sympathetic nerve activity
release of antidiuretic hormone (ADH), also called vasopressin
release of atrial natriuretic factor (ANF)
renin-angiotensin-aldosterone system

DIF: Application REF: p. 218 OBJ: 4

53. What factor stimulates the carotid and aortic chemoreceptors?
a. high carbon dioxide levels
b. high oxygen levels
c. high pH levels
d. high 2,3-DPG levels

ANS: A
They are strongly stimulated by decreased oxygen tensions, although low pH or high levels of carbon dioxide also can increase their discharge rate.

DIF: Application REF: p. 219 OBJ: 4

54. What are the major effects of peripheral chemoreceptor stimulation?
a. decreased drive to breathe
b. decreased production of erythropoietin
c. vasoconstriction and increased heart rate
d. vasodilation and increased stroke volume

ANS: C
It is important for the respiratory therapist to know that the major cardiovascular effects of chemoreceptor stimulation are vasoconstriction and increased heart rate.

DIF: Application REF: p. 219 OBJ: 4

55. Significant loss of blood volume causes an increase in which of the following?
1. vascular tone
2. secretion of antidiuretic hormone (ADH)
3. heart rate
a. 1, 2, and 3
b. 2 and 3
c. 1 and 3
d. 1 and 2

ANS: A
As the blood loss becomes more severe (20%), atrial receptor activity decreases further. This increases the intensity of sympathetic discharge from the cardiovascular centers. Plasma ADH and heart rate continue to climb, as does peripheral vasculature tone.

DIF: Application REF: p. 220 OBJ: 5

56. During the normal events of the cardiac cycle, which of the following statements is true?
a. Electrical depolarization follows mechanical contraction.
b. Electrical depolarization precedes mechanical contraction.
c. Heart sounds precede electrical depolarization.
d. Heart sounds precede cardiac valve opening or closing.

ANS: B
The P wave signals atrial depolarization. Within 0.1 second, the atria contract, causing a slight rise in both atrial and ventricular pressures (the a waves).

DIF: Application REF: p. 221 OBJ: 8

57. Immediately following the P wave of the electrocardiogram, an A wave appears on both the left and right heart pressure graphs. This A wave corresponds to which of the following?
a. atrial contraction
b. atrioventricular valve closure
c. semilunar valve closure
d. ventricular contraction

ANS: A
The P wave signals atrial depolarization. Within 0.1 second, the atria contract, causing a slight rise in both atrial and ventricular pressures (the A waves).

DIF: Analysis REF: p. 221 OBJ: 8

58. The first heart sound is associated with what mechanical event of the cardiac cycle?
a. atrioventricular valve closure
b. atrioventricular valve opening
c. semilunar valve closure
d. semilunar valve opening

ANS: A
As soon as ventricular pressures exceed those in the atria, the atrioventricular valves close. Closure of the mitral valve occurs first, followed immediately by closure of the tricuspid valve. This marks the end of ventricular diastole, producing the first heart sound on the phonocardiogram.

DIF: Application REF: p. 221 OBJ: 8

59. Opening of the semilunar valves occurs when which of the following occurs?
a. The pressures in the arteries exceed those in the ventricles.
b. The pressures in the atria exceed those in the ventricles.
c. The pressures in the ventricles exceed those in the aorta and pulmonary artery.
d. The pressures in the ventricles exceed those in the atria.

ANS: C
Within 0.05 second, ventricular pressures rise to exceed those in the aorta and pulmonary artery. This opens the semilunar valves.

DIF: Application REF: p. 221 OBJ: 8

60. Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles begin to relax. Which of the following will occur next?
a. rapid rise in ventricular pressures
b. arterial pressures exceed ventricular pressures
c. closure of the atrioventricular valves
d. opening of semilunar valves

ANS: B
Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles begin to relax. Consequently, ventricular pressures drop rapidly. When arterial pressures exceed those in the relaxing ventricles, the semilunar valves shut.

DIF: Analysis REF: p. 221 OBJ: 8

61. The semilunar valves close when which of the following occurs?
a. The pressures in the arteries exceed those in the ventricles.
b. The pressures in the ventricles and arteries become equal.
c. The pressures in the atria exceed those in the ventricles.
d. The pressures in the ventricles exceed those in the atria.

ANS: A
Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles begin to relax. Consequently, ventricular pressures drop rapidly. When arterial pressures exceed those in the relaxing ventricles, the semilunar valves shut.

DIF: Application REF: p. 221 OBJ: 8

62. The second heart sound is associated with what mechanical event of the cardiac cycle?
a. atrioventricular valve closure
b. atrioventricular valve opening
c. semilunar valve closure
d. semilunar valve opening

ANS: C
Closure of the semilunar valves generates the second heart sound.

DIF: Application REF: p. 221 OBJ: 8

63. The dicrotic notch recorded in the aorta immediately follows what mechanical event of the cardiac cycle?
a. closure of the aortic valve
b. closure of the atrioventricular valves
c. isovolume contraction
d. opening of the aortic valve

ANS: A
Rather than immediately dropping off, aortic and pulmonary pressures rise again after the semilunar valves close. Note the feature termed the dicrotic notch, which is caused by the elastic recoil of the arteries. This recoil provides the extra push that helps maintain the head of pressure created by the ventricles.

DIF: Application REF: p. 221 OBJ: 8

64. During the later stages of ventricular relaxation, the pressures in their chambers drop below those in the atria. This results in which of the following?
1. rapid drop in atrial pressures
2. opening of the atrioventricular valves
3. rapid ventricular filling
4. V pressure wave
a. 2 and 3
b. 1 and 2
c. 1, 2, 3, and 4
d. 2, 3, and 4

ANS: C
As the ventricles continue to relax, their pressures drop below the pressures in the atria. This drop reopens the atrioventricular valves. As soon as the atrioventricular valves open, the blood collected in the atria rushes to fill the ventricles, causing a rapid drop in atrial pressures (the V wave).

DIF: Application REF: p. 221 OBJ: 8

65. What is a potential cause of cardiac tamponade?
a. a large pericardial effusion
b. blockage of the left ventricle
c. excessive amount of fluid the pleural space
d. clots in the superior vena cava

ANS: A
A large pericardial effusion may affect the pumping function of the heart resulting in a cardiac tamponade. A cardiac tamponade will compress the heart muscle leading to a serious drop in blood flow to the body that may ultimately lead to shock and death.

DIF: Application REF: p. 205 OBJ: 1

66. What is the cause of a myocardial infarction?
a. decreased perfusion to the pulmonary artery
b. partial or complete obstruction of a coronary artery
c. blockage in one or more of the great vessels
d. narrowing of part of the aorta

ANS: B
Partial obstruction of a coronary artery may lead to tissue ischemia (decreased oxygen supply), a clinical condition called angina pectoris. Complete obstruction may cause tissue death or infarct, a condition called Myocardial Infarction (MI).

DIF: Application REF: p. 208 OBJ: 1

67. An abnormal amount of fluid can accumulate between the layers of the pericardium resulting in which of the following?
a. pericardial effusion
b. pulmonary embolism
c. atrial fibrillation
d. premature ventricular contractions

ANS: A
Abnormal amount of fluid can accumulate between the layers resulting in a pericardial effusion.

DIF: Recall REF: p. 205 OBJ: 1

68. What is the role of the left and right ventricle?
a. supply the body with blood
b. increase the concentration of red blood cells in the blood
c. the forward movement of the blood
d. draining of blood into the right atrium

ANS: C
The responsibility of the right and left ventricle is the forward movement of blood

DIF: Application REF: p. 205 OBJ: 2

69. What is the role of the dense connective tissue termed anuli fibrosi cordis in the function of the heart?
a. provides an anchoring structure for the heart valves, and also electrically isolates the atria from the ventricle
b. allows the blood to enter the left atrium from the right atrium before birth
c. pulls in the right ventricular wall, aiding its contraction
d. separate the right and left ventricle

ANS: A
It provides an anchoring structure for the heart valves, it also electrically isolates the atria from the ventricle

DIF: Application REF: p. 205 OBJ: 2

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