AHA CH 15 Blood Vessels

The level at which the jugular venous pulse is visible gives an indication of _________________________.

ANS: right atrial pressure The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 336

The arterial pulse is produced by ____________________.

ANS: ventricular systole Arterial pulses are palpable and at times visible during ventricular systole. During this time, the left ventricle contracts, pushing blood from the heart to the body. Atrial contraction pushes blood into the ventricles. Diastolic pressure is the force exerted against the wall of the artery when the heart is in the filling or relaxed state. Diastolic pressure is a function of peripheral vascular resistance. DIF: Cognitive Level: Applying (Application) REF: p. 336

Thrombosis of a leg vein should be suspected if the patient feels calf pain: a.after running a marathon. b.on dorsiflexion of the foot. c.on extending a flexed thigh. d.while wearing high-heeled shoes.

ANS: B Deep vein thrombosis should be suspected if calf pain occurs with dorsiflexion of the foot. The maneuver is referred to as a positive Homan sign. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 344

You are assessing Mr. Z's fluid volume status as a result of heart failure. If your finger depresses a patient's edematous ankle to a depth of 6 mm, you should record this pitting as: a.1+. b.2+. c.3+. d.4+.

ANS: C Pitting edema to 6 mm represents a 3+ rating. This edema is noticeably deep and may last more longer a minute; the dependent extremity looks fuller and swollen. Edema is graded on a scale of mild (1+) through worse (4+). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 344

A bounding pulse in an infant may be associated with: a.patent ductus arteriosus. b.coarctation of the aorta. c.decreased cardiac output. d.peripheral vaso-occlusion.

ANS: A A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between the upper extremities or between the femoral and radial pulses, and absence of the femoral pulse, suggest a coarctation of the aorta. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 341

The term claudication refers to: a.pain from muscle ischemia. b.lack of palpable pulsations. c.visible extremity changes of arterial occlusion. d.numbness and tingling in toes and fingers.

ANS: A Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease (PAD) experience claudication because of the decrease in the amount of blood passing through the artery as a result of atherosclerosis, which causes arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 340

In children, coarctation of the aorta should be suspected if you detect: a.a delay between the radial and femoral pulses. b.a simultaneous radial and femoral pulse. c.an absent femoral pulse on the left. d.bilateral absence of femoral pulses.

ANS: A Coarctation of the aorta is a congenital stenosis or narrowing seen most commonly in the descending aortic arch, near the origin of the left subclavian artery and ligamentum arteriosum. Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay and/or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion. Coarctation of the aorta should not be suspected if the radial and femoral pulses are palpated simultaneously, if the femoral pulse on the left is absent, or if there is bilateral absence of femoral pulses. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 348

During a routine prenatal visit, Ms. T was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings: a.are usual conditions during pregnancy. b.indicate a need for hospitalization. c.indicate the need for amniocentesis. d.suggest that she is having twins.

ANS: A Explain to the patient that these are usual conditions during pregnancy. Blood in the lower extremities tends to pool in later pregnancy because of the occlusion of the pelvic veins and inferior vena cava from pressure created by the enlarged uterus. This occlusion results in an increase in dependent edema, varicosities of the legs and vulva, and hemorrhoids. DIF: Cognitive Level: Applying (Application) REF: p. 337

a.conjunctival injection, strawberry tongue, and edema of the hands and feet. b.conjunctival infection, lymphadenopathy, and a vesicular rash. c.low-grade fever, strawberry tongue, and edema of the hands and feet. d.dermatomal bullae rash, high fever, and cyanotic hands and feet.

ANS: A Kawasaki disease is an acute illness whose cause is uncertain. It usually affects children younger than 4 years, males more often than females. Clinical manifestations are fever lasting a few days to 3 weeks, a systemic vasculitis with conjunctival infection, strawberry tongue, edema of the hands and feet, some lymphadenopathy, and polymorphous nonvesicular rashes. Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a disease in which blood vessels throughout the body become inflamed.[1] The most common symptoms include a fever that lasts for more than five days not affected by usual medications, large lymph nodes in the neck, a rash in the genital area, and red eyes, lips, palms or soles of the feet.[1] Other symptoms include sore throat and diarrhea.[1] Within three weeks of the onset of symptoms, the skin from the hands and feet may peel.[1] Recovery then typically occurs.[1] In some children, coronary artery aneurysms may form in the heart.[1] DIF: Cognitive Level: Analyzing (Analysis) REF: p. 349 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reducti

The most prominent component of the jugular venous pulse is the: a.a wave. b.c wave. c.v wave. d.x slope.

ANS: A The a wave is the first and most prominent component of the jugular venous pulse. The a wave represents a brief backflow of blood into the vena cava during right atrial contraction. The activity of the right side of the heart is transmitted back through the jugular veins as a pulse* that has five identifiable components—three peaks and two descending slopes (Fig. 15-7): a wave The a wave, the first and most prominent component, is the result of a brief backflow of blood to the vena cava during right atrial contraction. c wave The c wave is a transmitted impulse from the vigorous backward push produced by closure of the tricuspid valve during ventricular systole. v wave The v wave is caused by the increasing volume and concomitant increasing pressure in the right atrium. It occurs after the c wave, late in ventricular systole. x slope The downward x slope is caused by passive atrial filling. y slope The y slope following the v wave reflects the open tricuspid valve and the rapid filling of the ventricle. . DIF: Cognitive Level: Understanding (Comprehension) REF: p. 336

The structure that carries oxygenated blood to the body from the left ventricle is the: a.aorta. b.pulmonary artery. c.pulmonary vein. d.superior vena cava.

ANS: A The aorta carries oxygenated blood from the left ventricle to the body. The pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. The pulmonary vein carries oxygenated blood from the lungs to the left side of the heart. The superior vena cava carries blood from the upper body to the right atrium. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 332

In newborn infants, closure of the ductus arteriosus usually occurs: a.12 to 14 hours after birth. b.after 7 days of life. c.between the second and third months. d.during the toddler period.

ANS: A The ductus arteriosus usually closes within the first 12 to 14 hours of life. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 337

In differentiating between an occluded artery and occluded vein, a distinguishing sign (present in venous but not arterial occlusion) is: a.color change. b.edema. c.pain with walking. d.pain with palpation.

ANS: B Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 344

When examining arterial pulses the thumb may be used: a.especially if vessels have a tendency to move. b.never for palpating pulses. c.checking the jugular venous pressure. d.during the Allen test.

ANS: A The thumb may be used, especially if the vessels have a tendency to move when probed by the fingers. The thumb is particularly useful in fixing the brachial and even the femoral pulses. You cannot palpate for jugular venous pressure waves. The Allen test is used to ensure ulnar patency prior to radial artery puncture. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 339

To assess a patient's jugular veins, the patient should first be placed in which position? a.Supine b.Semi-Fowler c.Upright d.Left lateral recumbent

ANS: A To assess jugular veins, place the patient in the supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the pulsations of the jugular vein become visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 342

Vascular changes expected in the older adult include: a.loss of vessel elasticity. b.decreased peripheral resistance. c.decreased pulse pressure. d.constriction of the aorta and major bronchi.

ANS: A With age, the walls of the arteries become calcified and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increase in blood pressure. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 337

When palpating the carotid artery, which of the following is most important? (Select all that apply.) a.Rotate the patient's head to the side being examined to relax the sternocleidomastoid. b.Excessive carotid sinus massage can compromise blood flow to the brain. c.Excessive carotid sinus massage can cause slowing of the pulse. d.Palpate both sides simultaneously.

ANS: A, B, C When palpating the carotid arteries, never palpate both sides simultaneously. Excessive carotid sinus massage can cause slowing of the pulse and a drop in blood pressure and can compromise blood flow to the brain, leading to syncope. If you have difficulty feeling the pulse, rotate the patient's head to the side being examined to relax the sternocleidomastoid muscle. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 339

Which of the following are risk factors for varicose veins? (Select all that apply.) a.Gender b.Alcohol use c.Lower extremity trauma d.Increased body mass e.Hypertension f.Diabetes

ANS: A, C, D Gender (women are four times more likely than men to have varicose veins—geneticpredisposition), tobacco use, increased body mass, age, and history of lower extremitytrauma are all risk factors for varicose veins. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 338

Conduction system impairment should be suspected if an irregular heartbeat is: a.galloping. b.paradoxical. c.loud. d.weak.

ANS: B A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspiration. Conduction system impairment would not be suspected if an irregular heartbeat is loud or weak. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 341

A pulsation that is diminished to the point of being barely palpable would be graded as: a.0. b.1. c.2. d.3.

ANS: B A pulse that is diminished and barely palpable would be graded as a 1 on a scale of 0 to 4. 0 is absent, not palpable; 1 is diminished, barely palpable; 2 is expected finding; 3 is full, increased; and 4 is bounding, aneurysmal DIF: Cognitive Level: Remembering (Knowledge) REF: p. 340

A venous hum heard over the internal jugular vein of a child: a.usually signifies untreatable illness. b.usually has no pathologic significance. c.usually requires surgical intervention. d.must be monitored until the child is grown.

ANS: B A venous hum is caused by the turbulence of blood flow in the internal jugular veins. It is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 345

Induration, edema and hyperpigmentation are common associated findings with which of the following? a.Peripheral arterial disease b.Venous ulcer c.Arterial embolic disease d.Venous thrombus

ANS: B A venous ulcer also results from chronic venous insufficiency and demonstrates induration edema and hyperpigmentation. Peripheral arterial edema results in ischemia, in which the foot or leg is painful and cold; nonulceration is common as the muscles atrophy. Arterial embolic disease includes occlusion of the small arteries, resulting in blue toe syndrome and splinter hemorrhages in the nail bed. A venous thrombus presents with minimal ankle edema, low-grade fever, tachycardia, and possibly a positive Homan sign. DIF: Cognitive Level: Applying (Application) REF: p. 349

A major risk factor for arterial embolic disease is: a.venous thrombosis. b.atrial fibrillation. c.hypotension. d.diuretic therapy.

ANS: B Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 347

Mrs. Carrol is a 33-year-old patient who is pregnant and presents for a routine checkup. On examination, you note that her blood pressure has decreased. Blood pressure normally decreases during which period? a.First trimester of pregnancy b.Second trimester of pregnancy c.Third trimester of pregnancy d.Labor and delivery

ANS: B Blood pressure reaches its lowest during the second trimester. During the third trimester, hypotension usually occurs when the patient is lying in the supine position. DIF: Cognitive Level: Applying (Application) REF: p. 337

In which location would carotid bruits be heard best? a.Posterior cervical triangle b.Anterior margin of the sternocleidomastoid muscle c.Over the aortic valve d.At the angle of the mandible

ANS: B Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 342

You are palpating bilateral pedal pulses and cannot feel one of the pulses. The feet are equally warm. You find that both great toes are pink, with a capillary refill within 2 seconds. Which of the following statements is correct? a.Immediate emergency surgery is indicated. b.Pedal pulses are not always palpable. c.Unilateral pulses are never normal. d.Venogram studies will be needed.

ANS: B Dorsalis pedis and posterior tibia pulses may be difficult to palpate or may not be palpable in some well persons. The feet are warm and capillary refill is less than 2 seconds; there is adequate circulation to the feet. Immediate emergency surgery is not indicated. Unilateral pulses may be normal. Venogram studies will not be needed. DIF: Cognitive Level: Applying (Application) REF: p. 340

Which of the following statements is most accurate in describing hepatojugular reflux? a.It is an accurate indicator of heart failure. b.It is exaggerated in patients with right heart failure. c.It is normal when patients are sitting up straight. d.It should be absent in older patients with heart failure.

ANS: B Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. Use your hand and apply firm pressure to the abdomen in the midepigastric region while the patient breathes regularly. Observe the neck for increased jugular venous pressure (JVP) followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and release of the abdominal hand pressure. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 343

If pitting edema is unilateral, you would suspect occlusion of a: a.lymphatic duct. b.major vein. c.surface capillary. d.superficial artery.

ANS: B If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 344

A characteristic distinguishing primary Raynaud phenomenon from secondary Raynaud phenomenon includes which of the following? a.Vasospasm. b.Digital ischemia with pain. c.Triphasic demarcated skin. d.Cold and achy improving with warming.

ANS: B In primary Raynaud phenomenon, there is triphasic demarcation of the skin—white, cyanotic, and reperfused— and vasospasm that lasts a minutes to less than an hour, areas of cold, and an achy feeling that improves with rewarming. In secondary Raynaud phenomenon, there is intense pain from digital ischemia. • Primary Raynaud phenomenon occurs most commonly in young, otherwise healthy individuals, most commonly women, with no evidence of underlying cause. • Secondary Raynaud phenomenon is associated with an underlying connective tissue disease such as scleroderma or systemic lupus erythematosus. DIF: Cognitive Level: Applying (Application) REF: p. 347 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduct

The amplitude of pulses is recorded on a(n): a.Likert scale of absent to bounding. b.numeric scale of 0 to 4. c.alphabetic scale of A to E. d.descriptive scale of mild, moderate, and severe.

ANS: B The amplitude of pulses is recorded on a numeric scale of 0 to 4— 0 is absent, not palpable; 1 is diminished, barely palpable; 2 is expected finding; 3 is full, increased; and 4 is bounding, aneurysmal DIF: Cognitive Level: Remembering (Knowledge) REF: p. 340

Which of the following statements is true regarding the examination of peripheral arteries? a.The thumb should not be used to assess pulses. b.Palpate at least one pulse in each extremity, usually the most proximal one. c.The pulses are most readily felt over bony prominences. d.Extremity pulses do not normally generate waveforms.

ANS: C A pulse is most readily felt over a bony prominence. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers. Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. The most distal pulse, not the most proximal one, in each extremity is palpated to determine the sufficiency of the arterial circulation. Extremity pulses generate waveforms. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 339

The characteristics of arterial pulses are directly affected by all the following except: a.the volume of blood ejected. b.peripheral arterial resistance. c.venous valvular competence. d.blood viscosity.

ANS: C Arterial pulses are not affected by venous valvular competence. Venous valvular competence contributes to the venous blood flow back to the heart. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 336

In infants or small children, a capillary refill time of 4 seconds: a.is normal. b.indicates hypervolemia. c.indicates dehydration or hypovolemic shock. d.indicates renal artery stenosis.

ANS: C Capillary refill time represents the time it takes the capillary bed to refill after being occluded by pressure to the nail bed for several seconds. Observe the time it takes for the nail to regain its full color, which should be less than 2 seconds for an intact system. The capillary refill time will be longer than 2 seconds during arterial occlusion, hypovolemic shock, hypothermia, and dehydration. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 345

You are performing jugular venous pressure measurement for your patient in heart failure. You see a pulse wave with the patient's head elevated at a 45-degree angle. Your action as a result of this assessment is to: a.record this measurement as less than 9 cm H2O pressure. b.record this measurement as more than 9 cm H2O pressure. c.confirm that the pulsations decrease with inspirations. d.confirm that the pulsations increase with inspirations.

ANS: C Confirmation that you are assessing venous pressure, rather than a carotid wave pulse, is necessary. The jugular venous pulse will decrease on inspiration and increase on expiration, whereas the carotid pulse will not be affected. DIF: Cognitive Level: Applying (Application) REF: p. 342 (SEE CHART)

Observation of hand veins can facilitate assessment of: a.mitral valve competency. b.a heart murmur. c.right heart pressure. d.left heart pressure.

ANS: C Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the patient's side. Then raise the hand until the veins collapse, and use a ruler to measure the vertical distance between the midaxillary line (level of the heart) and the level of the collapsed hand veins. DIF: Cognitive Level: Applying (Application) REF: p. 343

In pregnancy, blood pressure is at its lowest at: a.conception. b.4 to 12 weeks. c.16 to 20 weeks. d.time of delivery.

ANS: C In pregnancy, the lowest level of blood pressure occurs in the second trimester (16 to 20 weeks). DIF: Cognitive Level: Applying (Application) REF: p. 337

An idiopathic spasm of arterioles in the digits is termed: a.arteriosclerosis obliterans. b.giant cell arteritis. c.Raynaud disease. d.a peripheral arterial aneurysm.

ANS: C Raynaud disease is idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects the carotid, temporal, and occipital arteries. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. Aneurysms occur in the aorta, renal, femoral, and popliteal arteries. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 347

Which of the following statements is true regarding the development of venous ulcers in older adults? a.The major symptom is severe leg pain, especially when walking. b.The affected leg is commonly pale and hairless, and pulses are difficult to palpate. c.Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors. d.The ulcers are generally located on the tips of toes.

ANS: C Venous ulcers are generally found on the medial or lateral aspects of the lower limbs, most often in older adults. Induration, edema, and hyperpigmentation are common. Heart failure, hypoalbuminemia, peripheral neuropathy, diabetes mellitus, nutritional deficiencies, and arterial disease cause the venous ulcers to develop. The major symptom of venous ulcers is not severe leg pain. In patients with venous ulcers, the affected leg is not commonly pale and hairless, and pulses are not difficult to palpate. Venous ulcers are not generally located on the tips of toes. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 349

A sound similar to a murmur that is heard over arteries is a: a.thrill. b.heave. c.friction rub. d.bruit.

ANS: D A bruit is the sound of turbulent blood flow that is auscultated over the arteries and heard best with the bell of the stethoscope. Thrills, as well as heaves, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together, as occurs with pericardial or pleural inflammation. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 340

You are examining Mr. S, a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of peripheral arterial disease? a.Thick, calloused skin b.Ruddy, thin skin c.Warmer temperature of extremity in contrast to other body parts d.Loss of hair over the extremities

ANS: D An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area, and loss of hair over the extremities. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 347

Which arterial pulse is most useful for evaluating heart activity? a.Femoral b.Radial c.Temporal d.Carotid

ANS: D Carotid arteries are the most easily accessible arterial pulse and closest to the heart; therefore, the carotid pulse is the most useful for evaluating heart activity. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 338-339

Persons of Irish or German descent and genetically predisposed women who take birth control pills are at risk for developing: a.kidney dysfunction. b.liver disease. c.renal calculi. d.varicose veins.

ANS: D Genetically predisposed women who take birth control pills are at risk for developing varicose veins. Other risk factors include female gender, being a daughter of a woman with varicosities, leading a sedentary lifestyle, old age, and being white. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 338

You are performing a physical examination on a 46-year-old male patient. His examination findings include the following: positive peripheral edema, holosystolic murmur in the tricuspid region, and a pulsatile liver. His diagnosis is: a.an aortic aneurysm. b.an arteriovenous fistula. c.tricuspid stenosis. d.tricuspid regurgitation.

ANS: D Tricuspid regurgitation results in a holosystolic murmur in the tricuspid region, a pulsatile liver (pulsating), and peripheral edema. An aneurysm is a localized isolation that results in a pulsatile swelling and a thrill or bruit. An arteriovenous fistula is a pathologic communication between an artery and vein resulting in a thrill or bruit and edema or ischemia in the involved extremity. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 348