Chapter 15: Blood Vessels Test Bank—Nursing

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.

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.

ANS: B Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle.

ANS: C Arterial pulses are not affected by venous valvular competence. Venous valvular competence contributes to the venous blood flow back to the heart.

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.

ANS: A The ductus arteriosus usually closes within the first 12 to 14 hours of life.

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.

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

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.

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, living a sedentary lifestyle, old age, and being white.

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.

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

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.

ANS: B A pulse that is diminished and barely palpable would be graded as a 1 on a scale of 0 to 4.

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.

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.

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.

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.

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.

ANS: D 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. Tricuspid regurgitation results in a holosystolic murmur in the tricuspid region, a pulsatile liver, and peripheral edema.

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.

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.

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.

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.

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.

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.

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.

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

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.

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+).

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.

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.

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.

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.

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.

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.

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.

ANS: C In pregnancy, the lowest level of blood pressure occurs in the second trimester (16 to 20 weeks).

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.

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

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.

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.

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.