Chapter 16: Blood Vessels Flashcards
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
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
Observation of hand veins can facilitate the 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.
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+).
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, suggests a coarctation of the
aorta.
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.
