Seidel's CH 16

Question 1

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.
e. inferior vena cava.

Answer 1

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 and inferior venae cavae carry blood from the upper and lower body to the right atrium.

Question 2

The arterial pulse is produced by

a. atrial contraction.
b. ventricular systole.
c. peripheral vascular resistance.
d. diastolic pressure.
e. atrial relaxation.

Answer 2

ANS: B
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 the function of peripheral vascular resistance.

Question 3

The characteristics of arterial pulses are directly affected by all of the following except

a. the volume of blood ejected.
b. peripheral arterial resistance.
c. venous valvular competence.
d. blood viscosity.
e. distensibility of aorta.

Answer 3

ANS: C
Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart.

Question 4

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

a. mitral valve efficiency.
b. aortic valve efficiency.
c. stroke volume.
d. left ventricular pressure.
e. right atrial pressure.

Answer 4

ANS: E
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. The other four possible answers reflect the competency of the left side of the heart.

Question 5

The most prominent component of the jugular venous pulse is the

a. a wave.
b. c wave.
c. v wave.
d. x slope.
e. y slope.

Answer 5

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.

Question 6

In newborn infants, closure of the ductus arteriosus usually occurs

a. before the initiation of labor.
b. 12 to 14 hours after birth.
c. after 7 days of life.
d. between the second and third month.
e. during the toddler period.

Answer 6

ANS: B

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

Question 7

Blood pressure normally decreases during what period?

a. Fertilization
b. First trimester of pregnancy
c. Second trimester of pregnancy
d. Third trimester of pregnancy
e. During labor and delivery

Answer 7

ANS: B
Blood pressure reaches its lowest during the second trimester. During the third trimester, hypotension most often occurs when the patient is lying in the supine position.

Question 8

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.
e. suggest that she never lie on her side.

Answer 8

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. The occlusion results in an increase in dependent edema, varicosities of the legs and vulva, and hemorrhoids. Lying in the lateral recumbent position may help relieve some her symptoms.

Question 9

Vascular changes expected in older adults include

a. loss of vessel elasticity.
b. decreased peripheral resistance.
c. decreased pulse pressure.
d. constriction of the aorta and major bronchi.
e. increased vasomotor tone.

Answer 9

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.

Question 10

The amplitude of pulses is recorded on a(n)

a. Likert scale of absent to bounding.
b. numerical scale of 0 to 4.
c. alphabetic scale of A to E.
d. descriptive scale of mild, moderate, and severe.
e. graded scale of I to VI.

Answer 10

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.

Question 11

Which of the following statements is true regarding the examination of peripheral arteries?
a. The thumb should never 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 arteries that lie over bones.
d. Extremity pulses do not normally generate waveforms.
e. The pads of the fourth and fifth digits of the examiner’s hands are the most
sensitive.

Answer 11

ANS: C
The pulses are best palpated over arteries that are close to the surface of the body and lie over bones. The arterial pulses with the digital pads of the second and third fingers. 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. Arterial pulses have contour (waveform).

Question 12

Which arterial pulse is most useful in evaluating heart activity?

a. Femoral
b. Radial
c. Temporal
d. Brachial
e. Carotid

Answer 12

ANS: E
Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity.

Question 13

A pulsation that is diminished to the point of being barely palpable would be graded as

a. 0.
b. 1.
c. 2.
d. 3.
e. 4.

Answer 13

ANS: B

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

Question 14

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.
e. constriction or narrowing of

Answer 14

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 experience claudication because of a decrease in the amount of blood passing through the artery as a result of atherosclerosis, which cause the arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age.

Question 15

Conduction system impairment should be suspected if an irregular heartbeat is

a. galloping.
b. paradoxical.
c. patternless.
d. weak.
e. bounding.

Answer 15

ANS: C
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.

Question 16

In which location would carotid bruits best be heard?

a. Posterior cervical triangle
b. Anterior margin of the sternocleidomastoid muscle
c. Over the aortic valve
d. At the angle of the mandible
e. Just anterior to the ear

Answer 16

ANS: B

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

Question 17

You are examining Mr. S., a 79-year-old man with diabetes who is complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial insufficiency?

a. Thick, calloused skin
b. Ruddy, thin skin
c. Warmer temperature of extremity in contrast to other body parts
d. Thin atrophied skin
e. Full superficial veins with rapid filling

Answer 17

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. There may be collapsed superficial veins with delayed filling.

Question 18

A sound similar to a murmur that is heard over arteries is a

a. thrill.
b. hum.
c. friction rub.
d. bruit.
e. heave.

Answer 18

ANS: D
A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system.

Question 19

In differentiating between an occluded artery or vein, a differentiating sign (present in venous but not arterial occlusion) is

a. color change.
b. edema.
c. pain with walking.
d. pain with palpation.
e. paralysis.

Answer 19

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. Paralysis is a rare complication of arterial occlusion.

Question 20

To assess a patient’s jugular veins, he or she should first be placed in which position?

a. Supine
b. Semi-Fowler
c. Upright
d. Left lateral recumbent
e. Leaning forward

Answer 20

ANS: A
To assess jugular veins, place the patient in supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the jugular vein pulsating becomes visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated.

Question 21

Observation of hand veins can facilitate assessment of

a. mitral valve competency.
b. stoke volume.
c. right heart pressure.
d. pulse pressure.
e. left heart pressure.

Answer 21

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 then use a ruler to measure the vertical distance between the mid-axillary line (level of the heart) and the level of the collapsed hand veins.

Question 22

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+.
e. 5+.

Answer 22

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

Question 23

If pitting edema is unilateral, you would suspect occlusion of a

a. lymphatic duct.
b. major vein.
c. surface capillary.
d. superficial artery.
e. deep artery.

Answer 23

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.

Question 24

Thrombosis of a leg vein should be suspected if the patient feels calf pain

a. after running a short distance.
b. on dorsiflexion of the foot.
c. on extending a flexed thigh.
d. while wearing high-heeled shoes.
e. flexing the knee.

Answer 24

ANS: B
Suspect deep vein thrombosis if calf pain occurs with dorsiflexion of the foot. The maneuver is referred to as a positive Homan sign.

Question 25

Which of the following statements is most accurate in describing hepatic jugular 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.
e. It never elevates the jugular venous pressure (JVP) in patients without heart
failure.

Answer 25

ANS: B
Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. All patients will have elevation of the JVP with this maneuver, depending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the abdomen in the mid-epigastric region while the patient breathes regularly. Observe the neck for increased 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 the release of the abdominal hand pressure.

Question 26

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.
e. place the patient in the supine position and recheck.

Answer 26

ANS: C
Confirmation of assessing venous pressure rather than a carotid wave pulse is necessary. Jugular venous pulse will decrease on inspiration and increases on expiration, but the carotid pulse will not be affected.

Question 27

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.
e. painful, swollen extremities.

Answer 27

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 upper extremities or between femoral and radial pulses and absence of the femoral pulse suggests a coarctation of the aorta. Painful, swollen extremities are usually a sign of venous occlusion.

Question 28

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.
e. indicates venous occlusion.

Answer 28

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 will be greater than 2 seconds during arterial occlusion, hypovolemic shock, hypothermia, and dehydration.

Question 29

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.
e. usually indicates dehydration.

Answer 29

ANS: B
A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum 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.

Question 30

In pregnancy, blood pressure is lowest

a. at conception.
b. during the first trimester.
c. during the second trimester.
d. during the third trimester.
e. at the time of delivery.

Answer 30

ANS: C

The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels.

Question 31

An idiopathic spasm of arterioles in the digits is called

a. arteriosclerosis obliterans.
b. giant cell arteritis.
c. arteriovenous fistula.
d. peripheral arterial aneurysm.
e. Raynaud disease.

Answer 31

ANS: E
Raynaud phenomenon is an idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is the occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects arteries of the carotid, temporal, and occipital arteries. Arteriovenous fistula is a pathologic communication between an artery and a vein. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. They occur in the aorta, renal, femoral, and popliteal arteries.

Question 32

A major risk factor for arterial embolic disease is

a. venous thrombosis.
b. atrial fibrillation.
c. hypotension.
d. diuretic therapy.
e. constrictive pericarditis.

Answer 32

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.

Question 33

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.
e. equal blood pressures in the arms and legs.

Answer 33

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 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.

Question 34

Kawasaki disease is suspected when assessments of a child reveal

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.
e. recent streptococcal pharyngitis, vesicular rash, and geographic tongue.

Answer 34

ANS: A
Kawasaki disease is an acute small vessel vasculitic illness of uncertain cause affecting young males more often than females. Findings may include fever, conjunctival injection, strawberry tongue, and edema of the hands and feet. Findings may also include lymphadenopathy and polymorphous nonvesicular rashes.