Question 1

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.

tricuspid regurgitation.

Accepted Answer

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.

Question 2

A bounding pulse in an infant may be associated with:&#10;A) patent ductus arteriosus.&#10;B) coarctation of the aorta.&#10;C) decreased cardiac output.&#10;D) peripheral vaso-occlusion.

Accepted Answer

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.

Question 3

A venous hum heard over the internal jugular vein of a child:&#10;A) usually signifies untreatable illness.&#10;B) usually has no pathologic significance.&#10;C) usually requires surgical intervention.&#10;D) must be monitored until the child is grown.

Accepted Answer

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.

Question 4

Vascular changes expected in the older adult include:&#10;A) loss of vessel elasticity.&#10;B) decreased peripheral resistance.&#10;C) decreased pulse pressure.&#10;D) constriction of the aorta and major bronchi.

Accepted Answer

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 5

When examining arterial pulses the thumb may be used:&#10;A) especially if vessels have a tendency to move.&#10;B) never for palpating pulses.&#10;C) checking the jugular venous pressure.&#10;D) during the Allen test.

Accepted Answer

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.

Question 6

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?&#10;A) Thick, calloused skin&#10;B) Ruddy, thin skin&#10;C) Warmer temperature of extremity in contrast to other body parts&#10;D) Loss of hair over the extremities

Accepted Answer

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.

Question 7

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.

Accepted Answer

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.

Question 8

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:&#10;A) 1+.&#10;B) 2+.&#10;C) 3+.&#10;D) 4+.

Accepted Answer

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+).

Question 9

To assess a patient's jugular veins, the patient should first be placed in which position?&#10;A) Supine&#10;B) Semi-Fowler&#10;C) Upright&#10;D) Left lateral recumbent

Accepted Answer

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.

Question 10

Observation of hand veins can facilitate the assessment of:&#10;A) mitral valve competency.&#10;B) a heart murmur.&#10;C) right heart pressure.&#10;D) left heart pressure.

Accepted Answer

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.

Question 11

Induration, edema, and hyperpigmentation are common associated findings with which of the following?&#10;A) Peripheral arterial disease&#10;B) Venous ulcer&#10;C) Arterial embolic disease&#10;D) Venous thrombus

Accepted Answer

The answer of Induration, edema, and hyperpigmentation are common associated...

Question 12

In children, coarctation of the aorta should be suspected if you detect:&#10;A) a delay between the radial and femoral pulses.&#10;B) a simultaneous radial and femoral pulse.&#10;C) an absent femoral pulse on the left.&#10;D) bilateral absence of femoral pulses.

Accepted Answer

The answer of In children, coarctation of the aorta should...

Question 13

A characteristic distinguishing primary Raynaud phenomenon from secondary Raynaud phenomenon includes which of the following?&#10;A) Vasospasm&#10;B) Digital ischemia with pain&#10;C) Triphasic demarcated skin&#10;D) Cold and achy improving with warming

Accepted Answer

The answer of A characteristic distinguishing primary Raynaud phenomenon from...

Question 14

When palpating the carotid artery, which of the following is most important? (Select all that apply.)&#10;A) Rotate the patient's head to the side being examined to relax the sternocleidomastoid.&#10;B) Excessive carotid sinus massage can compromise blood flow to the brain.&#10;C) Excessive carotid sinus massage can cause slowing of the pulse.&#10;D) Palpate both sides simultaneously.

Accepted Answer

The answer of When palpating the carotid artery, which of...

Question 15

Which are risk factors for varicose veins? (Select all that apply.)&#10;A) Gender&#10;B) Alcohol use&#10;C) Lower extremity trauma&#10;D) Increased body mass&#10;E) Hypertension&#10;F) Diabetes

Accepted Answer

The answer of Which are risk factors for varicose veins?...

Question 16

Which of the following statements is true regarding the development of venous ulcers in older adults?&#10;A) The major symptom is severe leg pain, especially when walking.&#10;B) The affected leg is commonly pale and hairless, and pulses are difficult to palpate.&#10;C) Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors.&#10;D) The ulcers are generally located on the tips of toes.

Accepted Answer

The answer of Which of the following statements is true...

Question 17

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.

Accepted Answer

The answer of During a routine prenatal visit, Ms. T...

Question 18

In infants or small children, a capillary refill time of 4 seconds:&#10;A) is normal.&#10;B) indicates hypervolemia.&#10;C) indicates dehydration or hypovolemic shock.&#10;D) indicates renal artery stenosis.

Accepted Answer

The answer of In infants or small children, a capillary...

Question 19

The most prominent component of the jugular venous pulse is the:&#10;A) a wave.&#10;B) c wave.&#10;C) v wave.&#10;D) x slope.

Accepted Answer

The answer of The most prominent component of the jugular...

Deck 16: Blood Vessels