Chapter 15 test bank PDF

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Chapter 15: Blood Vessels Test Bank—Nursing MULTIPLE CHOICE 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. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. Induration, edema and hyperpigmentation are common associated findings with which of the

following? Peripheral arterial disease Venous ulcer Arterial embolic disease Venous thrombus

a. b. c. d.

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 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Reduction of Risk Potential 3. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 4. The characteristics of arterial pulses are directly affected by all the following except:

a. b. c. d.

the volume of blood ejected. peripheral arterial resistance. venous valvular competence. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 5. 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. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 336 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 6. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 7. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential

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. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 9. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 10. Persons of Irish or German descent and genetically predisposed women who take birth control

pills are at risk for developing: kidney dysfunction. liver disease. renal calculi. varicose veins.

a. b. c. d.

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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 11. 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. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 340 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 12. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 13. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 14. 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. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 340 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 15. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 16. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 17. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 18. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 19. 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? Thick, calloused skin Ruddy, thin skin Warmer temperature of extremity in contrast to other body parts Loss of hair over the extremities

a. b. c. d.

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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 20. 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. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 348 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Reduction of Risk Potential 21. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 22. A characteristic distinguishing primary Raynaud phenomenon from secondary Raynaud

phenomenon includes which of the following? Vasospasm. Digital ischemia with pain. Triphasic demarcated skin. Cold and achy improving with warming.

a. b. c. d.

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. DIF: Cognitive Level: Applying (Application) REF: p. 347 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 23. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 24. Kawasaki disease is suspected when assessment of a child reveals: 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. DIF: Cognitive Level: Analyzing (Analysis)

REF: p. 349

OBJ: Nursing process—assessment

MSC: Physiologic Integrity: Reduction of Risk Potential

25. Which of the following statements is true regarding the development of venous ulcers in older

adults? The major symptom is severe leg pain, especially when walking. The affected leg is commonly pale and hairless, and pulses are difficult to palpate. Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors. The ulcers are generally located on the tips of toes.

a. b. c. d.

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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 26. 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 27. In differentiating between an occluded artery and occluded vein, a distinguishing sign (present

in venous but not arterial occlusion) is: color change. edema. pain with walking. pain with palpation.

a. b. c. d.

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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 28. To assess a patient’s jugular veins, the patient should first be placed in which position?

a. b. c. d.

Supine Semi-Fowler Upright 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 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 29. 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 han...