Chapter 15 & 16: Cardiovascular - PD II (Exam III)

1. The condition in which a pa- tient's heart is either rotated or displaced to the right or is situated as a mirror image of the expected position is called a. amyloidosis. b. cardiomyopathy. c. dextrocardia. d. situs inversus. e. coarctation. 2. Heart position can vary de- pending on body habitus. In a short, stocky individual, you would expect the heart to be located a. more to the right and hang- ing more vertically. b. more to the left and lying more horizontally. c. riding higher in the chest and pushed anteriorly. d. hanging lower in the chest and riding more vertically. e. more to the right and lying more horizontally. 3. Thin-walled reservoirs of the heart are the a. atria. b. pericardia. c. sinuses. d. ventricles. e. septa. c. dextrocardia. b. more to the left and lying more horizontally. a. atria. 4. Which cardiac structure is responsible for the heart's pumping action? a. Pericardium b. Epicardium c. Myocardium d. Endocardium e. Atria 5. Which two heart structures are most anterior in the chest? a. Both atria b. Both ventricles c. The right atrium and ventri- cle d. the left atrium and ventri- cle. e. superior and inferior venae cavae 6. Contraction of the ventricles causes a. closure of the atrioventricu- lar valves. b. closure of the pulmonic and aortic valves. c. opening of the mitral valve and closure of the tricuspid valve. d. opening of the mitral and tricuspid valves. e. opening of the auricular septa. c. Myocardium c. The right atrium and ventricle a. closure of the atrioventricular valves. 7. e. Right and left ventricles Which two structures togeth- er form the primary muscle mass of the heart? a. Right atria and left ventricle b. Left ventricle and the aorta c. Right and left atria d. Left atrium and the pul- monary vein e. Right and left ventricles 8. The major heart sounds are normally created by a. valves opening. b. valves closing. c. the rapid movement of blood. d. rubbing together of the car- diac walls. e. pulmonic veins. 9. Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the a. P wave. b. PR interval. c. QRS complex. d. ST segment. e. T wave. 10. A third heart sound is created by a. atrial contraction. b. ventricular contraction. b. valves closing. a. P wave. c. diastolic filling. c. diastolic filling. d. regurgitation between the right and left ventricles. e. blood in the pericardium. 11. The "pacing" structure of the heart's electrical activity is the a. atrioventricular (AV) node. b. bundle of His. c. Purkinje fibers. d. coronary sinus. e. sinoatrial (SA) node. 12. Purkinje fibers are located in the a. sinoatrial node. b. atrioventricular node. c. myocardium. d. aortic arch e. pericardium 13. The spread of the impulse through the ventricles (ven- tricular depolarization) is de- picted on the ECG as the a. P wave. b. QRS complex. c. PR interval. d. T wave. e. U wave. 14. In a fetus, the right ventricle pumps blood through the a. left atrium. b. ductus arteriosus. e. sinoatrial (SA) node. c. myocardium. b. QRS complex. b. ductus arteriosus. c. lungs. d. foramen ovale. e. septum primum. 15. In what group are the right and left ventricles equal in weight and muscle mass? a. Newborns b. School-age children c. Adolescents d. Older adults e. Pregnant women 16. Closure of the ductus arterio- sus usually occurs a. just before the initiation of labor. b. 24 to 48 hours after birth. c. after 7 days of life. d. between the second and third months of life. e. during the toddler stage. 17. The apex of a 2-month-old baby's heart typically lies closest to the a. left midsternal area. b. fourth left intercostal space. c. midthoracic spinal area. d. sixth left intercostal space. e. right midsternal area. 18. Normal cardiac changes that occur during pregnancy in- clude a. Newborns b. 24 to 48 hours after birth. b. fourth left intercostal space. b. increased thickness and mass of the left ventricle. a. decreased cardiac output. b. increased thickness and mass of the left ventricle. c. decreased heart rate. d. dilation of the ventricles. e. heart is shifted more verti- cal. 19. Which ECG change would not be expected as an age-related pattern? a. First-degree block b. Bundle branch block c. Left ventricular hypertro- phy d. ventricular fibrillation e. atrial fibrillation d. ventricular fibrillation 20. Mr. O, age 50 years, comes for b. have the patient describe his exercise. his yearly health assessment, which is provided by his em- ployer. During your initial his- tory-taking interview, Mr. O mentions that he routinely en- gages in light exercise. At this time, you should a. ask if he makes his own bed daily. b. have the patient describe his exercise. c. make a note that he walks each day. d. record "light exercise" in the history. e. record "questionable exer- cise" in the history. 21. Pleural pain differs from chest discomfort caused by other conditions in that it is a. precipitated by breathing. b. eased with deep breathing. c. usually described as dull in nature. d. related to the time of day. e. eased with coughing. 22. Which of the following infor- mation belongs in the past medical history section relat- ed to heart and blood vessel assessment? a. Adolescent inguinal hernia b. Childhood mumps c. Past incidence of bee stings d. Previous unexplained fever e. Parents with a history of cardiac problems 23. A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history in- terview of his family history, he relates that his father died of heart trouble. The most important follow-up question you should pose is which of the following? a. "Did your father have coro- a. precipitated by breathing. d. Previous unexplained fever d. "What age was your father at the time of his death?" nary bypass surgery?" b. "Did your father's father have heart trouble also?" c. "What were your father's usual dietary habits?" d. "What age was your father at the time of his death?" e. "Did your mother also have heart trouble?" 24. Which one of the following is a common symptom of car- diovascular disorders in an older adult? a. Fatigue b. Joint pain c. Poor night vision d. Urticaria e. Fevers 25. In an adult, the apical impulse should be most visible when the patient is in which posi- tion? a. Supine b. Leaning backward c. Lithotomy d. Right lateral recumbent e. Up right 26. If the apical impulse is more vigorous than expected to the chest wall, it is called a. a lift. b. a thrill. c. a bruit. a. Fatigue e. Up right a. a lift. d. a murmur. e. crepitus. 27. A palpable rushing vibration over the base of the heart at the second intercostal space is called a a. heave. b. lift. c. thrill. d. thrust. e. murmur. c. thrill. 28. An apical point of maximal im- c. left ventricular hypertrophy. pulse (PMI) palpated beyond the left fifth intercostal space may indicate a. decreased cardiac output. b. dextrocardia. c. left ventricular hypertro- phy. d. hyperventilation. e. obesity. 29. A lift along the left sternal bor- der is most likely the result of a. aortic stenosis. b. atrial septal defect. c. pulmonary hypertension. d. right ventricular hypertro- phy. e. left ventricular hypertrophy. d. right ventricular hypertrophy. 30. Normal heart sounds are best b. over areas where blood flows after it pass- heard a. directly over the semilunar es through a valve. and bicuspid heart valves. b. over areas where blood flows after it passes through a valve. c. near the carotid vessels. d. over the central sternum. e. over the ribs. 31. To estimate heart size by per- cussion, you should begin tapping at the a. apex. b. left sternal border. c. midclavicular line. d. midsternal line. e. anterior axillary line. 32. To hear diastolic heart sounds, you should ask pa- tients to a. lie on their backs. b. lie on their left sides. c. lie on their right sides. d. sit up and lean forward. e. lie prone. 33. The carotid pulse should coincide with which heart sound? a. S1 b. S2 c. S3 d. S4 e. S3-4 34. You are listening to a patient's heart sounds in the aortic and e. anterior axillary line. b. lie on their left sides. a. S1 b. S2 pulmonic areas. The sound becomes asynchronous dur- ing inspiration. The prevalent heart sound to this area is most likely which of the fol- lowing? a. S1 b. S2 c. S3 d. S4 e. S3-4 35. During auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split.You should ask the patient to inhale deeply while listening at the area. a. aortic b. pulmonic c. tricuspid d. mitral e. apex 36. The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing a. the splitting of S2. b. high-pitched murmurs. c. presystolic gallops. d. systolic ejection sounds. e. pericardial friction rub. 37. You are conducting an exam- ination of Mr. C's heart and b. pulmonic c. presystolic gallops. c. moderately loud. blood vessels and auscultate a grade III murmur. The inten- sity of this murmur is a. barely discernible. b. quiet but audible. c. moderately loud. d. loud with palpable thrill. e. very loud without a stetho- scope. 38. A grade I or II murmur, with- out radiation and of medium pitch, is a common variation found in a. school-age children. b. older women. c. middle-aged men. d. sedentary individuals. e. older adults. 39. An example of a functional heart murmur is one that is caused by a. anemia. b. a ventricular septal defect. c. an atrial septal defect. d. mitral valve prolapse. e. a leaking aortic valve. 40. A split second heart sound is a. abnormal. b. greatest at the peak of in- spiration. c. heard best after forceful expiration. d. supposed to disappear a. school-age children. a. anemia. b. greatest at the peak of inspiration. with deep inspiration. e. always accompanied by a thrill. 41. The earliest sign of heart fail- ure in an infant is frequently a. an apical impulse in the fourth intercostal space. b. moisture in the lungs. c. enlarged thyroid. d. clubbing of the fingers. e. liver enlargement. 42. Chest pain in a child with an organic cause is more likely the result of a. cardiac disease. b. asthma. c. esophageal reflux. d. arthritis. e. peptic ulcer disease. 43. Which dysrhythmia is a phys- iologic event during child- hood? a. First-degree AV block b. Mobitz type II c. Multifocal PVCs d. Sinus arrhythmia e. Third-degree AV block 44. An increase in heart rate dur- ing inspiration, with a de- crease in this rate during ex- piration, is an expected find- ing in e. liver enlargement. b. asthma d. Sinus arrhythmia b. 4-year-old children. a. adults under stress. b. 4-year-old children. c. pregnant women. d. older adults. e. premature infants. 45. A condition that is likely to present with dizziness and fainting is a. bacterial endocarditis. b. hypertension. c. sick sinus syndrome. d. pericarditis. e. hyperlipidemia. 46. The auscultation of a tripha- sic friction rub in a patient with acute chest pain should lead you to suspect a. congestive heart failure. b. mitral stenosis. c. endocarditis. d. cardiac tamponade. e. pericarditis.. 47. Your patient, who abuses in- travenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender ery- thematic lesions to the palms. These findings are consistent with the development of a. rheumatic fever. b. cor pulmonale. c. sick sinus syndrome. e. pericarditis.. d. endocarditis. c. pericarditis. d. endocarditis. e. cardiac tamponade. 48. Fat deposits in the circulatory system of an older adult can lead to a. diffuse conduction distur- bances. b. exaggerated con- tractility. c. heart failure. d. thinning of the ventricles. e. amyloidosis. 49. A holosystolic murmur in an infant that is best heard along the left sternal border in the third to fifth intercostal spaces and does not radiate to the neck is indicative of a. a ventricular septal defect. b. patent ductus arteriosus. c. pulmonary stenosis. d. aortic sclerosis. e. dextrocardia. 50. Ms. S. is a 22-year-old sec- retary. She presents with fa- tigue, malaise, and a rash. On auscultation of her heart, you note murmurs of mitral regur- gitation and aortic stenosis. She reports a recent severe sore throat. You suspect a. angina. b. acute rheumatic fever. c. heart failure. a. a ventricular septal defect. b. acute rheumatic fever. c. cardiac amyloidosis. d. aortic sclerosis. e. sick sinus syndrome. 51. A grade IV mitral regurgita- tion murmur would a. be described as a diastolic murmur. b. not be expected to have a thrill. c. radiate to the axilla. d. be heard best at the base. e. radiate to the neck. 52. The most helpful finding in determining left-sided heart failure is a. dyspnea. b. orthopnea. c. jugular vein distention. d. an S4 heart sound. e. tachycardia. 53. Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting, and is often associ- ated with focal tenderness is most likely a. cardiac. b. pleural. c. esophageal. d. musculoskeletal. e. psychoneurotic. 54. The structure that carries oxy- genated blood to the body c. radiate to the axilla. c. jugular vein distention. d. musculoskeletal. a. aorta. from the left ventricle is the a. aorta. b. pulmonary artery. c. pulmonary vein. d. superior vena cava. e. inferior vena cava. 55. The arterial pulse is produced by a. atrial contraction. b. ventricular systole. c. peripheral vascular resis- tance. d. diastolic pressure. e. atrial relaxation. 56. The characteristics of arterial pulses are directly affected by all of the following except a. the volume of blood eject- ed. b. peripheral arterial resis- tance. c. venous valvular compe- tence. 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 pul- monary vein carries oxygenated blood from the lungs to the left side of the heart. The su- perior and inferior venae cavae carry blood from the upper and lower body to the right atrium. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 371). Kindle Edition. b. 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 con- traction pushes blood into the ventricles. Di- astolic 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 resis- tance. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 371). Kindle Edition. c. venous valvular competence. 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. NTH, MR.. TEST BANK Seidel's Guide to d. blood viscosity. e. distensibility of aorta. 57. 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. 58. The most prominent compo- nent of the jugular venous pulse is the a. a wave. b. c wave. c. v wave. d. x slope. e. y slope. 59. In newborn infants, closure of the ductus arteriosus usually occurs a. before the initiation of la- bor. 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. Physical Examination 8th edition (p. 371). Kindle Edition. e. 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 compe- tency of the right side of the heart. The other four possible answers reflect the competen- cy of the left side of the heart. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 372). Kindle Edition. a. a wave. 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 contrac- tion. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 372). Kindle Edition. b. 12 to 14 hours after birth. The ductus arteriosus closes usually within the first 12 to 14 hours of life. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 372). Kindle Edition. 60. Blood pressure normally de- creases during what period? a. Fertilization b. First trimester of pregnan- cy c. Second trimester of preg- nancy d. Third trimester of pregnan- cy e. During labor and delivery 61. During a routine prenatal vis- it, Ms. T. was noted as hav- ing dependent edema, vari- cosities of the legs, and hem- orrhoids. She expressed con- cern about these symptoms. You explain to Ms. T. that her enlarged uterus is com- pressing 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 hospital- ization. c. indicate the need for amnio- centesis. d. suggest that she is having twins. e. suggest that she never lie on her side. c. Second trimester of pregnancy Blood pressure reaches its lowest during the second trimester. During the third trimester, hypotension most often occurs when the pa- tient is lying in the supine position. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (pp. 372-373). Kindle Edition. a. are usual conditions during pregnancy. Explain to the patient that these are usual conditions during pregnancy. Blood in the lower extremities tends to pool in later preg- nancy because of the occlusion of the pelvic veins and inferior vena cava from pressure created by the enlarged uterus. The occlu- sion results in an increase in dependent ede- ma, varicosities of the legs and vulva, and hemorrhoids. Lying in the lateral recumbent position may help relieve some her symp- toms. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 373). Kindle Edition. 62. Vascular changes expected in a. loss of vessel elasticity. older adults include With age, the walls of the arteries become a. loss of vessel elasticity. b. decreased peripheral resis- tance. c. decreased pulse pressure. d. constriction of the aorta and major bronchi. e. increased vasomotor tone. 63. 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. 64. Which of the following state- ments is true regarding the examination of peripheral ar- teries? 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 wave- forms. e. The pads of the fourth and calcified, and they lose their elasticity and va- somotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resis- tance occurs, causing an increase in blood pressure. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 373). Kindle Edition. b. numerical scale of 0 to 4. 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. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 373). Kindle Edition. c. The pulses are most readily felt over arter- ies that lie over bones. 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 deter- mine the sufficiency of the arterial circulation. Arterial pulses have contour (waveform). NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 374). Kindle Edition. fifth digits of the examiner's hands are the most sensitive. 65. Which arterial pulse is most useful in evaluating heart ac- tivity? a. Femoral b. Radial c. Temporal d. Brachial e. Carotid 66. 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. 67. The term claudication refers to e. Carotid Carotid arteries provide the most easily ac- cessible arterial pulse and are closest to the heart and therefore are most useful in evalu- ating heart activity. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 374). Kindle Edition. b. 1. A pulse that is diminished and barely palpa- ble would be graded as a 1 on a scale of 0 to 4. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 374). Kindle Edition. a. pain from muscle ischemia. Claudication is known as pain that results a. pain from muscle ischemia. from muscle ischemia. This pain is described b. lack of palpable pulsations. as a dull ache with muscle fatigue and can c. visible extremity changes of arterial occlusion. d. numbness and tingling in toes and fingers. e. constriction or narrowing of a vessel. often be accompanied by cramping. It is brought on by sustained exercise and re- lieved by rest. Individuals with peripheral artery disease experience claudication be- cause 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. NTH, MR.. TEST BANK Seidel's Guide to 68. Conduction system impair- ment should be suspected if an irregular heartbeat is a. galloping. b. paradoxical. c. patternless. d. weak. e. bounding. 69. In which location would carotid bruits best be heard? a. Posterior cervical triangle b. Anterior margin of the ster- nocleidomastoid muscle c. Over the aortic valve d. At the angle of the mandible e. Just anterior to the ear 70. You are examining Mr. S., a 79-year-old man with diabetes who is complaining of clau- dication. Which of the follow- ing physical findings is con- sistent with the diagnosis of arterial insufficiency? a. Thick, calloused skin b. Ruddy, thin skin c. Warmer temperature of ex- tremity in contrast to other Physical Examination 8th edition (p. 375). Kindle Edition. c. patternless. 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 decreas- es on inspiration. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 375). Kindle Edition. b. Anterior margin of the sternocleidomastoid muscle Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 375). Kindle Edition. d. Thin atrophied skin An individual with peripheral artery disease or claudication will have thin skin with lo- calized pallor and cyanosis, a loss of body warmth in the affected area. There may be collapsed superficial veins with delayed fill- ing. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 376). Kindle Edition. body parts d. Thin atrophied skin e. Full superficial veins with rapid filling 71. A sound similar to a murmur that is heard over arteries is a a. thrill. b. hum. c. friction rub. d. bruit. e. heave. 72. In differentiating between an occluded artery or vein, a dif- ferentiating sign (present in venous but not arterial occlu- sion) is a. color change. b. edema. c. pain with walking. d. pain with palpation. e. paralysis. 73. 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. bruit. 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 sur- faces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the ve- nous system. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 376). Kindle Edition. b. edema. 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. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 376). Kindle Edition. a. Supine 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 pulsat- ing becomes visible between the angle of the d. Left lateral recumbent e. Leaning forward 74. 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. 75. You are assessing Mr. Z.'s flu- id volume status as a result of heart failure. If your finger depresses a patient's edema- jaw and the clavicle. Jugular veins cannot be palpated. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 377). Kindle Edition. c. right heart pressure. Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the pa- tient'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. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 377). Kindle Edition. c. 3+. Pitting edema to 6 mm represents a 3+ rat- ing. This edema is noticeably deep and may tous ankle to a depth of 6 mm, last more than 1 minute; the dependent ex- you should record this pitting as a. 1+. b. 2+. c. 3+. d. 4+. e. 5+. 76. If pitting edema is unilateral, you would suspect occlusion of a a. lymphatic duct. tremity looks fuller and swollen. Edema is graded on a scale of mild (1+) through worse (4+). NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 377). Kindle Edition. b. major vein. If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If b. major vein. c. surface capillary. d. superficial artery. e. deep artery. 77. Thrombosis of a leg vein should be suspected if the pa- tient feels calf pain a. after running a short dis- tance. b. on dorsiflexion of the foot. edema occurs without pitting, suspect arter- ial disease and occlusion or lymphedema. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 378). Kindle Edition. b. on dorsiflexion of the foot. Suspect deep vein thrombosis if calf pain occurs with dorsiflexion of the foot. The ma- neuver is referred to as a positive Homan sign. NTH, MR.. TEST BANK Seidel's Guide to c. on extending a flexed thigh. Physical Examination 8th edition (p. 378). d. while wearing high-heeled shoes. e. flexing the knee. 78. Which of the following state- ments is most accurate in de- scribing hepatic jugular re- flux? 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 pa- tients without heart failure. Kindle Edition. b. It is exaggerated in patients with right heart failure. 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, de- pending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the ab- domen 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 be- tween the abdominal hand pressure and the release of the abdominal hand pressure. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 378). Kindle Edition. 79. You are performing jugular venous pressure measure- ment for your patient in heart failure. You see a pulse wave with the patient's head elevat- ed at a 45-degree angle. Your action as a result of this as- sessment is to a. record this measurement as less than 9 cm H2O pres- sure. b. record this measurement as more than 9 cm H2O pres- sure. 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. 80. 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 extremi- ties. 81. c. confirm that the pulsations decrease with inspirations. Confirmation of assessing venous pressure rather than a carotid wave pulse is neces- sary. Jugular venous pulse will decrease on inspiration and increases on expiration, but the carotid pulse will not be affected. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 379). Kindle Edition. a. patent ductus arteriosus. A bounding pulse is associated with a large left-to-right shunt produced by a patent duc- tus arteriosus. A weaker or thinner pulse rep- resents diminished cardiac output or periph- eral vasoconstriction. A difference in pulse amplitude between upper extremities or be- tween femoral and radial pulses and ab- sence of the femoral pulse suggests a coarc- tation of the aorta. Painful, swollen extremi- ties are usually a sign of venous occlusion. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 379). Kindle Edition. In infants or small children, a capillary refill time of 4 sec- onds a. is normal. b. indicates hypervolemia. c. indicates dehydration or hypovolemic shock. d. indi- cates renal artery stenosis. e. indicates venous occlu- sion. 82. A venous hum heard over the internal jugular vein of a child a. usually signifies untreat- able illness. b. usually has no pathologic significance. c. usually requires surgical in- tervention. d. must be monitored until the child is grown. e. usually indicates dehydra- tion. 83. In pregnancy, blood pressure is lowest a. at conception. b. during the first trimester. c. during the second trimester. c. indicates dehydration or hypovolemic shock. Capillary refill time represents the time it takes the capillary bed to refill after being occluded by pressure to the nail bed for sev- eral 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 sec- onds during arterial occlusion, hypovolemic shock, hypothermia, and dehydration. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 379). Kindle Edition. b. usually has no pathologic significance. 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 de- tect 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. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 380). Kindle Edition. c. during the second trimester. The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 380). Kindle Edition. d. during the third trimester. e. at the time of delivery. 84. An idiopathic spasm of arteri- oles in the digits is called a. arteriosclerosis obliterans. b. giant cell arteritis. c. arteriovenous fistula. d. peripheral arterial aneurysm. e. Raynaud disease. e. Raynaud disease. Raynaud phenomenon is an idiopathic, in- termittent spasm of the arterioles in the dig- its, which causes skin pallor. Arteriosclero- sis 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 commu- nication 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 arter- ies. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 380). Kindle Edition. 85. A major risk factor for arterial b. atrial fibrillation. embolic disease is a. venous thrombosis. b. atrial fibrillation. c. hypotension. d. diuretic therapy. e. constrictive pericarditis. 86. In children, coarctation of the aorta should be suspected if you detect 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. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 381). Kindle Edition. a. a delay between the radial and femoral pulses 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. 87. Kawasaki disease is suspect- ed when assessments of a child reveal a. conjunctival injection, strawberry tongue, and ede- ma of the hands and feet. b. conjunctival infection, lym- phadenopathy, and a vesicu- lar rash. c. low-grade fever, strawber- ry 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. 88. Which two heart chambers are most anterior in the chest? 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, coarcta- tion must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (p. 381). Kindle Edition. a. conjunctival injection, strawberry tongue, and edema of the hands and feet. Kawasaki disease is an acute small vessel vasculitic illness of uncertain cause affect- ing young males more often than females. Findings may include fever, conjunctival in- jection, strawberry tongue, and edema of the hands and feet. Findings may also include lymphadenopathy and polymorphous non- vesicular rashes. NTH, MR.. TEST BANK Seidel's Guide to Physical Examination 8th edition (pp. 381-382). Kindle Edition. c. The right atrium and ventricle a. Both atria b. Both ventricles c. The right atrium and ventri- cle d. The left atrium and ventricle