Deck 21: Peripheral Vascular System and Lymphatic System

Question 1

A patient complains of leg pain that wakes him up at night.He states that he "has been having problems" with his legs.He has pain in his legs when they are elevated,but the pain disappears when he dangles the legs.He recently noticed "a sore" on the inner aspect of the right ankle.This information would indicate that the patient is most likely experiencing:

A)pain related to lymphatic abnormalities.
B)problems related to arterial insufficiency.
C)problems related to venous insufficiency.
D)pain related to musculoskeletal abnormalities.

Answer 1

problems related to arterial insufficiency.

Question 2

Which of the following statements about the arterial system is true?

A)Arteries are large-diameter vessels.
B)The arterial system is a high-pressure system.
C)The walls of arteries are thinner than those of veins.
D)Arteries can expand greatly to accommodate a large blood volume increase.

Answer 2

The arterial system is a high-pressure system.

Question 3

A 67-year-old patient states that he recently began experiencing pain in his left calf while climbing the 10 stairs to his apartment.This pain is relieved by sitting for about 2 minutes;then he is able to resume his activities.This patient is most likely experiencing:

A)claudication.
B)sore muscles.
C)muscle cramps.
D)venous insufficiency.

Answer 3

claudication.

Question 4

During assessment of a patient,the nurse notes an enlarged right epitrochlear lymph node.What should the nurse do next?

A)Palpate the patient's abdomen,noting any tenderness.
B)Carefully palpate the cervical lymph nodes,checking for any enlargement.
C)Ask additional history questions regarding any recent ear infection or sore throat.
D)Examine the patient's lower arm and hand,checking for the presence of any infection or lesions.

Question 5

To assess the dorsalis pedis artery,the nurse would palpate:

A)behind the knee.
B)over the lateral malleolus.
C)in the groove behind the medial malleolus.
D)lateral to the extensor tendon of the great toe.

Question 6

When assessing a patient,the nurse documents the left femoral pulse as 0/0-3+.Which of the following findings would the nurse expect at the dorsalis pedis pulse?

A)0/0-3+
B)1+/0-3+
C)2+/0-3+
D)3+/0-3+

Question 7

Which of the following statements best describes the mechanism(s)by which venous blood returns to the heart?

A)Intraluminal valves ensure unidirectional flow toward the heart.
B)Contracting skeletal muscles milk blood distally toward the veins.
C)The high-pressure system of the heart helps to facilitate venous return.
D)Increased thoracic pressure and decreased abdominal pressure facilitate venous return to the heart.

Question 8

The nurse is examining the lymphatic system of a healthy 3-year-old child.Which of the following would the nurse expect to find?

A)Excessive swelling of the lymph nodes
B)The presence of palpable lymph nodes
C)No nodes palpable because of the immature immune system of a child
D)Fewer numbers and decreased size of lymph nodes compared with an adult

Question 9

A 35-year-old man is at the clinic for an "infection in my left foot." Which of the following would the nurse expect to find during assessment of this patient?

A)Hard and fixed cervical nodes
B)Enlarged and tender inguinal nodes
C)Bilateral enlargement of the popliteal nodes
D)"Pellet-like" nodes in the supraclavicular region

Question 10

A 65-year-old patient is experiencing pain in his left calf during exercise,which disappears after resting for a few minutes.The nurse recognizes that this description is most consistent with:

A)venous obstruction of the left leg.
B)claudication due to venous abnormalities in the left leg.
C)ischemia caused by partial blockage of an artery supplying the left leg.
D)ischemia caused by complete blockage of an artery supplying the left leg.

Question 11

Which of the following veins are responsible for most of the venous return in the arm?

A)Deep veins
B)Ulnar veins
C)Subclavian veins
D)Superficial veins

Question 12

The nurse uses the "profile sign" to detect:

A)pitting edema.
B)early clubbing.
C)symmetry of the fingers.
D)insufficient capillary refill.

Question 13

Which of the following statements about the lymphatic system is true?

A)Lymph flow is propelled by the contraction of the heart.
B)The flow of lymph is slow compared with that of blood.
C)One of the functions of the lymph is to absorb lipids from the biliary tract.
D)Lymph vessels have no valves,so there is a free flow of lymph from the tissue spaces into the bloodstream and back again.

Question 14

The major artery supplying the arm is the:

A)ulnar artery.
B)radial artery.
C)brachial artery.
D)deep palmar artery.

Question 15

Which of the following is a normal physiological change associated with the aging process?

A)Hormonal changes causing vasodilation and a resulting drop in blood pressure
B)Progressive atrophy of the intramuscular calf veins,causing venous insufficiency
C)Peripheral blood vessels growing more rigid with age,producing a rise in systolic blood pressure
D)Narrowing of the inferior vena cava,causing low blood flow and increases in venous pressure,resulting in varicosities

Question 16

The nurse is performing a well-child assessment on a 3-year-old child.The child's vital signs are normal.Capillary refill time is 5 seconds.The nurse would:

A)ask the parent if the child has had frostbite in the past.
B)suspect that the child has a venous insufficiency problem.
C)consider this a delayed capillary refill time and investigate further.
D)consider this a normal capillary refill time that requires no further assessment.

Question 17

Which of the following pulses would most likely be a finding in an individual with untreated hyperthyroidism?

A)A normal pulse
B)An absent pulse
C)A bounding pulse
D)A weak,thready pulse

Question 18

Which of the following situations best describes a person at risk for development of venous disease?

A)A woman in her fifth month of pregnancy
B)A person who has been in bed rest for 4 days
C)A person with a 30-year,1-pack-per-day smoking history
D)An older adult taking anticoagulant medication

Question 19

When performing peripheral vascular assessment on a patient,the nurse is unable to palpate the ulnar pulses.The patient's skin is warm,and capillary refill time is normal.The nurse would next:

A)check for the presence of claudication.
B)refer the individual for further evaluation.
C)consider this a normal finding and proceed with peripheral vascular evaluation.
D)ask the patient if he or she has experienced any unusual cramping or tingling in the arm.

Question 20

A 70-year-old patient is scheduled for open-heart surgery.The physicians plan to use the great saphenous vein for the coronary bypass grafts.The patient asks,"What happens to my circulation when the veins are removed?" The nurse should reply:

A)"Venous insufficiency is a common problem after this type of surgery."
B)"Oh,there are lots of veins in your body-you won't even notice that one has been removed."
C)"You will probably experience decreased circulation after the vein has been removed."
D)"Because the deeper veins in your leg are in good condition,this vein can be removed without harming your circulation."

Question 21

When describing a weak,thready pulse,the nurse should document:

A)"Easily palpable,pounds under the fingertips."
B)"Greater than normal force,then collapses suddenly."
C)"Hard to palpate,may fade in and out,easily obliterated by pressure."
D)"Rhythm is regular,but force varies with alternating beats of large and small amplitude."

Question 22

A patient has been diagnosed with venous stasis.Which of the following would the nurse most likely observe?

A)A cool foot
B)Thin,shiny,atrophic skin
C)Pallor of the toes and cyanosis of the nail beds
D)Brownish discoloration of the skin on the lower leg

Question 23

The nurse is performing a well-child assessment on a 5-year-old boy.He has no current history that would lead the nurse to suspect any illness.His past medical history is unremarkable,and he received immunizations 1 week ago.Which of the following findings would be considered normal in this situation?

A)Enlarged,warm,tender nodes
B)Lymphadenopathy of the cervical nodes
C)Palpable firm,small,shotty,mobile,nontender lymph nodes
D)Firm,rubbery,large nodes,somewhat fixed to the underlying tissue

Question 24

The nurse is performing peripheral vascular assessment on a bedridden patient and notes the following findings in the right leg: increased warmth,swelling,redness,tenderness to palpation,and a positive Homan's sign.The nurse would:

A)reevaluate the patient in a few hours.
B)consider this a normal finding for a bedridden patient.
C)seek emergency referral because of the risk of pulmonary embolism.
D)ask the patient to raise his leg off of the bed and check for pain on elevation.

Question 25

A patient has bilateral pitting edema of the feet.While assessing the peripheral vascular system,the nurse's primary focus should be:

A)oxygenation of the lower extremities.
B)arterial function of the lower extremities.
C)venous function of the lower extremities.
D)possible thrombophlebitis of the lower extremities.

Question 26

Why would the nurse perform a modified Allen test?

A)To measure the rate of lymphatic drainage
B)To evaluate the adequacy of capillary patency before drawing venous blood
C)To evaluate the adequacy of collateral circulation before cannulating the radial artery
D)To evaluate the venous refill rate that occurs after the ulnar and radial arteries are temporarily occluded

Question 27

A patient has hard,nonpitting edema of the left lower leg and ankle.The nurse is aware that:

A)nonpitting,hard edema occurs with lymphatic obstruction.
B)alterations in arterial function will cause this edema.
C)phlebitis of a superficial vein will cause bilateral edema.
D)longstanding arterial obstruction will cause pitting edema.

Question 28

Which of the following statements about the manual compression test is true?

A)Rapid filling of the veins indicates incompetent veins.
B)Competent valves in the veins will transmit a wave to the distal fingers.
C)A palpable wave transmission occurs when the valves are incompetent.
D)The test assesses whether the valves of varicosity are competent when the person is in the supine position.

Question 29

The nurse is attempting to assess the femoral pulse in an obese patient.Which of the following actions would be most appropriate?

A)Have the patient assume a prone position.
B)Ask the patient to bend the knees to the side in a froglike position.
C)With the patient in a semi-Fowler's position,press firmly against the bone.
D)Listen with a stethoscope for pulsations because it is very difficult to palpate the pulse.

Question 30

Which of the following statements about assessment of the ankle-brachial index (ABI)is true?

A)Normal ABI indices are from 0.50 to 1.0.
B)The normal ankle pressure is slightly lower than the brachial pressure.
C)The ABI is a reliable measurement of peripheral vascular disease in diabetic individuals.
D)An ABI of 0.90 to 0.70 indicates the presence of peripheral vascular disease and mild claudication.

Question 31

During assessment,the nurse notes that a patient's left arm is swollen from the shoulder down to the fingers,with nonpitting edema.The right arm is normal.The patient had a mastectomy 1 year ago.Which of the following problems does the nurse suspect?

A)Venous stasis
B)Lymphedema
C)Arteriosclerosis
D)Deep-vein thrombosis

Question 32

The nurse is aware that a positive Homan's sign in a patient:

A)occurs with venous insufficiency.
B)is indicative of possible thrombophlebitis.
C)is seen in the presence of severe edema.
D)indicates problems with arterial circulation.

Question 33

The nurse is reviewing the assessment of a patient's peripheral pulses and notes that the radial pulses are "2+." What type of pulse does this reading indicate?

A)Bounding
B)Normal
C)Weak
D)Absent

Question 34

During an assessment the nurse assists the patient to sit up and dangle his legs over the side of the table.The nurse would expect that a normal finding at this point would be:

A)marked elevational pallor.
B)venous filling within 15 seconds.
C)pain in the feet and lower legs when assuming a sitting position.
D)colour returning to the feet within 20 seconds of assuming a sitting position.

Question 35

During assessment,a patient tells the nurse that her fingers often change colour when she goes out in cold weather.She describes these episodes as her fingers first turning white,then blue,then red with a burning,throbbing pain.The nurse suspects that she is experiencing:

A)lymphedema.
B)Raynaud's syndrome.
C)deep-vein thrombosis.
D)chronic arterial insufficiency.

Question 36

Which of the following sounds is heard when using a Doppler ultrasonic stethoscope to recognize venous flow?

A)A low humming sound
B)A regular "lub,dub" pattern
C)A swishing,whooshing sound
D)A steady,even,flowing sound

Question 37

How would the nurse document mild,slightly pitting edema of the ankles of a pregnant patient?

A)1+/0-4+
B)3+/0-4+
C)4+/0-4+
D)Edema present

Question 38

During a routine visit to the clinic,a patient takes off his shoes and shows the nurse "this awful sore that won't heal." On examination,the nurse notes on the left great toe a 3-cm round ulcer with a pale ischemic base,well-defined edges,and no drainage.The nurse will assess for other signs and symptoms of:

A)varicosities.
B)a venous stasis ulcer.
C)an arterial ischemic ulcer.
D)pitting edema.

Question 39

When auscultating over a patient's femoral arteries,the nurse notes a bruit on the left side.The nurse knows that:

A)bruits are often associated with venous disease.
B)bruits occur in the presence of lymphadenopathy.
C)hypermetabolic states will cause bruits in the femoral arteries.
D)bruits occur with turbulent blood flow,indicating partial occlusion.

Question 40

When assessing a patient's pulse,the nurse notes that the amplitude is weaker during inspiration and stronger during expiration.When the nurse measures the blood pressure,the reading decreases by 20 mm Hg during inspiration and increases with expiration.This patient is experiencing:

A)pulsus alternans.
B)pulsus bisferiens.
C)pulsus bigeminus.
D)pulsus paradoxus.

Question 41

A patient is recovering after having undergone several hours of orthopedic surgery.During assessment of the patient's lower legs,the nurse will look for signs of acute venous problems.What are these signs of acute venous problems? (Select all that apply. )

A)Intense,sharp pain,with the deep muscle tender to touch
B)Aching,tired pain,with a feeling of fullness
C)Pain worse at the end of the day
D)Sudden onset
E)Warm,red,and swollen calf
F)Pain relieved with elevation of leg