CH 21 - Peripheral Vascular System and Lymphatic System

Question 1

1. Which statement is true regarding the arterial system?
   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 the veins.
   d. Arteries can greatly expand to accommodate a large blood volume increase.

Answer 1

The arterial system is a high-pressure system.

Question 2

2. The nurse is reviewing the blood supply to the arm. The major artery supplying the arm is the _____ artery.

Ulnar
Radial 
Brachial 
Deep 
palmar

Answer 2

Brachial

Question 3

3. The nurse is preparing to assess the dorsalis pedis artery. Where is the correct location for palpation?
   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

Answer 3

d. Lateral to the extensor tendon of the great toe

Question 4

4. A 65-year-old patient is experiencing pain in his left calf when he exercises that disappears after resting for a few minutes. The nurse recognizes that this description is most consistent with _______ the left leg.
   a. Venous obstruction of
   b. Claudication due to venous abnormalities in
   c. Ischemia caused by a partial blockage of an artery supplying
   d. Ischemia caused by the complete blockage of an artery supplying

Answer 4

c. Ischemia caused by a partial blockage of an artery supplying

Question 5

5. The nurse is reviewing venous blood flow patterns. Which of these 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. High-pressure system of the heart helps facilitate venous return.
   d. Increased thoracic pressure and decreased abdominal pressure facilitate venous return to the heart.

Answer 5

a. Intraluminal valves ensure unidirectional flow toward the heart.

Question 6

6. Which vein(s) is(are) responsible for most of the venous return in the arm?

Deep

Ulnar

Subclavian

Superficial

Answer 6

Superficial

Question 7

7. A 70-year-old patient is scheduled for open-heart surgery. The surgeon plans to use the great saphenous vein for the coronary bypass grafts. The patient asks, What happens to my circulation when this vein is removed? The nurse should reply:
   a. Venous insufficiency is a common problem after this type of surgery.
   b. Oh, you have lots of veinsyou wont even notice that it has been removed.
   c. You will probably experience decreased circulation after the vein is removed.
   d. This vein can be removed without harming your circulation because the deeper veins in your leg are in good condition.

Answer 7

d. This vein can be removed without harming your circulation because the deeper veins in your leg are in good condition.

Question 8

8. The nurse is reviewing the risk factors for venous disease. Which of these situations best describes a person at highest risk for the development of venous disease?
   a. Woman in her second month of pregnancy
   b. Person who has been on bed rest for 4 days
   c. Person with a 30-year, 1 pack per day smoking habit
   d. Older adult taking anticoagulant medication

Answer 8

b. Person who has been on bed rest for 4 days

Question 9

9. The nurse is teaching a review class on the lymphatic system. A participant shows correct understanding of the material with which statement?
   a. Lymph flow is propelled by the contraction of the heart.
   b. The flow of lymph is slow, compared with that of the blood.
   c. One of the functions of the lymph is to absorb lipids from the biliary tract.

d. Lymph vessels have no valves; therefore, lymph fluid flows freely from the tissue spaces into the
bloodstream.

Answer 9

b. The flow of lymph is slow, compared with that of the blood.

Question 10

10. When performing an assessment of a patient, the nurse notices the presence of an enlarged right epitrochlear lymph node. What should the nurse do next?
    a. Assess the patients abdomen, and notice any tenderness.
    b. Carefully assess the cervical lymph nodes, and check for any enlargement.
    c. Ask additional health history questions regarding any recent ear infections or sore throats.
    d. Examine the patients lower arm and hand, and check for the presence of infection or lesions.

Answer 10

d. Examine the patients lower arm and hand, and check for the presence of infection or lesions.

Question 11

11. A 35-year-old man is seen in the clinic for an infection in his left foot. Which of these findings should the nurse expect to see during an assessment of this patient?
    a. Hard and fixed cervical nodes
    b. Enlarged and tender inguinal nodes
    c. Bilateral enlargement of the popliteal nodes
    d. Pelletlike nodes in the supraclavicular region

Answer 11

b. Enlarged and tender inguinal nodes

Question 12

12. The nurse is examining the lymphatic system of a healthy 3-year-old child. Which finding should the nurse expect?
    a. Excessive swelling of the lymph nodes
    b. Presence of palpable lymph nodes
    c. No palpable nodes because of the immature immune system of a child
    d. Fewer numbers and a smaller size of lymph nodes compared with those of an adult

Answer 12

b. Presence of palpable lymph nodes

Question 13

13. During an assessment of an older adult, the nurse should expect to notice which finding as a normal physiologic 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

Answer 13

c. Peripheral blood vessels growing more rigid with age, producing a rise in systolic blood pressure

Question 14

14. A 67-year-old patient states that he recently began to have pain in his left calf when climbing the 10 stairs to his apartment. This pain is relieved by sitting for approximately 2 minutes; then he is able to resume his activities. The nurse interprets that this patient is most likely experiencing:
    a. Claudication.
    b. Sore muscles.
    c. Muscle cramps.
    d. Venous insufficiency.

Answer 14

a. Claudication.

Question 15

15. A patient complains of leg pain that wakes him at night. He states that he has been having problems with his legs. He has pain in his legs when they are elevated that disappears when he dangles them. He recently noticed a sore on the inner aspect of the right ankle. On the basis of this health history information, the nurse interprets 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 15

b. Problems related to arterial insufficiency.

Question 16

16. During an assessment, the nurse uses the profile sign to detect:
    a. Pitting edema.
    b. Early clubbing.
    c. Symmetry of the fingers.
    d. Insufficient capillary refill.

Answer 16

b. Early clubbing.

Question 17

17. The nurse is performing an assessment on an adult. The adults vital signs are normal, and capillary refill time is 5 seconds. What should the nurse do next?
    a. Ask the patient about a history of frostbite.
    b. Suspect that the patient has venous insufficiency.
    c. Consider this a delayed capillary refill time, and investigate further.
    d. Consider this a normal capillary refill time that requires no further assessment.

Answer 17

c. Consider this a delayed capillary refill time, and investigate further.

Question 18

18. When assessing a patient, the nurse notes that the left femoral pulse as diminished, 1+/4+. What should the nurse do next?

a. Document the finding.
b. Auscultate the site for a bruit.
c. Check for calf pain.
d. Check capillary refill in the toes.

Answer 18

b. Auscultate the site for a bruit.

Question 19

19. When performing a peripheral vascular assessment on a patient, the nurse is unable to palpate the ulnar pulses. The patients skin is warm and capillary refill time is normal. Next, the nurse should:

a. Check for the presence of claudication.
b. Refer the individual for further evaluation.
c. Consider this finding as normal, and proceed with the peripheral vascular evaluation.
d. Ask the patient if he or she has experienced any unusual cramping or tingling in the arm.

Answer 19

c. Consider this finding as normal, and proceed with the peripheral vascular evaluation.

Question 20

20. The nurse is assessing the pulses of a patient who has been admitted for untreated hyperthyroidism. The nurse should expect to find a(n) _______ pulse.

a. Normal
b. Absent
c. Bounding
d. Weak, thready

Answer 20

c. Bounding

Question 21

21. The nurse is preparing to perform a modified Allen test. Which is an appropriate reason for this test?

a. To measure the rate of lymphatic drainage
b. To evaluate the adequacy of capillary patency before venous blood draws
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

Answer 21

c. To evaluate the adequacy of collateral circulation before cannulating the radial artery

Question 22

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

a. Unilateral cool foot
b. Thin, shiny, atrophic skin
c. Pallor of the toes and cyanosis of the nail beds
d. Brownish discoloration to the skin of the lower leg

Answer 22

d. Brownish discoloration to the skin of the lower leg

Question 23

23. The nurse is attempting to assess the femoral pulse in a patient who is obese. Which of these actions would be most appropriate?

a. The patient is asked to assume a prone position.
b. The patient is asked to bend his or her knees to the side in a froglike position.
c. The nurse firmly presses against the bone with the patient in a semi-Fowler position.
d. The nurse listens with a stethoscope for pulsations; palpating the pulse in an obese person is extremely difficult.

Answer 23

b. The patient is asked to bend his or her knees to the side in a froglike position.

Question 24

24. When auscultating over a patients femoral arteries, the nurse notices the presence of a bruit on the left side. The nurse knows that bruits:

a. Are often associated with venous disease.
b. Occur in the presence of lymphadenopathy.
c. In the femoral arteries are caused by hypermetabolic states.
d. Occur with turbulent blood flow, indicating partial occlusion.

Answer 24

d. Occur with turbulent blood flow, indicating partial occlusion.

Question 25

25. How should the nurse document mild, slight pitting edema the ankles of a pregnant patient?

a. 1+/0-4+
b. 3+/0-4+
c. 4+/0-4+
d. Brawny edema

Answer 25

a. 1+/0-4+

Question 26

26. A patient has hard, nonpitting edema of the left lower leg and ankle. The right leg has no edema. Based on these findings, the nurse recalls that:

a. Nonpitting, hard edema occurs with lymphatic obstruction.
b. Alterations in arterial function will cause edema.
c. Phlebitis of a superficial vein will cause bilateral edema.
d. Long-standing arterial obstruction will cause pitting edema.

Answer 26

a. Nonpitting, hard edema occurs with lymphatic obstruction.

Question 27

27. When assessing a patients 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 20 mm Hg during inspiration and increases with expiration. This patient is experiencing pulsus:

a. Alternans.
b. Bisferiens.
c. Bigeminus.
d. Paradoxus.

Answer 27

d. Paradoxus.

Question 28

28. During an assessment, the nurse has elevated a patients legs 12 inches off the table and has had him wag his feet to drain off venous blood. After helping him sit up and dangle his legs over the side of the table, the nurse should expect that a normal finding at this point would be:

a. Significant elevational pallor.
b. Venous filling within 15 seconds.
c. No change in the coloration of the skin.
d. Color returning to the feet within 20 seconds of assuming a sitting position.

Answer 28

b. Venous filling within 15 seconds.

Question 29

29. During a visit to the clinic, a woman in her seventh month of pregnancy complains that her legs feel heavy in the calf and that she often has foot cramps at night. The nurse notices that the patient has dilated, tortuous veins apparent in her lower legs. Which condition is reflected by these findings?

a. Deep-vein thrombophlebitis
b. Varicose veins
c. Lymphedema
d. Raynaud phenomenon

Answer 29

b. Varicose veins

Question 30

30. During an assessment, the nurse notices that a patients left arm is swollen from the shoulder down to the fingers, with nonpitting brawny edema. The right arm is normal. The patient had a left-sided mastectomy 1 year ago. The nurse suspects which problem?

a. Venous stasis
b. Lymphedema
c. Arteriosclerosis
d. Deep-vein thrombosis

Question 31

32. The nurse is performing a well-child checkup on a 5-year-old boy. He has no current condition that would lead the nurse to suspect an illness. His health history is unremarkable, and he received immunizations 1 week ago. Which of these findings should be considered normal in this patient?

a. Enlarged, warm, and tender nodes
b. Lymphadenopathy of the cervical nodes
c. Palpable firm, small, shotty, mobile, and nontender lymph nodes
d. Firm, rubbery, and large nodes, somewhat fixed to the underlying tissue

Answer 31

c. Palpable firm, small, shotty, mobile, and nontender lymph nodes

Question 32

33. When using a Doppler ultrasonic stethoscope, the nurse recognizes venous flow when which sound is heard?
    a. Low humming sound
    b. Regular lub, dub pattern
    c. Swishing, whooshing sound
    d. Steady, even, flowing sound

Answer 32

c. Swishing, whooshing sound

Question 33

34. The nurse is describing a weak, thready pulse on the documentation flow sheet. Which statement is
    correct?
    a. Is easily palpable; pounds under the fingertips.
    b. Has greater than normal force, then suddenly collapses.
    c. Is hard to palpate, may fade in and out, and is easily obliterated by pressure.
    d. Rhythm is regular, but force varies with alternating beats of large and small amplitude.

Answer 33

c. Is hard to palpate, may fade in and out, and is easily obliterated by pressure.

Question 34

35. During an assessment, a patient tells the nurse that her fingers often change color 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 disease.
c. Deep-vein thrombosis.
d. Chronic arterial insufficiency.

Answer 34

b. Raynaud disease.

Question 35

36. During a routine office visit, a patient takes off his shoes and shows the nurse this awful sore that wont heal. On inspection, the nurse notes a 3-cm round ulcer on the left great toe, with a pale ischemic base, well- defined edges, and no drainage. The nurse should assess for other signs and symptoms of:

a. V aricosities.
b. Venous stasis ulcer.
c. Arterial ischemic ulcer.
d. Deep-vein thrombophlebitis.

Answer 35

c. Arterial ischemic ulcer.

Question 36

37. The nurse is reviewing an assessment of a patients peripheral pulses and notices that the documentation states that the radial pulses are 2+. The nurse recognizes that this reading indicates what type of pulse?

a. Bounding
b. Normal
c. Weak
d. Absent

Answer 36

a. Bounding

Question 37

1. A patient is recovering from several hours of orthopedic surgery. During an assessment of the patients lower legs, the nurse will monitor for signs of acute venous symptoms. Signs of acute venous symptoms include which of the following? Select all that apply.

a. Intense, sharp pain, with the deep muscle tender to the touch
b. Aching, tired pain, with a feeling of fullness
c. Pain that is worse at the end of the day
d. Sudden onset
e. Warm, red, and swollen calf
f. Pain that is relieved with elevation of the leg

Answer 37

a. Intense, sharp pain, with the deep muscle tender to the touch
d. Sudden onset
e. Warm, red, and swollen calf

Question 38

2. A patient has been admitted with chronic arterial symptoms. During the assessment, the nurse should expect which findings?
   Select all that apply.
   a. Patient has a history of diabetes and cigarette smoking.
   b. Skin of the patient is pale and cool.
   c. His ankles have two small, weeping ulcers.
   d. Patient works long hours sitting at a computer desk.
   e. He states that the pain gets worse when walking.
   f. Patient states that the pain is worse at the end of the day.

Answer 38

a. Patient has a history of diabetes and cigarette smoking.

b. Skin of the patient is pale and cool.