Jarvis - Ch 21: Peripheral Vascular system & Lymphatic System Flashcards
As the arteries are the vessels through which the heart pumps oxygenated blood to the body, it is important that arteries are:
a. Large in diameter
b. Strong tough and tesne
c. Thinner walled vessels
d. Controlled by skeletal muscles
b. Strong tough and tesne
The nurse is reviewing the blood supply to the arm. The major artery supplying the arm is the ______ artery.
a. Ulnar
b. Radial
c. Brachial
d. Deep palmar
Brachial
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.
c. In the groove behind the medial malleolus
A 65-year-old patient is experiencing pain in his left calf when he exercises, but the pain 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 caused by venous abnormalities in
c. Ischemia caused by partial blockage of an artery supplying
d. Ischemia caused by the complete blockage of an artery supplying
c. Ischemia caused by partial blockage of an artery supplying the left leg.
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.
a. Intraluminal valves ensure unidirectional flow toward the heart.
Which vein(s) is (are) responsible for most of the venous return in the arm?
a. Deep
b. Ulnar
c. Subclavian
d. Superficial
d. Superficial
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 veins–you won’t 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.”
d. “This vein can be removed without harming your circulation because the deeper veins in your leg are in good condition.”
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. A 25 year old female who is 3 months pregnant
b. A 50 year old female who has remained in bed for 4 days.
c. A 35 year old male with a BMI of 18
d. A 60 year old female taking anticoagulant medication.
b. A 50 year old female who has remained in bed for 4 days.
People who undergo prolonged standing, sitting, or bed rest are at risk for venous disease.
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 slower 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; therefore lymph fluid flows freely from the tissue spaces into the bloodstream. “
b. “The flow of lymph is slower compared with that of blood”
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 patient’s 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 patient’s lower arm and hand and check for the presence of infection or lesions.
d. Examine the patient’s lower arm and hand and check for the presence of infection or lesions.
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. Pellet-like nodes in the supraclavicular region.
b. Enlarged and tender inguinal nodes
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 smaller size of lymph nodes compared with those of an adult.
b. Presence of palpable lymph nodes
During an assessment of an older adult, the nurse should expect to notice which finding as 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
c. Peripheral blood vessels growing more rigid with age, producing a rise in systolic blood pressure.
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. The 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
a. Claudication
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 he elevates them, and the pain 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
b. Problems related to arterial insufficiency
During assessment of a patient with emphysema, the nurse examines the patient’s fingers from the side to detect:
a. Pitting edema
b. Early clubbing
c. Symmetry of the fingers
d. Insufficient capillarr refill
b. Early clubbing
The nurse is assessing a 64-year-old patient whose vital signs are normal, with a capillary refill time of 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.
c. Consider this a delayed capillary refill time, and investigate further.
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
b. Auscultate the site for a bruit
When performing a 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 less than 2 seconds. 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.
c. Consider this finding as normal and proceed with the peripheral vascular evaluation
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
c. Bounding
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 te porarily occluded.
c. To evaluate the adequacy of collateral circulation before cannulating the radial artery.
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 of the skin of the lower leg.
d. Brownish discoloration of the skin of the lower leg.
The nurse is attempting to assess the femoral pulses in an obese patient and should:
a. Ask the patient to assume a prone position
b. Ask the patient to bend his or her knees to the side in a frog-like position.
c. Firmly press against the bone with the patient in a semi-fowler’s position.
d. Listen with a stethoscope for pulsations as palpating the pulse in an obese person is extremely difficult.
b. Ask the patient to bend his or her knees to the side in a frog-like position.
When auscultating a patient’s femoral arteries with the bell, 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
d. Occur with turbulent blood flow, indicating partial occlusion
How should the nurse document mild, slight pitting edema in both of the ankles of a pregnant patient?
a. Bilateral pedal 1+ edema
b. Unilateral pedal 3+ edema
c. Edema 4+ to upper extremities
d. Bilateral brawny edema
a. Bilateral pedal 1+ edema
A patient has hard, non-pitting edema of the left lower leg and ankle. The right leg has no edema. On the basis of these findings, the nurse recalls that:
a. Non-pitting, 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. Longstanding arterial obstruction will cause pitting edema
a. Non-pitting, hard edema occurs with lymphatic obstruction
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 30 mm Hg during inspiration and increases with expiration. This patient is experiencing pulsus ________.
a. Alternans
b. Bisferiens
c. Bigeminus
d. Paradoxus
d. Paradoxus
During an adult patient assessment, the nurse has elevated the patient’s 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. Colour returning to the feet within 20 seconds of assuming a sitting position
b. Venous filling within 15 seconds
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 that are apparent in her lower legs. Which condition is reflected by these findings?
a. DVT
b. Varicose veins
c. Lymphedema
d. Raynaud’s phenomenon
b. Varicose veins
During an assessment, the nurse notices that a patient’s left arm is swollen from the shoulder down to the fingers, with non-pitting 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. DVT
b. Lymphedema
The nurse is preparing to assess the ankle-brachial index (ABI) of a patient. Which statement about the ABI is true?
a. Normal ABI indices are from 0.5 to 1.0
b. Normal ankle pressure is slightly lower than the brachial pressure.
c. The ABI is reliable measurement of peripheral vascular disease in individuals with diabetes.
d. An ABI of 0.9 to 0.7 indicates the presence of peripheral vascular disease and mild claudication.
d. An ABI of 0.9 to 0.7 indicates the presence of peripheral vascular disease and mild claudication
The nurse is performing a well-child check-up on a 5-year-old boy. He has no current condition that would lead the nurse to suspect an illness. His health hx 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. Large, soft, palpable nodes
c. Palpable firm, small, shotty, mobile, and nontender lymph nodes
d. Firm rubbery, and large nodes, somewhat fixed to the underlying tissue.
c. Palpable firm, small, shotty, mobile, and nontender lymph nodes
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
c. swishing, whooshing sound
The nurse is describing a weak, thready pulse on the documentation flow sheet. Which statement is correct?
a. “it is easily palpable; pounds under the fingertips.”
b. “It has greater than normal force, and then it suddenly collapses.”
c. “It is hard to palpate, fades in and out, and is easily obliterated by pressure.”
d. “The rhythm is regular, but the force varies with alternating beats of large and small amplitudes.”
c. “It is hard to palpate, fades in and out, and is easily obliterated by pressure.”
During an 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, and then red with a burning, throbbing pain. The nurse suspects that she is experiencing:
a. Lymphedema
b. Raynaud’s Phenomenon
c. DVT
d. Chronic arterial insufficiency
b. Raynaud’s Phenomenon
During a routine office visit, a patient takes off his shows and shows the nurse “this awful sore that won’t 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. Varicosities
b. Venous stasis ulcer
c. Arterial Ischemic ulcer
d. DVT
c. Arterial Ischemic ulcer
The nurse is reviewing an assessment of a patient’s peripheral pulses and notes previous documentation of radial pulses to be “2+.” The nurse recognizes that this reading indicates what type of pulse?
a. Bounding
b. Normal
c. Weak
d. Absent
b. Normal
