Jarvis Chapter 21 Peripheral Vascular System and Lymphatic System

Which of these statements 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.

ANS: B

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

ANS: C

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

ANS: D

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

ANS:C

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.

ANS: A

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

a.

Deep

b.

Ulnar

c.

Subclavian

d.

Superficial

ANS: D

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 the veins are 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."

ANS: D

The nurse is reviewing risk factors for venous disease. Which of these situations best describes a person at highest risk for 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

ANS: B

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."

ANS: B

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.

ANS: D

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

ANS: B

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

ANS: B

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

ANS: C

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 about 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.

ANS: A.

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 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.

ANS: B

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.

ANS: B.

The nurse is performing an assessment on an adult. The adult's 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.

ANS: C

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.

ANS: B

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 normal. The nurse should next:

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.

ANS: C

.

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

ANS: C

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

ANS: C

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

ANS: D

The nurse is attempting to assess the femoral pulse in an obese patient. 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.

ANS: B

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

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.

ANS: D

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

a.

1+/0-4+

b.

3+/0-4+

c.

4+/0-4+

d.

Brawny edema

ANS: A

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.

ANS: A

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 20 mm Hg during inspiration and increases with expiration. This patient is experiencing pulses:

a.

Alternans.

b.

Bisferiens.

c.

Bigeminus.

d.

Paradoxus.

ANS: D

During an assessment the nurse has elevated a patient's legs 12 inches off the table and has had him wag his feet to drain off venous blood. After helping him to sit up and dangle his legs over the side of the table, the nurse should expect 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.

ANS: B

During a clinic visit, 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 in her lower legs. Which condition is reflected by these findings?

a.

Deep-vein thrombophlebitis

b.

Varicose veins

c.

Lymphedema

d.

Raynaud phenomenon

ANS: B

During an assessment, the nurse notices that a patient's 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

ANS: B

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 a 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.

ANS: D

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

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

ANS: C

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

ANS: C

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."

ANS: C

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.

ANS: B

During a routine office visit, a patient takes off his shoes 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.

Deep-vein thrombophlebitis.

ANS: C

The nurse is reviewing an assessment of a patient's 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

ANS: B

A patient is recovering from several hours of orthopedic surgery. During an assessment of the patient's 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

ANS: A. D. E.

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.

ANS: A. B. E.

The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. The nurse knows that this finding indicates:

a.

Decreased fluid volume.

b.

Increased cardiac output.

c.

Narrowing of jugular veins.

d.

Elevated pressure related to heart failure.

ANS: D

Lymph nodes are palpable in:

adults with infections.

All of the options.

children with infections.

healthy children.

All of the options.

Mrs. Lukianchuk is a 65-year-old patient who presents to the ambulatory health centre with a complaint of bilateral foot pain. On examination, you note delayed venous filling. This occurs with:

incompetent valves.

anemia.

arterial insufficiency.

aortic valve stenosis.

arterial insufficiency.

Mr. Duguay is a 68-year-old man who comes to the clinic for a routine health assessment. In the older adult:

the peripheral vessels become less rigid.

the number of lymph nodes increases.

the lymphatic tissue decreases.

the intramuscular calf veins shrink.

the lymphatic tissue decreases.

Mrs. Schneider comes to the office for a routine health assessment and without complaints. On examination, you note a water-hammer "Corrigan's" pulse. This is associated with:

hyperkinetic states.

aortic valve regurgitation.

conduction disturbance.

decreased cardiac output.

aortic valve regurgitation.

Pulsus bigeminus is associated with:

aortic valve regurgitation.

hyperkinetic states.

heart failure.

conduction disturbance.

conduction disturbance.

Mr. Worrigan is a 67-year-old patient who comes with his son to the ambulatory health centre. On examination of Mr. Worrigan, you note a pulsus alternans. This is associated with:

heart failure.

pulmonary embolisms.

hyperkinetic states.

decreased cardiac output.

heart failure.

Mrs. Gorman comes to the ambulatory health centre for a routine health assessment. On examination, you perform the modified Allen test, which assesses:

early clubbing.

the presence of thrombophlebitis.

the degree of pedal edema.

the patency of the radial and ulnar arteries.

the patency of the radial and ulnar arteries.

An aneurysm is:

a fatty plaque deposited in the intima of the arteries.

a thickening and loss of elasticity of the arterial walls.

a sac formed by dilation in the arterial wall.

a variation from the heart's normal rhythm.

a sac formed by dilation in the arterial wall.

Arteriosclerosis refers to:

a deposition of fatty plaques along the intima of the arteries.

thickening and loss of elasticity of the arterial walls.

a sac formed by dilation in the arterial wall.

a variation from the heart's normal rhythm.

thickening and loss of elasticity of the arterial walls.

Atherosclerosis is defined as:

a swooshing sound heard through a stethoscope when an artery is partially occluded.

a thickening and loss of elasticity of the arterial walls.

plaques of fatty deposits forming in the intima of the arteries.

a sac formed by dilation in the arterial wall.

plaques of fatty deposits forming in the intima of the arteries.

When providing his health history, Mr. Meier sates that his mother had lymphedema and then says, "Just what is that?" Your best reply would be that lymphedema is:

the swelling of an extremity due to an obstructed lymph channel.

an inflammation of the vein associated with thrombus formation.

the indentation left after the examiner depresses the skin over swollen edematous tissue.

a thickening and loss of elasticity of the arterial walls.

the swelling of an extremity due to an obstructed lymph channel.

Mr. Kimbel is a 59-year-old patient who comes to the clinic for a routine health assessment at the request of his son. On examination, you note a positive profile sign. This indicates:

early clubbing.

the patency of the radial and ulnar arteries.

the presence of thrombophlebitis.

the degree of pedal edema.

early clubbing.

In previewing the medical record of a patient, you find documentation of pulsus alternans. On the basis of this fact, what do you expect when you assess the patient?

Pulse with a regular rhythm, but the force of the pulse varies with alternating beats.

Pulse with weaker amplitude with respiratory inspiration and stronger amplitude with expiration.

Deficiency of oxygenated arterial blood to a body part.

Pulse with coupled rhythm; every other beat is premature.

Pulse with a regular rhythm, but the force of the pulse varies with alternating beats.

In pulsus bigeminus:

there is a deficiency of oxygenated arterial blood to a body part.

the rhythm is regular, but the force of the pulse varies with alternating beats.

the rhythm is coupled-every other beat is premature.

beats have weaker amplitude with respiratory inspiration and stronger amplitude with expiration.

the rhythm is coupled-every other beat is premature.

One of the leg's deep veins is the:

great saphenous.

popliteal.

small saphenous.

tibial.

popliteal.

The blood is returned to the heart through the veins by means of:

All of the options.

breathing.

unidirectional valves.

walking.

All of the options.

Axillary nodes drain the:

anterior abdominal wall.

lower extremities.

hand and lower arm.

breast and upper arm.

breast and upper arm.

The cervical nodes drain the:

upper arm and breast.

external genitalia.

head and neck.

hand and lower arm.

head and neck.

The inguinal nodes drain the:

hand and lower arm.

upper arm and breast.

head and neck.

anterior abdominal wall.

anterior abdominal wall.

Palatine, pharyngeal, and lingual are specific names for:

cervical lymph nodes.

tonsils.

epitrochlear lymph nodes.

axillary lymph nodes.

tonsils.

Which direction would you give a patient to assist you with palpating the femoral pulse?

"Push your leg down against the examining table."

"Relax your leg and turn your foot and knee inward."

"Bend your knee outward like a frog."

"Straighten your leg and point your toe."

"Bend your knee outward like a frog."

Mr. Harris comes to the clinic for a follow-up appointment. On examination, you note a full "bounding" pulse. This is associated with: (Select all that apply.)

Select all that apply.

anxiety.

aortic valve stenosis.

elevated temperature.

hyperthyroidism.

anemia.

patent ductus arteriosus.

anxiety.

anemia

hyperthroidism

elevated temperature

Mr. Jankowski comes to your clinic with his child, who has been studying about the thymus gland in school. She is correct when she tells you the following is/are true about the thymus gland. (Select all that apply.)

Select all that apply.

Develops T-lymphocytes

The gland atrophies after puberty.

Is vital to the immune system

Develops B-lymphocytes

Develops T-lymphocytes

The gland atrophies after puberty

Is vital to the immune system