Chapter 21: Peripheral Vascular System and Lymphatic System
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
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.
2. The nurse is reviewing the blood supply to the arm. What major artery supplies blood to the
arm?
a.
Ulnar
b.
Radial
c.
Brachial
d.
Deep palmar
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
4. A 65-year-old patient is experiencing pain in his left calf when he exercises which disappears
after resting for a few minutes. What problem in the left leg does this indicate?
a.
Venous obstruction
b.
Partial blockage of an artery
c.
Claudication due to venous abnormalities
d.
Ischemia caused by the complete blockage of an artery
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.
6. Which vein(s) is(are) responsible for most of the venous return in the arm?
a.
Deep
b.
Ulnar
c.
Subclavian
d.
Superficial
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?” How should the nurse 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.”
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.
Person who has been on bed rest for 4 days
b.
Older adult taking anticoagulant medication
c.
Woman in the second month of her first pregnancy
d.
Person with a 30-year, 1 pack per day smoking habit
9. The nurse is teaching a review class on the lymphatic system. Which statement by a class
participant indicates correct understanding of the material?
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.”
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 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.
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
12. The nurse is examining the lymphatic system of a healthy 3-year-old child. Which finding
should the nurse expect?
a.
Palpable superficial lymph nodes
b.
Excessive swelling of the lymph nodes
c.
No palpable nodes because of the immature immune system of a child
d.
Fewer and smaller sized lymph nodes compared with those of an adult
13. During an assessment of an older adult, the nurse should expect to 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
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 “a couple of minutes”; then
he is able to resume his activities. What do these symptoms suggest?
a.
Claudication
b.
Sore muscles
c.
Muscle cramps
d.
Venous insufficiency
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 outer aspect of the right ankle. What do
these findings suggest?
a.
Pain r/t lymphatic abnormalities
b.
Problems r/t venous insufficiency
c.
Problems r/t arterial insufficiency
d.
Pain r/t musculoskeletal abnormalities
16. The nurse uses the profile sign during an assessment. What does this technique detect?
a.
Barrel chest
b.
Early clubbing
c.
Symmetry of the fingers
d.
Insufficient capillary refill
17. 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.
18. 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. What should
the nurse do next?
a.
Check for the presence of claudication.
b.
Refer the individual for further evaluation.
c.
Consider this finding 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.
19. The nurse is assessing the pulses of a patient who has been admitted for untreated
hyperthyroidism. When assessing this patient’s pulse, what should the nurse expect?
a.
Normal
b.
Bounding
c.
Weak, thready
d.
Unpalpable pedal pulse
20. 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
21. 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
22. The nurse is attempting to assess the femoral pulse in a patient who is obese. Which of these
actions would be most appropriate?
a.
Ask the patient to assume a prone position.
b.
Ask the patient 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.
23. When auscultating over a patient’s femoral arteries, the nurse notices the presence of a bruit
on the left side. Which statement about bruits is accurate?
a.
Often associated with venous disease
b.
Occur in the presence of lymphadenopathy
c.
Femoral artery bruits are caused by hypermetabolic states
d.
Occur with turbulent blood flow, indicating partial occlusion
24. 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
25. A patient has hard, nonpitting edema of the left lower leg and ankle. The right leg has no
edema. When interpreting these findings, what should the nurse recall?
a.
Alterations in arterial function will cause edema.
b.
Nonpitting, hard edema occurs with lymphatic obstruction.
c.
Phlebitis of a superficial vein will cause bilateral edema.
d.
Long-standing arterial obstruction will cause pitting edema.
26. 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. What do these
findings indicate?
a.
Pulsus alternans
b.
Pulsus bisferiens
c.
Pulsus bigeminus
d.
Pulsus paradoxus
27. During an assessment, the nurse elevated a patient’s legs 12 inches off the table and 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, what should the nurse expect for a normal finding?
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
28. During a visit to the clinic, a woman in her seventh month of pregnancy states 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.
Lymphedema
b.
Varicose veins
c.
Raynaud phenomenon
d.
Deep vein thrombophlebitis
29. 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. Based on these findings, what does the nurse suspect?
a.
Lymphedema
b.
Venous stasis
c.
Arteriosclerosis
d.
Deep-vein thrombosis
30. 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.
31. The nurse is performing a well-child checkup on a 5-year-old boy. The child 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
32. When using a Doppler ultrasonic stethoscope, the nurse recognizes venous flow when which
sound is heard?
a.
Low humming sound
b.
Swishing, whooshing sound
c.
Regular “lub, dub” pattern
d.
Steady, even, flowing sound
33. The nurse is describing a weak, thready pulse on the documentation flow sheet. Which
statement is correct?
a.
“Easily palpable; pounds under the fingertips.”
b.
“Greater than normal force that suddenly collapses.”
c.
“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.”
34. 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. What does the nurse suspect?
a.
Lymphedema
b.
Raynaud phenomenon
c.
Deep-vein thrombosis
d.
Chronic arterial insufficiency
35. 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. Based on these findings, what does
the nurse suspect?
a.
Varicosities
b.
Venous stasis ulcer
c.
Arterial ischemic ulcer
d.
Deep vein thrombophlebitis
36. 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.
Weak
b.
Absent
c.
Normal
d.
Bounding
MULTIPLE RESPONSE
1. 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.
Sudden onset
b.
Warm, red, and swollen calf
c.
Pain that is worse at the end of the day
d.
Aching, tired pain, with a feeling of fullness
e.
Pain that is relieved with elevation of the leg.
f.
Intense, sharp pain, with the deep muscle tender to the touch
2. A patient has been admitted with chronic arterial symptoms. During the assessment, the nurse
should expect which findings? (Select all that apply.)
a.
Skin of the patient is pale and cool.
b.
His ankles have two small, weeping ulcers.
c.
He states that the pain gets worse when walking.
d.
Patient works long hours sitting at a computer desk.
e.
Patient has a history of diabetes and cigarette smoking.
f.
Patient states that the pain is worse at the end of the day.
