Peripheral Vascular System and Lymphatic System

Peripheral Vascular System and Lymphatic System MULTIPLE CHOICE 1. Which statement is true regarding the arterial system? Arteries are large-diameter vessels. b. The arterial system is a high-pressure system. 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 pumping heart makes the arterial system a high-pressure system. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: General 2. The nurse is reviewing the blood supply to the arm. The major artery supplying the arm is the artery. Ulnar Radial b. Brachial d. Deep palmar ANS: C The major artery supplying the arm is the brachial artery. The brachial artery bifurcates into the ulnar and radial arteries immediately below the elbow. In the hand, the ulnar and radial arteries form two arches known as the superficial and deep palmar arches. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: General 3. The nurse is preparing to assess the dorsalis pedis artery. Where is the correct location for palpation? Behind the knee b. Over the lateral malleolus In the groove behind the medial malleolus. d. Lateral to the extensor tendon of the great toe ANS: D The dorsalis pedis artery is located on the dorsum of the foot. The nurse should palpate just lateral to and parallel with the extensor tendon of the big toe. The popliteal artery is palpated behind the knee. The posterior tibial pulse is palpated in the groove between the malleolus and the Achilles tendon. No pulse is palpated at the lateral malleolus. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: General 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. d. Claudication due to venous abnormalities in Ischemia caused by a partial blockage of an artery supplying Ischemia caused by the complete blockage of an artery supplying ANS: C NURSINGTB.COM Ischemia is a deficient supply of oxygenated arterial blood to a tissue. A partial blockage creates an insufficien supply, and the ischemia may be apparent only during exercise when oxygen needs increase. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 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? Intraluminal valves ensure unidirectional flow toward the heart. Contracting skeletal muscles milk blood distally toward the veins. High-pressure system of the heart helps facilitate venous return. Increased thoracic pressure and decreased abdominal pressure facilitate venous return to the heart. b d. ANS: A Blood moves through the veins by (1) contracting skeletal muscles that proximally milk the blood; (2) pressure gradients caused by breathing, during which inspiration makes the thoracic pressure decrease and the abdominal pressure increase; and (3) the intraluminal valves, which ensure unidirectional flow toward the heart. If pitting edema is present, then the nurse should grade it on a scale of 1+ (mild) to 4+ (severe). Brawny edema appears as nonpitting edema and feels hard to the touch. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 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: Nonpitting, hard edema occurs with lymphatic obstruction. Alterations in arterial function will cause edema. Phlebitis of a superficial vein will cause bilateral edema. d. Long-standing arterial obstruction will cause pitting edema. ANS: A Unilateral edema occurs with occlusion of a deep vein and with unilateral lymphatic obstruction. With these factors, the edema is nonpitting and feels hard to the touch (brawny edema). DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation NURSINGTB.COM 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: Alternans. Bisferiens. Bigeminus. Paradoxus. b. с. b. d. ANS: D In pulsus paradoxus, beats have weaker amplitude with inspiration and stronger amplitude with expiration and is best determined during blood pressure measurement; reading decreases (>10 mm Hg) during inspiration and increases with expiration. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 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 1. Significant elevational pallor. b. Venous filling within 15 seconds. No change in the coloration of the skin. d. Color returning to the feet within 20 seconds of assuming a sitting position. ANS: B In this test, it normally takes 10 seconds or less for the color to return to the feet and 15 seconds for the veins of the feet to fill. Significant elevational pallor, as well as delayed venous filling, occurs with arterial insufficiency. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 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 с. Lymphedema d. Raynaud phenomenon ANS: B Superficial varicose veins are caused by incompetent distant valves in the veins, which results in the reflux of blood, producing dilated, tortuous veins. Varicose veins are more common in wonen, and pregnancy can also be a cause. Symptoms include aching, heaviness in the calf, easy fatigability, and night leg or foot cramps. Dilated, tortuous veins are observed on assessment. DIF: Cognitive Level: Applying (Application). MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation. 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? Venous stasis b. Lymphedema с. Arteriosclerosis d. Deep-vein thrombosis ANS: B Lymphedema after breast cancer causes unilateral swelling and nonpitting brawny edema, with overlying skin indurated. It is caused by the removal of lymph nodes with breast surgery or damage to lymph nodes and channels with radiation therapy for breast cancer, and lymphedema can impede drainage of lymph. The other responses are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 31. The nurse is preparing to assess the ankle-brachial index (ABI) of a patient. Which statement about the ABI is true? Normal ABI indices are from 0.5 to 1.0. b. Normal ankle pressure is slightly lower than the brachial pressure. 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 Use of the Doppler stethoscope is a noninvasive way to determine the extent of peripheral vascular disease. The normal ankle pressure is slightly greater than or equal to the brachial pressure. An ABI of 0.9 to 0.7 indicates the presence of peripheral vascular disease and mild claudication. The ABI is less reliable in patients with diabetes mellitus because of claudication, which makes the arteries noncompressible and may give a false high-ankle pressure. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 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 I week ago. Which of these findings should be considered normal in this patient? Enlarged, warm, and tender nodes b. Lymphadenopathy of the cervical nodes Palpable firm, small, shotty, mobile, and nontender lymph nodes d. Firm, rubbery, and large nodes, somewhat fixed to the underlying tissue ANS: C