Chapter 20: Peripheral Vascular System and Lymphatic System

A patient has a positive Homan's sign. The nurse knows that a positive Homan's sign: 1. occurs with venous insufficiency. 2. is indicative of possible thrombophlebitis. 3. is seen in the presence of severe edema. 4. indicates problems with arterial circulation.

is indicative of possible thrombophlebitis.

A patient has hard, nonpitting edema of the left lower leg and ankle. The nurse knows that: 1. nonpitting, hard edema occurs with lymphatic obstruction. 2. alterations in arterial function will cause this edema. 3. phlebitis of a superficial vein will cause bilateral edema. 4. long-standing arterial obstruction will cause pitting edema.

nonpitting, hard edema occurs with lymphatic obstruction.

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, which 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 patient is most likely experiencing: 1. pain related to lymphatic abnormalities. 2. problems related to arterial insufficiency. 3. problems related to venous insufficiency. 4. pain related to musculoskeletal abnormalities.

problems related to arterial insufficiency.

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: 1. pulsus alternans. 2. pulsus bisferiens. 3. pulsus bigeminus. 4. pulsus paradoxus.

pulsus paradoxus.

The nurse is performing a peripheral vascular assessment on a bedridden patient, and notes the following findings in the right leg: increased warmth, swelling, redness, tenderness to palpation, and a positive Homan's sign. The nurse would: 1. reevaluate the patient in a few hours. 2. consider this a normal finding for a bedridden patient. 3. seek emergency referral because of the risk of pulmonary embolism. 4. ask the patient to raise his leg off of the bed and check for pain on elevation.

seek emergency referral because of the risk of pulmonary embolism.

Which of the following statements best describes the mechanism(s) by which venous blood returns to the heart? 1. Intraluminal valves ensure unidirectional flow toward the heart. 2. Contracting skeletal muscles milk blood distally toward the veins. 3. The high-pressure system of the heart helps to facilitate venous return. 4. Increased thoracic pressure and decreased abdominal pressure facilitate venous return to the heart.

Intraluminal valves ensure unidirectional flow toward the heart.

A 70-year-old patient is scheduled for open-heart surgery. The physicians plan 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: 1. "Venous insufficiency is a common problem after this type of surgery." 2. "Oh, we have lots of veins—you won't even notice that it has been removed." 3. "You will probably experience decreased circulation after the veins are removed." 4. "Because the deeper veins in your leg are in good condition, this vein can be removed without harming your circulation."

"Because the deeper veins in your leg are in good condition, this vein can be removed without harming your circulation."

When describing a weak, thready pulse, the nurse should document: 1. "Easily palpable, pounds under the fingertips." 2. "Greater than normal force, then collapses suddenly." 3. "Hard to palpate, may fade in and out, easily obliterated by pressure." 4. "Rhythm is regular, but force varies with alternating beats of large and small amplitude."

"Hard to palpate, may fade in and out, easily obliterated by pressure."

When assessing a patient the nurse documents the left femoral pulse as 0/0-4+. Which of the following findings would the nurse expect at the dorsalis pedis pulse? 1. 0/0-4+ 2. 1+/0-4+ 3. 2+/0-4+ 4. 3+/0-4+

0/0-4+

How would the nurse document mild, slight pitting edema present at the ankles of a pregnant patient? 1. 1+/0-4+ 2. 3+/0-4+ 3. 4+/0-4+ 4. Edema present

1+/0-4+

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: Select all that apply. 1. Intense, sharp pain, with the deep muscle tender to touch 2. Aching, tired pain, with a feeling of fullness 3. Pain is worse at the end of the day. 4. Onset is sudden. 5. Calf is warm, red, and swollen. 6. Pain is relieved with elevation of leg.

1. Intense, sharp pain, with the deep muscle tender to touch 4. Onset is sudden. 5. Calf is warm, red, and swollen.

Which of the following pulses would most likely be seen in an individual with untreated hyperthyroidism? 1. A normal pulse 2. An absent pulse 3. A bounding pulse 4. A weak, thready pulse

A bounding pulse

A patient has been diagnosed with venous stasis. Which of the following would the nurse most likely observe? 1. A unilateral cool foot 2. Thin, shiny, atrophic skin 3. Pallor of the toes and cyanosis of the nailbeds 4. A brownish discoloration to the skin of the lower leg

A brownish discoloration to the skin of the lower leg

Which of the following is a true statement regarding the manual compression test? 1. Rapid filling of the veins indicates incompetent veins. 2. Competent valves in the veins will transmit a wave to the distal fingers. 3. A palpable wave transmission occurs when the valves are incompetent. 4. The test assesses whether the valves of varicosity are competent when the person is in the supine position.

A palpable wave transmission occurs when the valves are incompetent.

Which of the following situations best describes a person at risk for development of venous disease? 1. A woman in her fifth month of pregnancy 2. A person who has been on bed rest for 4 days 3. A person with a 30-year, 1 pack per day smoking history 4. An elderly person taking anticoagulant medication

A person who has been on bed rest for 4 days

When using a Doppler ultrasonic stethoscope, the nurse recognizes venous flow when which sound is heard 1. A low humming sound 2. A regular "lub, dub" pattern 3. A swishing, whooshing sound 4. A steady, even, flowing sound

A swishing, whooshing sound

The nurse is attempting to assess the femoral pulse in an obese patient. Which of the following actions would be most appropriate? 1. Have the patient assume a prone position. 2. Ask the patient to bend his or her knees to the side in a frog like position. 3. Press firmly against the bone with the patient in a semi-Fowler's position. 4. Listen with a stethoscope for pulsations because it is very difficult to palpate the pulse.

Ask the patient to bend his or her knees to the side in a frog like position.

Which of the following statements is true regarding assessment of the ankle- brachial index (ABI)? 1. Normal ABI indices are from 0.50 to 1.0. 2. The normal ankle pressure is slightly lower than the brachial pressure. 3. The ABI is a reliable measurement of peripheral vascular disease in diabetic individuals. 4. An ABI of 0.90 to 0.70 indicates the presence of peripheral vascular disease and mild claudication.

An ABI of 0.90 to 0.70 indicates the presence of peripheral vascular disease and mild claudication.

A 35-year-old man is seen in the clinic for an "infection in my left foot." Which of the following would the nurse expect to find during an assessment of this patient? 1. Hard and fixed cervical nodes 2. Enlarged and tender inguinal nodes 3. Bilateral enlargement of the popliteal nodes 4. "Pellet-like" nodes in the supraclavicular region

Enlarged and tender inguinal nodes

When performing an assessment of a patient, the nurse notes the presence of an enlarged right epitrochlear lymph node. What should the nurse do next? 1. Assess the patient's abdomen, noting any tenderness. 2. Carefully assess the cervical lymph nodes, checking for any enlargement. 3. Ask additional history questions regarding any recent ear infections or sore throats. 4. Examine the patient's lower arm and hand, checking for the presence of infection or lesions.

Examine the patient's lower arm and hand, checking for the presence of infection or lesions.

During an assessment, the nurse notes that a patient's left arm is swollen from the shoulder down to the fingers, with nonpitting edema. The right arm is normal. The patient had a mastectomy 1 year ago. The nurse suspects which problem? 1. Venous stasis 2. Lymphedema 3. Arteriosclerosis 4. Deep vein thrombosis

Lymphedema

The nurse is reviewing an assessment of a patient's peripheral pulses and notes that the documentation states that the radial pulses are "2+." The nurse recognizes that this reading indicates what type of pulse? 1. Bounding 2. Normal 3. Weak 4. Absent

Normal

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 past medical history is unremarkable, and he received immunizations 1 week ago. Which of the following findings would be considered normal in this situation? 1. Enlarged, warm, tender nodes 2. Lymphadenopathy of the cervical nodes 3. Palpable firm, small, shotty, mobile, nontender lymph nodes 4. Firm, rubbery, large nodes, somewhat fixed to the underlying tissue

Palpable firm, small, shotty, mobile, nontender lymph nodes

The nurse recognizes that which of the following is a normal physiologic change associated with the aging process? 1. Hormonal changes causing vasodilation and a resulting drop in blood pressure. 2. Progressive atrophy of the intramuscular calf veins, causing venous insufficiency. 3. Peripheral blood vessels growing more rigid with age, producing a rise in systolic blood pressure. 4. Narrowing of the inferior vena cava, causing low blood flow and increases in venous pressure resulting in varicosities.

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

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: 1. lymphedema. 2. Raynaud's syndrome. 3. deep vein thrombosis. 4. chronic arterial insufficiency.

Raynaud's syndrome.

Which of the following veins are responsible for most of the venous return in the arm? 1. Deep veins 2. Ulnar veins 3. Subclavian veins 4. Superficial veins

Superficial veins

Which of the following statements is true regarding the arterial system? 1. Arteries are large-diameter vessels. 2. The arterial system is a high-pressure system. 3. The walls of arteries are thinner than those of veins. 4. Arteries can expand greatly to accommodate a large blood volume increase.

The arterial system is a high-pressure system.

Which of the following statements regarding the lymphatic system is true? 1. Lymph flow is propelled by the contraction of the heart. 2. The flow of lymph is slow compared with that of the blood. 3. One of the functions of the lymph is to absorb lipids from the biliary tract. 4. Lymph vessels have no valves, so there is a free flow of lymph fluid from the tissue spaces into the bloodstream and back again.

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

The nurse is examining the lymphatic system of a healthy 3-year-old child. Which finding would the nurse expect to note? 1. Excessive swelling of the lymph nodes 2. The presence of palpable lymph nodes 3. No nodes palpable because of the immature immune system of a child 4. Fewer numbers and a decrease in size of lymph nodes compared with those of an adult

The presence of palpable lymph nodes

The nurse would perform a modified Allen test for which reason? 1. To measure the rate of lymphatic drainage 2. To evaluate the adequacy of capillary patency before venous blood draws 3. To evaluate the adequacy of collateral circulation before cannulating the radial artery 4. To evaluate the venous refill rate that occurs after the ulnar and radial arteries are temporarily occluded

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

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 will assess for other signs and symptoms of: 1. varicosities. 2. a venous stasis ulcer. 3. an arterial ischemic ulcer. 4. pitting edema.

an arterial ischemic ulcer.

The major artery supplying the arm is the: 1. ulnar artery. 2. radial artery. 3. brachial artery. 4. deep palmar artery.

brachial artery.

When auscultating over a patient's femoral arteries the nurse notes the presence of a bruit on the left side. The nurse knows that: 1. bruits are often associated with venous disease. 2. bruits occur in the presence of lymphadenopathy. 3. hypermetabolic states will cause bruits in the femoral arteries. 4. bruits occur with turbulent blood flow, indicating partial occlusion.

bruits occur with turbulent blood flow, indicating partial occlusion.

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. This patient is most likely experiencing: 1. claudication. 2. sore muscles. 3. muscle cramps. 4. venous insufficiency.

claudication.

The nurse is performing a well-child assessment on a 3-year-old child. The child's vital signs are normal. Capillary refill time is 5 seconds. The nurse would: 1. ask the parent if the child has had frostbite in the past. 2. suspect that the child has a venous insufficiency problem. 3. consider this a delayed capillary refill time and investigate further. 4. consider this a normal capillary refill time that requires no further assessment.

consider this a delayed capillary refill time and investigate further.

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 would next: 1. check for the presence of claudication. 2. refer the individual for further evaluation. 3. consider this a normal finding and proceed with the peripheral vascular evaluation. 4. ask the patient if he or she has experienced any unusual cramping or tingling in the arm.

consider this a normal finding and proceed with the peripheral vascular evaluation.

The nurse uses the "profile sign" to detect: 1. pitting edema. 2. early clubbing. 3. symmetry of the fingers. 4. insufficient capillary refill.

early clubbing.

A 65-year-old patient is experiencing pain in his left calf when he exercises, which disappears after resting for a few minutes. The nurse recognizes that this description is most consistent with: 1. venous obstruction of the left leg. 2. claudication due to venous abnormalities in the left leg. 3. ischemia caused by partial blockage of an artery supplying the left leg. 4. ischemia caused by complete blockage of an artery supplying the left leg.

ischemia caused by partial blockage of an artery supplying the left leg.

To assess the dorsalis pedis artery, the nurse would palpate: 1. behind the knee. 2. over the lateral malleolus. 3. in the groove behind the medial malleolus. 4. lateral to the extensor tendon of the great toe.

lateral to the extensor tendon of the great toe

During an assessment, the nurse has elevated a patient's legs 12 inches off the table and has had him wiggle 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 would expect a normal finding at this point would be: 1. marked elevational pallor. 2. venous filling within 15 seconds. 3. pain in the feet and lower legs when assuming a sitting position. 4. color returning to the feet within 20 seconds of assuming a sitting position.

venous filling within 15 seconds.

A patient has bilateral pitting edema of the feet. In the assessment of the peripheral vascular system, the nurse's primary focus should be: 1. oxygenation of the lower extremities. 2. arterial function of the lower extremities. 3. venous function of the lower extremities. 4. possible thrombophlebitis of the lower extremities.

venous function of the lower extremities.