Question 1

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?

Accepted Answer

The pulses of a patient with untreated hyperthyroidism are expected to be full or bounding (easily palpable, pounds under your fingertips). Bounding pulses occur with hyperkinetic states (e.g., exercise, anxiety, fever), anemia, and hyperthyroidism. The pedal pulse is likely to be easier to palpate, not unpalpable. An absent pulse occurs with an arterial occlusion and a weak, thready pulse occurs with shock and peripheral artery disease.

Question 2

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?

Accepted Answer

The epitrochlear nodes are located in the antecubital fossa and drain the hand and lower arm. The nurse should examine the patient's lower arm and hand, and check for the presence of infection or lesions. The other actions are not correct for this assessment finding. The epitrochlear nodes are located in the antecubital fossa and drain the hand and lower arm, thus, there is no need to assess the patient's abdomen, cervical lymph nodes, or ask about recent ear infections or sore throats based on an enlarged epitrochlear lymph node. Instead, the nurse should examine the patient's lower arm and hand, and check for the presence of infection or lesions.

Question 3

The nurse is preparing to perform a modified Allen test. Which is an appropriate reason for this test?

Accepted Answer

A modified Allen test is used to evaluate the adequacy of collateral circulation before the radial artery is cannulated. The other responses are not reasons for a modified Allen test.

Question 4

The nurse is examining the lymphatic system of a healthy 3-year-old child. Which finding should the nurse expect?

Accepted Answer

Lymph nodes are relatively large in children, and the superficial ones are often palpable even when the child is healthy.

Question 5

The nurse is preparing to assess the dorsalis pedis artery. Where is the correct location for palpation?

Accepted Answer

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.

Question 6

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?

Accepted Answer

Efficient venous return depends on contracting skeletal muscles, competent valves in the veins, and a patent lumen. Problems with any of these three elements lead to venous stasis. People who undergo prolonged standing, sitting, or bed rest are at risk for venous disease because they do not benefit from the milking action to the veins that walking accomplishes. Hypercoagulable (not anticoagulated) states and vein wall trauma also place the person at risk for venous disease. Obesity and multiple pregnancies are also risk factors. Smoking is a risk factor for arterial disease, not venous disease

Question 7

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?

Accepted Answer

These symptoms indicate ischemia, a deficient supply of oxygenated arterial blood to the tissue, in the leg. A partial blockage creates an insufficient supply and may be apparent only during exercise when oxygen needs increase and is relieved with rest. Although the term for this is claudication, it is due to insufficient arterial blood, not venous abnormalities. With a complete blockage of an artery, the pain would be constant, not just with walking/exercise, and would not be relieved with rest.

Question 8

The nurse is teaching a review class on the lymphatic system. Which statement by a class participant indicates correct understanding of the material?

Accepted Answer

The flow of lymph is slow, compared with flow of the blood. Lymph flow is not propelled by the heart but rather by contracting skeletal muscles, pressure changes secondary to breathing, and contraction of the vessel walls. Lymph does not absorb lipids from the biliary tract. The vessels do have valves; therefore, flow is one way from the tissue spaces to the bloodstream.

Question 9

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?

Accepted Answer

The inguinal nodes in the groin drain most of the lymph of the lower extremities. With local inflammation, the nodes in that area become swollen and tender. Since it is the inguinal nodes that drain the lymph from the lower extremities, the cervical and supraclavicular lymph nodes would not be affected and there are no popliteal lymph nodes.

Question 10

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?

Accepted Answer

Blood moves through the veins by (1) contracting skeletal muscles that milk the blood proximally back toward the heart; (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.

Question 11

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?

Accepted Answer

Intermittent claudication feels like a cramp and is usually relieved by rest within 2 minutes. The other responses are not correct. Sore muscles and muscle cramps do not usually occur while performing an activity, but afterwards, and are not relieved by resting for a couple of minutes. Venous insufficiency does not cause pain with walking or exercise that is relieved by rest, but rather presents with edema, thickened skin, and brown discoloration in lower legs. The symptoms this patient described suggest intermittent claudication.

Question 12

During an assessment of an older adult, the nurse should expect to which finding as a normal physiologic change associated with the aging process?

Accepted Answer

Peripheral blood vessels become more rigid with age, resulting in a rise in systolic blood pressure. Aging produces progressive enlargement of the intramuscular calf veins, not atrophy. The other options are not correct. Although older age does increase the risk for varicose veins, it is due to the thinning of elastic lamina of veins and degeneration of vascular smooth muscle, not narrowing of the inferior vena cava.

Question 13

Which vein(s) is(are) responsible for most of the venous return in the arm?

Accepted Answer

The superficial veins of the arms are in the subcutaneous tissue and are responsible for most of the venous return.

Question 14

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?

Accepted Answer

Palpating the ulnar pulses is not usually necessary and they are not often palpable in the normal person. There is no need to check for claudication, refer for further evaluation, or ask about cramping and tingling in the arm.

Question 15

The nurse uses the profile sign during an assessment. What does this technique detect?

Accepted Answer

The profile sign involves viewing the finger from the side. This is done to detect early clubbing.

Question 16

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?

Accepted Answer

As long as the femoral and popliteal veins remain intact, the superficial veins can be excised without harming circulation. The other responses are not correct. Venous insufficiency or decreased circulation is not a common problem with this procedure. The nurse should not just say "you won't even notice" but should provide more factual information.

Question 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?

Accepted Answer

Normal capillary refill time is less than 1 to 2 seconds. A capillary refill time of 5 is a decrease in capillary refill which indicates vasoconstriction or decreased cardiac output. The nurse should investigate further. Decreased capillary refill is not a characteristic of previous frostbite or venous insufficiency and some conditions can skew the findings: a cool room, decreased body temperature, cigarette smoking, peripheral edema, and anemia.

Question 18

The nurse is reviewing the blood supply to the arm. What major artery supplies blood to the arm?

Accepted Answer

The major artery supplying blood to 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.

Question 19

Which statement is true regarding the arterial system?

Accepted Answer

The pumping heart makes the arterial system a high-pressure system.

Question 20

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?

Accepted Answer

Night leg pain is common in aging adults and may indicate the ischemic rest pain of peripheral arterial disease (PAD). Alterations in arterial circulation cause pain that becomes worse with leg elevation and is eased when the extremity is dangled. In addition, ulcers associated with PAD, or arterial ulcers, often occur on the lateral ankle (as in this patient), toes, metatarsal heads, and heels.

Quiz 21: Peripheral Vascular System and Lymphatic System