Question 1

A patient has hard, nonpitting edema of the left lower leg and ankle.The right leg has no edema.On the basis of these findings, the nurse recalls that:

Accepted Answer

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).

Question 2

During an adult patient assessment, the nurse has elevated the patient's 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:

Accepted Answer

In this test, it normally takes 10 seconds or less for colour to return to the feet and 15 seconds for the veins of the feet to fill.Significant elevational pallor and delayed venous filling occur with arterial insufficiency.

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 preparing to assess the ankle-brachial index (ABI) of a patient.Which statement about the ABI is true?

Accepted Answer

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.

Question 5

A patient has been admitted with chronic arterial symptoms.During the assessment, the nurse should expect which findings? (Select all that apply.)

Accepted Answer

A patient with chronic arterial symptoms may have a decreased blood flow to their extremities due to arterial blockages. Risk factors such as cigarette smoking and diabetes can contribute to arterial blockages. Additionally, the patient may experience pain that is worse with walking (intermittent claudication) due to insufficient blood supply to their muscles, resulting in fatigue and discomfort. The skin may also appear pale and cool to the touch. Therefore, options A, B, and E are all expected findings in a patient with chronic arterial symptoms. Options C and F are not specific to arterial disease and can be present in other conditions as well. Option D can contribute to poor posture and musculoskeletal pain but is not directly related to chronic arterial symptoms.

Question 6

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:

Accepted Answer

The presence of a pale ischemic base, well-defined edges, and no drainage are indicative of an arterial ischemic ulcer. The location of the ulcer on the toe also suggests arterial disease, as this is a common location for arterial insufficiency ulcers. The nurse should assess for other signs and symptoms of arterial disease, such as decreased pulses, cool skin, and hair loss on the affected extremity. Venous stasis ulcers typically have a moist, red base with surrounding edema, and varicosities are visible veins that may indicate venous insufficiency but are not necessarily indicative of an ulcer. Deep vein thrombophlebitis may present with swelling, redness, warmth, and pain in the affected limb, but not necessarily with an ulcer.

Question 7

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.)

Accepted Answer

Signs and symptoms of acute venous problems include pain in the calf that has a sudden onset and that is intense and sharp with tenderness in the deep muscle when touched.The calf is warm, red, and swollen.The other options are symptoms of chronic venous problems.

Question 8

When using a Doppler ultrasonic stethoscope, the nurse recognizes venous flow when which sound is heard?

Accepted Answer

When using the Doppler ultrasonic stethoscope, the pulse site is found when one hears a swishing, whooshing sound.

Question 9

A patient has been diagnosed with venous stasis.Which of these findings would the nurse most likely observe?

Accepted Answer

A brown discoloration occurs with chronic venous stasis as a result of hemosiderin deposits (a by-product of red blood cell degradation).Pallor, cyanosis, atrophic skin, and unilateral coolness are all signs associated with arterial problems.

Question 10

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 1 week ago.Which of these findings should be considered normal in this patient?

Accepted Answer

Palpable lymph nodes are often normal in children and infants.They are small, firm, shotty, mobile, and nontender.Vaccinations can produce lymphadenopathy.Enlarged, warm, and tender nodes indicate a current infection.

Question 11

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 that are apparent in her lower legs.Which condition is reflected by these findings?

Accepted Answer

The dilated and tortuous veins in the patient's lower legs suggest varicose veins, which are a common condition in pregnancy due to increased pressure on the veins by the uterus. This can cause symptoms such as heaviness in the legs and foot cramps. Deep-vein thrombophlebitis would present with localized pain, swelling, and redness in the affected area, while lymphedema would present with swelling and an accumulation of fluid in the affected limb. Raynaud's phenomenon would present with episodes of cold and numbness in the fingers and toes.

Question 12

The nurse is describing a weak, thready pulse on the documentation flow sheet.Which statement is correct?

Accepted Answer

A weak, thready pulse is hard to palpate, may fade in and out, and is easily obliterated by pressure.It is associated with decreased cardiac output and peripheral arterial disease.

Question 13

The nurse is reviewing an assessment of a patient's peripheral pulses and notes previous documentation of radial pulses to be "2+." The nurse recognizes that this reading indicates what type of pulse?

Accepted Answer

When documenting the force, or amplitude, of pulses, 3+ indicates an increased, full, or bounding pulse, 2+ indicates a normal pulse, 1+ indicates a weak pulse, and 0 indicates an absent pulse.

Question 14

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 by 20 mm Hg during inspiration and increases with expiration.This patient is experiencing pulsus ___________.

Accepted Answer

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.

Question 15

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

Accepted Answer

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.

Question 16

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?

Accepted Answer

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.

Question 17

During an assessment, a patient tells the nurse that her fingers often change colour when she goes out in cold weather.She describes these episodes as her fingers first turning white, then blue, and then red with a burning, throbbing pain.The nurse suspects that she is experiencing:

Accepted Answer

The symptoms described by the patient are characteristic of Raynaud's phenomenon, a condition in which the small blood vessels in the extremities spasm in response to cold or stress, leading to changes in color and sensation. Lymphedema involves swelling and fluid retention due to a lymphatic system blockage. Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, typically in the legs. Chronic arterial insufficiency is a condition in which there is not enough blood flow to the extremities due to narrowed or blocked arteries. None of these conditions match the patient's symptoms as well as Raynaud's phenomenon.

Question 18

The nurse is attempting to assess the femoral pulses in an obese patient and should:

Accepted Answer

To help expose the femoral area, particularly in obese people, the nurse should ask the person to bend his or her knees to the side in a froglike position.

Question 19

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

Accepted Answer

A bruit occurs with turbulent blood flow and indicates partial occlusion of the artery.The other responses are not correct.

Quiz 21: Peripheral Vascular System and Lymphatic System