20

Question 1

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.

Answer 1

ANS: B

Question 2

2.	The nurse is reviewing the blood supply to the arm. The major artery supplying the arm is the \_\_\_\_\_ artery.
a.
Ulnar
b.
Radial
c.
Brachial
d.
Deep palmar

Answer 2

ANS: C

Question 3

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

Answer 3

ANS: D

Question 4

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.
   Claudication due to venous abnormalities in
   c.
   Ischemia caused by a partial blockage of an artery supplying
   d.
   Ischemia caused by the complete blockage of an artery supplying

Answer 4

ANS: C

Question 5

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.

Answer 5

ANS: A

Question 6

6.	Which vein(s) is(are) responsible for most of the venous return in the arm?
a.
Deep
b.
Ulnar
c.
Subclavian
d.
Superficial

Answer 6

ANS: D

Question 7

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?” The nurse should 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.”

Answer 7

ANS: D

Question 8

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.
   Woman in her second month of pregnancy
   b.
   Person who has been on bed rest for 4 days
   c.
   Person with a 30-year, 1 pack per day smoking habit
   d.
   Older adult taking anticoagulant medication

Answer 8

ANS: B

Question 9

9. The nurse is teaching a review class on the lymphatic system. A participant shows correct understanding of the material with which statement?
   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.”

Answer 9

ANS: B

Question 10

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.

Answer 10

ANS: D

Question 11

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

Answer 11

ANS: B

Question 12

12. The nurse is examining the lymphatic system of a healthy 3-year-old child. Which finding should the nurse expect?
    a.
    Excessive swelling of the lymph nodes
    b.
    Presence of palpable lymph nodes
    c.
    No palpable nodes because of the immature immune system of a child
    d.
    Fewer numbers and a smaller size of lymph nodes compared with those of an adult

Answer 12

ANS: B

Question 13

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 approximately 2 minutes; then he is able to resume his activities. The nurse interprets that this patient is most likely experiencing:
a.
Claudication.
b.
Sore muscles.
c.
Muscle cramps.
d.
Venous insufficiency.

Answer 13

ANS: A

Question 14

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 inner aspect of the right ankle. On the basis of this health history information, the nurse interprets that the patient is most likely experiencing:
    a.
    Pain related to lymphatic abnormalities.
    b.
    Problems related to arterial insufficiency.
    c.
    Problems related to venous insufficiency.
    d.
    Pain related to musculoskeletal abnormalities.

Answer 14

ANS: B

Question 15

16.	During an assessment, the nurse uses the profile sign to detect:
a.
Pitting edema.
b.
Early clubbing.
c.
Symmetry of the fingers.
d.
Insufficient capillary refill.

Answer 15

ANS: B

Question 16

18.	When assessing a patient, the nurse notes that the left femoral pulse as diminished, 1+/4+. What should the nurse do next?
a.
Document the finding.
b.
Auscultate the site for a bruit.
c.
Check for calf pain.
d.
Check capillary refill in the toes.

Answer 16

ANS: B

Question 17

19. 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. Next, the nurse should:
    a.
    Check for the presence of claudication.
    b.
    Refer the individual for further evaluation.
    c.
    Consider this finding as 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.

Answer 17

ANS: C

Question 18

20.	The nurse is assessing the pulses of a patient who has been admitted for untreated hyperthyroidism. The nurse should expect to find a(n) \_\_\_\_\_\_\_ pulse.
a.
Normal
b.
Absent
c.
Bounding
d.
Weak, thready

Answer 18

ANS: C

Question 19

21. 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

Answer 19

ANS: C

Question 20

22. 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

Answer 20

ANS: D

Question 21

23. The nurse is attempting to assess the femoral pulse in a patient who is obese. Which of these actions would be most appropriate?
    a.
    The patient is asked to assume a prone position.
    b.
    The patient is asked 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.

Answer 21

ANS: B

Question 22

24. When auscultating over a patient’s femoral arteries, the nurse notices the presence of a bruit on the left side. The nurse knows that bruits:
    a.
    Are often associated with venous disease.
    b.
    Occur in the presence of lymphadenopathy.
    c.
    In the femoral arteries are caused by hypermetabolic states.
    d.
    Occur with turbulent blood flow, indicating partial occlusion.

Answer 22

ANS: D

Question 23

25.	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

Answer 23

ANS: A

Question 24

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:
    a.
    Nonpitting, hard edema occurs with lymphatic obstruction.
    b.
    Alterations in arterial function will cause edema.
    c.
    Phlebitis of a superficial vein will cause bilateral edema.
    d.
    Long-standing arterial obstruction will cause pitting edema.

Answer 24

ANS: A

Question 25

``` 27. 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 pulsus: a. Alternans. b. Bisferiens. c. Bigeminus. d. Paradoxus. ```

Answer 25

ANS: D

Question 26

``` 28. During an assessment, the nurse has elevated a 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: 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. ```

Answer 26

ANS: B

Question 27

``` 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 c. Lymphedema d. Raynaud phenomenon ```

Answer 27

ANS: B

Question 28

``` 30. 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? a. Venous stasis b. Lymphedema c. Arteriosclerosis d. Deep-vein thrombosis ```

Answer 28

ANS: B

Question 29

31. 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.

Answer 29

ANS: D

Question 30

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 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

Answer 30

ANS: C

Question 31

``` 33. When using a Doppler ultrasonic stethoscope, the nurse recognizes venous flow when which sound is heard? a. Low humming sound b. Regular “lub, dub” pattern c. Swishing, whooshing sound d. Steady, even, flowing sound ```

Answer 31

ANS: C

Question 32

34. The nurse is describing a weak, thready pulse on the documentation flow sheet. Which statement is correct? a. “Is easily palpable; pounds under the fingertips.” b. “Has greater than normal force, then suddenly collapses.” c. “Is 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.”

Answer 32

ANS: C

Question 33

``` 35. 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: a. Lymphedema. b. Raynaud disease. c. Deep-vein thrombosis. d. Chronic arterial insufficiency. ```

Answer 33

ANS: B

Question 34

``` 36. 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: a. Varicosities. b. Venous stasis ulcer. c. Arterial ischemic ulcer. d. Deep-vein thrombophlebitis. ```

Answer 34

ANS: C

Question 35

``` 37. 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. Bounding b. Normal c. Weak d. Absent ```

Answer 35

ANS: B

Question 36

38. 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. Intense, sharp pain, with the deep muscle tender to the touch b. Aching, tired pain, with a feeling of fullness c. Pain that is worse at the end of the day d. Sudden onset e. Warm, red, and swollen calf f. Pain that is relieved with elevation of the leg

Answer 36

ANS: A, D, E

Question 37

39. A patient has been admitted with chronic arterial symptoms. During the assessment, the nurse should expect which findings? Select all that apply. a. Patient has a history of diabetes and cigarette smoking. b. Skin of the patient is pale and cool. c. His ankles have two small, weeping ulcers. d. Patient works long hours sitting at a computer desk. e. He states that the pain gets worse when walking. f. Patient states that the pain is worse at the end of the day.

Answer 37

ANS: A, B, E