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2023-2024 Test Bank - Physical Examination & Health Assessment (Jarvis), Exams of Nursing

City University of New York (CUNY) - City CollegeNursing
Prof. John Authur

Peripheral Vascular System and Lymphatic System

Typology: Exams

2022/2023

Available from 07/10/2023

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Chapter 21: Peripheral Vascular System and Lymphatic System
Jarvis: Physical Examination & Health Assessment, 3rd Canadian edition
MULTIPLE CHOICE
1. As the arteries are the vessels through which the heart pumps oxygenated blood to the body, it
is important that arteries are:
a. Large in diameter
b. Strong tough and tense
c. Thinner walled vessels
d. Controlled by skeletal muscles
ANS: B
The heart pumps freshly oxygenated blood through the arteries to all body tissues. The
pumping of the heart makes this a high-pressure system. The artery walls are strong, tough,
and tense to withstand pressure demands. Arteries contain elastic fibres, which allow their
walls to stretch with systole and recoil with diastole. Arteries also contain muscle fibres
(vascular smooth muscle), which control the amount of blood delivered to the tissues. The
vascular smooth muscle contracts and dilates, which changes the diameter of the arteries to
control the rate of blood flow.
DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: General
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
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?
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
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.
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Chapter 21: Peripheral Vascular System and Lymphatic System

Jarvis: Physical Examination & Health Assessment, 3rd Canadian edition

MULTIPLE CHOICE

1. As the arteries are the vessels through which the heart pumps oxygenated blood to the body, it

is important that arteries are:

a. Large in diameter

b. Strong tough and tense

c. Thinner walled vessels

d. Controlled by skeletal muscles

ANS: B

The heart pumps freshly oxygenated blood through the arteries to all body tissues. The

pumping of the heart makes this a high-pressure system. The artery walls are strong, tough,

and tense to withstand pressure demands. Arteries contain elastic fibres, which allow their

walls to stretch with systole and recoil with diastole. Arteries also contain muscle fibres

(vascular smooth muscle), which control the amount of blood delivered to the tissues. The

vascular smooth muscle contracts and dilates, which changes the diameter of the arteries to

control the rate of blood flow.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: General

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

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?

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

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, but the pain

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 caused by 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

ANS: C

Ischemia is a deficient supply of oxygenated arterial blood to a tissue. A partial blockage

creates an insufficient 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?

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.

ANS: A

Blood moves through the veins by (1) contracting skeletal muscles that proximally milk

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.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: General

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

a. Deep

b. Ulnar

c. Subclavian

d. Superficial

ANS: D

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

of the venous return.

DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: General

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.”

ANS: D

The epitrochlear nodes are located in the antecubital fossa and drain the hand and lower arm.

The other actions are not correct for this assessment finding.

DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care

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

ANS: B

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.

DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

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

ANS: B

Lymph nodes are relatively large in children, and the superficial ones are often palpable even

when the child is healthy.

DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance

13. During an assessment of an older adult, the nurse should expect to notice which finding as a

normal physiological change associated with the aging process?

a. Hormonal changes causing vasodilation and a resulting drop in blood pressure

b. Progressive atrophy of the intramuscular calf veins, causing venous insufficiency

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

blood pressure

d. Narrowing of the inferior vena cava, causing low blood flow and increases in

venous pressure resulting in varicosities

ANS: C

Peripheral blood vessels grow 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.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance

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

ANS: A

Intermittent claudication feels like a cramp and is usually relieved by rest within 2 minutes.

The other responses are not correct.

DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

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 he elevates them, and the pain

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

ANS: B

Night leg pain is common in aging adults and may indicate the ischemic rest pain of

peripheral vascular disease. Alterations in arterial circulation cause pain that becomes worse

with leg elevation and is eased when the extremity is dangled.

DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

16. During assessment of a patient with emphysema, the nurse examines the patient’s fingers from

the side to detect:

a. Pitting edema

b. Early clubbing

c. Symmetry of the fingers

d. Insufficient capillary refill

ANS: B

The nurse should use the profile sign (viewing the finger from the side) to detect early

clubbing. Clubbing occurs with emphysema, chronic bronchitis, and chronic, cyanotic heart

diseases.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

17. The nurse is assessing a 64-year-old patient whose vital signs are normal, with a capillary

refill time of 5 seconds. What should the nurse do next?

a. Ask the patient about a history of frostbite

A full, bounding pulse occurs with hyperkinetic states (e.g., exercise, anxiety, fever), anemia,

and hyperthyroidism. An absent pulse occurs with occlusion. Weak, thready pulses occur with

shock and peripheral artery disease.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

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

ANS: C

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.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

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

ANS: D

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.

DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

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

a. Ask the patient to assume a prone position

b. Ask the patient to bend his or her knees to the side in a froglike position

c. Firmly press against the bone with the patient in a semi-Fowler’s position

d. Listen with a stethoscope for pulsations as palpating the pulse in an obese person

is extremely difficult

ANS: B

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.

DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care

24. 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:

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

ANS: D

A bruit occurs with turbulent blood flow and indicates partial occlusion of the artery. The

other responses are not correct.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Safe and Effective Care Environment: Management of Care

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

patient?

a. Bilateral pedal 1+ edema

b. Unilateral pedal 3+edema

c. Edema 4+ to upper extremities

d. Bilateral brawny edema

ANS: A

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. On the basis of 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. Longstanding 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

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 by 20 mm Hg during inspiration and increases with expiration. This patient

is experiencing pulsus ___________.

a. Alternans

b. Bisferiens

c. Bigeminus

d. Paradoxus

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?

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.

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

this patient?

a. Enlarged, warm, and tender nodes

b. Large, soft, palpable nodes

c. Palpable firm, small, shotty, mobile, and nontender lymph nodes

d. Firm, rubbery, and large nodes, somewhat fixed to the underlying tissue

ANS: C

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.

DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Health Promotion and Maintenance

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

ANS: C

When using the Doppler ultrasonic stethoscope, the pulse site is found when one hears a

swishing, whooshing sound.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Safe and Effective Care Environment: Management of Care

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

statement is correct?

a. “It is easily palpable; pounds under the fingertips.”

b. “It has greater than normal force, and then it suddenly collapses.”

c. “It is hard to palpate, fades in and out, and is easily obliterated by pressure.”

d. “The rhythm is regular, but the force varies with alternating beats of large and

small amplitudes.”

ANS: C

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.

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Safe and Effective Care Environment: Management of Care

35. 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:

a. Lymphedema

b. Raynaud’s phenomenon

c. Deep vein thrombosis

d. Chronic arterial insufficiency

ANS: B

The condition with episodes of abrupt, progressive tricolour changes of the fingers in response

to cold, vibration, or stress is known as Raynaud’s phenomenon. (Lymphedema is described in

Table 21-2; deep venous thrombosis is described in Table 21-5; and chronic arterial

insufficiency is described in Table 21-4.)

DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

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

ANS: C

f. Patient states that the pain is worse at the end of the day.

ANS: A, B, E

Patients with chronic arterial symptoms often have a history of smoking and diabetes (among

other risk factors). The pain has a gradual onset with exertion and is relieved by rest or

dangling of legs. The skin appears cool and pale (see Table 21-3). The other responses reflect

chronic venous problems.

DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potential