TB-Chapter 21 Peripheral Vascular System and Lymphatic System PDF

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These are test bank questions that I paid for. All of the exams use these questions from the test banks....

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK

TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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Chapter21:PeripheralVascularSystemandLymphaticSystem MULTIPLECHOICE 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.

ANS:B Thepumpingheartmakesthearterialsystemahigh-pressuresystem. DIF:CognitiveLevel:Remembering(Knowledge) 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 NURSINGTB.COM

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

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

d.

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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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

ANS:C

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Ischemiaisadeficientsupplyofoxygenatedarterialbloodtoatissue.Apartialblockagecreatesaninsufficien 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the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.

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305

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: NURSINGTB.COM

a.

Venousinsufficiencyisacommonproblemafterthistypeofsurgery.

b.

Oh,youhavelotsofveinsyouwont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.

ANS:D 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. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 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

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

c.

Personwitha30-year,1packperdaysmokinghabit

d.

Olderadulttakinganticoagulantmedication

306

ANS:B Peoplewhoundergoprolongedstanding,sitting,orbedrestareatriskforvenousdisease.Hypercoagulable (notanticoagulated)statesandvein-walltraumaalsoplacethepersonatriskforvenousdisease.Obesityand thelatemonthsofpregnancyarealsoriskfactors. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential 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 NURSINGTB.COM bloodstream.

ANS:B 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. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 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patients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patientslowerarmandhand,andcheckforthepresenceofinfectionorlesions.

ANS:D

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307

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 NURSINGTB.COM

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 physiologicchangeassociatedwiththeagingprocess? a.

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

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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.

NURSINGTB.COM

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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.

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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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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.

ANS:B Thenurseshouldusetheprofilesign(viewingthefingerfromtheside)todetectearlyclubbing. DIF:CognitiveLevel:Understanding(Comprehension) NURSINGTB.COM

MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 17.Thenurseisperforminganassessmentonanadult.Theadultsvitalsignsarenormal,andcapillaryrefill timeis5seconds.Whatshouldthenursedonext? a.

Askthepatientaboutahistoryoffrostbite.

b.

Suspectthatthepatienthasvenousinsufficiency.

c.

Considerthisadelayedcapillaryrefilltime,andinvestigatefurther.

d.

Considerthisanormalcapillaryrefilltimethatrequiresnofurtherassessment.

ANS:C Normalcapillaryrefilltimeislessthan1to2seconds.Thefollowingconditionscanskewthefindings:acool room,decreasedbodytemperature,cigarettesmoking,peripheraledema,andanemia. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 18.Whenassessingapatient,thenursenotesthattheleftfemoralpulseasdiminished,1+/4+.Whatshouldthe nursedonext?

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

a.

Documentthefinding.

b.

Auscultatethesiteforabruit.

c.

Checkforcalfpain.

d.

Checkcapillaryrefillinthetoes.

310

ANS:B Ifapulseisweakordiminishedatthefemoralsite,thenthenurseshouldauscultateforabruit.Thepresenceo abruit,orturbulentbloodflow,indicatespartialocclusion.Theotherresponsesarenotcorrect. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 19.Whenperformingaperipheralvascularassessmentonapatient,thenurseisunabletopalpatetheulnar pulses.Thepatients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. NURSINGTB.COM

d.

Askthepatientifheorshehasexperiencedanyunusualcrampingortinglinginthearm.

ANS:C Palpatingtheulnarpulsesisnotusuallynecessary.Theulnarpulsesarenotoftenpalpableinthenormal person.Theotherresponsesarenotcorrect. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 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

ANS:C

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

311

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periphera 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) NURSINGTB.COM 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pulseinapatientwhoisobese.Whichoftheseactionswould bemostappropriate?

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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.

312

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overapatientsfemoralarteries,th...