Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

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 veiNns bRy (1I) coGntrBCg sMkeletal 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.” 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. A 25-year-old female who is 3 months pregnant b. A 50-year-old female who has remained in bed for 4 days c. A 35-year-old male with a body mass index (BMI) of 18 d. A 60-year-old female taking anticoagulant medication 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 risk factors as well. 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 propelledNbyRtheIconGtracBCofMthe heart.” b. “The flow of lymph is slower compared with that of 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.” ANS: B The flow of lymph is slower compared with the flow of 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; ensuring that 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 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