Jarvis Chapter 21: Vascular and Lymphatic Systems

Questions and Answers

Worrigan is a 67-year-old patient who comes with his son to the ambulatory health centre. On examination, what is pulsus alternans associated with?

Hyperkinetic states

Heart failure (correct)

Pulmonary embolisms

Decreased cardiac output (correct)

What does the modified Allen test assess?

The degree of pedal edema

Early clubbing

The presence of thrombophlebitis

The patency of the radial and ulnar arteries (correct)

What is an aneurysm?

A sac formed by dilation in the arterial wall.

What does arteriosclerosis refer to?

Thickening and loss of elasticity of the arterial walls. Signup and view all the answers

What is atherosclerosis defined as?

Plaques of fatty deposits forming in the intima of the arteries. Signup and view all the answers

What is lymphedema?

The swelling of an extremity due to an obstructed lymph channel. Signup and view all the answers

What does a positive profile sign indicate?

Early clubbing. Signup and view all the answers

What do you expect when assessing a patient with pulsus alternans?

Pulse with a regular rhythm, but the force of the pulse varies with alternating beats. Signup and view all the answers

What is pulsus bigeminus?

The rhythm is coupled; every other beat is premature. Signup and view all the answers

One of the leg's deep veins is the?

Popliteal. Signup and view all the answers

How is blood returned to the heart through the veins?

All of the options Signup and view all the answers

Axillary nodes drain the?

Breast and upper arm. Signup and view all the answers

The cervical nodes drain the?

Head and neck. Signup and view all the answers

The inguinal nodes drain the?

Anterior abdominal wall. Signup and view all the answers

Palatine, pharyngeal, and lingual are specific names for?

Tonsils. Signup and view all the answers

Which direction would you give a patient to assist you with palpating the femoral pulse?

Bend your knee outward like a frog. Signup and view all the answers

Mr. Harris comes to the clinic for a follow-up appointment. What does a full 'bounding' pulse indicate? (Select all that apply)

Hyperthyroidism Signup and view all the answers

What are true statements about the thymus gland? (Select all that apply)

Is vital to the immune system Signup and view all the answers

Arteries can greatly expand to accommodate a large blood volume increase.

False Signup and view all the answers

The major artery supplying the arm is the _____ artery.

Brachial Signup and view all the answers

Where is the correct location for palpation of the dorsalis pedis artery?

Lateral to the extensor tendon of the great toe Signup and view all the answers

The nurse recognizes that a 65-year-old patient experiencing pain in his left calf when he exercises is most likely experiencing:

Ischemia caused by a partial blockage of an artery supplying the left leg Signup and view all the answers

Which statement best describes the mechanisms by which venous blood returns to the heart?

Intraluminal valves ensure unidirectional flow toward the heart. Signup and view all the answers

Which veins are responsible for most of the venous return in the arm?

Superficial Signup and view all the answers

What should the nurse reply to a patient asking about circulation when the great saphenous vein is removed?

This vein can be removed without harming your circulation because the deeper veins in your leg are in good condition. Signup and view all the answers

Which situation best describes a person at highest risk for the development of venous disease?

Person who has been on bed rest for 4 days Signup and view all the answers

Which statement shows correct understanding of the lymphatic system?

The flow of lymph is slow compared with that of the blood. Signup and view all the answers

What should the nurse do next if noticing an enlarged right epitrochlear lymph node?

Examine the patient's lower arm and hand and check for the presence of infection or lesions. Signup and view all the answers

The nurse expects to see which finding during an assessment of a 35-year-old man with an infection in his left foot?

Enlarged and tender inguinal nodes Signup and view all the answers

What should the nurse expect while examining the lymphatic system of a healthy 3-year-old child?

Presence of palpable lymph nodes Signup and view all the answers

During an assessment, the nurse should expect which finding as a normal physiological change associated with aging?

Peripheral blood vessels growing more rigid with age, producing a rise in systolic blood pressure Signup and view all the answers

A 67-year-old patient experiencing pain in his left calf when climbing stairs is most likely experiencing:

Claudication Signup and view all the answers

A patient has leg pain that wakes him at night. What condition is most likely?

Problems related to arterial insufficiency Signup and view all the answers

During an assessment, the nurse uses the 'profile sign' to detect which condition?

Early clubbing Signup and view all the answers

What should the nurse do if capillary refill time is 5 seconds during an assessment?

Consider this a delayed capillary refill time and investigate further Signup and view all the answers

When a nurse notes a diminished left femoral pulse (1+/4+), what should be done next?

Auscultate the site for a bruit Signup and view all the answers

If the nurse is unable to palpate the ulnar pulses but the patient's skin is warm and capillary refill time is normal, the next step should be:

Consider this finding as normal and proceed with the peripheral vascular evaluation Signup and view all the answers

What should the nurse expect to find when assessing the pulses of a patient with untreated hyperthyroidism?

Bounding Signup and view all the answers

The nurse is preparing to perform a modified Allen test. What is an appropriate reason for this test?

To evaluate the adequacy of collateral circulation before cannulating the radial artery Signup and view all the answers

Which finding would the nurse most likely observe in a patient diagnosed with venous stasis?

Brownish discoloration to the skin of the lower leg Signup and view all the answers

What action is most appropriate when assessing the femoral pulse in an obese patient?

Ask the patient to bend knees to the side in a froglike position Signup and view all the answers

What does the presence of a bruit on the left side of the femoral artery indicate?

Occurs with turbulent blood flow, indicating partial occlusion Signup and view all the answers

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

1+/0-4+ Signup and view all the answers

What does nonpitting, hard edema of the lower leg indicate?

Nonpitting, hard edema occurs with lymphatic obstruction Signup and view all the answers

What does the description of the pulse being weaker during inspiration and stronger during expiration indicate?

Paradoxus Signup and view all the answers

What should the nurse expect after helping a patient sit up and dangle his legs after elevating them?

Venous filling within 15 seconds Signup and view all the answers

Which condition is reflected by dilated, tortuous veins in the lower legs during pregnancy?

Varicose veins Signup and view all the answers

What does the nurse suspect when noticing swollen left arm post-mastectomy with nonpitting brawny edema?

Lymphedema Signup and view all the answers

Which statement about the ankle-brachial index (ABI) is true?

An ABI of 0.9 to 0.7 indicates the presence of peripheral vascular disease and mild claudication. Signup and view all the answers

Which finding is normal in a 5-year-old boy with no current health problems?

Palpable firm, small, shotty, mobile, and nontender lymph nodes Signup and view all the answers

What indicates venous flow when using a Doppler ultrasonic stethoscope?

Swishing, whooshing sound Signup and view all the answers

Which statement correctly describes a weak, thready pulse?

Is hard to palpate, may fade in and out, and is easily obliterated by pressure. Signup and view all the answers

What condition is characterized by fingers turning white, blue, then red with pain in cold weather?

Raynaud disease Signup and view all the answers

What should the nurse assess for signs and symptoms of after noting a round ulcer on the left great toe?

Arterial ischemic ulcer Signup and view all the answers

What does a documentation of '2+' for radial pulses indicate?

Normal Signup and view all the answers

What symptoms should the nurse monitor for signs of acute venous symptoms after orthopedic surgery? Select all that apply.

Warm, red, and swollen calf Signup and view all the answers

What findings should the nurse expect in a patient with chronic arterial symptoms? Select all that apply.

Skin of the patient is pale and cool. Signup and view all the answers

What does the finding of jugular venous pulsations indicate in a 70-year-old patient with swollen ankles?

Elevated pressure related to heart failure Signup and view all the answers

Lymph nodes are palpable in which contexts?

All of the options Signup and view all the answers

Delayed venous filling occurs with which condition?

Arterial insufficiency Signup and view all the answers

In older adults, which of these findings is expected?

The lymphatic tissue decreases. Signup and view all the answers

What does a water-hammer 'Corrigan's' pulse signify?

Aortic valve regurgitation Signup and view all the answers

What is pulsus bigeminus associated with?

Conduction disturbance Signup and view all the answers

Study Notes

Arterial System

Arteries are a high-pressure system responsible for transporting oxygenated blood from the heart.
The brachial artery is the major artery supplying the arm.
Palpation of the dorsalis pedis artery occurs lateral to the extensor tendon of the great toe.

Pain and Ischemia

Claudication manifests as calf pain during exercise, relieved by rest, indicating ischemia from partial arterial blockage.
Venous blood return is supported by intraluminal valves, which ensure unidirectional flow toward the heart.

Venous Return and Risks

Most venous return in the arm is through superficial veins.
Prolonged bed rest increases the risk for developing venous diseases.

Lymphatic System

Lymph flow is slower than blood flow and relies on muscle contraction to propel lymph.
The presence of enlarged lymph nodes could indicate localized infection; palpation of nodes is common in children.

Assessment Techniques

The modified Allen test evaluates collateral circulation by assessing the patency of the radial and ulnar arteries before procedures.
A profile sign checks for early clubbing.

Edema and Skin Changes

Nonpitting, hard edema signifies lymphatic obstruction.
Signs of chronic arterial symptoms can include cool, pale skin and delayed venous filling.

Pulse Characteristics

A normal pulse amplitude is indicated as "2+", while a weak or thready pulse is difficult to palpate.
Pulsus paradoxus demonstrates a decrease in blood pressure during inspiration.

Venous stasis results in brownish discoloration on lower leg skin due to deposition of red blood cells.
Raynaud's disease is characterized by color changes in the fingers due to cold exposure, cycling through white, blue, and red.

Atherosclerosis and Arteriosclerosis

Atherosclerosis is the buildup of fatty plaques in the arterial walls.
Arteriosclerosis involves thickening and loss of elasticity in arterial walls.

Normal Findings in Lymphatic Assessment

Palpable lymph nodes can be expected in children and adults with infections, but should be small and nontender.
During a well-child check, small, shotty, mobile lymph nodes in a healthy child are considered normal.

Vascular Abnormalities

Pulsus alternans is a sign of heart failure.
Documenting mild, slight pitting edema is denoted as "1+/0-4+".

Patient Consultation

For patients undergoing procedures like bypass surgery, healthy deeper veins compensate for removed superficial veins.
Lymphedema arises from obstructed lymph channels, resulting in swelling of an extremity.

Capillary Refill and Vital Signs

A capillary refill time exceeding 2 seconds is considered delayed and warrants further investigation.
Normal ankle-brachial index (ABI) suggests no significant peripheral vascular disease.

Venous Symptoms

Acute venous symptoms may present as sudden onset and swelling in the calf; signs to monitor include warmth and redness.
Chronic symptoms often worsen with prolonged periods of sitting or standing.### Edema and Vascular Conditions
Indentation left after skin depression indicates the presence of edema in swollen tissue.
Thickening and loss of elasticity are characteristic of arterial wall changes.

Patient Assessment

A positive profile sign in a patient hints at early clubbing, affecting nailbed angle.
Pulsus alternans indicates a pulse with regular rhythm but varying force in alternating beats.
Pulsus bigeminus presents as a coupled rhythm with every other beat being premature.

Veins and Blood Return

The popliteal vein is identified as one of the deep veins in the leg.
Blood is returned to the heart through veins aided by breathing, unidirectional valves, and walking.

Lymphatic Drainage

Axillary nodes are responsible for draining the breast and upper arm.
The cervical nodes drain the head and neck.
Inguinal nodes drain the anterior abdominal wall.
Palatine, pharyngeal, and lingual refer specifically to tonsils in the lymphatic system.

Physical Examination Techniques

To palpate the femoral pulse, instruct the patient to bend their knee outward like a frog for better access.

Clinical Findings and Conditions

A full "bounding" pulse indicates potential associations with anxiety, hyperthyroidism, elevated temperature, and anemia in patients.
The thymus gland plays a crucial role in developing T-lymphocytes, is vital to the immune system, and undergoes atrophy after puberty.

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This quiz focuses on the key concepts from Chapter 21 of the Jarvis textbook, covering the peripheral vascular system and lymphatic system. It features flashcards that test your understanding of the arterial system and blood supply dynamics. Perfect for nursing students preparing for exams.

Jarvis Chapter 21: Vascular and Lymphatic Systems

Questions and Answers

Worrigan is a 67-year-old patient who comes with his son to the ambulatory health centre. On examination, what is pulsus alternans associated with?

What does the modified Allen test assess?

What is an aneurysm?

What does arteriosclerosis refer to?

What is atherosclerosis defined as?

What is lymphedema?

What does a positive profile sign indicate?

What do you expect when assessing a patient with pulsus alternans?

What is pulsus bigeminus?

One of the leg's deep veins is the?

How is blood returned to the heart through the veins?

Axillary nodes drain the?

The cervical nodes drain the?

The inguinal nodes drain the?

Palatine, pharyngeal, and lingual are specific names for?

Which direction would you give a patient to assist you with palpating the femoral pulse?

Mr. Harris comes to the clinic for a follow-up appointment. What does a full 'bounding' pulse indicate? (Select all that apply)

What are true statements about the thymus gland? (Select all that apply)

Arteries can greatly expand to accommodate a large blood volume increase.

The major artery supplying the arm is the _____ artery.

Where is the correct location for palpation of the dorsalis pedis artery?

The nurse recognizes that a 65-year-old patient experiencing pain in his left calf when he exercises is most likely experiencing:

Which statement best describes the mechanisms by which venous blood returns to the heart?

Which veins are responsible for most of the venous return in the arm?

What should the nurse reply to a patient asking about circulation when the great saphenous vein is removed?

Which situation best describes a person at highest risk for the development of venous disease?

Which statement shows correct understanding of the lymphatic system?

What should the nurse do next if noticing an enlarged right epitrochlear lymph node?

The nurse expects to see which finding during an assessment of a 35-year-old man with an infection in his left foot?

What should the nurse expect while examining the lymphatic system of a healthy 3-year-old child?

During an assessment, the nurse should expect which finding as a normal physiological change associated with aging?

A 67-year-old patient experiencing pain in his left calf when climbing stairs is most likely experiencing:

A patient has leg pain that wakes him at night. What condition is most likely?

During an assessment, the nurse uses the 'profile sign' to detect which condition?

What should the nurse do if capillary refill time is 5 seconds during an assessment?

When a nurse notes a diminished left femoral pulse (1+/4+), what should be done next?

If the nurse is unable to palpate the ulnar pulses but the patient's skin is warm and capillary refill time is normal, the next step should be:

What should the nurse expect to find when assessing the pulses of a patient with untreated hyperthyroidism?

The nurse is preparing to perform a modified Allen test. What is an appropriate reason for this test?

Which finding would the nurse most likely observe in a patient diagnosed with venous stasis?

What action is most appropriate when assessing the femoral pulse in an obese patient?

What does the presence of a bruit on the left side of the femoral artery indicate?

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

What does nonpitting, hard edema of the lower leg indicate?

What does the description of the pulse being weaker during inspiration and stronger during expiration indicate?

What should the nurse expect after helping a patient sit up and dangle his legs after elevating them?

Which condition is reflected by dilated, tortuous veins in the lower legs during pregnancy?

What does the nurse suspect when noticing swollen left arm post-mastectomy with nonpitting brawny edema?

Which statement about the ankle-brachial index (ABI) is true?

Which finding is normal in a 5-year-old boy with no current health problems?

What indicates venous flow when using a Doppler ultrasonic stethoscope?

Which statement correctly describes a weak, thready pulse?

What condition is characterized by fingers turning white, blue, then red with pain in cold weather?

What should the nurse assess for signs and symptoms of after noting a round ulcer on the left great toe?

What does a documentation of '2+' for radial pulses indicate?

What symptoms should the nurse monitor for signs of acute venous symptoms after orthopedic surgery? Select all that apply.

What findings should the nurse expect in a patient with chronic arterial symptoms? Select all that apply.

What does the finding of jugular venous pulsations indicate in a 70-year-old patient with swollen ankles?

Lymph nodes are palpable in which contexts?

Delayed venous filling occurs with which condition?

In older adults, which of these findings is expected?

What does a water-hammer 'Corrigan's' pulse signify?

What is pulsus bigeminus associated with?

Study Notes

Arterial System

Pain and Ischemia

Venous Return and Risks

Lymphatic System

Assessment Techniques

Edema and Skin Changes

Pulse Characteristics

Conditions Related to Vascular Issues

Atherosclerosis and Arteriosclerosis

Normal Findings in Lymphatic Assessment

Vascular Abnormalities

Patient Consultation

Capillary Refill and Vital Signs

Venous Symptoms