, 2.Ulnar veins
3.Subclavian veins
4.Superficial veins
The nurse is performing a well-child assessment on a 3-year-old child. The child’s
vital signs are normal. Capillary refill time is 5 seconds. The nurse would:
1.ask the parent if the child has had frostbite in the past.
2.suspect that the child has a venous insufficiency problem.
3.consider this a delayed capillary refill time and investigate further.
4.consider this a normal capillary refill time that requires no further assessment.
Normal capillary refill time is less than 1 to 2 seconds. Note that these conditions can skew your
findings: a cool room, decreased body temperature, cigarette smoking, peripheral edema, and
anemia.
Which of the following statements is true regarding assessment of the ankle-
brachial index (ABI)?
ABI = highest ankle pressure divided by the highest brachial pressure
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 the veins are removed?” The nurse should
reply:
“Because the deeper veins in your leg are in good condition, this vein can be removed without
harming your circulation.”
A 57-year-old maintenance worker comes to your office for evaluation of pain in
his legs. He has smoked two packs per day since the age of 16, but he is otherwise
healthy. You are concerned that he may have peripheral vascular disease. Which