NR 304 Health Assessment 2 Exam 1
A nurse is palpating the dorsalis pedis pulse of a patient and finds it difficult to locate.
What is the next best action?
A. Document "absent dorsalis pedis pulse."
B. Use a Doppler ultrasound device.
C. Ask the patient to walk and reassess.
D. Notify the healthcare provider immediately. - answerB
When assessing the peripheral pulses, the nurse uses which grading scale to document
a "normal" pulse?
A. 0
B. 1+
C. 2+
D. 3+ - answerC
***A patient presents with pain in the left calf that occurs during exercise and is relieved
by rest. What condition does this most likely suggest?
A. Chronic venous insufficiency
B. Arterial occlusion
C. Intermittent claudication
D. Deep vein thrombosis - answerC.
***What is the most reliable method to assess for pitting edema?
A. Use a tape measure to determine circumference.
B. Apply firm pressure over a bony prominence for 5 seconds and release.
C. Inspect the skin for swelling and discoloration.
D. Ask the patient if they feel tightness in their legs. - answerB
A nurse observes the following signs in a patient: cold, pale extremities with no palpable
pulse. What is the priority intervention?
A. Apply a warm compress.
B. Notify the healthcare provider immediately.
C. Assess the capillary refill time.
D. Elevate the extremities above the heart. - answerB
A nurse auscultates a bruit over the femoral artery. This finding suggests:
A. An arterial occlusion
B. A venous thrombosis
C. Turbulent blood flow
D. Normal blood flow - answerC
, Which patient is at the highest risk for peripheral arterial disease (PAD)?
A. A 45-year-old who smokes and has a history of hypertension
B. A 60-year-old with a sedentary lifestyle and low HDL levels
C. A 70-year-old with a history of recurrent deep vein thrombosis
D. A 35-year-old with diabetes and chronic venous insufficiency - answerA
****When palpating lymph nodes, a nurse documents "normal findings" if the nodes are:
A. Nonpalpable and mobile
B. Hard, fixed, and tender
C. Soft, mobile, and nontender
D. Enlarged, firm, and warm - answerC
***A patient presents with a red, warm, and swollen left lower leg. The nurse suspects
deep vein thrombosis (DVT). What is the priority assessment?
A. Measure calf circumference.
B. Perform a Homan's sign test.
C. Assess for peripheral pulses.
D. Auscultate for bruits. - answerA
The nurse is teaching a patient about prevention of venous stasis. Which activity is most
appropriate?
A. Elevate the legs while sitting.
B. Stand for prolonged periods to strengthen veins.
C. Limit water intake to reduce edema.
D. Wear tight compression stockings. - answerA
A patient reports enlarged lymph nodes in the neck and groin that are tender to
palpation. Which cause does the nurse most likely suspect?
A. Cancerous metastasis
B. A systemic infection
C. Congenital lymphedema
D. An allergic reaction - answerB
Which lymph nodes are most likely to drain the lower extremities?
A. Axillary
B. Inguinal
C. Submandibular
D. Cervical - answerB
***Which of the following findings is consistent with lymphedema?
A. Bilateral swelling that resolves with elevation
B. Pitting edema and dependent redness
C. Unilateral swelling without pitting
D. Generalized swelling in the hands and feet - answerC
A nurse is palpating the dorsalis pedis pulse of a patient and finds it difficult to locate.
What is the next best action?
A. Document "absent dorsalis pedis pulse."
B. Use a Doppler ultrasound device.
C. Ask the patient to walk and reassess.
D. Notify the healthcare provider immediately. - answerB
When assessing the peripheral pulses, the nurse uses which grading scale to document
a "normal" pulse?
A. 0
B. 1+
C. 2+
D. 3+ - answerC
***A patient presents with pain in the left calf that occurs during exercise and is relieved
by rest. What condition does this most likely suggest?
A. Chronic venous insufficiency
B. Arterial occlusion
C. Intermittent claudication
D. Deep vein thrombosis - answerC.
***What is the most reliable method to assess for pitting edema?
A. Use a tape measure to determine circumference.
B. Apply firm pressure over a bony prominence for 5 seconds and release.
C. Inspect the skin for swelling and discoloration.
D. Ask the patient if they feel tightness in their legs. - answerB
A nurse observes the following signs in a patient: cold, pale extremities with no palpable
pulse. What is the priority intervention?
A. Apply a warm compress.
B. Notify the healthcare provider immediately.
C. Assess the capillary refill time.
D. Elevate the extremities above the heart. - answerB
A nurse auscultates a bruit over the femoral artery. This finding suggests:
A. An arterial occlusion
B. A venous thrombosis
C. Turbulent blood flow
D. Normal blood flow - answerC
, Which patient is at the highest risk for peripheral arterial disease (PAD)?
A. A 45-year-old who smokes and has a history of hypertension
B. A 60-year-old with a sedentary lifestyle and low HDL levels
C. A 70-year-old with a history of recurrent deep vein thrombosis
D. A 35-year-old with diabetes and chronic venous insufficiency - answerA
****When palpating lymph nodes, a nurse documents "normal findings" if the nodes are:
A. Nonpalpable and mobile
B. Hard, fixed, and tender
C. Soft, mobile, and nontender
D. Enlarged, firm, and warm - answerC
***A patient presents with a red, warm, and swollen left lower leg. The nurse suspects
deep vein thrombosis (DVT). What is the priority assessment?
A. Measure calf circumference.
B. Perform a Homan's sign test.
C. Assess for peripheral pulses.
D. Auscultate for bruits. - answerA
The nurse is teaching a patient about prevention of venous stasis. Which activity is most
appropriate?
A. Elevate the legs while sitting.
B. Stand for prolonged periods to strengthen veins.
C. Limit water intake to reduce edema.
D. Wear tight compression stockings. - answerA
A patient reports enlarged lymph nodes in the neck and groin that are tender to
palpation. Which cause does the nurse most likely suspect?
A. Cancerous metastasis
B. A systemic infection
C. Congenital lymphedema
D. An allergic reaction - answerB
Which lymph nodes are most likely to drain the lower extremities?
A. Axillary
B. Inguinal
C. Submandibular
D. Cervical - answerB
***Which of the following findings is consistent with lymphedema?
A. Bilateral swelling that resolves with elevation
B. Pitting edema and dependent redness
C. Unilateral swelling without pitting
D. Generalized swelling in the hands and feet - answerC
