NUR 3066C: Module 8: Heart and Respiratory – Abnormal
Questions With Complete Solutions
Assessment of Peripheral Arteries: Abnormal Findings: Sit -
Assess for Pain Distal to Possible Occulusion
Dull ache, fatigue, and cramping
Constant excruciating pain
Weak, irregular, or absent pulses
Systolic bruits over carotid and femoral arteries
Loss of body warmth localized to the affected area
Localized pallor or cyanosis
Thin, atrophied skin
Muscle atrophy
Loss of hair
Assessment of Peripheral Arteries: Abnormal Findings: Degree
of Occlusion
Delayed return of color >2 seconds
,Assessment of Peripheral Arteries: Abnormal Findings: Measure
of Blood Pressure
Hypertension
Typically BP greater than 140/90
Significant differences between arms (>10 mm Hg)
Pulse pressure of <30 or >40 mm Hg
Assessment of Peripheral Veins: Abnormal Findings: Affected
Area
Elevation (>9 cm H2O) or bilateral or one-sided distention
Constant pain with swelling and tenderness over muscles
Engorgement of superficial veins
Cyanosis
Persistent venous distention
Assessment of Peripheral Veins: Abnormal Findings:
Thrombosis
Redness, thickening, tenderness along the superficial vein
Calf pain when Homans' sign is tested
Assessment of Peripheral Veins: Abnormal Findings: Edema
Orthostatic (pitting) edema
Thickening and ulceration of skin
, 1+ = slight pitting, no visible distortion, disappears rapidly
2+ = deeper than 1+ and disappear in 10-15 seconds
3+ = noticeably deep and may last 1 minute with dependent
extremity and swollen
4+ = very deep, lasts 2-5 minutes, gross distortion
Assessment of Peripheral Veins: Abnormal Findings: Varicose
Veins
Dilated and swollen veins
Pain that disappears when extremity is elevated
Rapidly filling veins
Superficial veins that fail to empty
Stripped vessel fills before pressure is released
Blood fills entire vein when pressure is released by proximal
finger
Inspection of the Chest: Normal Findings
Symmetric, clavicles prominent, sternum flat with no abundance
of overlying tissue, anterior-posterior diameter half the
transverse diameter, trachea midline, spine midline with normal
curve.
Questions With Complete Solutions
Assessment of Peripheral Arteries: Abnormal Findings: Sit -
Assess for Pain Distal to Possible Occulusion
Dull ache, fatigue, and cramping
Constant excruciating pain
Weak, irregular, or absent pulses
Systolic bruits over carotid and femoral arteries
Loss of body warmth localized to the affected area
Localized pallor or cyanosis
Thin, atrophied skin
Muscle atrophy
Loss of hair
Assessment of Peripheral Arteries: Abnormal Findings: Degree
of Occlusion
Delayed return of color >2 seconds
,Assessment of Peripheral Arteries: Abnormal Findings: Measure
of Blood Pressure
Hypertension
Typically BP greater than 140/90
Significant differences between arms (>10 mm Hg)
Pulse pressure of <30 or >40 mm Hg
Assessment of Peripheral Veins: Abnormal Findings: Affected
Area
Elevation (>9 cm H2O) or bilateral or one-sided distention
Constant pain with swelling and tenderness over muscles
Engorgement of superficial veins
Cyanosis
Persistent venous distention
Assessment of Peripheral Veins: Abnormal Findings:
Thrombosis
Redness, thickening, tenderness along the superficial vein
Calf pain when Homans' sign is tested
Assessment of Peripheral Veins: Abnormal Findings: Edema
Orthostatic (pitting) edema
Thickening and ulceration of skin
, 1+ = slight pitting, no visible distortion, disappears rapidly
2+ = deeper than 1+ and disappear in 10-15 seconds
3+ = noticeably deep and may last 1 minute with dependent
extremity and swollen
4+ = very deep, lasts 2-5 minutes, gross distortion
Assessment of Peripheral Veins: Abnormal Findings: Varicose
Veins
Dilated and swollen veins
Pain that disappears when extremity is elevated
Rapidly filling veins
Superficial veins that fail to empty
Stripped vessel fills before pressure is released
Blood fills entire vein when pressure is released by proximal
finger
Inspection of the Chest: Normal Findings
Symmetric, clavicles prominent, sternum flat with no abundance
of overlying tissue, anterior-posterior diameter half the
transverse diameter, trachea midline, spine midline with normal
curve.
