nr304 exam 1 latest 2023 actual exam questions and
nr304 exam 1 latest 2023 actual exam questions
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NR304 EXAM 1 LATEST 2023 ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS ALREADY GRADEDA+
1. Signs of DVT (clinical manifestations) – 2 questions
○ Unilateral swelling of the affected leg
○ Tenderness to severe pain
○ Possibly warmth & redness (accompanying inflammation)
○ Possibly superficial venous dilation
2. Effects of smoking
○ Bilateral cool feet
○ Strongest risk for peripheral vascular disease
○ Risk for arterial ulcers
○ Risk for atherosclerosis
3. Assessing peripheral blood flow
○ Modified Allen Test → → →
○ Doppler
○ Capillary refill
4. Peripheral vascular system assessment for different age groups
○ Infants & Children (normal vs. abnormal findings)
Transient acrocyanosis & skin mottling at birth Weak pulses occur with vasoconstriction of
Pulse force should be normal & symmetric diminished CO
Force should be same in upper & lower extremities Full, bounding pulses occur with patent ductus
arteriosus from the large left-to-right shunt
Diminished or absent femoral pulses but normal
upper-extremity pulses suggest coarctation of aorta
Palpable lymph nodes occur often (healthy) Enlarged, warm, tender nodes indicate current
They are small, firm (shotty), mobile, nontender infection
May be sequelae of past infections Look for source of infection
Vaccinations can produce local lymphadenopathy
Note characteristics of palpable nodes
(local/generalized)
○ Pregnanacy (normal vs. abnormal findings)
Expect diffuse bilateral pitting edema in lower extremities, Remain alert for generalized edema, plus
especially at the end of the day & into 3rd trimester hypertension, which suggests preeclampsia,
Nearly 80% of pregnant women have some peripheral edema a dangerous obstretric condition
because of increased water retention
Varicose veins in legs also common in 3rd trimester
○ Older adults (normal findings)
■ The dorsalis pedis & posterior tibial pulses may become more difficult to find
■ Trophic changes associated with arterial insufficiency
● Thin, shiny skin
● Thick-ridged nails
● Loss of hair on legs
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5. Why/how would you use a Doppler?
○ Why?
■ Doppler flow studies can ensure collateral flow that is quantifiable
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■ To detect a weak peripheral pulse
■ To monitor BP in infants or children
■ To measure a low BP or BP in a lower extremity
○ How?
■ Probe magnifies sounds from the heart & blood vessels
■ Position the person supine, with legs externally rotated so you can reach medial ankles easily
■ Place a drop of coupling gel on the end of the handheld transducer
■ Place transducer over a pulse site at about a 90-degree angle
■ Apply very light pressure & located the pulse site by the swishing, whooshing sound
6. Signs of PAD
○ Ankle-Brachial Index (ABI) of 0.90 or less
■ 0.90 - 0.71 → mild PAD
■ 0.70 - 0.41 → moderate PAD
■ 0.40 - 0.30 → severe PAD
○ Pain Profiles
■ Location
● Deep muscle pain (usually in calf, but may be lower leg or dorsum of foot)
■ Character
● Intermittent claudication (feels like <cramp,= <numbness & tingling,= or <feeling of cold=)
■ Onset & duration
● Chronic pain, onset gradual after exertion
■ Aggravating factors
● Activity (walking, stairs)
○ <Claudication distance= → specific number of blocks, stairs it takes to produce pain
● Elevation (rest pain indicates severe involvement)
■ Relieving factors
● Rest (usually within 2 minutes)
● Dangling (severe involvement)
■ Associated symptoms
● Low ankle-brachial index
● Cool, pale skin
● Diminished pulses, pallor on elevation
○ Signs
■ Arteriosclerosis (peripheral blood vessels more rigid)
■ Atherosclerosis (deposition of fatty plaques on intima of arteries)
■ Poor wound healing
■ Intermittent claudication (leg cramping when walking)
■ Ischemic rest pain
■ Coolness
■ Weak, <thready= pulse (1+)
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