Ch 38 Vascular Disorders – Flashcards
Unlock all answers in this set
Unlock answersquestion
A patient with peripheral vascular disease has marked peripheral neuropathy. An appropriate nursing diagnosis for the patient is 1. risk for injury related to decreased sensation. 2. impaired skin integrity related to decreased peripheral circulation. 3. ineffective peripheral tissue perfusion related to decreased arterial blood flow. 4. activity intolerance related to imbalance between oxygen supply and demand.
answer
1 (Rationale: Peripheral neuropathy is caused by diminished perfusion to neurons and results in loss of both pressure and deep pain sensations. The patient may not notice lower extremity injuries. Neuropathy increases susceptibility to traumatic injury and results in delay in seeking treatment.)
question
When teaching a patient with peripheral arterial disease, the nurse determines that further teaching is needed when the patient says, 1. "I should not use heating pads to warm my feet." 2. "I will examine my feet every day for any sores or red areas." 3. "I should cut back on my walks if they cause pain in my legs." 4. "I think I can quit smoking with the use of short-term nicotine replacement and support groups."
answer
3 (Rationale: Patients should be taught to exercise to the point of discomfort, stop and rest, and then resume walking until the discomfort recurs. Smoking cessation and proper foot care are also important interventions for patients with peripheral arterial disease.)
question
Following an aortic aneurysm repair, the patient suddenly develops severe pain in the right lower extremity. The right pedal pulse is decreased, and the right foot is cool and pale. The nurse suspects 1. hypothermia. 2. a wound infection. 3. bleeding from the graft site. 4. an embolization or graft occlusion.
answer
4 (Rationale: A decreased or absent pulse together with a cool, pale, mottled, or painful extremity may indicate embolization or graft occlusion.)
question
When discussing risk factor modification for a 60-year-old patient who has a 4-cm abdominal aortic aneurysm, the nurse will focus patient teaching on which of these patient risk factors? A. Male gender B. Marfan syndrome C. Abdominal trauma history D. Uncontrolled hypertension
answer
d (Feedback: All of the factors contribute to the patient's risk, but only the hypertension can potentially be modified to decrease the patient's risk for further expansion of the aneurysm.)
question
A patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, it will be most important to ask about A. back or lumbar pain. B. difficulty swallowing. C. abdominal tenderness. D. changes in bowel habits.
answer
b (Rationale: Difficulty swallowing may occur with a thoracic aneurysm because of pressure on the esophagus. Abdominal tenderness or changes in bowel habits are consistent with an abdominal aneurysm. Dizziness or weakness may occur if there is blood loss from the aneurysm, but this aneurysm was discovered accidentally, not because the patient was symptomatic.)
question
Several hours after an open surgical repair of an abdominal aortic aneurysm, the patient develops a urinary output of 20 mL/hr for 2 hours. The nurse notifies the health care provider and anticipates orders for A. an additional antibiotic. B. a white blood cell (WBC) count. C. a decrease in IV infusion rate. D. a blood urea nitrogen (BUN) level.
answer
d (Rationale: The pain and decreased urine output suggest a renal artery embolism, and monitoring of renal function is needed. The data are not consistent with the complications of infection, hypovolemia, or bleeding.)
question
A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which medication category will the nurse plan to include when providing patient teaching about PAD management? A. Statins B. Vitamins C. Thrombolytics D. Anticoagulants
answer
a (current research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other medication categories in PAD.)
question
A patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. The nurse should notify the health care provider and A. elevate the left leg on a pillow. B. apply an elastic wrap to the leg. C. assist the patient in gently exercising the leg. D. keep the patient in bed in the supine position.
answer
d (The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the leg.)
question
A patient at the clinic says, "I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." The nurse should A. attempt to palpate the dorsalis pedis and posterior tibial pulses. B. check for the presence of tortuous veins bilaterally on the legs. C. ask about any skin color changes that occur in response to cold. D. assess for unilateral swelling, redness, and tenderness of either leg.
answer
a (Rationale: The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness point to deep vein thrombosis, DVT)
question
The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe would expect to find A. a positive Homans' sign. B. swollen, dry, scaly ankles. C. prolonged capillary refill in all the toes. D. a large amount of drainage from the ulcer.
answer
c (Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.)
question
In evaluating the patient outcomes following teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, A. "I will have to buy some loose clothing that does not bind across my legs or waist." B. "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." C. "I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily." D. "I will change my position every hour and avoid long periods of sitting with my legs down."
answer
b (Rationale: Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful)
question
After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective? A. The patient avoids the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). B. The patient exercises indoors during the winter months. C. The patient places the hands in hot water when they turn pale. D. The patient takes pseudoephedrine (Sudafed) for cold symptoms.
answer
b (Rationale: Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking aspirin and NSAIDs with Raynaud's phenomenon.)
question
The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with deep vein thrombosis. The best method for the nurse to use in elevating the patient's feet is to A. place the patient in the Trendelenburg position. B. place two pillows under the calf of the affected leg. C. elevate the bed at the knee and put pillows under the feet. D. put one pillow under the thighs and two pillows under the lower legs.
answer
d (The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the patient in the Trendelenburg position will lower the head below heart level, which is not indicated for this patient. Placing pillows under the calf or elevating the bed at the knee may cause blood stasis at the calf level)
question
The health care provider prescribes an infusion of argatroban (Acova) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to A. avoid giving any IM medications to prevent localized bleeding. B. discontinue the infusion for PTT values greater than 50 seconds. C. monitor posterior tibial and dorsalis pedis pulses with the Doppler. D. have vitamin K available in case reversal of the argatroban is needed.
answer
a (IM injections are avoided in patients receiving anticoagulation. A PTT of 50 seconds is withinthe therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.)
question
A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate? A. "Administration of two anticoagulants reduces the risk for recurrent venous thrombosis." B. "Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots from occurring." C. "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation." D. "Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant."
answer
c (Low molecular weight heparin, LMWH, is used because of the immediate effect on coagulationand discontinued once the international normalized ratio, INR, value indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic properties. The use of two anticoagulants is not related to the risk for pulmonary embolism, and two are not necessary to reduce the risk for another VTE.)
question
The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says, A. "I should reduce the amount of green, leafy vegetables that I eat." B. "I should wear a Medic Alert bracelet stating that I take Coumadin." C. "I will need to have blood tests routinely to monitor the effects of the Coumadin." D. "I will check with my health care provider before I begin or stop any medication."
answer
a (Patients taking Coumadin are taught to follow a consistent diet with regard to foods that are highin vitamin K, such as green, leafy vegetables. The other patient statements are accurate)
question
A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that A. sitting at the work counter, rather than standing, is recommended. B. compression stockings should be applied before getting out of bed. C. exercises such as walking or jogging cause recurrence of varicosities. D. taking one aspirin daily will help prevent clotting around venous valves.
answer
b (Compression stockings are applied with the legs elevated to reduce pressure in the lower legs.Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to preventvenous thrombosis and would not be recommended to the patient who had just hadsclerotherapy)
question
Which topic will the nurse include in patient teaching for a patient with a venous stasis ulcer on the right lower leg? A. Adequate carbohydrate intake B. Prophylactic antibiotic therapy C. Application of compression to the leg D. Methods of keeping the wound area dry
answer
c (Compression of the leg is essential to healing of venous stasis ulcers. High dietary intake of protein, rather than carbohydrates, is needed. Prophylactic antibiotics are not routinely used forvenous ulcers. Moist environment dressings are used to hasten wound healing)
question
A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of these statements by the patient is most consistent with the diagnosis? A. "I can't get my shoes on at the end of the day." B. "I can never seem to get my feet warm enough." C. "I wake up during the night because my legs hurt." D. "I have burning leg pains after I walk three blocks."
answer
a (Because the edema associated with venous insufficiency increases when the patient has beenstanding, shoes will feel tighter at the end of the day. The other patient statements arecharacteristic of peripheral artery disease, PAD.)
question
Which nursing action will be included in the plan of care after endovascular repair of an abdominal aortic aneurysm? A. Record hourly chest tube drainage. B. Monitor fluid intake and urine output. C. Check the abdominal wound for redness or swelling. D. Teach the reason for a prolonged rehabilitation process.
answer
b (Because renal artery occlusion can occur after endovascular repair, the nurse should monitorparameters of renal function such as intake and output. Chest tubes will not be needed forendovascular surgery, the recovery period will be short, and there will not be an abdominalwound.)
question
Which action by a nurse who is administering fondaparinux (Arixtra) to a patient with venous thromboembolism (VTE) indicates that more education about the medication is needed? A. The nurse avoids rubbing the injection site after giving the medication. B. The nurse injects the medication into the abdominal subcutaneous tissue. C. The nurse fails to assess the partial thromboplastin time (PTT) before administration of the medication. D. The nurse ejects the air bubble in the syringe before administering the Arixtra.
answer
d ( The air bubble is not ejected before giving Arixtra. The other actions by the nurse areappropriate.)
question
A patient tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynaud's phenomenon. The nurse will anticipate teaching the patient about tests for A. hypertension. B. hyperlipidemia. C. autoimmune disorders. D. coronary artery disease.
answer
c (Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis, and patients should be screened for autoimmune disorders. Raynaud's phenomenon is not associated with hyperlipidemia, hypertension, or coronary artery disease.)
question
While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information? A. "When I stand too long, my feet start to swell up." B. "Sometimes I get tired when I climb a lot of stairs." C. "My fingers hurt when I go outside in cold weather." D. "My legs cramp whenever I walk more than a block."
answer
d (Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication. Finger pain associated with cold weather is typical of Raynaud's phenomenon.Fatigue that occurs sometimes with exercise is not typical of intermittent claudication, which is reproducible. Swelling associated with prolonged standing is typical of venous disease.)
question
When developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD), which information should the nurse include? A. "Exercise only if you do not experience any pain." B. "It is very important that you stop smoking cigarettes." C. "Try to keep your legs elevated whenever you are sitting." D. "Put on support hose early in the day before swelling occurs."
answer
b (Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.)
question
A patient with a history of an abdominal aortic aneurysm is admitted to the emergency department (ED) with severe back pain and absent pedal pulses. Which action should the nurse take first? A. Obtain the blood pressure. B. Ask the patient about tobacco use. C. Draw blood for ordered laboratory testing. D. Assess for the presence of an abdominal bruit.
answer
a (Since the patient appears to be experiencing aortic dissection, the nurse's first action should be to determine the hemodynamic status by assessing blood pressure. The other actions also may be done, but they will not provide information that will determine what interventions are needed immediately for this patient.)
question
Which of these patients admitted to the emergency department should the nurse assess first? A. 62-year-old who has gangrenous ulcers on both feet B. 50-year-old who is complaining of "tearing" chest pain C. 45-year-old who is taking anticoagulants and has bloody stools D. 36-year-old who has right calf tenderness, redness, and swelling
answer
b (The patient's presentation is consistent with dissecting thoracic aneurysm, which will require rapid intervention. The other patients do not need urgent interventions.)
question
Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? A. Wrap both the legs in warm blankets. B. Notify the surgeon and anesthesiologist. C. Document that the pulses are absent and recheck in 30 minutes. D. Review the preoperative assessment form for data about the pulses.
answer
d (Many patients with aortic aneurysms also have peripheral arterial disease, so the nurse should check the preoperative assessment to determine whether pulses were present before surgery before notifying the health care providers about the absent pulses. Because the patient's symptoms may indicate graft occlusion or multiple emboli and a possible need to return to surgery, it is not appropriate to wait 30 minutes before taking action. Warm blankets will not improve the circulation to the patient's legs.)
question
When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important to communicate to the health care provider? A. Absence of flatus B. Loose, bloody stools C. Hypotonic bowel sounds D. Abdominal pain with palpation
answer
b (Loose, bloody stools at this time may indicate intestinal ischemia or infarction and should bereported immediately because the patient may need an emergency bowel resection. The otherfindings are normal on the first postoperative day after abdominal surgery.)
question
When caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty, which action should the nurse take first? A. Take the blood pressure and pulse rate. B. Check for the presence of pedal pulses. C. Assess the appearance of any ischemic ulcers. D. Start discharge teaching about antiplatelet drugs.
answer
a (Bleeding is a possible complication after catheterization of the femoral artery, so the nurse's first action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions also are appropriate but can be done after determining that bleeding is not occurring.)
question
A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene? A. The LPN/LVN places the patient in a Fowler's position for meals. B. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. C. The LPN/LVN assists the patient to ambulate 40 feet in the hallway. D. The LPN/LVN administers the ordered aspirin 160 mg after breakfast.
answer
b (The patient should avoid sitting for long periods because of the increased stress on the suture linecaused by leg edema and because of the risk for venous thromboembolism (VTE). The otheractions by the LPN/LVN are appropriate)
question
A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient? A. Cessation of smoking B. Control of serum lipid levels C. Maintenance of appropriate weight D. Demonstration of meticulous foot care
answer
a (Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease. Other therapies have limited success in treatment of this disease.)
question
Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? A. Complaint of left calf pain B. New onset shortness of breath C. Red skin color of left lower leg D. Temperature of 100.4° F (38° C)
answer
b (New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as oxygen administration and notification of the health care provider. The other findings are typical of VTE.)
question
Which nursing action in the care plan for a patient who had an open repair of an abdominal aortic aneurysm 3 days previously is appropriate for the nurse to delegate to experienced nursing assistive personnel (NAP)? A. Check the lower extremity strength and movement. B. Monitor the quality and presence of the pedal pulses. C. Teach the patient the signs of possible wound infection. D. Help the patient to use a pillow to splint while coughing.
answer
d (Assisting a patient who has already been taught how to cough is part of routine postoperative care and within the education and scope of practice for an experienced NAP. Patient teaching and assessment of essential postoperative functions such as circulation and movement should be done by RNs)
question
The nurse is teaching a patient about risk factors for aortic abdominal aneurysms. Which risk factors should the nurse include in the teaching plan? A. Smoking, high cholesterol, and hypertension B. Female gender, hyperhomocysteinemia, and substance abuse C. Diabetes mellitus, obesity, and metabolic syndrome D. Physical inactivity, African American, and renal insufficiency
answer
a (Rationale: The most common etiology of descending abdominal aortic aneurysm, AAA, is atherosclerosis. Risk factors include male gender, age 65 years or older, and tobacco use are the major risk factors for AAAs of atherosclerotic origin. Other risk factors include the presence of coronary or peripheral artery disease, high blood pressure, and high cholesterol.)
question
A patient has peripheral artery disease. Which symptom, if experienced by the patient, indicates to the nurse that the patient is experiencing intermittent claudication? A. Patient complains of chest pain with strenuous activity B. Patient has numbness and tingling of the toes and feet C. Patient states the feet become red if in a D. Patient reports muscle leg pain that occurs with exercise
answer
d (Rationale: Intermittent claudication is an ischemic muscle ache or pain that is precipitated by a consistent level of exercise, resolves within 10 minutes or less with rest, and is reproducible. Angina is the term used to describe chest pain. Paresthesia is the term used to describe numbness or tingling in the toes or feet. Reactive hyperemia is the term used to describe redness of the foot; if the limb is in a dependent position the term is dependent rubor.)
question
A patient with Raynaud's phenomenon is prescribed diltiazem (Cardizem). To evaluate the patient's response to this medication, what is most important for the nurse to assess in this patient? A. Increased prothrombin time (PT) B. Improved perfusion to distal fingers C. Increased mean arterial pressure D. Increased capillary refill time
answer
b (Raynaud's phenomenon is an episodic vasospastic disorder of small cutaneous arteries, most frequently involving the fingers and toes. Diltiazem, Cardizem, is a calcium channel blocker that will relax smooth muscles of the arterioles by blocking the influx of calcium into the cells, thus reducing the frequency and severity of vasospastic attacks. There will be improved perfusion to the fingertips and a reduction of the vasospastic attacks.)
question
A patient is admitted with venous thromboembolism (VTE) and prescribed unfractionated heparin. What laboratory test should the nurse assess while the patient is receiving this medication? A. International normalized ratio (INR) B. Activated partial thromboplastin time (APTT) C. Anti-factor Xa D. Platelet count
answer
b (Rationale: Unfractionated heparin can be given by continuous intravenous, IV, for VTE treatment. When given IV, heparin requires frequent laboratory monitoring of clotting status as measured by activated partial thromboplastin time, aPTT.)
question
A patient has a venous ulcer related to chronic venous insufficiency. The nurse should provide education on which type of diet for this patient? A.1200-calorie-restricted diet B. High-carbohydrate diet C. High-protein diet D. Low-fat diet
answer
c (Rationale: A patient with a venous ulcer should have a balanced diet with adequate protein, calories, and micronutrients; this type of diet is essential for healing. Nutrients most important for healing include protein, vitamins A and C, and zinc. Foods high in protein, e.g., meat, beans, cheese, tofu;vitamin A, green leafy vegetables; vitamin C; citrus fruits, tomatoes, cantaloupe, and zinc; meat, seafood; must be provided. For patients with diabetes mellitus, maintaining normal blood glucose levels assists the healing process. For overweight individuals and no active venous ulcer, a weight-loss diet should be considered.)
question
The nurse instructs a patient with a pulmonary embolism about enoxaparin (Lovenox). Which statement by the patient indicates understanding about the instructions? a. "The medicine will dissolve the clot in my lung." b. "I need to take this medicine with meals." c. "The medicine will be prescribed for 10 days." d. "I will inject this medicine into my abdomen."
answer
c (Rationale: Enoxaparin is a low-molecular weight heparin that is administered for 10 to 14 days and prevents future clotting but does not dissolve existing clots. Fibrinolytic agents, e.g., tissue plasminogen activator or alteplase, will dissolve an existing clot. Enoxaparin is administered subcutaneously by injection.)
question
The nurse is caring for a patient who has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed? A. Decreased cardiac output B. Increased blood pressure C. Cerebral or pulmonary emboli D. Excessive bleeding from incision or IV sites
answer
c (Rationale: Warfarin is an anticoagulant that is used to prevent thrombi from forming on the walls of the atria during a fib. Once the medication is terminated, thrombi could again form. If one or more detach from the atrial wall, they could travel as cerebral emboli from the left atrium, or pulmonary emboli from the right atrium.)
question
--
answer
--
question
--
answer
--
question
A 50yr old woman weighs 85 kg and has a history of cigarette smoking, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease (PAD) that need to be modified are: A. weight and diet B. activity level and diet C. cigarette smoking and high blood pressure D. sedentary lifestyle and high blood pressure
answer
c (Significant risk factors for peripheral artery disease include tobacco use, hyperlipidemia, elevated levels of high-sensitivity C-reactive protein, diabetes mellitus, and uncontrolled hypertension; the most important is tobacco use. Other risk factors include family history, hypertriglyceridemia, hyperuricemia, increasing age, obesity, sedentary lifestyle, and stress.)
question
A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. which of the following S/S would suggest that his aneurysm has ruptured? A. sudden shortness of breath and hemoptysis B. sudden, severe low back pain and bruising along his flank C. gradually increasing substernal chest pain and diaphoresis D. sudden, patchy blue mottling on his feet and toes and rest pain
answer
b (The clinical manifestations of a ruptured abdominal aortic aneurysm include severe back pain, back or flank ecchymosis, Grey Turner's sign, and hypovolemic shock, tachycardia, hypotension, pale clammy skin, decreased urine output, altered level of consciousness, and abdominal tenderness.)
question
Priority nursing measures after an abdominal aortic aneurism repair include: A. assessment of cranial nerves and mental status B. administration of IV heparin and monitoring aPTT C. administration of IV fluids and monitoring of kidney function D. elevation of legs and application of graduated compression stockings
answer
c (Rationale: Postoperative priorities include administration of intravenous, IV, fluids and maintenance of renal perfusion. An adequate blood pressure is important to maintain graft patency, and administration of IV fluids and blood components, as indicated, is essential for adequate blood flow. The nurse should evaluate renal function by hourly urine output measurements and monitoring daily blood urea nitrogen, BUN, and serum creatinine levels. Irreversible renal failure may occur after aortic surgery, particularly in high-risk individuals.)
question
Rest pain is a manifestation of PAD that occurs due to a chronic: A. vasospasm of small cutaneous arteries in the feet B. increase in retrograde venous blood flow in the legs C. decrease in arterial blood flow to the nerves of the feet D. decrease in arterial blood flow to the leg muscles during exercise
answer
c (Rationale: Rest pain most often occurs in the forefoot or toes and is aggravated by limb elevation. Rest pain occurs when there is insufficient blood flow to meet basic metabolic requirements of the distal tissues. Rest pain occurs more often at night because cardiac output tends to drop during sleep and the limbs are at the level of the heart. Patients often try to achieve partial pain relief by dangling the leg over the side of the bed or sleeping in a chair to allow gravity to maximize blood flow.)
question
A patient with infective endocarditis develops sudden sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to: A. elevate the leg to promote venous return B. start anticoagulant therapy with IV heparin C. notify the physician of the change in peripheral perfusion D. place the bed in reverse Trandelelbrug to promote perfusion
answer
c (Rationale: The patient has potentially developed acute arterial ischemia, sudden interruption in the arterial blood supply to the extremity, caused by an embolism from a cardiac thrombus that occurred as a complication of infective endocarditis. Clinical manifestations of acute arterial ischemia include pain, pallor, paralysis, pulselessness, paresthesia, and poikilothermia. Without immediate intervention, ischemia may progress quickly to tissue necrosis and gangrene within a few hours. If the nurse detects these signs, the physician should be notified immediately.)
question
Which clinical manifestation are seen in both patients with Buerger's disease and Raynaud's phenomenon (select all that apply): A. intermittent fevers B. sensitivity to cold temperatures C. gangrenous ulcers of fingertips D. color changes of fingers and toes E. episodes of superficial vein thrombosis
answer
b, c, d (Rationale: Both Buerger's disease and Raynaud's phenomenon have the following clinical manifestations in common: cold sensitivity, ischemic and gangrenous ulcers on fingertips, and color changes of the distal extremity, fingers or toes.)
question
A patient at the highest risk for venous thromboembolism, VTE, is: A. a 62 year old man with spider veins who is having arthroscopic knee surgery B. a 32 year old woman who smokes, takes oral contraceptives, and is planning a trip to Europe C. a 26 year old woman who is 3 days postpartum and received maintenance IV fluid for 12 hours during her labor D. an active 72 year old man at home recovering from transuerthral resection of the prostate for benign prostatic hyperplasia
answer
b (Rationale: Three important factors, called Virchow's triad, in the etiology of venous thrombosis are, 1, venous stasis, 2, damage of the endothelium, inner lining of the vein, and, 3, hypercoagulability of the blood. The patient at risk for venous thrombosis usually has predisposing conditions for these three disorders, see Table 38-7. The 32-year-old woman has the highest risk: long trips without adequate exercise, venous stasis, cigarette smoking, and use of oral contraceptives (especially in women older than 35 years who smoke, the likelihood of hypercoagulability of blood is increased.)
question
Which are probable clinical findings in a person with an acute VTE (select all that apply): A. pallor and coolness of the foot and calf B. mild to moderate calf pain and tenderness C. grossly diminished or absent pedal pulses D. unilateral edema and induration of the thigh E. palpable cord along a superficial varicose vein
answer
b, d (Rationale: The patient with lower extremity venous thromboembolism, VTE, may or may not have unilateral leg edema, extremity pain, a sense of fullness in the thigh or calf, paresthesias, warm skin, erythema, or a systemic temperature >100.4F, 38 C. If the calf is involved, it may be tender to palpation. A positive Homans' sign, pain on forced dorsiflexion of the foot when the leg is raised, is a classic but very unreliable sign with frequent false positives.)
question
The recommended treatment for an initial VTE in an otherwise healthy person with no significant comorbidities would include: A. IV agratoban (Acova) as an inpatient B. IV unfractionated heparin as an inpatient C. subcutaneous unfractionated heparin as an outpatient D. subcutaneous low-molecular weight heparin as an outpatient
answer
d (Rationale: Patients with confirmed VTE should receive initial treatment with low-molecular-weight heparin, LMWH, unfractionated heparin, UFH, or fondaparinux and with warfarin for at least 5 days or until the international normalized ratio, INR, is >2.0 for 24 hours. Patients with multiple co-morbidities, complex medical issues, or a very large VTE usually are hospitalized for treatment and typically receive intravenous UFH. LMWH is recommended over UFH for most patients with acute VTE. Depending on the clinical presentation, patients often can be safely and effectively managed as outpatients.)
question
A key aspect of teaching for the patient on anticoagulant therapy includes which instructions? A. monitor for and report any signs of bleeding B. do not take acetaminophen for a headache C. decrease your dietary intake of foods containing vitamin K D. arrange to have your blood drawn regularly to check drug levels
answer
a (Patients on anticoagulants should be taught to monitor and report any signs of bleeding, which can be a serious complication. Other important patient teaching includes reduction of vitamin K intake and routine coagulation laboratory studies if taking warfarin.)
question
In planning patient care and teaching for the patient with venous leg ulcers, the nurse recognizes that the most important intervention in healing and control of this condition is: A. sclerotherapy B. taking horse chestnut extract daily C. using moist environment dressing D. applying graduated compression stockings
answer
d (Compression is essential for treating chronic venous insufficiency, CVI, healing venous ulcers, and preventing ulcer recurrence. Use of custom-fitted graduated compression stockings is one option for compression therapy.)
question
When obtaining a health history from a 72-year-old man with peripheral arterial disease(PAD) of the lower extremities, the nurse asks about a history of related conditions such as: a) Venous thrombosis b) Venous stasis ulcers c) Pulmonary embolism d) Carotid artery disease
answer
d (Regardless of the location, atherosclerosis is responsible for peripheral arterial disease and is related to other cardiovascular disease and its risk factors.)
question
A surgical repair is planned for a patient who has a 5-cm abdominal aortic aneurysm (AAA). On physical assessment of the patient, the nurse would expect to find... A) hoarseness and dysphagia B) sever back pain with flank ecchymosis C) the presence of a bruit in the periumbilical area D) weakness in the lower extremities progressing to paraplegia
answer
C (the presence of a bruit in the periumbilical area, although most abdominal aortic aneurysms, AAA, are asymptomatic, on physical exam a pulsatile mass in the periumbilical area slightly to the left of the midline may be detected, and bruits may be audible with a stethoscope placed over the aneurysm. Hoarseness and dysphagia may occur with aneurysms of the ascending aorta and the aortic arch. Severe back pain with flank ecchymosis is usually present on rupture of an AAA, and neurologic loss in the lower extremities may occur from the pressure of a thoracic aneurysm.)
question
A thoracic aortic aneurysm is found when a patient has a routine chest radiograph. The nurse anticipates that additional diagnostic testing to determine the size and structure of the aneurysm will include... A) angiography B) Ultrasonography C) echocardiography D) CT scan
answer
d (CT scan, The most accurate test to determine the diameter of the aneurysm and whether a thrombus is present. The other tests may also be used, but the CT yields the most descriptive results.)
question
A patient with a small AAA is not a good surgical candidate. The nurse teaches the patient that one of the best ways to prevent expansion of the lesion is to A. Avoid strenous physical activity B. Control hypertension with prescribed therapy C. Comply with prescribed anticoagulant therapy D. Maintain a low-calcium diet to prevent calcification fo the vessel
answer
b (Control hypertension with prescribed therapy, because Increased systolic BP continually puts pressure on the diseased area of the artery, promoting its expansion. Small aneurysms can be treated by decreasing BP, modifying atherosclerosis risk factors, and monitoring the size of the aneurysm.)
question
During preop preparation of the patient scheduled for a AAA, the nurse establishes baseline data for the patient knowing that... A. All physiologic processes will be altered postop B. The cause of the aneurysm is a systemic vascular disease C. Surgery will be cancelled if any physiologic function is not normal D. BP and heart rate (HR) will be maintained well below the baseline levels during the postop peroid
answer
b (the cause of the aneurysm is a systemic vascular disease, because atherosclerosis is a systemic disease, the patient with an AAA is likely to have cardiac, pulmonary, cerebral, or lower-extremity vascular problems that should be noted and monitored throughout the perioperative period.)
question
Following an ascending aortic aneurysm repair, which of the following findings should the nurse report immediately to the health care provider? a) a change in LOC and ability to speak b) shallow respirations and poor coughing c) decreased drainage from the chest tubes d) lower-extremity pulses that are decreased from preoperative baseline
answer
a (A change in level of consciousness and ability to speak; because during a repair of an AAA, the blood supply to the carotid arteries may be interrupted, leading to neurologic complications manifested by a decreased LOC and altered pupil responses to light as well as changes in facial symmetry, speech, and movement of upper extremities. The thorax is opened is opened for ascending aortic surgery, and shallow breathing, poor cough, and decreasing chest drainage are expected. Often, lower limb pulses are normally decreased or absent for a short time following surgery.)
question
The most important measure in the treatment of venous stasis ulcers is... A. elevation of the limb B. extrinsic compression C. application of moist dressings D. application of topical antibiotics
answer
b (Although leg elevation, moist dressings, and topical antibiotics are useful in treatment of venous stasis ulcers, the most important factor appears to be extrinsic compression to minimize venous stasis, venous hypertension, and edema. Extrinsic compression methods include compression gradient stockings, elastic bandages, and Unna's boot.)
