Deck 15: Vascular Surgery

Question 1

Surgically created arteriovenous fistulas are also referred to as a(n) _________ and are indicated for enabling __________.

A)axillo-femoral bypass; end-stage renal disease
B)bridge shunt; peritoneal dialysis
C)arteriovenous shunt; hemodialysis
D)side-to-side anastomosis; cannulation

Answer 1

C
Arteriovenous fistulas-direct connections between an artery and a vein-are the standard means of vascular access for long-term renal dialysis. The dilated vein can then be used for direct cannulation with large-bore needles for hemodialysis. This method is preferable to an external shunt, which carries a high risk of thrombosis and infection. The best access is achieved using the patient's own vessels and creating a subcutaneous connection between the artery and vein, referred to as an arteriovenous shunt, or bridge fistula. Arteriovenous shunts are indicated for long-term renal dialysis access.

Question 2

During the 4-hour vascular procedure, the circulating nurse, Karen, and the surgical technologist, Judy, have each had a coffee break and a lunch break. Judy has returned from lunch to find four medicine cups with clear fluid, each unlabeled. The outgoing relief scrub person, during her hand-off report to Judy, points to each cup and states; "The first one is contrast dye, the second cup is heparin, the third is heparinized saline and the fourth is papaverine; it's easy, they're in alphabetical order." Judy discarded all four medications and Karen replaced them into appropriately labeled medicine cups. After the procedure, Karen completed an unusual occurrence report. What recommendations should she include in her corrective action plan that the relief scrub person should have done? Select all that apply from the listed options.

A)Ensure concurrent medication verification, both verbally and visually; include medication name, strength, dose, and expiration date.
B)Verify all medications concurrently with the entering and exiting personnel at shift change or break relief.
C)Remove any unlabeled medication or solution from the field.
D)Keep all medication containers used during the procedure in the OR until the conclusion of the procedure.
E) None of the aobve

Answer 2

Ensure concurrent medication verification, both verbally and visually; include medication name, strength, dose, and expiration date.
Verify all medications concurrently with the entering and exiting personnel at shift change or break relief.
Remove any unlabeled medication or solution from the field.
Keep all medication containers used during the procedure in the OR until the conclusion of the procedure.

Question 3

Why is the change in sound made by a passing train's whistle similar to the reason the pitch rises quickly in systole and drops quickly in early diastole when measuring arterial sounds?

A)Both are explained by B-mode ultrasonography.
B)Both involve the science of plethysmography.
C)Both are explained by the Doppler effect.
D)Both are explained by the science of atomic behavior in a strong magnetic field such as MRI.

Answer 3

C
The Doppler effect is the change in the frequency of echo signals that occurs whenever there is a change in the distance between the sources of a sound and the receiving object. The probe, or transducer, is aimed toward the blood vessel at an angle of 45 to 60 degrees. This directs an ultrasound beam that is reflected back to the probe by moving red blood cells (RBCs). The velocity of the flow of cells is converted into an audible signal heard through a speaker. The signal is described as a swishing sound. The sound is called a signal, not a pulse. The Doppler transducer is the most widely used instrument for vascular study. It has the advantages of being readily available, inexpensive, and easy to use.

Question 4

The Doppler transducer is the most widely used instrument for vascular study. What statement regarding a Doppler is true?

A)Doppler probes are expensive but can be steam sterilized.
B)The Doppler probe can provide five different forms of information.
C)Water-soluble gel is needed when the Doppler is used on intact skin.
D)The Doppler is valuable in detecting accurate findings in the presence of stenosis.

Question 5

Heparin sodium is an anticoagulant. The basic mechanism of heparin's action is best described as:

A)it blocks the conversion of prothrombin to thrombin and fibrinogen to fibrin.
B)it acts as an enzyme by lysing the fibrin-thrombin matrix.
C)it extends the activated partial thromboplastin time (APTT).
D)it dissolves and liquefies existing blood clots and thromboemboli.

Question 6

What drug is used to reverse the effects of heparin?

A)Prostigmine
B)Protonics hydrochloride
C)Protamine sulfate
D)Prothrombin

Question 7

Patients with chronic venous insufficiency (CVI) are not typically treated surgically as often as patients with arterial disease because:

A)CVI is not life-threatening or limb-threatening.
B)venous surgery contributes to thromboembolism.
C)surgical interventions for venous valves have not been refined.
D)All of the options are correct.

Question 8

When selecting a vascular graft for a vascular bypass or replacement procedure, what are the desirable characteristics that influence the surgeon's choice of graft? Select all that apply from the listed options.

A)Thrombo-resistant, biocompatible, and easy to handle
B)Fairly priced, variety of sizes, and ability to clot blood
C)Sterilizable, nonantigenic, and last a lifetime
D)Reasonably priced, permit blood passage without clotting, and hypoallergenic

Question 9

Select the statement that best describes the comparative difference between open aortic aneurysm repair and endovascular aneurysm (EVAR) repair.

A)The open aneurysm surgery approach has a major abdominal incision and increased patient morbidity.
B)In EVAR, the prosthetic endograft or stent-graft is introduced into the aneurysm through a surgically exposed femoral artery.
C)In EVAR, self-expanding or balloon-expandable stents are used rather than sutures.
D)All the options are correct.

Question 10

Varicose veins are enlarged and distended veins that are visible and palpable beneath the skin. Secondary varicose veins are believed to be a result of insufficiency of the deep venous system. The primary objective of varicose vein surgery, for the patient with secondary disease, is to prevent:

A)thromboemboli, claudication, and unsightly blue clusters of veins.
B)ulceration, edema, pain, and fatigue.
C)venospasm, phlebitis, and vascular sacculations.
D)vasculitis, pitting edema, and sclerosed vein clusters.

Question 11

Karen Masterson, circulator, is preparing the OR for a vascular procedure where heparin will be used. She has obtained the heparin from the medication dispensing system and is preparing to mix the heparin in IV saline according to the dosage on the surgeon's preference/pick list. The scrub person, Judy Rothman, a surgical technologist, is preparing the sterile back table. What expected and appropriate risk reduction strategies related to the use of heparin would both Karen and Judy perform?

A)Label syringe, medicine cup, and IV saline bag with the drug name, dosage, strength, date, and expiration date.
B)Verify the drug and labels with three qualified individuals including the surgeon.
C)Be aware of sound-alike cautions by not placing the heparin vial next to Hespan.
D)Comply with the 7 rights of medication storage and documentation.

Question 12

While arteriosclerosis is a natural part of the aging process and occurs when the walls of the arterial vasculature undergo changes such as increased thickness and hardening, reducing the elasticity of the arteries, certain risk factors for arteriosclerosis are modifiable by the individual. Select the two modifiable risk factors that could minimize the potential for acute or chronic vascular insufficiency.

A)Past surgical history and hypercholesterolemia
B)Cigarette smoking and sedentary lifestyle
C)Hypertension and diabetes
D)Hyperhomocysteinemia and hypertriglyceridemia

Question 13

Substituting a cryo-preserved cadaveric vein or an in situ or reversed vein graft from the patient for an arterial bypass graft is an option for patients who have healthy, easily accessed saphenous veins. How does an in situ vein graft differ from a reversed vein graft?

A)With the in situ method, the vein segment is resected, reversed, and anastomosed into position.
B)The in situ method leaves the vein in its position and the valves are removed.
C)Arteriovenous fistulas are a common complication with the reversed vein graft method.
D)Valvulotomes are used to remove the valves in both methods.

Question 14

What properties enable arteries to compensate for changes in blood pressure and blood volume?

A)Regeneration and thick muscularis
B)Dilatation and absence of valves
C)Contraction and constriction
D)Elasticity and distensibility

Question 15

During an open femoropopliteal bypass with graft, an incision is made into the femoral artery with a #11 knife blade and extended with a Potts angulated scissors. What is the proper name of this surgical approach?

A)Potts arterial punch cut
B)Medial vasculotomy
C)Femoral arteriotomy
D)Popliteal arteriostomy

Question 16

Identify the venous structure that prevents blood backflow.

A)Semilunar intimal folds
B)Coarctation segments
C)Pressure receptors
D)Venules

Question 17

What statement regarding risk factors for developing vascular disease is true?

A)Cigarette smoking is more of a risk factor for lung disease than vascular disease.
B)Advanced age, male gender, and family history are established risk factors for atherosclerosis.
C)A sedentary lifestyle can contribute to developing diabetes if one has atherosclerosis.
D)Arteriosclerosis is a natural part of the aging process.

Question 18

Assessing blood flow through diseased vessels by palpation is often difficult. Assessment of the patient's hemodynamic status during surgery can be further complicated by spasm of the vessel walls, the cool environment of the OR, and alterations in blood pressure caused by hemorrhage. Vascular monitoring during carotid endarterectomy (CEA) is critical to determine the quality of cerebral perfusion. What vascular monitoring device is employed during CEA and what important surgical need is determined by its results?

A)Doppler, need for embolectomy
B)Laser flow cytometry, need for increased IV fluids
C)Electromyogram (EMG), need for muscle relaxants
D)Electroencephalogram (EEG), need for a shunt

Question 19

Patients with acute arterial insufficiency with occlusion usually present with the onset of the six P's: sudden severe pain, pulselessness, paresthesia, paralysis, pallor, and poikilothermia (coolness) of an extremity. This occlusion can be the result of which condition?

A)Atrial tachycardia
B)Rupture of an unstable atherosclerotic plaque
C)Asystole
D)Hypothermia

Question 20

Vascular surgery patients are at risk for impaired skin integrity and ineffective tissue perfusion related to surgical positioning, presence of vascular disease, and vascular clamping. Positioning of the patient undergoing vascular surgery is of particular importance because of restricted circulation distal to the area of arterial obstruction and a generalized state of poor circulation. An appropriate protective intervention is reflected in which true statement about patient positioning for vascular surgery?

A)The patient should be positioned on a radiopaque pressure-reducing mattress on the OR bed.
B)The patient's vulnerable neurovascular bundles should be protected from compression.
C)There should be warmed sterile saline compresses provided to bony prominences to increase vascular perfusion.
D)The weight of instruments on top of the patient should be equally distributed to prevent pressure injuries.