Question 1

In planning care for a patient with a venous stasis ulcer on the right lower leg,what does the nurse understand is the most important intervention in promoting healing of the ulcer?

Accepted Answer

The application of external compression to the lower leg is the most important intervention in promoting healing of the ulcer because it helps improve blood flow and reduce swelling in the affected area. Adequate dietary intake of proteins and vitamins and prevention of infection with prophylactic antibiotics are also important, but the use of external compression is the priority intervention. Keeping the ulcer moist with hydrocolloid dressings can also promote healing, but it is not the most important intervention.

Question 2

A patient has been receiving IV heparin therapy for 6 days for treatment of DVT.The physician now orders warfarin (Coumadin)without discontinuing the heparin.The patient questions the nurse about the use of both drugs.What is the best response to the patient?

Accepted Answer

It is important for the patient to continue both medications for several days because warfarin takes time to achieve a therapeutic effect. The overlap of warfarin and heparin reduces the risk of thrombosis, and once the therapeutic level of warfarin is reached, the heparin can be tapered off. It is important for the patient to understand this reasoning to reduce anxiety about being on two medications. Option A is inaccurate because the nurse should be knowledgeable about the use of anticoagulants and should not need to consult the physician for this question. Option B is incorrect because adding more anticoagulants without tapering off the heparin increases the risk of bleeding, which is not the desired outcome. Option D is incorrect because the metabolism of heparin is not affected by activity level.

Question 3

Which statement by a patient who is being discharged on anticoagulant therapy 5 days after an AAA repair and graft indicates that the discharge teaching has been effective?

Accepted Answer

This statement indicates that the patient understands the importance of informing their dentist about their anticoagulant therapy to avoid potential bleeding complications during any dental procedures. The other statements are incorrect and could indicate a misunderstanding or missed information during the discharge teaching.

Question 4

While working in the outpatient clinic,the nurse notes that the chart states that a patient has intermittent claudication.Which of these statements by the patient would be consistent with this information?

Accepted Answer

Intermittent claudication refers to pain, cramping, or weakness in the legs that occurs during physical activity and goes away with rest. Option D is consistent with this description, as the patient indicates that their legs cramp whenever they walk more than a block. Options A, B, and C are not consistent with intermittent claudication.

Question 5

A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency.Which of the following statements by the patient is most consistent with this diagnosis?

Accepted Answer

Chronic venous insufficiency often leads to edema, or swelling, in the legs, which can make it difficult for patients to fit into their shoes by the end of the day. This symptom is a direct result of the impaired blood flow back to the heart, causing fluid to accumulate in the lower extremities.

Question 6

The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin following hospitalization for DVT.The nurse determines that additional teaching is needed when the patient makes which of the following statements?

Accepted Answer

Warfarin interacts with vitamin K, which is found in high amounts in green, leafy vegetables. Patients on warfarin should not change their diets without consulting their healthcare provider, as it can affect the effectiveness of the medication. The other statements indicate appropriate understanding of warfarin and its management.

Question 7

A patient who is seen in the clinic tells the physician 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 screening tests for which of the following conditions?

Accepted Answer

Raynaud's phenomenon can be associated with immune disorders such as lupus, scleroderma, or rheumatoid arthritis, so the nurse should anticipate testing for these conditions. Screening tests for coronary artery disease, familial dyslipidemia, or high blood pressure would not be directly related to Raynaud's phenomenon.

Question 8

A patient with PAD has a new prescription for clopidogrel (Plavix).Which information should the nurse include when teaching the patient about this medication?

Accepted Answer

Clopidogrel can increase the risk of bleeding, so it is important for the patient to be aware of signs of bleeding such as black or bloody stools and to report them immediately.

Question 9

Which of the following results of a D-dimer test would suggest that the patient has venous thromboembolism?

Accepted Answer

A high D-dimer level suggests that there is an increased risk of clot formation, and a value of 300 mcg/L is particularly high, indicating a high likelihood of venous thromboembolism. However, a D-dimer test alone is not conclusive and should be combined with other diagnostic tests for a proper diagnosis.

Question 10

The nurse has identified the collaborative problem of "potential complication: pulmonary embolism" for a patient with DVT.What is an appropriate nursing intervention to prevent embolization of a thrombus?

Accepted Answer

Maintaining bed rest until edema resolves helps prevent the dislodgement of the thrombus, which could lead to embolization.

Question 11

A 42-year-old service counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient centre.What should the nurse teach the patient before discharge?

Accepted Answer

Elastic compression stockings should be applied before getting out of bed in the morning to promote venous circulation and prevent blood clots. Limiting exercise to leg raising and deep knee bends may not provide sufficient physical activity for overall health. A work station revision may not be necessary for all individuals and should be assessed on a case-by-case basis. While aspirin may be used for prevention of blood clots, it should only be taken under the guidance of a healthcare provider.

Quiz 40: Nursing Management: Vascular Disorders