Deck 38: Care of Patients With Vascular Problems

Question 1

A nurse is about to administer the first dose of captopril (Capoten)to a client with hypertension.Which is the priority nursing intervention?

A) Take the client's apical pulse for 1 full minute before drug administration.
B) Place the client in Trendelenburg position to facilitate blood flow to the heart.
C) Educate the client to sit on the side of the bed for a few minutes before rising.
D) Instruct the client to drink 3 L of fluid daily when taking this medication.

Answer 1

Educate the client to sit on the side of the bed for a few minutes before rising.

Question 2

The nurse is educating a client before a right leg atherectomy.What priority education does the nurse provide?

A) "You may use the bathroom after the procedure."
B) "You will be sedated for 6 hours after the procedure."
C) "You will not need to take a daily aspirin anymore."
D) "You may be on heparin during the procedure."

Answer 2

"You may be on heparin during the procedure."

Question 3

After reviewing the client's chart upon admission to the unit,the nurse consults the health care provider about a new order for lovastatin (Mevacor).What triggered the nurse's action?

A) Blood glucose of 182 mg/dL
B) History of peptic ulcers
C) History of high cholesterol
D) Elevated liver enzymes

Answer 3

Elevated liver enzymes

Question 4

A client with chronic peripheral arterial disease and claudication tells the nurse that burning pain often awakens him from sleep.What is the nurse's interpretation of this change?

A) The client has inflow disease.
B) The client has outflow disease.
C) The client's disease is worsening.
D) The client's disease is stable.

Question 5

A client with high cholesterol is beginning treatment with simvastatin (Zocor).What priority instruction does the nurse give this client?

A) "Increase your intake of dietary fiber to minimize constipation."
B) "Take this drug on an empty stomach to promote absorption."
C) "Report any muscle tenderness to your health care provider."
D) "You may experience flushing of the skin with this medication."

Question 6

The nurse is a assessing a client with hypertension.Which client outcome is indicative of effective hypertension management?

A) Pedal edema is not present in the lower legs.
B) No complaints of sexual dysfunction occur.
C) No indication of renal impairment is present.
D) The blood pressure reading is 148/94 mm Hg.

Question 7

The nurse incorporates dietary teaching into the plan for a client with a low-density lipoprotein (LDL)level of 158 mg/dL.What dietary instruction by the nurse is most appropriate?

A) "You should keep your saturated fat intake below 10% of your total calories."
B) "This result is normal, so continue your current dietary practices."
C) "Your total cholesterol intake should be less than 300 mg/day."
D) "You should restrict protein sources to fish and chicken only."

Question 8

The nurse is caring for a client with newly diagnosed hypertension.What statement by the client indicates adequate understanding of his or her diet restrictions?

A) "I will give my canned soups to the food pantry."
B) "I'm going to miss my evening glass of wine."
C) "I will mostly use salt substitutes for flavoring."
D) "I can have regular coffee only in the morning."

Question 9

The nurse is assisting the hospitalized client with his food selections for breakfast.The client is on a low-cholesterol diet.What recommendations are most appropriate for this client?

A) Cheese omelet, skim milk, whole wheat toast, coffee
B) Skim milk, oatmeal, banana, orange juice, coffee
C) Whole wheat French toast, a side of bacon, coffee
D) Blueberry muffin, orange juice, decaffeinated coffee

Question 10

A client with atherosclerosis asks a nurse which factors are responsible for this condition.What is the nurse's best response?

A) "Injury to the arteries causes them to spasm, reducing blood flow to the extremities."
B) "Excess fats in your diet are stored in the lining of your arteries, causing them to constrict."
C) "A combination of platelets and fats accumulates, narrowing the artery and reducing blood flow."
D) "Excess sodium causes injury to the arteries, reducing blood flow and eventually causing obstruction."

Question 11

The nurse is assessing a client who reports claudication after walking a distance of one block.The nurse notes a painful ulcer on the fourth toe of the client's right foot.What condition do these findings correlate with?

A) Diabetic foot ulceration
B) Peripheral arterial disease
C) Peripheral venous disease
D) Deep vein thrombosis

Question 12

The nurse is reviewing the menu selections of a client who has ordered a low-cholesterol diet.What meal items does the nurse question?

A) Vegetarian wrap
B) Cheesesteak sandwich
C) Fruit salad with yogurt
D) Grilled fish sandwich

Question 13

A client with atherosclerosis is attempting to stop cigarette smoking with the use of a nicotine patch.Which statement by the client indicates a good understanding of smoking cessation education?

A) "Abruptly discontinuing this patch can cause high blood pressure."
B) "Abruptly discontinuing this patch can cause nausea and vomiting."
C) "Smoking while using this patch increases the risk of respiratory infection."
D) "Smoking while using this patch increases the risk of a heart attack."

Question 14

A client has been diagnosed with Cushing's syndrome.What assessment does the nurse perform to detect vascular complications associated with this illness?

A) Auscultation of heart and lung sounds
B) Assessment of blood pressure
C) Daily weight using the same scale
D) Monitoring of urine output every 24 hours

Question 15

The nurse is working with clients at a health fair.Which teaching takes priority to reduce the risk of atherosclerosis?

A) Instructing a diabetic client not to smoke or use any tobacco
B) Teaching diet changes to a client with elevated cholesterol levels
C) Suggesting limiting alcohol to an older client with hypolipidemia
D) Encouraging exercise to an obese client who lives a sedentary lifestyle

Question 16

The nurse notes a venous ulcer on the client's left ankle.What additional assessment finding does the nurse expect in this client?

A) Absence of hair on the left lower extremity
B) Skin surrounding the ulcer mottled but blanchable
C) Brownish discoloration of the lower extremity
D) Cold and gray-blue lower extremity

Question 17

The nurse is providing care for a client with hypertension.What priority physical assessment does the nurse include in examination of this client?

A) Skin examination for telangiectasia
B) Otoscopic examination of the inner ear
C) Funduscopic examination of the retina
D) Neurologic examination of the cranial nerves

Question 18

A client with hypercholesterolemia and atherosclerosis is prescribed nicotinic acid (Niaspan).Which instruction does the nurse provide the client?

A) "This medication may make you flush."
B) "Take this medication on an empty stomach."
C) "You will not need to change your diet with this medication."
D) "Take this medication when you experience chest pain."

Question 19

The nurse is assessing a client's understanding of his hypertension therapy.What client statement indicates a need for further teaching?

A) "If I lose weight, I might be able to reduce my blood pressure medication."
B) "If my blood pressure stays under control, I will reduce my risk for a heart attack."
C) "When my blood pressure is normal, I will no longer need to take medication."
D) "When getting out of bed in the morning, I will sit for a few moments then stand."

Question 20

A client with hyperlipidemia who is being treated with dietary fat restrictions and an exercise program asks the nurse why his serum lipid levels are still elevated.What activity by the nurse is most appropriate?

A) Developing a very low-fat diet that the client will adhere to
B) Explaining familial tendencies in hyperlipidemia
C) Referring the client to a registered dietitian for weight loss
D) Educating the client on antihyperlipidemic medications

Question 21

The health care provider has prescribed a client sodium warfarin (Coumadin)while he is still receiving intravenous heparin.Which is the nurse's best action?

A) Administer both heparin and warfarin as prescribed.
B) Turn off the heparin before administering the warfarin.
C) Clarify the warfarin order with the nursing supervisor.
D) Hold the warfarin dose until the heparin is discontinued.

Question 22

The nurse is caring for a client who develops compartment syndrome after an embolectomy for peripheral arterial disease.What is the nurse's best action?

A) Perform passive range-of-motion exercise to improve distal blood flow.
B) Prepare the client for return to the operative suite for surgical correction.
C) Medicate the client for pain and place the client in a knee-chest position.
D) Loosen the dressing and elevate the extremity to the level of the heart.

Question 23

A client with a diagnosed abdominal aortic aneurysm (AAA)develops lower back pain radiating to the groin.What is the nurse's interpretation of this information?

A) The aneurysm clotted and is obstructing blood flow.
B) The aneurysm is expanding and is preparing to rupture.
C) The client feels the inflammation of the aneurysm.
D) This is a normal sensation associated with an AAA.

Question 24

The nurse is providing discharge education to a client after repair of an abdominal aortic aneurysm (AAA).What priority instruction does the nurse include?

A) "No restrictions on driving your car are necessary."
B) "Avoid sleeping on your left side for 6 weeks."
C) "Avoid lifting heavy objects for about 3 months."
D) "You will have a distended abdomen for 2 weeks."

Question 25

A nurse is recovering a client who has undergone surgical repair of an abdominal aortic aneurysm (AAA).The client develops coolness of the extremities and reports a bloated feeling in the abdomen.What is the nurse's best action?

A) Measure the abdominal girth and check pulses.
B) Raise the head of the bed to 90 degrees.
C) Assess cardiac output and blood pressure.
D) Auscultate and then palpate the abdomen.

Question 26

The nurse is assessing for skin changes in an African-American client admitted with peripheral arterial disease.What does the nurse monitor for?

A) Excess hair growth
B) Pitting edema in the feet
C) Cyanosis of the nail beds
D) Loss of toenails

Question 27

The nurse is caring for a client with Buerger's disease.What client education does the nurse provide to minimize disease progression?

A) "Keep environmental temperatures warm."
B) "Avoid highly stressful activities."
C) "Use a heating pad on your extremities."
D) "Abstain from all forms of tobacco."

Question 28

The nurse is recovering a client with peripheral arterial disease who has just undergone percutaneous transluminal angioplasty.What complication does the nurse monitor for in the immediate postprocedure period?

A) Bleeding
B) Aspiration
C) Hypertensive crisis
D) Chest pain

Question 29

The nurse is caring for a client with peripheral arterial disease.What priority nursing intervention does the nurse perform to promote vasodilation?

A) Increase the client's exercise regimen daily.
B) Apply a heating pad to the affected limb.
C) Administer an aspirin on a daily basis.
D) Educate the client to abstain from smoking.

Question 30

The new graduate nurse is assessing a client with an unrepaired abdominal aortic aneurysm.What assessment technique requires further education by the supervising nurse?

A) Measurement of abdominal girth
B) Observation of abdominal wall movement
C) Auscultation of any area of the abdomen
D) Palpation of the abdominal midline area

Question 31

The nurse assesses a client's legs.Which assessment finding indicates arterial insufficiency?

A) Ankle discoloration and pitting edema
B) Dependent mottling and absence of hair
C) Pain with activity but not while resting
D) Full veins present in dependent extremity

Question 32

The nurse is providing health education to a client with chronic venous stasis ulcers.What priority instruction does the nurse include?

A) "Apply antiembolism stockings before getting out of bed in the morning."
B) "Clean venous ulcers with Betadine before applying a dressing."
C) "Take 1 low-dose aspirin (81 mg) daily to prevent inflammation."
D) "Remove and reapply a new DuoDerm dressing to your ulcers each day."

Question 33

The nurse is reviewing a client's laboratory results.The nurse correlates elevations in which values as risk factors for atherosclerosis?

A) Total cholesterol, 280 mg/dL
B) High-density cholesterol, 50 mg/dL
C) Triglycerides, 200 mg/dL
D) Serum albumin, 4 g/dL
E) Low-density cholesterol, 160 mg/dL

Question 34

The nurse is assessing the extremities of a client with Buerger's disease.What clinical manifestation does the nurse correlate with this disease?

A) Reddened, with diminished distal pulses
B) Cold and pale, with proximal bounding pulses
C) Cyanotic, with decreased deep tendon reflexes
D) Brownish discoloration, with pitting edema

Question 35

The nurse is discharging home a client at risk for venous thromboembolism (VTE)on low-molecular-weight heparin.What instruction does the nurse provide to this client?

A) "You must have your aPTT checked every 2 weeks."
B) "Massage the injection site after the heparin is injected."
C) "Notify your health care provider if your stools appear tarry."
D) "An IV catheter will be placed to administer your heparin."

Question 36

The nurse is caring for a client who is receiving heparin therapy for a venous thromboembolism (VTE).The client's activated partial thromboplastin time (aPTT)before heparin therapy was 30 seconds.Which aPTT result indicates that anticoagulation is adequate at this time?

A) 15 seconds
B) 30 seconds
C) 60 seconds
D) 150 seconds

Question 37

The nurse is monitoring a client who has returned to the unit after arterial revascularization.The client reports pain in the affected limb that is similar to the pain experienced before the procedure.What is the nurse's best action?

A) Assess the peripheral pulses in the limb.
B) Elevate the affected extremity on pillows.
C) Administer pain medication as prescribed.
D) Place a warm blanket on the operative limb.

Question 38

A client is recovering after an embolectomy.What clinical manifestations consistent with compartment syndrome does the nurse watch for?

A) Elevated temperature and excessive diaphoresis
B) Loss of sensation and pallor near the surgical site
C) Swelling, pain, and tension of the affected limb
D) Increased pulse and warmth below the surgical site

Question 39

The nurse is providing disease management education to a client with Raynaud's disease.What intervention does the nurse suggest to prevent complications of this disease?

A) "Take vasoconstrictive agents when you have symptoms."
B) "Wear warm clothing when exposed to cool temperatures."
C) "Avoid placing alcohol-based lotion on affected extremities."
D) "Check the strength of pulses in your arms and legs daily."

Question 40

The nurse is preparing a client with an aortic aneurysm for surgery.The nurse notes that the client's systolic blood pressure has increased by 30 mm Hg compared with the reading 1 hour ago.What is the nurse's best action?

A) Measure abdominal girth.
B) Auscultate the abdomen.
C) Increase the IV infusion rate.
D) Reassess the blood pressure.

Question 41

The nurse is caring for a client who is experiencing excessive bleeding after receiving unfractionated heparin.What orders does the nurse anticipate from the health care provider?

A) Laboratory draw for activated partial thromboplastin time (aPTT)
B) Administer vitamin K
C) Laboratory draw for prothrombin time (PT)/international normalized ratio (INR)
D) Administer protamine sulfate
E) Administer enoxaparin (Lovenox)

Question 42

An older adult client is prescribed furosemide (Lasix)for control of hypertension.What client education does the nurse provide?

A) "Confusion can occur when taking this medication."
B) "Drink at least 3 liters of water every day."
C) "Arise slowly from a chair or from your bed."
D) "Persistent coughing is a side effect of this drug."
E) "You should eat foods high in potassium."