Deck 37: Vascular Disorders

Question 1

A patient at the clinic says,"I always walk after dinner,but lately my leg cramps and hurts after just a few minutes of starting. The pain goes away after I stop walking,though." The nurse should

A)look for the presence of tortuous veins bilaterally on the legs.
B)ask about any skin color changes that occur in response to cold.
C)assess for unilateral swelling, redness, and tenderness of either leg.
D)palpate for the presence of dorsalis pedis and posterior tibial pulses.

Answer 1

palpate for the presence of dorsalis pedis and posterior tibial pulses.

Question 2

When discussing risk factor modification for a patient who has a 5-cm abdominal aortic aneurysm,the nurse will focus teaching on which patient risk factor?

A)Male gender
B)Turner syndrome
C)Abdominal trauma history
D)Uncontrolled hypertension

Answer 2

Uncontrolled hypertension

Question 3

Which topic should the nurse include in patient teaching for a patient with a venous stasis ulcer on the left lower leg?

A)Need to increase carbohydrate intake
B)Methods of keeping the wound area dry
C)Purpose of prophylactic antibiotic therapy
D)Application of elastic compression stockings

Answer 3

Application of elastic compression stockings

Question 4

A 46-yr-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Which instructions should the nurse provide to the patient before discharge?

A)Sitting at the work counter, rather than standing, is recommended.
B)Exercise, such as walking or jogging, can cause recurrence of varicosities.
C)Elastic compression stockings should be applied before getting out of bed.
D)Taking an aspirin daily will help prevent clots from forming around venous valves.

Question 5

The health care provider prescribes an infusion of heparin and daily partial thromboplastin time (PTT)testing for a patient with venous thromboembolism (VTE). The nurse will plan to

A)decrease the infusion when the PTT value is 65 seconds.
B)avoid giving IM medications to prevent localized bleeding.
C)have vitamin K available in case reversal of the heparin is needed.
D)monitor posterior tibial and dorsalis pedis pulses with the Doppler.

Question 6

The nurse performing an assessment of a patient who has chronic peripheral artery disease (PAD)of the legs and an ulcer on the right second toe would expect to find

A)dilated superficial veins.
B)swollen, dry, scaly ankles.
C)prolonged capillary refill in all the toes.
D)serosanguineous drainage from the ulcer.

Question 7

A patient has a 6-cm thoracic aortic aneurysm that was discovered during routine chest x-ray. When obtaining an admission history from the patient,it will be most important for the nurse to ask about

A)low back pain.
B)trouble swallowing.
C)abdominal tenderness.
D)changes in bowel habits.

Question 8

Which nursing action should 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)Assess the abdominal incision for redness.
D)Teach the patient to plan for a long recovery period.

Question 9

Which patient statement to the nurse is most consistent with the diagnosis of venous insufficiency?

A)"I can't get my shoes on at the end of the day."
B)"I can't ever seem to get my feet warm enough."
C)"I have burning leg pains after I walk two blocks."
D)"I wake up during the night because my legs hurt."

Question 10

A young adult patient tells the health care provider about experiencing cold,numb fingers when running during the winter,and Raynaud's phenomenon is suspected. The nurse will anticipate teaching the patient about tests for

A)hyperglycemia.
B)hyperlipidemia.
C)autoimmune disorders.
D)coronary artery disease.

Question 11

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 most accurate?

A)"Taking two blood thinners greatly reduces the risk for another clot to form."
B)"Enoxaparin will work right away, but warfarin takes several days to begin preventing clots."
C)"Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from forming."
D)"Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner."

Question 12

The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin)after hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says which of the following?

A)"I should get a Medic Alert device stating that I take warfarin."
B)"I should reduce the amount of green, leafy vegetables that I eat."
C)"I will need routine blood tests to monitor the effects of the warfarin."
D)"I will check with my health care provider before I begin any new drugs."

Question 13

Which action by a new nurse who is giving fondaparinux (Arixtra)to a patient with a lower leg venous thromboembolism (VTE)indicates that more education about the drug is needed?

A)The nurse avoids rubbing the injection site after giving the drug.
B)The nurse injects the drug into the abdominal subcutaneous tissue.
C)The nurse ejects the air bubble from the syringe before giving the drug.
D)The nurse does not check partial thromboplastin time (PTT) before giving the drug.

Question 14

While working in the outpatient clinic,the nurse notes that a patient has a history of intermittent claudication. Which statement by the patient would support this information?

A)"When I stand too long, my feet start to swell."
B)"My legs cramp when I walk more than a block."
C)"I get short of breath when I climb a lot of stairs."
D)"My fingers hurt when I go outside in cold weather."

Question 15

When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD),the nurse determines a need for further instruction when the patient says,"I will

A)use a heating pad on my feet at night to increase the circulation."
B)buy some loose clothes that do not bind across my legs or waist."
C)walk to the point of pain, rest, and walk again for at least 30 minutes 3 times a week."
D)change my position every hour and avoid long periods of sitting with my legs crossed."

Question 16

An older patient with chronic atrial fibrillation develops sudden severe pain,pulselessness,pallor,and coolness in the right leg. The nurse should notify the health care provider and immediately

A)apply a compression stocking to the leg.
B)elevate the leg above the level of the heart.
C)assist the patient in gently exercising the leg.
D)keep the patient in bed in the supine position.

Question 17

Several hours after a patient had an open surgical repair of an abdominal aortic aneurysm,the UAP reports to the nurse that urinary output for the past 2 hours has been 45 mL. The nurse notifies the health care provider and anticipates an order for a(n)

A)hemoglobin count.
B)additional antibiotic.
C)serum creatinine level.
D)increased IV infusion rate.

Question 18

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of drugs will the nurse plan to include when teaching about PAD management?

A)Statins
B)Antibiotics
C)Thrombolytics
D)Anticoagulants

Question 19

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition,which action by the patient best demonstrates that the teaching has been effective?

A)The patient exercises indoors during the winter months.
B)The patient immerses hands in hot water when they turn pale.
C)The patient takes pseudoephedrine (Sudafed) for cold symptoms.
D)The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).

Question 20

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism. Which action by the nurse to elevate the patient's feet is best?

A)The patient is placed in the Trendelenburg position.
B)Two pillows are positioned under the affected leg.
C)The bed is elevated at the knee and pillows are placed under the feet.
D)One pillow is placed under the thighs and two pillows are placed under the lower legs.

Question 21

The nurse is developing a discharge teaching plan for a patient diagnosed with thromboangiitis obliterans (Buerger's disease). Which expected outcome has the highest priority for this patient?

A)Cessation of all tobacco use
B)Control of serum lipid levels
C)Maintenance of appropriate weight
D)Demonstration of meticulous foot care

Question 22

After receiving change of shift report,which patient admitted to the emergency department should the nurse assess first?

A)A 67-yr-old patient who has a gangrenous left foot ulcer with a weak pedal pulse
B)A 50-yr-old patient who is complaining of sudden sharp and severe upper back pain
C)A 39-yr-old patient who has right calf tenderness, redness, and swelling after a plane ride
D)A 58-yr-old patient who is taking anticoagulants for atrial fibrillation and has black stools

Question 23

The nurse is admitting a patient newly diagnosed with peripheral artery disease. Which admission order should the nurse question?

A)Cilostazol drug therapy
B)Omeprazole drug therapy
C)Use of treadmill for exercise
D)Exercise to the point of discomfort

Question 24

The nurse who works in the vascular clinic has several patients with venous insufficiency scheduled today. Which patient should the nurse assign to an experienced licensed practical/vocational nurse (LPN/LVN)?

A)Patient who has been complaining of increased edema and skin changes in the legs
B)Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg
C)Patient who has a history of venous thromboembolism and is complaining of dyspnea
D)Patient who needs teaching about elastic compression stockings for venous insufficiency

Question 25

The nurse is 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 perform first?

A)Obtain vital signs.
B)Teach wound care.
C)Assess pedal pulses.
D)Check the wound site.

Question 26

The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment,the patient has absent popliteal,posterior tibial,and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first?

A)Notify the surgeon and anesthesiologist.
B)Wrap both the legs in a warming blanket.
C)Document the findings and recheck in 15 minutes.
D)Compare findings to the preoperative assessment of the pulses.

Question 27

Which actions could the nurse delegate to unlicensed assistive personnel (UAP)who are providing care for a patient who is at risk for venous thromboembolism?

A)Monitor for any bleeding after anticoagulation therapy is started.
B)Apply sequential compression device whenever the patient is in bed.
C)Ask the patient about use of herbal medicines or dietary supplements.
D)Instruct the patient to call immediately if any shortness of breath occurs.

Question 28

A patient is being evaluated for postthrombotic syndrome. Which assessment will the nurse perform?

A)Ask about leg pain with exercise.
B)Determine the ankle-brachial index.
C)Assess capillary refill in the patient's toes.
D)Inspect for presence of lipodermatosclerosis.

Question 29

A patient who is 2 days post femoral popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN)caring for the patient requires the registered nurse (RN)to intervene?

A)The LPN/LVN has the patient to sit in a chair for 2 hours.
B)The LPN/LVN gives the prescribed aspirin after breakfast.
C)The LPN/LVN assists the patient to walk 40 feet in the hallway.
D)The LPN/LVN places the patient in Fowler's position for meals.

Question 30

Which nursing intervention for a patient who had an open repair of an abdominal aortic aneurysm 2 days previously is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?

A)Monitor the quality and presence of the pedal pulses.
B)Teach the patient the signs of possible wound infection.
C)Check the lower extremities for strength and movement.
D)Help the patient to use a pillow to splint while coughing.

Question 31

Which instructions should the nurse include in a teaching plan for an older patient newly diagnosed with peripheral artery disease (PAD)?

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 elastic compression stockings on early in the morning."

Question 32

When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair,which assessment finding is most important for the nurse to communicate to the health care provider?

A)Presence of flatus
B)Hypoactive bowel sounds
C)Maroon-colored liquid stool
D)Abdominal pain with palpation

Question 33

When assessing a patient with possible peripheral artery disease (PAD),the nurse obtains a brachial blood pressure (BP)of 147/82 mm Hg and an ankle pressure of 112/74 mm Hg. The nurse calculates the patient's ankle-brachial index (ABI)as ________ (round up to the nearest hundredth).

Question 34

Which assessment finding for a patient who has been admitted with a right calf venous thromboembolism (VTE)requires immediate action by the nurse?

A)Erythema of right lower leg
B)Complaint of right calf pain
C)New onset shortness of breath
D)Temperature of 100.4°F (38°C)

Question 35

An older patient with a history of an abdominal aortic aneurysm arrives at the emergency department (ED)with severe back pain and absent pedal pulses. Which action should the nurse take first?

A)Check the blood pressure.
B)Draw blood for laboratory testing.
C)Assess for the presence of an abdominal bruit.
D)Determine any family history of heart disease.

Question 36

The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider?

A)Weak pedal pulses
B)Absent bowel sounds
C)Blood pressure of 138/88 mm Hg
D)25 mL of urine output over the past hour