Deck 24: Vascular Surgery

Question 1

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

A) blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin.
B) acting as an enzyme by lysing the fibrin-thrombin matrix.
C) extending the activated partial thromboplastin time (APTT).
D) dissolving and liquefying existing blood clots and thromboemboli.

Answer 1

A
Heparin sodium is an anticoagulant that interferes with blood coagulation by inactivating thrombin and preventing the conversion of fibrinogen to fibrin.

Question 2

Vascular surgery patients are at risk for impaired skin integrity and ineffective peripheral tissue perfusion related to surgical positioning,presence of vascular disease,and vascular clamping.Positioning of the patient undergoing vascular surgery is of 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 operating room (OR) bed.
B) The nurse should protect the patient's vulnerable neurovascular bundles from compression.
C) The nurse should provide warmed sterile saline compresses to bony prominences to increase vascular perfusion.
D) The scrub person should distribute the weight of instruments on top of the patient equally to prevent pressure injuries.

Answer 2

B
Protect vulnerable neurovascular bundles from compression.Position the patient on a pressure-reducing mattress on the OR bed that is radiolucent (X-ray compatible).Keep OR bedsheets dry and wrinkle-free.Pad all bony prominences.Maintain body alignment.

Question 3

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 extremity:

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

Answer 3

B
The objective of surgical intervention is to remove the diseased veins,thus preventing ulceration,secondary edema,pain,and fatigue in the extremity.Disease may prevent the normal functioning of these valves,resulting in distention; as the vein wall weakens and dilates,venous pressure increases,and the valves become incompetent.Dilation of the saphenous vein produces venous stasis,which may be followed by secondary complications,such as stasis ulcers.

Question 4

During an open exploration of above-knee popliteal artery,an incision is made into the femoral artery with a #11 knife blade and extended with Potts angulated scissors.What is the proper name of this surgical approach?

A) Femoral punch cut incision
B) Femoral arteriotomy
C) Popliteal vasculotomy
D) Popliteal arteriotomy

Question 5

A vena cava filter maintains a patent vena cava but prevents pulmonary emboli (PE)by trapping the emboli at the apex of the device.This procedure may be performed in the OR,radiology suite,or intensive care unit (ICU)for critical patients.Select the statement that best describes the appropriate preferred insertion approaches.

A) Right jugular and right femoral
B) Right jugular and left femoral
C) Left jugular and left femoral
D) Right and left femorals

Question 6

Patients with arterial disease are treated surgically more often than patients with chronic venous insufficiency (CVI)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) surgery is never successful.

Question 7

Which drug is used to reverse,or neutralize,the effects of heparin?

A) Prostigmine
B) Promethazine
C) Protamine sulfate
D) Prothrombin

Question 8

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 9

Identify the venous structure that prevents blood backflow.

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

Question 10

Substituting a cryopreserved cadaveric vein or an in situ or reversed vein graft from the patient for an arterial bypass graft is an option for patients who do not have healthy,easily accessible saphenous veins.How does an in situ vein graft differ from a reversed vein graft?

A) The vein segment is resected, reversed, and anastomosed into position in the in situ method.
B) The in situ method leaves the saphenous 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 11

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 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 12

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.Vascular monitoring during carotid endarterectomy (CEA)is critical to determine the quality of cerebral perfusion.What vascular monitoring device is employed during CEA and which important surgical need is determined by its results?

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

Question 13

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 14

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

Question 15

Which 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 16

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 types 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 17

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

A) The open aneurysm surgery approach has a small abdominal incision and similar 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 catheters are used rather than staples.
D) The EVAR prosthesis is a clone of the Greenfield thromboembolism filter.

Question 18

A perioperative nurse 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,also a perioperative nurse,is preparing the sterile back table.Which expected and appropriate risk reduction strategies related to the use of heparin would the scrub person perform?

A) Label syringe and medicine cup with the drug name, strength, and amount.
B) Verify the drug and labels with three qualified individuals including the surgeon.
C) Document medications used once the surgery is complete.
D) Comply with the seven rights of medication storage and documentation.

Question 19

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 magnetic resonance imaging (MRI).

Question 20

The perioperative nurse with the vascular surgery service is preparing to discharge a 51-year-old man who recently had endovascular surgery.The patient will be taking anticoagulation therapy for the next 12 weeks.Which statement regarding anticoagulation therapy is true and relevant to the patient?

A) Eat foods high in vitamin K, such as tomatoes, dark leafy vegetables, bananas, and fish.
B) Wear padding when engaging in contact sports.
C) Use only hair removal cream; do not use an electric razor.
D) Do not use tools such as saws or hammers, which could lead to an accident.

Question 21

Arterial procedures,especially those that involve the aorta,may place the patient at risk for significant blood loss.A nursing diagnosis related to the care of patients undergoing vascular surgery is risk for deficient fluid volume related to loss of body fluids,with a nursing outcome stated as,"Fluid balance will be maintained as evidenced by postoperative pulses equivalent to preoperative level,hourly urine output of at least 30 mL,and good skin turgor." Select all the nursing interventions that are appropriate to this outcome.

A) Initiate autotransfusion or use of an autologous blood salvage unit as required.
B) Confirm the availability of ordered blood-replacement products.
C) Monitor and record ongoing estimation of blood loss.
D) Provide the anesthesia provider with a fluid warmer.

Question 22

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?

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

Question 23

The perioperative nurse,with an understanding of the special surgical considerations for vascular procedures,will plan for the possibility of angiography studies being performed during the intraoperative or interventional procedure.An appropriate consideration when preparing the OR or interventional procedure room would be to:

A) assess the patient for allergies to contrast dyes.
B) provide a radiolucent OR bed surface with X-ray capabilities.
C) provide contrast media, catheters, impermeable sterile X-ray covers, and lead aprons.
D) provide radiation-protection devices, such as lead aprons and shields.