Deck 23: Vascular Surgery

Question 1

A vena cava filter (Greenfield 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 ICU for critical patients.Select the statement that best describes the appropriate preferred insertion approaches.

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

Answer 1

A
The head is turned to the left for jugular vein insertion,or the groin is exposed for femoral vein insertion.The right femoral vein is preferred over the left because the anatomy of the left vein often makes threading the filter more difficult.

Question 2

What drug is used to reverse the effects of heparin?

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

Answer 2

C
The effects of heparin can be reversed by the administration of protamine sulfate.Since protamine sulfate is derived from fish sperm and testes,caution is advised when administering it to patients who are allergic to fish or who have received protamine-containing insulin.One milligram of protamine neutralizes 100 mg of heparin.

Question 3

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

Answer 3

C
An incision is made into the femoral artery with a #11 knife blade and extended with a Potts angulated scissors.An incision is made into the popliteal artery as explained for femoral arteriotomy.Femoropopliteal bypass is the restoration of blood flow to the leg with a graft bypassing the occluded section of the femoral artery.A saphenous vein or a straight synthetic graft can be used as bypass material.

Question 4

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.

Question 5

Identify the venous structure that prevents blood backflow.

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

Question 6

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 7

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 8

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 9

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:

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) All of the options are appropriate for the procedure.

Question 10

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 11

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 12

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 13

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 dyad of 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 14

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 15

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 16

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 17

Myrtle Gruenwald is an 80-year-old relatively healthy woman with a 5-year history of cerebral ocular events,ultrasound-revealed irregular plaque formation in both carotid arteries,and several recent ischemic events.A risk reduction clinical decision strategy for Myrtle,based on best evidence and best practices,would be:

A) visit an emergency department with a stroke center.
B) have carotid surgery performed.
C) have neuroimaging and laboratory studies performed.
D) All of the strategies are equal priorities.

Question 18

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 19

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 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 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 surgical technologist should distribute the weight of instruments on top of the patient equally to prevent pressure injuries.

Question 21

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.

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 22

Karen Masterson,the 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,Judy Rothman,also a perioperative nurse,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 23

During the 4-hour vascular procedure,the circulating nurse,Karen,and the scrub person,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.

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.

Question 24

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) Ensure availability of rapid infusion systems or blood salvage equipment.
B) Confirm the availability of ordered blood-replacement products.
C) Collaborate with the anesthesia provider in ongoing estimation of blood loss.
D) Provide emotional support and comfort measures.

Question 25

The perioperative nurse with the vascular surgery service is preparing to discharge Mark Weston,a 51-year-old male who recently had endovascular surgery.He will be taking anticoagulation therapy for the next 12 weeks.What statement regarding anticoagulation therapy,that is relevant to Mark,is true?

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.