Deck 40: Nursing Management Vascular Disorders

Question 1

The nurse is providing teaching to a client with chronic venous insufficiency who has a venous ulcer on the right lower leg. Which of the following topics should the nurse include in the teaching plan?

A)Adequate carbohydrate intake
B)Prophylactic antibiotic therapy
C)Application of compression to the leg
D)Methods of keeping the wound area dry

Answer 1

Application of compression to the leg

Question 2

The nurse is obtaining a health history from a client who has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. Which of the following symptoms should the nurse expect to assess in the client?

A)Back or lumbar pain
B)Difficulty swallowing
C)Abdominal tenderness
D)Changes in bowel habits

Answer 2

Difficulty swallowing

Question 3

The nurse is providing teaching to a client with newly diagnosed Raynaud's phenomenon about how to manage the condition. Which of the following behaviours by the client indicates that the teaching has been effective?

A)The client avoids the use of Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).
B)The client exercises indoors during the winter months.
C)The client places the hands in hot water when they turn pale.
D)The client takes pseudoephedrine for cold symptoms.

Answer 3

The client exercises indoors during the winter months.

Question 4

The nurse is discussing risk factor modification for a client who has a 4-cm abdominal aortic aneurysm. The nurse should focus client teaching on which of the following risk factors?

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

Question 5

Which of the following nursing actions should be included in the plan of care for a client who has had endovascular repair of an abdominal aortic aneurysm?

A)Record hourly chest tube drainage.
B)Monitor fluid intake and urine output.
C)Check the abdominal wound for redness or swelling.
D)Teach the reason for a prolonged rehabilitation process.

Question 6

The nurse is assessing a client who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe. Which of the following findings should the nurse expect?

A)A positive Homans' sign
B)Swollen, dry, scaly ankles
C)Prolonged capillary refill in all the toes
D)A large amount of drainage from the ulcer

Question 7

Which of the following actions by a nurse who is administering fondaparinux to a client with venous thrombo-embolism (VTE) indicates that more education about the medication is needed?

A)The nurse avoids rubbing the injection site after giving the medication.
B)The nurse injects the medication into the abdominal subcutaneous tissue.
C)The nurse fails to assess the partial thromboplastin time (PTT) before administration of the medication.
D)The nurse ejects the air bubble in the syringe before administering the medication.

Question 8

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

A)"I can't get my shoes on at the end of the day."
B)"I can never seem to get my feet warm enough."
C)"I wake up during the night because my legs hurt."
D)"I have burning leg pains after I walk three blocks."

Question 9

The nurse is caring for a client who had a sclerotherapy for treatment of superficial varicose veins and is a service-counter worker. Which of the following information should the nurse include when providing discharge teaching to the client?

A)Sitting at the work counter, rather than standing, is recommended.
B)Compression stockings should be applied before getting out of bed.
C)Exercises such as walking or jogging cause recurrence of varicosities.
D)Taking one Aspirin daily will help prevent clotting around venous valves.

Question 10

A client tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynaud's phenomenon. Based upon this diagnosis, the client should be investigated for which of the following conditions?

A)Hypertension
B)Hyperlipidemia
C)Autoimmune disorders
D)Coronary artery disease

Question 11

The nurse notes bruising and discoloration of the right leg of a client that has just arrived in the recovery unit from having vein ligation surgery. Which of the following interventions is priority?

A)Place the client in the Trendelenburg position.
B)Contact the health care provider.
C)Elevate the bed at the knee and put pillows under the feet.
D)Elevate the legs 15 degrees to limit edema.

Question 12

The health care provider prescribes an infusion of argatroban and daily partial thromboplastin time (PTT) testing for a client with venous thrombo-embolism (VTE). Which of the following actions should the nurse include in the plan of care?

A)Avoid giving any IM medications to prevent localized bleeding.
B)Discontinue the infusion for PTT values greater than 50 seconds.
C)Monitor posterior tibial and dorsalis pedis pulses with the Doppler.
D)Have vitamin K available in case reversal of the argatroban is needed.

Question 13

The nurse is caring for a client with chronic atrial fibrillation who develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. Which of the following actions should the nurse implement first?

A)Elevate the left leg on a pillow.
B)Apply an elastic wrap to the leg.
C)Assist the client in gently exercising the leg.
D)Notify the health care provider.

Question 14

Several hours after an open surgical repair of an abdominal aortic aneurysm, the client develops a urinary output of 20 mL/hour for 2 hours. Which of the following prescriptions should the nurse anticipate?

A)An additional antibiotic
B)White blood cell (WBC) count
C)Decrease in IV infusion rate
D)Blood urea nitrogen (BUN) level

Question 15

Aclient at the clinic says, "I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." Which of the following actions should the nurse implement?

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

Question 16

While working in the outpatient clinic, the nurse notes that the medical record states that a client has intermittent claudication. Which of the following client statements is consistent with this information?

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

Question 17

The nurse is providing teaching to a client with critical limb ischemia. Which of the following client statements indicate further teaching is required?

A)"I will have to buy some loose clothing that does not bind across my legs or waist."
B)"I will use a heating pad on my feet at night to increase the circulation and warmth in my feet."
C)"I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily."
D)"I will change my position every hour and avoid long periods of sitting with my legs down."

Question 18

Aclient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which of the following medication categories should the nurse plan to include when providing client teaching about PAD management?

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

Question 19

A client with a venous thrombo-embolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are necessary. Which of the following responses by the nurse is accurate?

A)"Administration of two anticoagulants reduces the risk for recurrent venous thrombosis."
B)"Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from occurring."
C)"The enoxaparin will work immediately, but the warfarin takes several days to have an effect on coagulation."
D)"Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant."

Question 20

The nurse has initiated discharge teaching for a client who is to be maintained on warfarin following hospitalization for venous thrombo-embolism (VTE). Which of the following client statements indicates that additional teaching is required?

A)"I should reduce the amount of green, leafy vegetables that I eat."
B)"I should wear a Medic Alert bracelet stating that I take warfarin."
C)"I will need to have blood tests routinely to monitor the effects of the warfarin."
D)"I will check with my health care provider before I begin or stop any medication."

Question 21

Immediately after repair of an abdominal aortic aneurysm, a client has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which of the following actions should the nurse take first?

A)Wrap both the legs in warm blankets.
B)Notify the surgeon and anaesthesiologist.
C)Document that the pulses are absent and recheck in 30 minutes.
D)Review the preoperative assessment form for data about the pulses.

Question 22

A client asks the nurse if there are any natural products that would decrease anticoagulant effects. The nurse tells the client that which of the following natural products causes a decrease in anticoagulant effects?

A)Horse chestnut
B)Licorice root
C)Turmeric
D)Green tea

Question 23

The nurse is admitting a client to the emergency department with a history of an abdominal aortic aneurysm with severe back pain and absent pedal pulses. Which of the following actions should the nurse take first?

A)Obtain the blood pressure.
B)Ask the client about tobacco use.
C)Draw blood for ordered laboratory testing.
D)Assess for the presence of an abdominal bruit.

Question 24

The nurse is caring for a client with peripheral artery disease who is Aspirin intolerant. Which of the following medications should the nurse anticipate the health care provider prescribing for the client related to this intolerance?

A)Pentoxifylline
B)Clopidogrel
C)Ramipril
D)Warfarin

Question 25

The nurse is assessing a client with possible peripheral artery disease (PAD) and obtains a brachial BP of 140/80 and an ankle pressure of 110/70. The nurse calculates the client's ankle-brachial index (ABI) as .

Question 26

The nurse is caring for a client with a right calf venous thrombo-embolism. Which of the following information requires immediate action by the nurse?

A)Complaint of left calf pain
B)New onset shortness of breath
C)Red skin colour of left lower leg
D)Temperature of 38°C (100.4°F)

Question 27

The nurse is developing a teaching plan for a client newly diagnosed with peripheral artery disease (PAD). Which of the following information should the nurse include?

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 on support hose early in the day before swelling occurs."

Question 28

The nurse is caring for a client on the first postoperative day after an abdominal aortic aneurysm repair. Which of the following assessment findings is most important to communicate to the health care provider?

A)Absence of flatus
B)Loose, bloody stools
C)Hypotonic bowel sounds
D)Abdominal pain with palpation

Question 29

Which of the following responses by a client that is on anticoagulant therapy indicates the need for further teaching?

A)"I can still have a glass of wine with my dinner"
B)"For pain relief I will take ibuprofen"
C)"I take my pills at two o'clock every day"
D)"I will use an electric razor for shaving"

Question 30

Which of the following clients admitted to the emergency department should the nurse assess first?

A)62-year-old who has gangrenous ulcers on both feet
B)50-year-old who is complaining of "tearing" chest pain
C)45-year-old who is taking anticoagulants and has bloody stools
D)36-year-old who has right calf tenderness, redness, and swelling

Question 31

The nurse is planning expected outcomes for a client with thromboangiitis obliterans (Buerger's disease). Which of the following outcomes has the highest priority for this client?

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