Deck 40: Nursing Management: Vascular Disorders

Question 1

Which of the following is a characteristic of a venous ulcer?

A) Capillary refill 5 seconds
B) Smooth,uniform ulcer margin.
C) Skin warm to touch
D) No dermatitis

Answer 1

Skin warm to touch

Question 2

When teaching a patient with Raynaud's phenomenon how to manage the condition,which of the following behaviours by the patient indicates that the teaching has been effective?

A) The patient places the hands in hot water when they turn pale.
B) The patient exercises indoors during the winter months.
C) The patient takes pseudoephedrine (Sudafed)for cold symptoms.
D) The patient avoids the use of aspirin and NSAIDs.

Answer 2

The patient exercises indoors during the winter months.

Question 3

To determine the extent of a patient's PAD,how does the nurse perform an ankle-brachial index?

A) By subtracting the mean ankle BP from the mean brachial BP
B) By dividing the Doppler ultrasound-obtained ankle systolic BP by the highest brachial systolic BP
C) By comparing the amplitude of blood flow of the brachial artery with that of the posterior tibial artery using a Doppler ultrasonograph
D) By using a Doppler ultrasonograph to take blood pressures at the brachial artery,thigh,and ankle to determine the change in pressures

Answer 3

By dividing the Doppler ultrasound-obtained ankle systolic BP by the highest brachial systolic BP

Question 4

How frequently should the nurse check the operative extremity in the immediate postoperative period for a patient who has had surgical intervention for peripheral artery disease?

A) Every 10 minutes
B) Every 15 minutes
C) Every 30 minutes
D) Every 60 minutes

Question 5

When caring for a patient following an AAA repair,which information is most helpful to the nurse in assessing the patient's gastrointestinal function?

A) Serum lipase
B) Bowel sounds
C) Stool character
D) Central venous pressure

Question 6

Which of the following is a characteristic of PAD?

A) Normal peripheral pulse
B) Capillary refill 2 seconds
C) Ankle-brachial index 0.98
D) No lower leg edema

Question 7

When performing an assessment with a patient who has chronic PAD,what should the nurse expect to find?

A) Edema around the ankles and feet
B) Ulceration around the medial malleoli
C) Draining ulcer on the heel
D) Prolonged capillary refill

Question 8

A patient with a history of a 4-cm fusiform abdominal aortic aneurysm (AAA)is admitted to the emergency department with severe back pain and bilateral flank ecchymosis.His vital signs are blood pressure (BP)90/58 mm Hg,pulse 138 beats/min,and respiration 34 breaths/min.The nurse plans interventions for the patient based on the expectation that which of the following treatments will be included?

A) Immediate surgery
B) An immediate angiogram
C) A paracentesis when vital signs are stabilized with fluid replacement
D) Admission to the intensive care unit for observation while diagnostic tests are completed

Question 9

A 69-year old man is admitted to the hospital for elective repair of an AAA.His history includes hypertension for 25 years,dyslipidemia for 15 years,and smoking for 50 years.The patient's wife asks the nurse what caused her husband's aneurysm.The nurse's best response will include which following information?

A) A congenital weakness of an artery wall results in dilation of the artery after many years.
B) Aneurysms are a type of vascular disease in which atherosclerotic plaques damage the artery.
C) Chronic infections of the walls of the blood vessels are the most common cause of aneurysms.
D) If her husband did not smoke or have hypertension and dyslipidemia,he would not have an aneurysm.

Question 10

Several hours following an endovascular aneurysm repair,the patient develops left flank pain,and his urinary output has been 20 mL/hour for the past 2 hours.The nurse recognizes that these findings may indicate which of the following complications?

A) Infection
B) Hypovolemia
C) Intestinal ischemia
D) Renal artery occlusion

Question 11

After repair of an AAA,the nurse notes that the patient does not have popliteal,posterior tibial,or dorsalis pedis pulses.The legs are cool and mottled.Which action is appropriate for the nurse to take first?

A) Review the preoperative assessment form for data about the pulses.
B) Notify the surgeon and anaesthesiologist.
C) Document that the pulses are absent,and recheck in 30 minutes.
D) Elevate the lower extremities on pillows.

Question 12

Which one of the following therapies is not recommended to treat claudication?

A) Green tea
B) Diet low in fruits and vegetables
C) Vitamin E supplementation
D) Treadmill exercise training

Question 13

A 72-year-old man is hospitalized for an aortic dissection of the abdominal aorta that stabilizes with treatment.What emphasis should the nurse include when developing a teaching plan for the patient's discharge?

A) Performing leg exercises to increase peripheral collateral circulation
B) Using nonsteroidal anti-inflammatory drugs (NSAIDs)to control his chronic pain
C) Daily home monitoring of BP and pulse for signs of increased bleeding
D) Using prescribed antihypertensive medications to keep his BP as low as possible to maintain vital perfusion

Question 14

A 65-year-old patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest X-ray examination.When obtaining a nursing history from the patient,what would the nurse specifically ask the patient about?

A) Abdominal pain
B) Dysphagia
C) Intermittent back pain
D) Weakness and palpitations

Question 15

Duplex scanning confirms the presence of a large deep-vein thrombosis (DVT),and the physician orders continuous IV heparin infusion for a patient who has swelling and pain of the upper leg.While the patient is receiving the heparin infusion,what should the nurse do?

A) Avoid any intramuscular (IM)medications to prevent localized bleeding.
B) Notify the physician if the partial thromboplastin time value is greater than 50 seconds.
C) Have vitamin K available in case the patient bleeds from the action of heparin.
D) Start instruction for self-administered subcutaneous heparin injections for long-term home therapy.

Question 16

What is a nursing intervention that is indicated for the collaborative problem of "potential complication: cardiac dysrhythmia" in a patient who has had a repair of a descending thoracic aortic aneurysm?

A) Assess neurological signs hourly.
B) Titrate oxygen to keep oxygen saturation greater than 90%.
C) Maintain the patient on complete bed rest.
D) Monitor urinary output and daily blood urea nitrogen and serum creatinine levels.

Question 17

The nurse identifies the nursing diagnosis of ineffective peripheral perfusion related to decreased arterial blood flow for a patient with chronic PAD.In evaluating the patient outcomes following patient teaching,the nurse determines a need for further instruction when the patient makes which of the following statements?

A) "I will wear loose clothing that does not bind across my legs or waist."
B) "I will change my position every hour and avoid long periods of sitting with my legs down."
C) "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet."
D) "For about 40 minutes each day,I will walk to the point of pain,rest,and then walk again until I develop pain."

Question 18

A 36-year-old patient who has a history of thromboangiitis obliterans (Buerger's disease)is admitted to the hospital with a gangrenous lesion of his right small toe.In planning expected outcomes with the patient,which outcome should the nurse give the highest priority?

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

Question 19

During an assessment of a 63-year-old man at the clinic,the patient tells the nurse that for years he has taken an evening walk,but lately even a short walk causes leg pain and muscle cramps.If he stops for a while,the pain goes away.What should the nurse do?

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

Question 20

A patient admitted to the hospital with a chronic venous insufficiency has physician's orders for bed rest with the feet elevated.How should the nurse elevate the patient's feet?

A) Place two pillows under the calf of her affected leg.
B) Elevate the foot of the bed above the level of her heart.
C) Elevate the bed at the knee,and place pillows under her feet.
D) Place one pillow under her thighs and two pillows under her lower legs.

Question 21

In planning care for a patient with a venous stasis ulcer on the right lower leg,what does the nurse understand is the most important intervention in promoting healing of the ulcer?

A) Adequate dietary intake of proteins and vitamins
B) Prevention of infection with prophylactic antibiotics
C) Application of external compression to the lower leg
D) Keeping the ulcer moist with hydrocolloid dressings

Question 22

A patient has been receiving IV heparin therapy for 6 days for treatment of DVT.The physician now orders warfarin (Coumadin)without discontinuing the heparin.The patient questions the nurse about the use of both drugs.What is the best response to the patient?

A) "I will check with the doctor about this.You could be at risk for bleeding with both drugs."
B) "Because of the potential for a pulmonary embolism,it is important for you to have additional anticoagulants."
C) "It takes several days for the warfarin to have an effect,so we need to keep you on the heparin for a few more days."
D) "Because you are allowed more activity now,the heparin is metabolized faster and must be supplemented with the warfarin."

Question 23

Which statement by a patient who is being discharged on anticoagulant therapy 5 days after an AAA repair and graft indicates that the discharge teaching has been effective?

A) "I will call the doctor if my temperature is higher than 38.8°C."
B) "I will tell my dentist about my anticoagulant therapy the next time I have an appointment."
C) "I should not need to take anything but acetaminophen (Tylenol)for my pain."
D) "I am eager to get home so that I can pick up my 6-year-old granddaughter."

Question 24

While working in the outpatient clinic,the nurse notes that the chart states that a patient has intermittent claudication.Which of these statements by the patient would be consistent with this information?

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

Question 25

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

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

Question 26

The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin following hospitalization for DVT.The nurse determines that additional teaching is needed when the patient makes which of the following statements?

A) "I should change my diet to include more green,leafy vegetables."
B) "I will check with my physician before I begin or stop any medication."
C) "I should wear a MedicAlert bracelet to indicate I am on anticoagulant therapy."
D) "I will need to have my blood drawn routinely to monitor the effects of the warfarin."

Question 27

A patient who is seen in the clinic tells the physician about experiencing cold,numb fingers when running during the winter and is diagnosed with Raynaud's phenomenon.The nurse will anticipate teaching the patient about screening tests for which of the following conditions?

A) Coronary artery disease
B) Familial dyslipidemia
C) High BP
D) Immune disorders

Question 28

A patient with PAD has a new prescription for clopidogrel (Plavix).Which information should the nurse include when teaching the patient about this medication?

A) "Call if you notice that your stools are black or have blood in them."
B) "Take the clopidogrel on an empty stomach as soon as you get up."
C) "Change position slowly to avoid dizziness while you are taking clopidogrel."
D) "You should never use aspirin while you are taking clopidogrel."

Question 29

Which of the following results of a D-dimer test would suggest that the patient has venous thromboembolism?

A) 100 mcg/L
B) 175 mcg/L
C) 225 mcg/L
D) 300 mcg/L

Question 30

The nurse has identified the collaborative problem of "potential complication: pulmonary embolism" for a patient with DVT.What is an appropriate nursing intervention to prevent embolization of a thrombus?

A) Maintain bed rest until edema resolves.
B) Monitor vital signs and pulmonary status every 4 hours.
C) Apply compression-gradient stockings while the patient is on bed rest.
D) Perform passive range of motion of the affected extremity to increase venous return.

Question 31

A 42-year-old service counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient centre.What should the nurse teach the patient before discharge?

A) Her exercise should be limited to leg raising and deep knee bends.
B) She needs to revise her work station so that she can sit rather than stand at work.
C) Taking one aspirin a day will help prevent clotting around incompetent venous valves.
D) Elastic compression stockings should be applied before getting out of bed in the morning.