Deck 35: Caring for the Patient With Peripheral Vascular Disorders

Question 1

A patient who has had a dissecting aneurysm repaired is being prepared for discharge. The patient has a history of hypertension. The nurse is careful to emphasize the importance of which precaution? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "Do not run out of your prescribed medications."
B) "Take your pulse twice daily."
C) "Do not drink too much fluid."
D) "Watch the incision for signs of infection."
E) "Keep your blood pressure well managed."

Answer 1

"Do not run out of your prescribed medications."
"Watch the incision for signs of infection."
"Keep your blood pressure well managed."

Question 2

The nurse is providing preoperative instructions to a patient scheduled for endovascular repair to reduce peripheral vascular disease. The patient asks where the incision will be located. How should the nurse reply?

A) "There will be a small incision in the groin area because the procedure is done via the femoral artery."
B) "There will be no incisions because the repair is done via IV access."
C) "There will be an incision in the mid-chest because the surgeon will need to perform bypass surgery."
D) "There will be an incision in the abdomen so the surgeon can visualize the affected area."

Answer 2

"There will be a small incision in the groin area because the procedure is done via the femoral artery."

Question 3

The nurse notes that a patient with Raynaud's disease is more anxious than usual and states, "I don't understand why my hands keep turning colors. It seems to happen when I get upset." What is the nurse's most appropriate action?

A) Discuss how stress can cause the vasospasms in Raynaud's disease and develop a plan to manage stress.
B) Discuss using hot water to warm up the patient's hands and keep them warm.
C) Discuss how Raynaud's can impact the patient's health.
D) Implement a no-visitor policy to keep the patient calmer.

Answer 3

Discuss how stress can cause the vasospasms in Raynaud's disease and develop a plan to manage stress.

Question 4

A number of patients on the unit are at risk for deep venous thrombosis DVT). The nurse would consider which patient at highest risk?

A) The patient who had oral surgery
B) The patient who has pneumonia
C) The patient with diabetes
D) The patient who had a hip replacement

Question 5

A diabetic 68-year-old female patient arrives at the clinic with a history of smoking, hypertension, family history of cardiac disease, COPD, and infrequent exercise. The nurse identifies which of these as the most significant risk factors for peripheral arterial disease PAD)?

A) COPD and family history of cardiac disease
B) Age and gender
C) Sedentary lifestyle and diabetes
D) Hypertension and smoking

Question 6

A patient with peripheral arterial disease PAD) is a smoker. The nurse has established a nursing diagnosis of Deficient Knowledge of Self-Care Needs and Treatment Plan related to tobacco use. Which intervention should the nurse choose to implement?

A) Encourage the patient to use medications to stop smoking.
B) Discuss with the patient a smoking cessation plan.
C) Instruct the patient in increasing exercise.
D) Discuss the patient's use of herbal therapies for smoking cessation.

Question 7

A patient with peripheral arterial disease has a nursing diagnosis of Ineffective Tissue Perfusion. Which nursing intervention is most appropriate for this nursing diagnosis?

A) Assist the patient in taking hot baths.
B) Do not elevate the patient's legs.
C) Encourage the patient to limit activity.
D) Limit visitors.

Question 8

A patient with Raynaud's disease presents with pallor of the fingers. The patient states that the hands turn white, then blue, then red. How should the nurse explain these symptoms to the patient?

A) "Bleeding is occurring in the interior portion of your hands."
B) "You have inflammation of the small vessels of your hands and feet that will eventually form small clots."
C) "These symptoms are caused by spasm of the small arteries and arterioles in your hands."
D) "Your symptoms are associated with atherosclerosis caused by too many circulating lipids."

Question 9

A patient with a deep venous thrombosis DVT) is going home on warfarin Coumadin). The nurse instructs the patient that lab work will need to be performed frequently until the levels stabilize. For which international normalized ratio INR) result will the patient's warfarin need to be adjusted?

A) 2.8
B) 3.0
C) 2.1
D) 1.3

Question 10

A patient who is pondering surgical repair of varicose veins asks the nurse how long the hospital stay would be. How should the nurse respond?

A) "The procedure is an inpatient procedure that requires an overnight stay."
B) "The procedure is completed over several days, so you will return to the hospital every day until the process is complete."
C) "Surgical repair of varicose veins is an outpatient procedure. There is no inpatient stay."
D) "The procedure is complicated and will require at least 2 days in the hospital."

Question 11

A patient's visit to the health care clinic reveals a blood pressure of 130/82) The patient's blood pressure has been 138/88 at each of the last three clinic visits. How does the nurse evaluate this information?

A) The patient's blood pressure meets the criteria for stage 1 hypertension.
B) The patient should be educated on lifestyle modifications to reduce the risk of developing stage 1 hypertension.
C) The patient's risk of developing hypertension is no higher than anyone else's.
D) The patient has stage 2 hypertension and requires medication.

Question 12

A 38-year-old, 150-pound male has been diagnosed with deep venous thrombosis DVT). The patient's history includes recent cardiac bypass surgery, working in a pesticide plant, and hypertension. The family asks what might have put the patient at risk for DVT. How should the nurse respond?

A) "Hypertension is a major contributor to the development of DVTs."
B) "The cause of DVTs is unknown, but his weight may be a factor."
C) "His prior employment in the pesticide plant may have contributed to the DVT."
D) "His recent surgery and prolonged immobilization are risk factors."

Question 13

A patient on clopidogrel Plavix) is receiving discharge instructions. What information should the nurse provide?

A) "Be aware of food interactions with the medication."
B) "Take the medication with an NSAID pain reliever if it gives you a headache."
C) "Take vitamin C, vitamin E, and vitamin A supplements daily."
D) "Take the medication with food."

Question 14

A patient who has just been diagnosed with peripheral arterial disease PAD) asks what "intermittent claudication" means. How should the nurse describe this condition?

A) Leg pain that occurs at rest
B) Leg pain that occurs with exercise
C) A tingling feeling in the hands
D) Pain that can occur anywhere in the body with exercise

Question 15

A 65-year-old male patient arrives in the clinic complaining of numbness and tingling of the lower extremities and pain in the legs upon exercise. Which questions would the nurse ask to determine the patient's possible risk factors for peripheral arterial disease PAD)? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "Do you smoke?"
B) "Are you married?"
C) "Are you diabetic?"
D) "Where were you born?"
E) "Do you exercise?"

Question 16

A patient on whom an endovascular repair of the aorta has just been performed is now complaining of numbness and tingling in the toes. The nurse inspects the patient's legs and discovers weak pulses bilaterally, cool lower extremities, and capillary refill greater than 3 seconds. What immediate nursing action is indicated?

A) Contact the patient's family to come to the hospital.
B) Instruct the patient to take deep breaths to increase oxygenation.
C) Contact the ECG technician to get an ECG because the patient is likely having a heart attack.
D) Contact the health care provider because the patient has likely developed interruption of arterial flow.

Question 17

A patient who has been diagnosed with peripheral arterial disease PAD) has a nursing diagnosis of Risk for Impaired Skin Integrity related to reduced peripheral circulation. Which instruction is most appropriate to address this diagnosis?

A) PAD signs and symptoms
B) Pain control measures
C) Risk factors that may increase problems with PAD
D) Protecting the legs from injury

Question 18

A patient presents to the emergency department with complaints of "feeling like something is ripping in my chest" and sudden onset of mid-back pain. The patient has a history of hypertension. What is the top priority in the care of this patient?

A) Contact the patient's family.
B) Facilitate an immediate CT scan.
C) Obtain a surgical history.
D) Provide pain medication.

Question 19

A patient's visit to the health care clinic reveals a blood pressure of 142/90. What is the nurse's next step?

A) Notify the physician or primary health care provider immediately.
B) Identify medications the patient has been taking.
C) Discuss the diagnosis of hypertension with the patient.
D) Check the patient's record for the past several blood pressure readings.

Question 20

A patient receiving enoxaparin Lovenox) is scheduled for surgery. Why should the nurse discuss this medication with the anesthesia care provider?

A) Correct body alignment during surgery will be critical.
B) Aspirin may need to be substituted for the enoxaparin.
C) The patient should not receive medications that interact with enoxaparin.
D) The patient should not receive an epidural.

Question 21

During the abdominal assessment of an elderly patient, the nurse palpates a mass in the mid-abdomen. What actions should the nurse take? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Percuss the mass.
B) Ask the patient to cough forcefully and reassess.
C) Notify the physician immediately.
D) Auscultate the mass.
E) Ask the patient about any recent pain in the abdomen.

Question 22

The nurse has provided medication instruction for a patient who will be discharged on warfarin therapy. The nurse evaluates the patient has understood dietary restrictions when the patient lists which foods to avoid? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Green tea
B) Soybeans
C) Caffeinated beverages
D) Avocado
E) Cauliflower

Question 23

A patient's blood pressure continues to be elevated even though the patient was prescribed an ACE inhibitor for several weeks. What are appropriate nursing interventions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Ask if the patient is taking the prescribed medication.
B) Suggest to the physician that a different medication be prescribed.
C) Schedule another blood pressure check in a week.
D) Realize that the patient's anxiety over the diagnosis is affecting treatment.
E) Ask if the patient is experiencing side effects from the medication.

Question 24

A patient has been diagnosed with stage 2 hypertension. What should the nurse teach this patient about managing the disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Take the prescribed medication as directed.
B) Stop taking medication when blood pressure returns to normal limits.
C) Exercise when the weather permits.
D) Two or three glasses of wine with dinner will help to control blood pressure.
E) Eat three balanced meals every day.

Question 25

The nurse would conduct additional assessment for peripheral arterial disease if the patient's ankle-brachial index is lower than_______.

Question 26

The nurse suspects that a patient who is recovering from an abdominal aortic aneurysm repair is experiencing graft leaking. Which findings are indications of this event? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Urine output 45 mL/hr
B) Complaint of groin pain
C) Abdominal dressing dry and intact
D) Respiratory rate 16 and regular
E) Complaint of back discomfort

Question 27

A patient is transferred to the postanesthesia unit after surgery to repair an abdominal aortic aneurysm. The patient's temperature is 34.6°C. What actions should be taken by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Plan to keep the patient's temperature low until he is completely awake from anesthesia.
B) Wrap the patient's head in warmed blankets.
C) Rewarm the patient as quickly as possible.
D) Administer warmed IV fluids.
E) Ask respiratory therapy to warm inspired ventilator air.

Question 28

A patient has been prescribed propranolol Inderal) 80 mg twice daily. To maximize the patient's safety, what should the nurse teach the patient about this drug?

A) "Stop the medication immediately if you experience nausea or a cough, and then contact the health care provider."
B) "Do not stop the medication abruptly without consulting the physician."
C) "Contact the health care provider immediately if you experience fatigue."
D) "If you have a headache, take an extra tablet at the next dose time."

Question 29

A patient is demonstrating signs of thrombophlebitis. The nurse understands that which mechanisms occur with this disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Bleeding into surrounding tissues
B) Blood hypercoagulation
C) Sluggish blood flow
D) Elevated systemic blood pressure
E) Vessel damage

Question 30

The medical-surgical nurse is providing a hypertensive patient and the family with discharge instructions. The family is concerned about complications from hypertension. What information should the nurse provide?

A) "The complications are relatively minor."
B) "The physician will discuss the complications with you at a later date."
C) "There are potential complications, but the risks can be minimized if the hypertension is well controlled."
D) "People die if they don't manage their hypertension well."

Question 31

Which statements by the patient would the nurse evaluate as indicating a need for additional teaching about hypertension? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "Hypertension affects my blood vessels only if I have other underlying health problems."
B) "Hypertension causes my blood vessels to become inflamed and reduces the blood supply to my organs if left untreated."
C) "Hypertension damages my blood vessels even if I don't have any symptoms."
D) "I will be more prone to heart disease and eye problems if I discontinue my blood pressure medications."
E) "As long as I take my medications, I am cured of hypertension."

Question 32

The nurse is instructing a patient with hypertension about lifestyle modifications. Which instructions would be appropriate to include? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Review the DASH diet.
B) Begin a walking program, and progress to 30 minutes 5 to 6 days each week.
C) Plan a weight-lifting regimen.
D) Eliminate dairy products from the diet.
E) Restrict fluid intake.

Question 33

A patient has the nursing diagnosis Impaired Physical Mobility related to decreased blood flow to the lower extremities. To address this nursing diagnosis, the nurse should instruct the patient to walk for at least 30 minutes at least _______ times a week.

Question 34

A patient admitted with hypertension reports peripheral edema, difficulty breathing, and a cough following ambulation. The nurse chooses which priority nursing diagnosis?

A) Impaired Tissue Perfusion
B) Risk of Noncompliance
C) Imbalanced Nutrition
D) Fatigue

Question 35

The patient's brachial artery systolic pressure is 144 mmHg, and the right ankle systolic pressure is 120 mmHg. The nurse calculates the patient's ankle-brachial index to be ______.