Question 1

The health care provider has prescribed a client sodium warfarin (Coumadin)while he is still receiving intravenous heparin.Which is the nurse's best action?

Accepted Answer

Although both heparin and warfarin are anticoagulants,they have different mechanisms of action and onsets of action.Because warfarin has such a slow onset,it must be started while the client is still receiving heparin.Once the warfarin is therapeutic,as evidenced by the international normalized ratio (INR),the client's heparin can be safely discontinued.Effects of heparin will be cleared from the client's bloodstream within a few hours.

Question 2

The nurse is caring for a client who develops compartment syndrome after an embolectomy for peripheral arterial disease.What is the nurse's best action?

Accepted Answer

When a client develops compartment syndrome,the nurse should remove or loosen the dressing and elevate the extremity to the level of the heart.In addition,the nurse must notify the health care provider immediately.Passive range of motion and the knee-chest position are not indicated.Preparing the client for return to the operating room is not indicated at this time.The priority is to relieve pressure by loosening the dressing and positioning the extremity at the level of the heart.

Question 3

A client with a diagnosed abdominal aortic aneurysm (AAA)develops lower back pain radiating to the groin.What is the nurse's interpretation of this information?

Accepted Answer

When an aneurysm is expanding or is preparing to rupture,the client may experience severe,sudden back or lower abdominal pain that can radiate to the groin,buttocks,or legs.The other explanations are not related to potential or actual rupture of the aneurysm.

Question 4

The nurse is providing discharge education to a client after repair of an abdominal aortic aneurysm (AAA).What priority instruction does the nurse include?

Accepted Answer

Clients who have undergone AAA repair must refrain from placing stress on the graft.They should avoid lifting or pulling heavy objects,and activities such as vacuuming,raking leaves,and playing golf.Clients must be cleared by their surgeon for driving.The other two options are not valid instructions.

Question 5

A nurse is recovering a client who has undergone surgical repair of an abdominal aortic aneurysm (AAA).The client develops coolness of the extremities and reports a bloated feeling in the abdomen.What is the nurse's best action?

Accepted Answer

Graft occlusion or rupture is a postoperative complication following AAA repair.The nurse should monitor the client for increasing abdominal girth,cool or cold extremities,white or blue color in the flanks,and severe pain.Elevating the head of the bed would place too much pressure on the surgical site.The other two options are not warranted.

Question 6

The nurse is assessing for skin changes in an African-American client admitted with peripheral arterial disease.What does the nurse monitor for?

Accepted Answer

Because only severe cyanosis is evident in the skin of dark-skinned clients,cyanosis can be detected by assessing the skin and nail beds for a dull lifeless color.The soles of the feet and the toenails are less pigmented,which can enable detection of cyanosis or duskiness in the lower extremities.Loss of hair on the lower extremities is noted with peripheral artery disease.Pitting edema is associated with venous disease.Toenail beds are cyanotic,but loss of nails is not associated.

Question 7

The nurse is caring for a client with Buerger's disease.What client education does the nurse provide to minimize disease progression?

Accepted Answer

The greatest risk factor for the development and progression of Buerger's disease is cigarette smoking.To prevent the progression of Buerger's disease,complete abstinence from tobacco in all forms is essential.The vasoconstrictive effects of each cigarette may last up to 1 hour after the cigarette is smoked.Teach the client to avoid extreme cold or prolonged exposure to cold to prevent vasoconstriction.Keeping the environment warm will minimize vasoconstriction but has no direct effect on disease progression.Heating pads should be avoided because injury can occur secondary to decreased sensation in the lower extremities.

Question 8

The nurse is recovering a client with peripheral arterial disease who has just undergone percutaneous transluminal angioplasty.What complication does the nurse monitor for in the immediate postprocedure period?

Accepted Answer

For this procedure,a catheter is advanced through a cannula inserted through the femoral artery.The nurse must monitor the client for bleeding at the puncture site.

Question 9

The nurse is caring for a client with peripheral arterial disease.What priority nursing intervention does the nurse perform to promote vasodilation?

Accepted Answer

Smoking causes vasoconstriction,and its effects can last up to 1 hour after the cigarette is finished.Increasing activity may lead to collateral circulation but does not cause vasodilation.Use of a heating pad is contraindicated in the client with peripheral artery disease because of the risk of a burn caused by diminished sensation.The use of aspirin my impede platelet clumping and is contraindicated only when the client is on anticoagulants.

Question 10

The new graduate nurse is assessing a client with an unrepaired abdominal aortic aneurysm.What assessment technique requires further education by the supervising nurse?

Accepted Answer

Palpation on or near an aneurysm may cause pain and potential rupture.Observation,auscultation,and measurement are appropriate assessments.

Question 11

The nurse assesses a client's legs.Which assessment finding indicates arterial insufficiency?

Accepted Answer

Dependent mottling and absence of hair is an indication of arterial insufficiency.Pain may be present with activity and at rest.Edema and ankle discoloration would be indicative of venous insufficiency.

Question 12

The nurse is providing health education to a client with chronic venous stasis ulcers.What priority instruction does the nurse include?

Accepted Answer

Support hose or antiembolism stockings should be applied just before getting out of bed in the morning and should be removed before going to bed at night.Clients are advised that they will probably need to wear these stockings indefinitely.Betadine is not indicated and may cause irritation.Chronic venous ulcers are not caused by an inflammatory process,so daily aspirin is not indicated.Hydrocolloid (DuoDerm)dressings are left in place for a minimum of 3 to 5 days for best effect.

Question 13

The nurse is reviewing a client's laboratory results.The nurse correlates elevations in which values as risk factors for atherosclerosis?

Accepted Answer

A lipid panel is often used to screen for cardiovascular risk.Total cholesterol,triglycerides,and low-density cholesterol levels are all high,indicating higher risk for cardiovascular disease.High-density cholesterol is within the normal range for both males and females.Serum albumin is not assessed for atherosclerosis.

Question 14

The nurse is assessing the extremities of a client with Buerger's disease.What clinical manifestation does the nurse correlate with this disease?

Accepted Answer

Clients with Buerger's disease manifest with reddened or cyanotic extremities in the dependent position and diminished distal pulses caused by occlusions in the smaller vessels.Clients also may have ulcerations or gangrene of the digits secondary to impaired circulation.Pulses are diminished,not bounding.Reflex activity is not usually affected by this disorder.

Question 15

The nurse is discharging home a client at risk for venous thromboembolism (VTE)on low-molecular-weight heparin.What instruction does the nurse provide to this client?

Accepted Answer

As with any anticoagulation,low-molecular-weight heparin incurs risk of bleeding.Clients should be taught to report to their health care provider the presence of tarry stools,bleeding gums,hematuria,ecchymosis,or petechiae.Low-molecular-weight heparin does not affect activated partial thromboplastin time (aPTT),as does intravenous heparin.This type of heparin is administered subcutaneously to deliver a slow sustained response.Massaging the site would hasten absorption and decrease effects.

Question 16

The nurse is caring for a client who is receiving heparin therapy for a venous thromboembolism (VTE).The client's activated partial thromboplastin time (aPTT)before heparin therapy was 30 seconds.Which aPTT result indicates that anticoagulation is adequate at this time?

Accepted Answer

Therapeutic aPTT values for clients receiving heparin should range from 1.5 to 2.5 times the control value.

Question 17

The nurse is monitoring a client who has returned to the unit after arterial revascularization.The client reports pain in the affected limb that is similar to the pain experienced before the procedure.What is the nurse's best action?

Accepted Answer

Ischemic pain may be present because the graft is occluded.The nurse would assess the limb for peripheral pulses and would notify the surgeon if pulses are not found.Graft occlusion is a surgical emergency,and the nurse must recognize this as a sign of graft occlusion.Elevating the extremity would further compromise blood flow.Covering the extremity or administering pain addresses only the clinical manifestations,not the cause,of compromised blood flow.

Question 18

A client is recovering after an embolectomy.What clinical manifestations consistent with compartment syndrome does the nurse watch for?

Accepted Answer

Compartment syndrome occurs when tissue pressure within a confined space becomes elevated and blood flow is restricted.This causes increased swelling,tenderness,and tension in the affected limb.

Question 19

The nurse is providing disease management education to a client with Raynaud's disease.What intervention does the nurse suggest to prevent complications of this disease?

Accepted Answer

Education is important for helping the client avoid complications.The client is instructed to wear warm clothing,such as socks and gloves,when exposed to cool temperatures to decrease vasoconstriction.The client may be prescribed vasodilators to prevent vasoconstriction.

Question 20

The nurse is preparing a client with an aortic aneurysm for surgery.The nurse notes that the client's systolic blood pressure has increased by 30 mm Hg compared with the reading 1 hour ago.What is the nurse's best action?

Accepted Answer

A sudden increase in blood pressure or hypertension can cause enlargement or rupture of the aneurysm,which would be correlated with an increase in abdominal girth.The other options are not indicated.

Quiz 38: Care of Patients With Vascular Problems

The health care provider has prescribed a client sodium warfarin (Coumadin) while he is still receiving intravenous heparin.Which is the nurse's best action?