nursing 6 unit 5 Brunner chapter 30 Assessment and management of patients with vascular disorders and problems of peripheral circulation

The nurse completes discharge teaching for a patient following a femoral-to-popliteal bypass graft. What response by the patient would indicate teaching was effective? a) "I can now stop taking my Lipitor because my leg is fixed." b) "I can stop the exercises that were started in the hospital once I return home." c) "I will call if I develop any coldness, numbness, tingling, or pain in the surgical leg." d) "It will important for me to sit at the kitchen table to promote better breathing."

"I will call if I develop any coldness, numbness, tingling, or pain in the surgical leg." Correct Explanation: Page 838 The nurse ensures that the patient has the knowledge and ability to assess for any postoperative complications such as infection, occlusion of the artery or graft, and decreased blood flow. Coldness, numbness, tingling, and pain are signs of peripheral arterial occlusion, and immediate intervention is required.

A community health nurse teaches a group of seniors about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which of the following statements? a) "The older I get the higher my risk for peripheral arterial disease gets." b) "Since my family is from Italy, I have a higher risk of developing peripheral arterial disease." c) "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." d) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet."

"I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." Correct Explanation: P828 The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.

A client with peripheral arterial disease asks the nurse about using a heating pad to warm the feet. The nurse's best response is which of the following? a) "A heating pad to your feet is a good idea because it increases the metabolic rate." b) "It is better to soak your feet in hot water as long as the water temperature is below 110 degrees F." c) "It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet." d) "A heating pad to your feet is fine as long as the temperature stays below 105 degrees F

"It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet." Explanation: p. 831 It is safer to apply a heating pad to the abdomen, causing a reflex vasodilation in the extremities. Heat may be applied directly to ischemic extremities; however, the temperature of the heating source must not exceed body temperature. Excess heat may increase the metabolic rate of the extremities and increase the need for oxygen beyond that provided by the reduced arterial flow through the diseased artery.

A nurse is providing education about maintaining tissue integrity to a client with peripheral arterial disease. Which of the following statements by the client indicates a need for clarification? a) "I can use lamb's wool between my toes if necessary." b) "Shoes made of synthetic material are best for my feet." c) "I should apply powder daily because my feet perspire." d) "It is important to apply sunscreen to the top of my feet when wearing sandals."

"Shoes made of synthetic material are best for my feet." Correct Explanation: pg835 The client should wear leather shoes with an extra-depth toebox. Synthetic shoes do not allow air to circulate.

In a patient with a bypass graft, the distal outflow vessel must be at least what percentage patent for the graft to remain patent? a) 30 b) 50 c) 40 d) 20

50 Correct Explanation: Page 837 The distal outflow vessel must be at least 50% patent for the graft to remain patent.

A nursing instructor is discussing the diagnosis of intermittent claudication with students. To determine if the students understand the pathophysiology of the disease, the instructor asks, "What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?" a) 40 b) 20 c) 50 d) 30

50 Explanation: pg 824 Typically, about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced.

Which of the following diagnostic tests are used to quantify venous reflux and calf muscle pump ejection? a) Lymphangiography b) Air plethysmography c) Contrast phlebography d) Lymphoscintigraphy

Air plethysmography Explanation: p. 827 Air plethysmography is used to quantify venous reflux and calf muscle pump action. Contrast phlebography involves injecting a radiopaque contrast agent into the venous system. Lymphoscintigraphy is done when a radioactively labeled colloid is injected subcutaneously in the second interdigital space. The extremity is then exercised to facilitate the uptake of the colloid by the lymphatic system, and serial images are obtained at present intervals. Lymphoangiography provides a way of detecting lymph node involvement resulting from metastatic carcinoma, lymphoma, or infection in sites that are otherwise inaccessible to the examiner except by surgery.

A patient in the emergency department states, "I have always taken a morning walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." Based on this statement, which priority assessment should the nurse complete? a) Assess for unilateral swelling and tenderness of either leg. b) Ask about any skin color changes that occur in response to cold. c) Attempt to palpate the dorsalis pedis and posterior tibial pulses. d) Check for the presence of tortuous veins bilaterally on the legs.

Attempt to palpate the dorsalis pedis and posterior tibial pulses. Explanation: Page 824 Intermittent claudication is a sign of peripheral arterial insufficiency. The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. A thorough assessment of the patient's skin color and temperature and the character of the peripheral pulses are important in the diagnosis of arterial disorders.

Pentoxifylline (Trental) is a medication used for which of the following? a) Elevated triglycerides b) Claudication c) Thromboemboli d) Hypertension

Claudication Explanation: Page 837 Trental and Pletal are the only medications specifically indicated for the treatment of claudication. Thromboemboli, hypertension, and elevated triglycerides are not indications of Trental.

The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is which of the following? a) Lymphoscintigraphy b) Air plethysmography c) Contrast phlebography d) Lymphangiography

Contrast phlebography Correct Explanation: Page 827 Also known as venography, contrast phlebography involves injecting a radiopaque contrast agent into the venous system. If a thrombus exists, the x-ray image reveals an unfilled segment of vein in an otherwise completely filled vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In a lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system. (less)

Which of the following terms refers to a muscular, cramplike pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest? a) Intermittent claudication b) Aneurysm c) Ischemia d) Bruit

Correct response: Intermittent claudication Explanation: Page 823 Intermittent claudication is a sign of peripheral arterial insufficiency. An aneurysm is a localized sac of an artery wall formed at a weak point in the vessel. A bruit is the sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated vessel. Ischemia is a term used to denote deficient blood supply

A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities? a) Keep the extremities elevated slightly. b) Massage the calf muscles if pain occurs. c) Use a heating pad to promote warmth. d) Participate in a regular walking program.

Correct response: Participate in a regular walking program. Explanation: p. 831 Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and to resume activity when pain subsides. Extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. Heating pads should not be used by anyone with impaired circulation to avoid burns. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.

The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics? a) Aching, cramping pain b) Diminished or absent pulses c) Pulses are present, may be difficult to palpate d) Superficial ulcer

Diminished or absent pulses Explanation:p824 Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency

A nurse is developing a nursing care plan for a client with peripheral arterial disease. Which of the following will be the priority nursing diagnosis? a) Ineffective peripheral tissue perfusion b) Impaired tissue integrity c) Ineffective self-health management d) Ineffective thermoregulation

Ineffective peripheral tissue perfusion Correct Explanation: Page 832 The goal is to increase arterial blood supply to the extremities; the priority nursing diagnosis is Ineffective peripheral tissue perfusion related to compromised circulation.

A nurse is teaching a patient newly diagnosed with arterial insufficiency. Which of the following terms should the nurse use to refer to leg pain that occurs when the patient is walking? a) Intermittent claudication b) Thromboangiitis obliterans c) Dyspnea d) Orthopnea

Intermittent claudication Explanation: , p. 824 Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is the patient's subjective statement of difficulty breathing. Orthopnea is the inability of the patient to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Buerger's disease.

A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? a) Keeping the legs in a neutral or dependent position b) Elevation of the legs above the heart c) Application of ace wraps from the toe to below the knees d) Use of antiembolytic stockings

Keeping the legs in a neutral or dependent position Correct Explanation: p. 831 Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.

A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? a) Tissue loss to that foot b) Moderate to severe arterial insufficiency c) Very mild arterial insufficiency d) No arterial insufficiency

Moderate to severe arterial insufficiency Correct Explanation: Moderate to severe arterial insufficiency Correct Explanation: p826 Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less. Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess? a) Color of the leg every 4 hours b) Peripheral pulses every 15 minutes following surgery c) Blood pressure every 2 hours d) Ankle-arm indices every 12 hours

Peripheral pulses every 15 minutes following surgery Correct Explanation: p. 838 The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable.

Which of the following is the most effective intervention for preventing progression of vascular disease? a) Avoid trauma b) Use neutral soaps c) Wear sturdy shoes d) Risk factor modification

Risk factor modification Explanation: Risk factor modification is the most effective intervention for preventing progression of vascular disease. Measures to prevent tissue loss and amputation are a high priority. Patients are taught to avoid trauma; wear sturdy, well-fitting shoes or slippers; and use pH neutral soaps and body lotions.

A nurse and physician are preparing to visit a hospitalized client with perepheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details? a) The client can walk about 50 feet before getting pain in the right lower leg. b) The client experiences shortness of breath after walking about 50 feet. c) The client's fingers tingle when left in one position for too long. d) The client's legs awaken him during the night with itching.

The client can walk about 50 feet before getting pain in the right lower leg. Correct Explanation: pp. 823-824 Intermittent claudication is caused by the inability of the arterial system to provide adequate blood flow to the tissues when increased demands are made for oxygen and nutrients during exercise. Pain is then experienced. When the client rests and decreases demands, the pain subsides. The client can then walk the same distance and repeat the process.

The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes which of the following? a) Diuresis b) Vasospasm c) Slowed heart rate d) Depression of the cough reflex

Vasospasm Correct Explanation: Page 831 Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity. Patients with arterial insufficiency who smoke or chew tobacco must be fully informed of the effects of nicotine on circulation and be encouraged to stop.

Choice Multiple question - Select all answer choices that apply. Which of the following are complications of percutaneous transluminal balloon angioplasty (PTA)? Select all that apply. a) Embolization b) Bleeding c) Dissection of the vessel d) Hematoma e) Stent migration

• Hematoma • Embolization • Dissection of the vessel • Bleeding • Stent migration Explanation: Page 830 Complications from PTA include hematoma, embolization dissection of the vessel, bleeding, intimal damage (dissection), and stent migration.

Choice Multiple question - Select all answer choices that apply. Which of the following is accurate regarding the effects of nicotine and tobacco smoke on the body? Select all that apply. a) Decreases blood viscosity b) Causes vasospasm c) Impairs transport and cellular use of oxygen d) Reduces circulation to the extremities e) Increases blood viscosity

• Impairs transport and cellular use of oxygen • Reduces circulation to the extremities • Increases blood viscosity • Causes vasospasm Correct Explanation: Page 828 Nicotine from tobacco products causes vasospasm and can dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity