PrepU Chapter 30: Vascular Disorders & Probs with Peripheral Circulation (Exam 1)

Which is a characteristic of arterial insufficiency? -Diminished or absent pulses -Superficial ulcer -Aching, cramping pain -Pulses are present but may be difficult to palpate

-Diminished or absent pulses

Aortic dissection may be mistaken for which of the following disease processes? -Myocardial infarction (MI) -Stroke -Pneumothorax -Angina

-Myocardial infarction (MI) Aortic dissection may be mistaken for an acute MI, which could confuse the clinical picture and initial treatment. Aortic dissection is not mistaken for stroke, pneumothorax, or angina.

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? -Peripheral vascular disease -Raynaud's disease -Arterial occlusive diseases -Buerger's disease

-Raynaud's disease

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? -Arterial insufficiency -Venous insufficiency -Neither venous nor arterial insufficiency -Trauma

-Venous insufficiency Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.

A pregnant client who developed deep vein thrombosis (DVT) in her right leg is receiving heparin I.V. on the medical floor. Physical therapy is ordered to maintain her mobility and prevent additional DVT. A nursing assistant working on the medical unit helps the client with bathing, range-of-motion exercises, and personal care. Which collaborative multidisciplinary considerations should the care plan address? -The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include sequential compression device application and strict bed rest. -The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising. -The client is at risk for developing another DVT; therefore, the care plan should include reporting redness, tenderness, or edema in the other lower extremity. -The client is pregnant and receiving I.V. heparin, placing her at risk for premature labor; therefore, the care plan should include reporting signs of premature labor.

-The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include sequential compression device application and strict bed rest. Feedback about possible bleeding and bruising from physical therapy and other caregivers should be incorporated into the care plan to ensure safety and optimal outcomes. Using a sequential compression device, mandating strict bed rest, and reporting signs of DVT don't incorporate collaborative care. Reporting signs of premature labor doesn't address the consequences of thrombocytopenia, which may occur with I.V. heparin therapy.

Following abdominal surgery, which factor predisposes a client to deep vein thrombosis? -The client is 5? 9? tall and weighs 128 lb (58 kg). -The client has been pregnant four times. -The client usually walks 3 miles a day. -The client will be immobile during and shortly after surgery.

-The client will be immobile during and shortly after surgery. Postoperative immobility and subsequent venous stasis predispose the client to deep vein thrombosis. Other predisposing factors for this condition include obesity and current pregnancy, which don't apply to this client. Exercise isn't a risk factor for deep vein thrombosis.

The nurse is assessing a hospital client who has low albumin levels due to liver disease. What assessment finding should the nurse attribute to the client's low albumin levels? -There is severe edema to the client's legs and abdomen. -The client has had two episodes of epistaxis (nosebleeds) in the past 24 hours. -The client reports uncharacteristic levels of fatigue. -The client is short of breath on exertion, with an expiratory wheeze.

-There is severe edema to the client's legs and abdomen. Albumin helps to keep fluids within the vascular space. Deficiencies, as a result, cause the release of fluid into interstitial spaces, causing edema. Hypoalbuminemia does not cause excessive bleeding, reduced energy or respiratory difficulties.

Which of the following is the most common site for a dissecting aneurysm? -Thoracic area -Lumbar area -Sacral area -Cervical area

-Thoracic area The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.

The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for? -Rudor -Cellulitis -Dermatitis -Ulceration

-Ulceration Venous ulceration is the most serious complication of chronic venous insufficiency and can be associated with other conditions affecting the circulation of the lower extremities. Cellulitis or dermatitis may complicate the care of chronic venous insufficiency and venous ulcerations.

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? -Loose and wrinkled skin -Ulcers and infection in the edematous area -Evident scaring -Cyanosis

-Ulcers and infection in the edematous area In a client with lymphedema, the tissue nutrition is impaired as a result of the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area. Later, the skin also appears thickened, rough, and discolored. Scaring does not occur in clients with lymphedema. Cyanosis is a bluish discoloration of the skin and mucous membranes.

The most common site of aneurysm formation is in the: -abdominal aorta, just below the renal arteries. -ascending aorta, around the aortic arch. -descending aorta, beyond the subclavian arteries. -aortic arch, around the ascending and descending aorta.

-abdominal aorta, just below the renal arteries. About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries.

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals: -elevational rubor. -no rubor for 10 seconds after the maneuver. -dependent pallor. -a 30-second filling time for the veins.

-dependent pallor. If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves.

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: -encouraging ambulation to prevent pooling of blood. -providing warmth to the extremity. -elevating the extremity to prevent pooling of blood. -forcing blood into the deep venous system.

-forcing blood into the deep venous system. Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: -place a heating pad around the affected calf. -elevate the affected leg as high as possible. -keep the affected leg level or slightly dependent. -shave the affected leg in anticipation of surgery.

-keep the affected leg level or slightly dependent. While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? -"I like to soak my feet in the hot tub every day." -"I walk only to the mailbox in my bare feet." -"I stopped smoking and use only chewing tobacco." -"I have my wife look at the soles of my feet each day."

-"I have my wife look at the soles of my feet each day." A client with peripheral vascular disease should examine his feet daily for redness, dryness, or cuts. If a client isn't able to do this examination on his own, then a caregiver or family member should help him. A client with peripheral vascular disease should avoid hot tubs because decreased sensation in the feet may make him unable to tell if the water is too hot. The client should always wear shoes or slippers on his feet when he is out of bed to help minimize trauma to the feet. Any type of nicotine, whether it's from cigarettes or smokeless tobacco, can cause vasoconstriction and further decrease blood supply to the extremities.

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? -"Practice meticulous foot care." -"Consider cutting down on your smoking." -"Reduce your level of exercise." -"See the physician if complications occur."

-"Practice meticulous foot care." Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur.

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? -"Shoes made of synthetic material are best for my feet." -"It is important to apply sunscreen to the top of my feet when wearing sandals." -"I should apply powder daily because my feet perspire." -"I can use lamb's wool between my toes if necessary."

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

A client admitted to the medical-surgical unit with a venous thromboembolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are needed. Which response by the nurse is accurate? -"Administration of two anticoagulants decreases the risk of recurrent venous thrombosis." -"Enoxaparin will dissolve the clot, and warfarin will prevent any more clots from occurring." -"The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect." -"Because of the potential for a pulmonary embolism, it is important for you to take at least two anticoagulants."

-"The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect."

A client admitted to the medical-surgical unit with a venous thromboembolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are needed. Which response by the nurse is accurate? -"Administration of two anticoagulants decreases the risk of recurrent venous thrombosis." -"Enoxaparin will dissolve the clot, and warfarin will prevent any more clots from occurring." -"The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect." -"Because of the potential for a pulmonary embolism, it is important for you to take at least two anticoagulants."

-"The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect." Oral anticoagulants such as warfarin are monitored by the prothrombin time (PT) or the international normalized ratio (INR). Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0).

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? -"As soon as you feel pain, we will go back and elevate your legs." -"If you feel pain during the walk, keep walking until the end of the hallway is reached." -"Walk to the point of pain, rest until the pain subsides, then resume ambulation." -"If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

-"Walk to the point of pain, rest until the pain subsides, then resume ambulation." The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise.

The physician prescribed a Tegapore dressing to treat a venous ulcer. What should the nurse expect that the ankle-brachial index (ABI) will be if the circulatory status is adequate? -0.10 -0.25 -0.35 -0.50

-0.50 After the circulatory status has been assessed and determined to be adequate for healing (ABI of more than 0.5) (Mosti, Iabichella, & Partsch, 2012), surgical dressings can be used to promote a moist environment.

When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of: -1.5 to 2.5 times the baseline control. -2.5 to 3.0 times the baseline control. -3.5 times the baseline control. -4.5 times the baseline control.

-1.5 to 2.5 times the baseline control. A normal PTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage.

When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows that therapeutic benefits will not occur for: -At least 12 hours. -The first 24 hours. -2 to 3 days. -3 to 5 days.

-3 to 5 days. It takes 3 to 5 days for a therapeutic international normalized ratio (INR) to be achieved. Therefore, Coumadin is given concurrently with heparin until a therapeutic level is established, usually within 72 hours.

Which nursing diagnosis is most significant in planning the care for a client with Raynaud's disease? -Acute Pain -Disturbed Sensory Perception -Self-Care Deficit -Activity Intolerance

-Acute Pain The hallmark symptom of Raynaud's Disease is pain related to the arterial insufficiency. Disturbed Sensory Perception associated with paresthesia can occur but is less significant than pain. Self-Care Deficit and Activity Intolerance can occur but less significant than Acute Pain.

To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the: -Inside of the ankle just above the heel. -Exterior surface of the foot near the heel. -Outside of the foot just below the heel. -Anterior surface of the foot near the ankle joint.

-Anterior surface of the foot near the ankle joint. The dorsalis pedis pulse can be palpated on the dorsal surface of the foot distal to the major prominence of the navicular bone.

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? -Arterial insufficiency -Venous insufficiency -Neither venous nor arterial -Trauma

-Arterial insufficiency Characteristics of arterial insuffiency ulcers include location at the tips of the toes, extreme painfulness, and circular shape with pale to black ulcer bases. Ulcers caused by venous insufficiency will be irregular in shape, minimal pain if superficial (can be painful), and usually located around the ankles or the anterier tibial area.

You are presenting a workshop at the senior citizens center about how the changes of aging predisposes clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? -Aneurysm -Coronary thrombosis -Atherosclerosis -Raynaud's disease

-Atherosclerosis Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. Therefore, options A, B, and D are incorrect.

The nurse is caring for a client with Raynaud's disease. What are important instructions for a client who is diagnosed with this disease to prevent an attack? -Report changes in the usual pattern of chest pain. -Avoid situations that contribute to ischemic episodes. -Avoid fatty foods and exercise. -Take over-the-counter decongestants.

-Avoid situations that contribute to ischemic episodes. Teaching for clients with Raynaud's disease and their family members is important. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.

Which of the following assessment results is considered a major risk factor for PAD? -LDL of 100 mg/dL -BP of 160/110 mm Hg -Cholesterol of 200 mg/dL -Triglyceride level of 150 mg/dL

-BP of 160/110 mm Hg Hypertension is considered a major risk factor for PAD. Blood pressure should be less than 130/90 mm Hg. The other laboratory results are within the recommended range of normal to high normal.

A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection? -Urine output of 15 ml/hour and 2+ hematuria -Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute -Urine output of 150 ml/hour and heart rate of 45 beats/minute -Blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute

-Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute Assessment findings that indicate possible bleeding or recurring dissection include hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses. Hematuria, increased urine output, and bradycardia aren't signs of bleeding from aneurysm repair or recurring dissection.

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless temporary change? -Purplish stools -Bluish urine -Redness of the upper part of the feet -Coldness of the soles

-Bluish urine Lymphangiography may turn the urine blue temporarily; it doesn't alter stool color. For several months after the procedure, the upper part of the feet may appear blue, not red. Lymphangiography doesn't affect the soles.

Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is: -Cigarette smoking. -Lack of exercise. -Obesity. -Stress.

-Cigarette smoking. Nicotine decreases blood flow, increases heart rate and blood pressure, and increases the risk for clot formation by increasing platelet aggregation. Smokers have a four-fold higher risk of developing pain from arterial disease than nonsmokers. Carbon monoxide, produced by burning tobacco, combines with hemoglobin more readily than oxygen, thus depriving tissues of oxygen.

Pentoxifylline (Trental) is a medication used for which of the following conditions? -Claudication -Thromboemboli -Hypertension -Elevated triglycerides

-Claudication Trental and Pletal are the only medications specifically indicated for the treatment of claudication. Thromboemboli, hypertension, and elevated triglycerides are not indications for using Trental.

The nurse assesses a patient with hip pain related to intermittent claudication. She knows that the area of arterial narrowing is the: -Common iliac artery. -Common femoral artery. -Anterior tibial. -Posterior tibial.

-Common iliac artery. The location of the claudication occurs in muscle groups distal to the diseased vessel. Hip or buttock pain may result from reduced blood flow from the common iliac artery.

A patient is suspected to have a thoracic aortic aneurysm. What diagnostic test(s) does the nurse anticipate preparing the patient for? (Select all that apply.) -Computed tomography -Transesophageal echocardiography -X-ray -Electroencephalogram -Electrocardiogram (ECG)

-Computed tomography -Transesophageal echocardiography -X-ray Diagnosis of a thoracic aortic aneurysm is principally made by chest x-ray, computed tomography angiography (CTA), and transesophageal echocardiography (TEE).

A health care provider wants a cross-sectional image of the abdomen to evaluate the degree of stenosis in a patient's left common iliac artery. The nurse knows to prepare the patient for which of the following? -Doppler ultrasound -Magnetic resonance angiography (MRA) -Angiography -Computed tomography angiography (CTA)

-Computed tomography angiography (CTA) A CTA is used to visualize arteries and veins and help assess for stenosis and occlusion.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? -Constant, intense back pain and falling blood pressure -Constant, intense headache and falling blood pressure -Higher than normal blood pressure and falling hematocrit -Slow heart rate and high blood pressure

-Constant, intense back pain and falling blood pressure Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? -Constant, intense back pain and falling blood pressure -Constant, intense headache and falling blood pressure -Higher than normal blood pressure and falling hematocrit -Slow heart rate and high blood pressure

-Constant, intense back pain and falling blood pressure Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot? -Contrast phlebography -Air plethysmography -Lymphangiography -Lymphoscintigraphy

-Contrast phlebography When a thrombus exists, an X-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.

The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) -Cool and cyanotic skin -Initial absence of edema -Sharp pain that may be relieved by the elevation of the extremity -Full superficial veins -Brisk capillary refill of the toes

-Cool and cyanotic skin -Sharp pain that may be relieved by the elevation of the extremity -Full superficial veins Postthrombotic syndrome is characterized by chronic venous stasis, resulting in edema, altered pigmentation, pain, and stasis dermatitis. The patient may notice the symptoms less in the morning and more in the evening. Obstruction or poor calf muscle pumping in addition to valvular reflux must be present for the development of severe postthrombotic syndrome and stasis ulcers. Superficial veins may be dilated.

As the clinic nurse caring for a client with varicose veins, what is an appropriate nursing action for this client? -Demonstrate how to self-administer IV infusions. -Demonstrate how to apply and remove elastic support stockings. -Assess for the sites of bleeding. -Assess for skin integrity.

-Demonstrate how to apply and remove elastic support stockings. The nurse demonstrates how to apply and remove elastic support stockings. Varicose veins do not require the nurse to demonstrate how to self-administer IV infusions. Varicose veins require the client to elevate legs regularly and perform leg exercises. However, it does not involve bleeding or skin lesions.

Which is a characteristic of arterial insufficiency? -Diminished or absent pulses -Superficial ulcer -Aching, cramping pain -Pulses are present but may be difficult to palpate

-Diminished or absent pulses A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.

The nurse assessing a client who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which characteristic? -Diminished or absent pulses -Superficial ulcer -Aching, cramping pain -Pulses that are present but difficult to palpate

-Diminished or absent pulses 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.

Which aneurysm results in bleeding into the layers of the arterial wall? -Saccular -Dissecting -False -Anastomotic

-Dissecting Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma. An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites.

A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg? -Dorsiflex the foot while the leg is elevated to check for calf pain. -Elevate the patient's legs for 20 minutes and then lower them slowly while checking for areas of inadequate blood return. -Extend the leg, plantar flex the foot, and check for the patency of the dorsalis pedis pulse. -Lower the patient's legs and massage the calf muscles to note any areas of tenderness.

-Dorsiflex the foot while the leg is elevated to check for calf pain. Homan's sign is indicated by pain in the calf after the foot is sharply dorsiflexed.

A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency? -Elevate the legs periodically for at least an hour. -Avoid foods with iodine. -Elevate the legs periodically for at least 15 to 20 minutes. -Refrain from sexual activity for a week.

-Elevate the legs periodically for at least 15 to 20 minutes. The nurse should advise the client to periodically elevate the legs for at least 15 to 20 minutes. Avoiding foods with iodine or refraining from sexual activity for a week does not relate to venous insufficiency.

A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time? -Metoprolol (Lopressor) -Epinephrine -Hydrocortisone (Solu-Cortef) -Cimetidine (Tagamet)

-Epinephrine Infrequently, a patient may have an immediate or delayed allergic reaction to the iodine contained in the contrast agent used in angiography. Manifestations include dyspnea, nausea and vomiting, sweating, tachycardia, and numbness of the extremities. Any such reaction must be reported to the interventionalist at once; treatment may include the administration of epinephrine, antihistamines, or corticosteroids.

Which statement is accurate regarding Reynaud disease? -The disease generally affects the client bilaterally. -It affects more than two digits on each hand or foot. -It is most common in men 16 to 40 years of age. -Episodes may be triggered by unusual sensitivity to cold.

-Episodes may be triggered by unusual sensitivity to cold. Episodes of Reynaud disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.

Which class of medication lyses and dissolves thrombi? -Fibrinolytic -Anticoagulant -Platelet inhibitors -Factor XA inhibitors

-Fibrinolytic

Which class of medication lyses and dissolves thrombi? -Fibrinolytic -Anticoagulant -Platelet inhibitors -Factor XA inhibitors

-Fibrinolytic Thrombolytic (fibrinolytic) therapy lyses and dissolves thrombi in 50% of clients. Anticoagulants, platelet inhibitors, and factor XA inhibitors do not lyse or dissolve thrombi.

Providing postoperative care to a patient who has percutaneous transluminal angioplasty (PTA), with insertion of a stent, for a femoral artery lesion, includes assessment for the most serious complication of: -Hemorrhage. -Thrombosis of the graft. -Decreased motor function. -Stent dislodgement.

-Hemorrhage.

Providing postoperative care to a patient who has percutaneous transluminal angioplasty (PTA), with insertion of a stent, for a femoral artery lesion, includes assessment for the most serious complication of: -Hemorrhage. -Thrombosis of the graft. -Decreased motor function. -Stent dislodgement.

-Hemorrhage. All choices are serious and require medical/surgical intervention. However, hemorrhage is the most serious complication that requires immediate attention.

A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? -Romberg's -Phalen's -Rinne -Homans'

-Homans' A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Testing for Romberg's sign assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.

A patient with diabetes is being treated for a wound on the lower extremity that has been present for 30 days. What option for treatment is available to increase diffusion of oxygen to the hypoxic wound? -Surgical debridement -Enzymatic debridement -Hyperbaric oxygen -Vacuum-assisted closure device

-Hyperbaric oxygen Hyperbaric oxygenation (HBO) may be beneficial as an adjunct treatment in patients with diabetes with no signs of wound healing after 30 days of standard wound treatment. HBO is accomplished by placing the patient into a chamber that increases barometric pressure while the patient is breathing 100% oxygen. Treatment regimens vary from 90 to 120 minutes once daily for 30 to 90 sessions. The process by which HBO is thought to work involves several factors. The edema in the wound area is decreased because high oxygen tension facilitates vasoconstriction and enhances the ability of leukocytes to phagocytize and kill bacteria. In addition, HBO is thought to increase diffusion of oxygen to the hypoxic wound, thereby enhancing epithelial migration and improving collagen production.

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? -Within 12 hours -Within the first 24 hours -In 2 days -In 3 to 5 days

-In 3 to 5 days Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012).

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? -Increased abdominal and back pain -Decreased pulse rate and blood pressure -Retrosternal back pain radiating to the left arm -Elevated blood pressure and rapid respirations

-Increased abdominal and back pain Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? -Impaired gas exchange related to increased blood flow -Excess fluid volume related to peripheral vascular disease -Risk for injury related to edema -Ineffective peripheral tissue perfusion related to venous congestion

-Ineffective peripheral tissue perfusion related to venous congestion Ineffective peripheral tissue perfusion related to venous congestion takes highest priority because venous inflammation and clot formation impede blood flow in a client with DVT. Impaired gas exchange related to increased blood flow is incorrect because impaired gas exchange is related to decreased, not increased, blood flow. Excess fluid volume related to peripheral vascular disease is inappropriate because there's no evidence that this client has an excess fluid volume. Risk for injury related to edema may be warranted but is secondary to ineffective tissue perfusion.

A client is receiving enoxaparin and warfarin therapy for a venous thromboembolism (VTE). Which laboratory value indicates that anticoagulation is adequate and enoxaparin can be discontinued? -Activated partial thromboplastin time (aPPT) is half of the control value -Prothrombin time (PT) is 0.5 times normal. -International normalized ratio (INR) is 2.5. -K+ level is 3.5.

-International normalized ratio (INR) is 2.5. Oral anticoagulants such as warfarin are monitored by PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)

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? -Application of ace wraps from the toe to below the knees -Use of antiembolytic stockings -Elevation of the legs above the heart -Keeping the legs in a neutral or dependent position

-Keeping the legs in a neutral or dependent position 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.

The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest? -Elevating the limb above heart level -Lowering the limb so that it is dependent -Massaging the limb after application of cold compresses -Placing the limb in a plane horizontal to the body

-Lowering the limb so that it is dependent Persistent pain in the forefoot (i.e., the anterior portion of the foot) when the patient is resting indicates a severe degree of arterial insufficiency and a critical state of ischemia. Known as rest pain, this discomfort is often worse at night and may interfere with sleep. This pain frequently requires that the extremity be lowered to a dependent position to improve perfusion to the distal tissues.

Which term refers to enlarged, red, and tender lymph nodes? -Lymphadenitis -Lymphangitis -Lymphedema -Elephantiasis

-Lymphadenitis Acute lymphadenitis is demonstrated by enlarged, red, and tender lymph nodes. Lymphangitis is acute inflammation of the lymphatic channels. Lymphedema is demonstrated by swelling of tissues in the extremities because of an increased quantity of lymph that results from an obstruction of lymphatic vessels. Elephantiasis refers to a condition in which chronic swelling of the extremity recedes only slightly with elevation.

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? -Moderate to severe arterial insufficiency -No arterial insufficiency -Very mild arterial insufficiency -Tissue loss to that foot

-Moderate to severe arterial insufficiency

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? -Moderate to severe arterial insufficiency -No arterial insufficiency -Very mild arterial insufficiency -Tissue loss to that foot

-Moderate to severe arterial insufficiency 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.

The nurse is performing wound care for a patient with a necrotic sacral wound. The prescribed treatment is isotonic saline solution with fine mesh gauze and a dry dressing to cover. What type of debridement is the nurse performing? -Surgical debridement -Nonselective debridement -Enzymatic debridement -Selective debridement

-Nonselective debridement Nonselective débridement can be accomplished by applying isotonic saline dressings of fine mesh gauze to the ulcer. When the dressing dries, it is removed (dry), along with the debris adhering to the gauze. Pain management is usually necessary.

Which is a risk factor for venous disorders of the lower extremities? -Trauma -Pacing wires -Obesity -Surgery

-Obesity Careful assessment is invaluable in detecting early signs of venous disorders of the lower extremities. Clients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk. Other clients at high risk include those who are obese or older adults and women taking oral contraceptives.

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? -Keep the extremities elevated slightly. -Participate in a regular walking program. -Use a heating pad to promote warmth. -Massage the calf muscles if pain occurs.

-Participate in a regular walking program. 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.

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

-Peripheral pulses every 15 minutes after surgery 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 client's status remains stable.

A patient complains of a "stabbing pain and a burning sensation" in his left foot. The nurse notices that the foot is a lighter color than the rest of the skin. The artery that the nurse suspects is occluded would be the: -Internal iliac. -Common femoral. -Popliteal. -Posterior tibial.

-Posterior tibial. Clinical symptoms of PAD are manifested in organs or muscle groups supplied by specific arterial blood flow. The posterior tibial artery is a major artery that is a common site for occlusion.

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? -Decrease the heparin infusion rate. -Prepare to administer protamine sulfate. -Monitor the partial thromboplastin time (PTT). -Start an I.V. infusion of dextrose 5% in water (D5W).

-Prepare to administer protamine sulfate. Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.

A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description? -Phytonadione (vitamin K) -Protamine sulfate -Thrombin -Plasma protein fraction

-Protamine sulfate Protamine sulfate is the antidote specific to heparin. Phytonadione (vitamin K) is the antidote specific to oral anticoagulants such as warfarin. (Heparin isn't given orally.) Thrombin is a hemostatic agent used to control local bleeding. Plasma protein fraction, a blood derivative, supplies colloids to the blood and expands plasma volume; it's used to treat clients who are in shock.

A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs? -Bleeding time -Platelet count -Prothrombin time (PT) -Partial thromboplastin time (PTT)

-Prothrombin time (PT) PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample following addition of calcium ions and tissue thromboplastin and compares this time with the fibrin-clotting time in a control sample. The physician should adjust anticoagulant dosages as needed, to maintain PT at 1.5 to 2.5 times the control value. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reflects the number of circulating platelets in venous or arterial blood. PTT determines the effectiveness of heparin therapy and helps physicians evaluate bleeding tendencies. Physicians diagnose appoximately 99% of bleeding disorders on the basis of PT and PTT values.

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? -Peripheral vascular disease -Raynaud's disease -Arterial occlusive diseases -Buerger's disease

-Raynaud's disease Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches that interrupts blood flow to the legs and feet, causing pain and coolness. Buerger's disease is an inflammatory, nonatheromatous occlusive disease that causes segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs.

A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? -History of increased aspirin use -Recent pelvic surgery -An active daily walking program -A history of diabetes mellitus

-Recent pelvic surgery The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.

A nurse is admitting a new client with a deep vein thrombosis in her left leg. During the admission process, which information provided by the client would be a contraindication to anticoagulant therapy? -Scheduled eye surgery in 1 week -A cerebral vascular bleed 10 years ago -Three vaginal births, the most recent 18 months ago -Diet that includes many green, leafy vegetables every day

-Scheduled eye surgery in 1 week Contraindications to anticoagulant therapy include recent or impending eye surgery, recent cerebral vascular bleeds, and recent childbirth. A diet including green leafy vegetables is not a contraindication.

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? -Decreasing blood pressure and increasing mobility -Increasing blood pressure and reducing mobility -Stabilizing heart rate and blood pressure and easing anxiety -Increasing blood pressure and monitoring fluid intake and output

-Stabilizing heart rate and blood pressure and easing anxiety For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

Which of the following are alterations noted in Virchow's triad? Select all that apply. -Stasis of blood -Vessel wall injury -Altered coagulation -Edema -Tenderness

-Stasis of blood -Vessel wall injury -Altered coagulation Three factors, known as Virchow's triad, are believed to play a significant role in the development of venous thrombosis. They are stasis of blood, vessel wall injury, and altered coagulation. Edema and tenderness are clinical manifestations of venous thrombosis, but are not part of the triad.

A nurse is providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client? -Stop smoking. -Keep your feet elevated above your heart. -Wear antiembolytic stockings daily to assist with blood return to the heart. -Do not cross your legs for more than 30 minutes at a time.

-Stop smoking. Nicotine from tobacco products causes vasospasm and can thereby dramatically reduce circulation to the extremities. When the client elevates the feet above the heart level, the heart must work against gravity to supply blood to the feet. Antiembolytic stocking are helpful for venous return to the heart, but constriction is not helpful for lack of arterial blood flow. Crossing the legs for more than a few minutes at a time compresses arteries and decreases blood supply to the legs and feet.

On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? -Taking daily walks -Engaging in anaerobic exercise -Reducing daily fat intake to less than 45% of total calories -Abstaining from foods that increase levels of high-density lipoproteins (HDLs)

-Taking daily walks Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear. Anaerobic exercise may make these symptoms worse. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat, not abstain from, foods that raise HDL levels.

What should the nurse do to manage persistent swelling in a client with severe lymphangitis and lymphadenitis? -Teach the client how to apply a graduated compression stocking. -Inform the physician if the client's temperature remains low. -Avoid elevating the area. -Offer cold applications to promote comfort and to enhance circulation.

-Teach the client how to apply a graduated compression stocking. In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the client how to apply a graduated compression stocking. The nurse informs the physician if the client's temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

What should the nurse do to manage the persistent swelling in a client with severe lymphangitis and lymphadenitis? -Teach the client how to apply an elastic sleeve -Inform the physician if the client's temperature remains low -Avoid elevating the area -Offer cold applications to promote comfort and to enhance circulation

-Teach the client how to apply an elastic sleeve In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the client how to apply an elastic sleeve or stocking. The nurse informs the physician if the client's temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

A client with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which is the most likely cause? -The aneurysm has become obstructed. -The aneurysm may be preparing to rupture. -The client is experiencing inflammation of the aneurysm. -The client is experiencing normal sensations associated with this condition.

-The aneurysm may be preparing to rupture. Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized to the middle or lower abdomen to the left of the midline. Low-back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing AAA include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is quickly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

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? -The client can walk about 50 feet before getting pain in the right lower leg. -The client's fingers tingle when left in one position for too long. -The client experiences shortness of breath after walking about 50 feet. -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. 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 term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is -air plethysmography. -contrast phlebography. -lymphangiography. -lymphoscintigraphy.

-contrast phlebography.

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? -Loose and wrinkled skin -Ulcers and infection in the edematous area -Evident scarring -Cyanosis

-Ulcers and infection in the edematous area In a client with lymphedema, the tissue nutrition is impaired because of the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area. Later, the skin also appears thickened, rough, and discolored. Scarring does not occur in clients with lymphedema. Cyanosis is a bluish discoloration of the skin and mucous membranes.

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? -Arterial insufficiency -Venous insufficiency -Neither venous nor arterial insufficiency -Trauma

-Venous insufficiency

The nurse explains to a patient that the primary cause of a varicose vein is: -Phlebothrombosis. -An incompetent venous valve. -Venospasm. -Venous occlusion.

-An incompetent venous valve. Varicose veins are abnormally dilated, tortuous, superficial veins caused by incompetent venous valves.

Which of the following are indications of a rupturing aortic aneurysm? Select all that apply. -Constant, intense back pain -Decreasing blood pressure -Decreasing hematocrit -Increasing blood pressure -Increasing hematocrit

-Constant, intense back pain -Decreasing blood pressure -Decreasing hematocrit Indications of a rupturing abdominal aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

In a client with a bypass graft, the distal outflow vessel must have at least what percentage patency for the graft to remain patent? -20 -30 -40 -50

-50 The distal outflow vessel must be at least 50% patent for the graft to remain patent.

Which assessment finding by the nurse is the most significant finding suggestive of aortic aneurysm? -High blood pressure -Severe back pain -Abdomen bruit -Nausea and vomiting

-Abdomen bruit A pulsating mass or a bruit in the abdomen over the mass is most suggestive of aortic aneurysm. Severe back pain, nausea, and high blood pressure are all symptoms associated with aortic aneurysm but not as independently suggestive.