Vascular Disease (final)
2 (slow stead walking is a recommended activity for clients with PVD because it stimulates the development of collateral circulation. The client with PVD should not remain inactive. Elevating the legs above the heart or wearing antiembolism stockings is a strategy for alleviating venous congestion and may worsen peripheral artery disease)
A client has peripheral artery disease of both lower extremities. The client tells the nurse "I have really tried to manage my condition well". Which example indicates the client is using appropriate care management strategies? 1. The client rests with legs elevated above the level of the heart 2. the client walks slowly but steadily for 30 minutes twice a day 3. the client limits activity to walking around the house 4. The client wears antiembolism stockings at all times when out of bed
2
A client is admitted with a venous stasis leg ulcer. A nurse assesses the ulcer, expecting to note that the ulcer: 1 Has little granulation tissue 2 Has brown pigmentation around it 3 Has a pale colored base 4 Is deep, with even edges
atherosclerosis
The type of arteriosclerosis in which fat and fibrin impede and harden the arteries is called ____________________.
a (Aspects of the physical exam of the nursing assessment for the client with PVD include vital signs, capillary refill, and skin temperature. The nurse will assess the client's complaints of pain during the health history.)
What aspect is not assessed during the physical exam of the nursing assessment of a client with peripheral vascular disease (PVD)? a Complaints of pain b Vital signs c Skin temperature d Capillary refill
arteriosclerosis
___________________, which is the thickening, calcification, and decreased elasticity of the arterial wall.
4 (pentoxifylline can potentiate the effect of theophylline and increase the risk of theophylline toxicity. Therefore the nurse should monitor the clients theophylline level. Pentoxifylline does not interact with digoxin. Pentoxifylline can interact with heparin, and the clients PTT would need to be monitored closely if the client was taking heparin. It doesnt affect cholesterol levels.)
A client is with peripheral artery disease, coronary artery disease and COPD takes theophylline 200 mg. twice daily every day and digoxin 0.5 mg once a day. The HCP now prescribes pentoxifylline. To prevent adverse effects, the nurse should monitor: 1. digoxin level 2. partial thromboplastin time (PTT) 3. serum cholesterol level 4. theophylline level
2 (Angina is an adverse reaction to pentoxifylline, which should be used cautiously in clients with CAD. The nurse should report the clients symptoms to the HCP. who may prescribe nitroglycerin and possibly D/C the pentoxifylline. The client should rest until the chest pain subsides. It is not necessary at this point in time to initiate the rapid response team, or start an IV infusion. The clients reports of symptoms should never be dismissed.)
A client with a history of coronary artery disease (CAD) has been diagnosed with peripheral artery disease. The HCP started the client on pentoxifylline once daily. Approximately 1 hour after recieving the initial dose of pentoxifylline the client reports having chest pain, the nurse should first: 1. initiate the rapid response team 2. contact the HCP 3. have the client rest in bed 4. start an IV infusion of NS
c,d,e (Rationale Risk factors associated with PVD and CVI include increased cholesterol levels, excess body weight or obesity, and physical inactivity. Clients age 50 and older are at greatest risk for developing PVD or CVI. Males and females are equally affected by these conditions.)
A community health nurse is educating a group of adults about the risk factors associated with peripheral vascular disease (PVD) and chronic venous insufficiency (CVI). Which factors will the nurse include as those factors that increase the risk for developing CVI or PVD? (Select all that apply.) a Male gender b Age 45 or older c Increased cholesterol levels d Physical inactivity e Excess body weight
a (The nurse should assess the client for an allergy to contrast dye, as an angiogram procedure uses contrast dye to assess the occluded vessel. Contrast dye is eliminated via the renal system, not the liver, so asking about chronic liver conditions is not the priority for assessment. Barium is used in a barium swallow (upper GI series), not an angiogram. An angiogram does not utilize magnetic resonance imagining (MRI), which is contraindicated for those with embedded metal shrapnel or artificial implants.)
A nurse is caring for 72-year-old Selena Delgado, a client who has been admitted with severe claudication secondary to peripheral vascular disease (PVD). Due to the client's manifestations, Selena's healthcare provider has ordered an angiogram procedure. After Selena's healthcare provider has obtained informed consent from Selena, which assessment question will Selena's nurse ask as a priority prior to Selena's angiogram procedure? a Do you have an allergy to contrast dye? b Do you have any embedded metal shrapnel or artificial implants? c Do you have an allergy to barium? d Do you have chronic liver problems?
1 (although pentoxifylline 's precise mechanism of action in unknown, its therapeutic effect is to increase blood flow, and the client should have improved circ in the legs as evident by less pain. The client does not have nerve impairment and should be able to wiggle the toes. Urination is not improved by taking this med. Dizziness is a side effect of this drug not an intended outcome)
The client is receiving pentoxifylline for intermittant claudication. The nurse should determine the effectiveness of the drug by asking if the client: 1. has less pain in the legs 2. can wiggle the toes 3. is urinating more frequently 4. is less dizzy
b,d (Rationale Foot and leg care for clients with PVD includes applying moisturizing cream to feet and legs daily as well as drying between the toes after showering. The client should use powder on the feet to keep feet dry. When swimming, water should be warm because cool water causes vasospasm, worsening the client's condition. The client should buy shoes in the afternoon, when feet are largest.)
A home health nurse is caring for a client with peripheral vascular disease (PVD). When educating the client regarding foot and leg care, which statements will the nurse include? (Select all that apply.) a "Avoid using powder on your feet." b "Apply moisturizing cream to feet and legs daily." c "When swimming, ensure the water is cool, not warm." d "Dry between your toes after showering." e "Buy shoes in the morning, when feet are largest."
b (This client is likely describing pain called intermittent claudication, a common manifestation in clients with PVD. The nurse should instruct the client to maintain activity as much as possible, as this increases blood flow to extremities. However, the nurse should also tell the client to rest should the pain occur during activity. The other answer choices are incorrect.)
A home health nurse is caring for 62-year-old Allen Montgomery, a client with peripheral vascular disease (PVD). Allen has a venous stasis ulcer to the right medial lateral ankle and requires daily wound care. Allen tells the nurse, "I want to stay active but I am having a hard time getting motivated because every time I try to exercise, my legs hurt." What is the best response from the nurse? a "It is best to rest with your condition. You will always have pain with activity and you should avoid activity as much as possible." b "It is best to maintain activity with your condition, but make sure to rest if you develop pain during activity." c "It is best to rest with your condition. Once the peripheral vascular disease is treated, then you can start a moderate exercise program." d "It is best to maintain activity with your condition. You should continue activity if you have pain to increase your endurance." A nurse is talking to a client regarding safety measures for managing peripheral vascular disease.
d (Rationale Lower extremities of a client with PVD may be hairless due to a lack of adequate blood flow to the hair follicles of the legs. The client's legs may be dark red (rubor) when in dependent positions and pale when elevated. Toenails of a client with PVD may be thick, not spoon-shaped.)
A nurse is assessing a client with peripheral vascular disease (PVD). Which clinical manifestation will the nurse expect to find on assessment? a Spoon-shaped toenails b Pallor in lower extremities when in the dependent position c Dark red color to extremities when elevated d Hairless lower extremities
c (Rationale An endarterectomy is a procedure to surgically remove the plaque from the occluded vessel. The removal of plaque from an occluded vessel using heat is a thermal type of percutaneous transluminal angioplasty. A bypass graft is a surgical procedure that re-routes blood flow around an occluded vessel.)
A nurse is caring for a client who will undergo an endarterectomy due to severe peripheral vascular disease (PVD). When reviewing this procedure with the client, which statement will the nurse include? a "This is considered a nonsurgical procedure that treats your occluded vessel. " b "This procedure re-routes blood flow around your occluded vessel. " c "The plaque from your occluded vessel will be surgically removed. " d "The plaque from your occluded vessel will be removed by heat. "
c (Rationale Garlic supplements have been shown to slow the progression of PVD. A very low fat or vegetarian diet decreases cholesterol and atherosclerosis. Aromatherapy and yoga may be used in the collaborative care of the client with PVD. However, these therapies are used to improve circulation and to reduce stress, not slow the progression of the disease.)
A nurse is caring for a client with peripheral vascular disease (PVD) who asks the nurse, open double quote"Is there anything other than medication to help slow this disease?close double quote" What is the nurse's best response? a "Aromatherapy has been shown to slow the progression of PVD. " b "Yoga has been shown to slow the progression of PVD. " c "Garlic supplements have been shown to slow the progression of PVD. " d "A diet high in protein has been shown to slow the progression of PVD. "
d (Rationale Cilostazol (Pletal) is a medication that is used to improve blood flow to the peripheries, decreasing the incidence of intermittent claudication. This medication does not decrease the risk of developing a blood clot. Pentoxifylline (Trental) is a medication that is used to increase flexibility of RBCs. Cilostazol (Pletal) does not increase the client's energy to improve exercise tolerance)
A nurse is caring for a client with peripheral vascular disease (PVD) who complains of intermittent claudication, decreased exercise tolerance, and occasional pain in the lower extremities at rest. The client's healthcare provider has prescribed cilostazol (Pletal) for the collaborative treatment of the client's condition. Which statement will the nurse include in the client teaching about this medication? a "This medication is used to increase your energy so that you can exercise more efficiently." b "This medication is used to decrease your risk of developing a blood clot." c "This medication is used to increase flexibility of red blood cells, improving your condition. d "This medication is used to improve blood flow to your legs, decreasing incidence of cramping pain in your legs."
d (Rationale The client complains of a burning pain in the legs, which occurs at night in bed. This is known as rest pain, which occurs at rest. The nurse should instruct the client to place the lower extremities in a dependent position, such as dangling them off the side of the bed. Elevation of the legs will increase, not decrease, pain by reducing blood flow to the lower extremities. A client with PVD or CVI should not wear compression socks to bed, as this decreases circulation to the lower extremities and can worsen the client's condition.)
A nurse is caring for a client with peripheral vascular disease (PVD) who presents to the primary care clinic complaining of a burning pain in the legs, which occurs at night in bed. What is the best response from the nurse? a "This known as intermittent claudication. Elevating your legs may help your pain." b "This is known as rest pain. Elevating your legs may help your pain." c "This is known as intermittent claudication. Wearing compression socks to bed may help your pain." d "This is known as rest pain. Dangling your legs off your bed may help your pain."
c (The client is describing rest pain, which is pain that occurs at rest and is often described as a burning sensation. This pain is worse when the client's legs are elevated and is often alleviated when the client's legs are in the dependent position (as in when hanging off the side of the bed). The other answer choices are incorrect.)
A nurse is caring for 65-year-old Nathan Robertson, who has recently been diagnosed with peripheral vascular disease. During the nursing assessment, Mr. Robertson tells the nurse, "My legs burn when I am relaxing on the couch. I can't seem to find a comfortable position when I want to wind down." What is the nurse's best response to Nathan's concern? a "The pain you're referring to is called intermittent claudication. Is it usually worse with activity?" b "The pain you're referring to is called intermittent claudication. Does it improve with movement?" c "The pain you're referring to is called rest pain. Does it improve when you hang your legs off the bed?" d "The pain you're referring to is called rest pain. Does it improve if you elevate your legs above your heart?"
a,b,c,e (Rationale During the health history portion of the nursing assessment for the client with PVD, the nurse will assess client history of coronary artery disease (CAD), current medications and diet, and any complaints of pain. Presence of skin discoloration would be assessed during the physical exam of the nursing assessment.)
A nurse is performing a nursing assessment on a client with peripheral vascular disease (PVD). Which findings will the nurse anticipate during the health history portion of the nursing assessment? (Select all that apply.) a Current medications b History of coronary artery disease (CAD) c Current diet d Presence of skin discoloration e Complaints of pain
c (Rationale Delayed capillary refill in the lower extremities may be present in the client with PVD. The other clinical manifestations are not present in the client with PVD.)
A nurse is performing an assessment on a client with peripheral vascular disease (PVD). The nurse notes that the client's blood pressure is 142/86 mmHg. What additional manifestation, unique to PVD, will the nurse find upon physical examination of the nursing assessment of this client? a Decreased sensation of the upper extremities b Wheezing upon auscultation of the lungs c Delayed capillary refill in the lower extremities d Dilated blood vessels in the eye
a (Rationale Teaching the client guided imagery is an independent nursing intervention for the client with PVD. The nurse will encourage gradual increases in activity duration and intensity, but will instruct the client to rest if pain occurs. The nurse will assess the client's pain at least every 4 hours and as needed. Administering pain medications as ordered is a dependent nursing intervention.)
A nurse is planning care for a client with peripheral vascular disease (PVD) who is hospitalized due to increased pain associated with intermittent claudication. Which independent nursing intervention will the nurse implement to help the client's condition? a Teach the client guided imagery b Assess client pain every 12 hours using standard scale c Encourage the client to walk the halls, regardless of pain d Administer pain medications as ordered
c (Rationale An independent nursing intervention to promote client tissue perfusion is encouraging regular exercise, which improves circulation and perfusion to the lower extremities. Administering medication as ordered is a dependent, not independent nursing intervention. The nurse will place lower extremities in a dependent position, not elevate them. The nurse will keep the lower extremities warm; however, a heating pad should not be used due to the risk of the client being burned.)
A nurse is planning care for a client with peripheral vascular disease (PVD) who is scheduled to have revascularization surgery to improve circulation to the lower extremities. Which independent nursing intervention will the nurse implement to promote client tissue perfusion? a Administer medication as ordered b Elevate lower extremities above the heart c Encourage regular exercise d Warm lower extremities using heating pad
4 (before beginning dietary interventions, the nurse must assess the clients pattern of food intake, lifestyle, food preferences, and ethnic, cultural, and financial influence. With this information the nurse can then discuss the clients knowledge about cholesterol, foods high in fat, cholesterol and sodium and coach the client about the importance of following the diet plan
The client with peripheral artery disease and a history of hypertension is to be discharged on a low fat, low cholesterol, low sodium diet. Which should be the nurses first step in planning the dietary instructions? 1. determine the clients knowledge level about cholesterol 2. ask the client to name foods high in fat, cholesterol, and salt 3. explain the importance of complying with the diet 4. assess the familys food preference.
4 (diltiazem is a calcium channel blocker that blocks the influx of Ca into the cell. In this situation the primary use of diltiazem is to promote vasodilation and prevent spasms of the arteries. As a result of vasodilation, blood, O2, and nutrients can reach the muscles and tissues. )
The client with peripheral artery disease is prescribed diltiazem. the nurse should determine the effectiveness of this medication by assessing the client for: 1. relief of anxiety 2. sedation 3 vasoconstriction 4. vasodilation
4 ( decreased blood flow is a common characteristic of all peripheral artery disease. When the demand for O2 to the working muscles becomes greater than the supply, pain is the outcome. The nurse should suggest that the client enroll in a supervised exercise training program that will assist the client to gradually increase walking distances without pain. Not walking and resting will not increase blood flow to the legs. Support stockings may be prescribed, but the client should improve the capacity to walk and obtain exercise.)
The client with peripheral artery disease reports both legs hurt when walking. What should the nurse instruct the client to do? 1. avoid walking when pain occurs 2. rest freq with the legs elevated 3. wear support stockings 4. enroll in a supervised exercise training program
3 (gangrene refers to blackened, decomposing tissue that is devoid of circulation. Chronic ischemia and death of the tissue can lead to gangrene in the affected extremity. Injury, edema, and decreased circ lead to infection, gangrene and tissue death. Atrophy is the shrinking of tissue, and contraction is joint stiffnening secondary to disuse. The term rubor denotes a reddish color of the skin)
The nurse is assessing a client who has a history of peripheral artery disease. The nurse observes that the left great toe is black. The discoloration is likely a result of : 1. atrophy 2. contraction 3. gangrene 4. rubor
2,4 (Reduction of blood flow to a specific area results in decreased oxygen and nutrients. As a result, the skin may appear mottled. The skin will also be cool to the touch. Loss of hair and dry skin are other signs that the nurse may observe in a client with peripheral artery disease of the lower extremities.)
The nurse is assessing the lower extremities of the client with peripheral artery disease. Which findings are expected? Select all that apply 1. hairy legs 2. mottled skin 3. pink skin 4. coolness 5. moist skin
3 ( weakness, dizziness and headache are common adverse effects of clopidogrel, and the client should report these to the HCP. If they are problematic; in order to decrease the risk of clot formation, the drug must be taken regularly and should not be stopped or taken intermittently. The main adverse effect of clopidogrel is bleeding when brushing teeth. Clopidogrel is well absorbed, and while food may help decrease potential stomach upset the drug may be taken with or without food. Clopidogrel is an antiplatelet agent used to prevent clot formation in clients who have experienced or are at risk for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary syndrome.)
The nurse is caring for a client with peripheral artery disease who has recently been prescribed clopidogrel. The nurse understands that more teaching is necessary when the client states: 1. I should not be surprised if I bruise easier or if my gums bleed a little when brushing my teeth 2. it does not really matter if I take this medicine with or without food, whatever works best for my stomach 3. I should stop taking this medicine if it makes me feel weak or dizzy 4. The doctor prescribed this medicine to make my platelets less likely to stick together and helps prevent clots from forming
1,3 (Smoking and exposure to the cold cause vasoconstriction and should be avoided. Aspirin and clopidogrel should be taken as prescribed for the antiplatelet properties. Using extra bed clothes at night provides warmth, which increases vasodilation. The presence of pain should be investigated as it could indicate increasing arterial insufficiency. Tight socks should be avoided as they could impair circulation)
What instructions should the nurse give a client experiencing s/s related to decreased arterial insufficiency? select all that apply 1. avoid smoking and exposure to the cold 2. take acetaminophen if experiencing pain at night 3. take aspirin or clopidogrel as prescribed 4. wear tight socks to keep feet warm
b (The most common location of arterial plaque is at the vessel bifurcation, not at the vessel valves. While plaque can form in the pulmonary and femoral arteries, the location of the arterial plaque occurs at the vessel bifurcation.)
What is the most common location of arterial plaque? a Pulmonary artery b Vessel bifurcation c Vessel valves d Femoral artery
b (While all options may be used in the collaborative treatment of a client with PVD, only segmental pressure measurements use blood pressure cuffs and a Doppler device to compare blood pressures (BP) of the upper and lower extremities. A stress test uses a treadmill or elliptical to assess the functional limitations. A duplex Doppler ultrasound uses Doppler ultrasound with ultrasound imaging to detect arterial or venous alterations. Angiography locates and evaluates extent of vascular obstruction.)
Which diagnostic test used in the collaborative treatment of peripheral vascular disease (PVD) uses blood pressure cuffs and a Doppler device to compare blood pressures (BP) of the upper and lower extremities? a Duplex Doppler ultrasound b Segmental pressure measurements c Stress test d Angiography
3 (High serum lipids, especially the low-density (LDL) and very-low density (VLDL) types, are associated with peripheral vascular disease (PVD). Other listed laboratory findings have not been associated with PVD.)
Which laboratory level is a common finding associated with peripheral vascular disease (PVD)? 1 Low serum albumin 2 Potassium level of 3.1 3 High serum lipids 4 Total calcium level of 15 mg/dL
a,b,c,e (To promote tissue perfusion in the client with PVD, the nurse should: assess peripheral pulses to ensure adequate perfusion; keep lower extremities warm to prevent vasoconstriction associated with cold temperatures; encourage exercise to increase circulation to lower extremities; and encourage frequent position changes to avoid a decrease in circulation to the lower extremities. The nurse will not elevate the client's lower extremities, as this decreases circulation to the lower extremities. Rather, the nurse should place lower extremities in the dependent position.)
Which nursing interventions will the nurse implement to promote tissue perfusion for the client with peripheral vascular disease (PVD)? (Select all that apply.) a Assess peripheral pulses b Keep lower extremities warm c Encourage exercise d Elevate lower extremities e Encourage frequent position change
