Vascular NCLEX style questions

Impotence is a potential adverse effect of beta blockers and may cause patients to stop taking the medication. The other options are not adverse effects of beta blockers. Side note***NEVER admin Nitroglycerin to pt on Viagra (-fil drugs)

A 49-year-old patient is in the clinic for a follow-up visit 6 months after starting a beta blocker for treatment of hypertension. During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of an "embarrassing problem." What problem did the patient most likely experience with this medication that caused him to stop taking it?

ANS: D The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Unilateral leg swelling, redness, and tenderness indicate venous thromboembolism (VTE).

A patient at the clinic says, "I have always taken a walk after dinner, but lately my leg cramps and hurts after just a few minutes of starting. The pain goes away after I stop walking, though." The nurse should a.check for the presence of tortuous veins bilaterally on the legs. b.ask about any skin color changes that occur in response to cold. c.assess for unilateral swelling, redness, and tenderness of either leg. d. assess for the presence of the dorsalis pedis and posterior tibial pulses.

ANS: B The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of therapy. The other responses are incorrect.

A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum cholesterol. Which statement would be the nurse's best response? a."Blood levels return to normal within a week of beginning therapy." b. "It takes 6 to 8 weeks to see a change in cholesterol levels." c."It takes at least 6 months to see a change in cholesterol levels."

140-159 / 90-99 (SBP or DBP)

Classify a blood pressure reading as Stage 1 HTN

1. no identifiable cause, 90% of all cases 2. identifiable cause, such as (drug or disease) in 10% of cases **kidney disease is most common cause of secondary HTN

Differentiate between: 1. primary/essential hypertension 2. secondary hypertension

ANS: C Elevation of the legs decreases venous pressure, which in turn relieves edema and pain in the client with DVT. Warm (not cool!) compresses can be comforting. Restricting fluids is not in the plan of care.

For a client with deep vein thrombosis (DVT), the nurse would include in the plan of nursing care the intervention of a.applying cool compresses to the area. b.maintaining the legs in the dependent position. c.raising the foot of the bed 6 inches.

lactic acid buildup. Waste produced by lactic acid builds up quickly in oxygen-deprived muscles.

The nurse teaches the client with intermittent claudication that the pain results from?

mnemonic- DAD's HF Diabetes mellitus Age Dyslipidemia Smoking**very strong risk factor Hypertension Family history

What are the "Traditional" risk factors that contribute to peripheral artery disease?

>0.90 **anything less than 0.90 in either leg is a diagnostic of PAD

What is a normal range Ankle Brachial Indices (ABI)?

notify the physician immediately! Ruptured abdominal aortic aneurysm presents with a triad of manifestations, including abdominal pain combined with intense back and flank pain and possible scrotal pain, a pulsating abdominal mass or a rigid abdomen from the hemorrhage, and shock. Surgery is the only intervention for clients with a ruptured abdominal aortic aneurysm.

A client scheduled for a repair of an abdominal aortic aneurysm reports increased abdominal pain accompanied by new onset of intense back and flank pain. The priority action by the nurse would be to

ANS: B Not all beta blockers are used for the treatment of heart failure. Carvedilol and metoprolol are currently used in the treatment of heart failure. The other options are not indicated for the treatment of heart failure.

A patient is experiencing diastolic heart failure. The nurse expects which beta blocker to be ordered for this patient? a. atenolol (Tenormin) b. carvedilol (Coreg) c. acebutolol (Sectral) d. esmolol (Brevibloc)

ANS: A Patients need to be weaned off these medications slowly because rebound hypertension and chest pain are possible with abrupt withdrawal. The drugs should never be stopped abruptly nor doses skipped. First-dose hypotension occurs with alpha blockers.

A patient is going home with a new prescription for the beta blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug? a.Never stop taking this medication abruptly. b.The medication will be stopped once symptoms subside. c.If adverse effects occur, stop taking the drug for 24 hours, and then resume. d.Be watchful for first-dose hypotension.

ANS: B Arterial disease is characterized by claudication after walking short distances. Ulcerations caused by peripheral arterial disease are painful and initially are located at the most distal points on the extremity. Diabetic ulcers and venous ulcers are seldom painful and usually tend to occur where pressure is applied.

The nurse is assessing a client who reports claudication after walking a distance of one block. The nurse notes a painful ulcer on the fourth toe of the client's right foot. What condition do these findings correlate with? a.Diabetic foot ulceration b.Peripheral arterial disease c.Peripheral venous disease d.Deep vein thrombosis

ANS: C SCDs are used to prevent DVTs in high-risk clients. They need to be removed twice a day to allow perspiration to dry, for bathing, and to inspect the skin. The devices do not prevent a client from ambulating, although they need to be removed first. Many clients with SCDs will be on bed rest, however. There is no need to pre-wrap the legs or to turn the machine on and off.

A client is wearing sequential compression devices (SCDs) on the bilateral lower legs. Nursing care for these devices includes a. not allowing the client to ambulate. b. pre-wrapping the legs with Ace bandages. c. removing them twice a day to inspect skin.

ANS: A Current research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other medication categories in PAD.

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of medications will the nurse plan to include when providing patient teaching about PAD management? a.Statins b.Antibiotics c.Thrombolytics d. Anticoagulants

CAUSES: Chronic high blood pressure may stress the aortic tissue, making it more susceptible to tearing. You can also be born with a condition associated with a weakened and enlarged aorta, such as Marfan syndrome, or other rarer conditions associated with weakening of the walls of the blood vessels.

An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). Aortic dissections; Differ from aneurysms in that they are formed when blood accumulates in the wall of an artery; When these occur, the aneurysm enlarges, blood is lost, and blood flow to the organs is diminished.

>160 / >100 (SBP or DBP)

Classify a blood pressure reading as Stage 2 HTN

120-139 / 80-89 (SBP or DBP)

Classify a blood pressure reading as pre-hypertensive

ANS: A Cardiac depression can occur with beta blockers; instruct the patient to contact his prescriber if his pulse rate decreases to less than 60 per minute. The medication dose may need to be changed, but it is not appropriate for the nurse to change the dosage. The other options are incorrect.

During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats per minute, the nurse will instruct the patient to: a. notify his prescriber. b. reduce the dose of his beta blocker by half. c. continue the medication because this is an expected effect. d. skip the medication dose that day, and check his pulse again the next day.

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

The new graduate nurse is assessing a client with an unrepaired abdominal aortic aneurysm. What assessment technique requires further education by the supervising nurse? a.Measurement of abdominal girth b.Observation of abdominal wall movement c.Auscultation of any area of the abdomen d.Palpation of the abdominal midline area

ANS: A Medications that decrease platelet aggregation, such as aspirin and clopidogrel (Plavix), are used to increase the length of graft patency. Side note: DO NOT CONFUSE WITH PAXIL.

The nurse explains to a client started on daily doses of Plavix after femoral bypass surgery that the purpose of this regimen is to a.decrease platelet aggregation. b.decrease postoperative pain. c.increase vasodilation in the legs. d.prevent postoperative fever.

ANS: B The PT and INR are used to monitor therapy with warfarin. The PTT is used to guide heparin therapy. The Homan's sign is not considered a very reliable assessment for DVT. The nurse administering either warfarin or heparin should know the results of the latest monitoring test before giving the client the drug in order to prevent possible complications if the level is too high.

The nurse is caring for a client who is taking warfarin sodium (Coumadin) for a history of DVT. Before administering the medication, the nurse should assess the client's a. Homan's sign. b. PT, INR. c. PTT.

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

The nurse is discharging home a client at risk for venous thromboembolism (VTE) on low-molecular-weight heparin. What instruction does the nurse provide to this client? a."You must have your aPTT checked every 2 weeks." b."Massage the injection site after the heparin is injected." c."Notify your health care provider if your stools appear tarry." d."An IV catheter will be placed to administer your heparin."

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

The nurse is providing health education to a client with chronic venous stasis ulcers. What priority instruction does the nurse include? a."Apply antiembolism stockings before getting out of bed in the morning." b."Clean venous ulcers with Betadine before applying a dressing." c."Take 1 low-dose aspirin (81 mg) daily to prevent inflammation." d."Remove and reapply a new DuoDerm dressing to your ulcers each day."

ANS: C Venous ulcers are characterized by brown pigmentation of the skin of the lower extremity. Mottled skin, the presence of dependent rubor, and cyanosis are features of arterial ulcers.

The nurse notes a venous ulcer on the client's left ankle. What additional assessment finding does the nurse expect in this client? a.Absence of hair on the left lower extremity b.Skin surrounding the ulcer mottled but blanchable c.Brownish discoloration of the lower extremity d.Cold and gray-blue lower extremity

ANS: B Myopathy (muscle pain) is a clinically important adverse effect that may occur with -statins. It may progress to a serious condition known as rhabdomyolysis. Patients receiving statin therapy need to be advised to report any unexplained muscular pain or discomfort to their health care providers immediately. The other drugs and drug classes do not cause muscle pain or myopathy.

The nurse will monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic drugs? a.Niacin b. -statins (Cholesterol Inhibitors) c.Fibric acid derivatives d.Bile acid sequestrants

Arteriography

What is the gold standard of diagnosing chronic PAD?

varicose veins. Clients with varicose veins complain of aching, a feeling of heaviness, itching, moderate swelling, and the often unsightly appearance of their legs.

When a client complains of heaviness, aching, and itching of both legs for the past year, the nurse recognizes these complaints as being most suggestive of

b.in a recliner with feet dependent. Placing the legs in a dependent position provides increased gravitational blood supply.

When a client with arterial insufficiency complains of being awakened at night by pain in the legs, the nurse would recommend that the client sleep a.after exercising for 10 to 15 minutes. b.in a recliner with feet dependent. c.propped up by several pillows. d.with legs covered by an extra blanket.

ANS: D Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patient's MODIFIABLE LDL level. Decreases in LDL will help reduce the patient's risk for developing CAD. **elevated LDL's and low HDL's increase the risk of chemical injury to the vessel wall** <130 LDL >55 HDL (Remember H=healthy)

When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease, the nurse should focus on the a. family history of coronary artery disease. b.increased risk associated with the patient's gender. c.increased risk of cardiovascular disease as people age. d. elevation of the patient's low-density lipoprotein (LDL) level.

ANS: D All of the factors contribute to the patient's risk, but only the hypertension can potentially be modified to decrease the patient's risk for further expansion of the aneurysm.

When discussing risk factor modification for a 60-year-old patient who has a 4-cm abdominal aortic aneurysm, the nurse will focus patient teaching on which of these patient risk factors? a.Male gender b.Marfan syndrome c.Abdominal trauma history d.Uncontrolled hypertension

ANS: B Avoid grapefruit juice as it effects the metabolism of this meedication and may increase the amount of medication in the bloodstream and could increase the chances of side effects occurring. The presence of grapefruit juice in the body may therefore result in sustained levels of unmetabolized statin drug, which increases the risk for major drug toxicity, possibly leading to rhabdomyolysis. The other foods do not interact with these drugs.

When teaching a patient who is beginning antilipemic therapy with a -statin medication about possible drug-food interactions, the nurse will discuss which food? a.Oatmeal b.Grapefruit juice c.Licorice d.Dairy products