Chapter 26: Assessment and management of patients with vascular disorders and disorders of peripheral circulation

Heparin therapy is usually considered therapeutic when the activated partial thromboplastin time (aPTT) is how many times higher than a normal value? A. 0.5 to 1.5 B. 1.5 to 2.5 C. 2.5 to 3.5 D. 3.5 to 4.5

B. 1.5 to 2.5

Which of the following medications is considered a thrombolytic? A. Lovenox B. Alteplase C. Coumadin D. Heparin

B. Alteplase

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

B. An incompetent venous valve.

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

A. "I have my wife look at the soles of my feet each day.

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

A. Altered coagulation B. Vessel wall injury D. Stasis of blood

The nurse is preparing a teaching tool about the development of a venous thromboembolism. Which information about Virchow triad will the nurse include? Select all that apply. A. Altered coagulation B. Prominent veins C. Edematous extremity D. Endothelial damage E. Venous stasis

A. Altered coagulation D. Endothelial damage E. Venous stasis

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

A. Common iliac artery.

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? A. Diminished or absent pulses B. Aching, cramping pain C. Superficial ulcer D. Pulses that are present but difficult to palpate

A. Diminished or absent pulses

A client with peripheral artery disease (PAD) has limited access to supervised exercise therapy (SET). Which recommendation will the nurse make to help the client's intermittent claudication? A. Engage in an unsupervised walking program. B. Sleep with the legs in a horizontal position. C. Take an aspirin before going to bed at night. D. Elevate the lower extremities several times during the day.

A. Engage in an unsupervised walking program.

which class of medication lyses and dissolves thrombi? A. Fibrinolytic B. Platelet inhibitors C. Factor XA inhibitors D. Anticoagulant

A. Fibrinolytic

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: A. Hemorrhage. B. Stent dislodgement. C. Decreased motor function. D. Thrombosis of the graft.

A. Hemorrhage.

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? A. Hyperbaric oxygen B. Vacuum-assisted closure device C. Enzymatic debridement D. Surgical debridement

A. Hyperbaric oxygen

A client is recovering from sclerotherapy to treat varicose veins. Which information will the nurse provide to the client after the procedure? Select all that apply. A. Increase the amount of time walking at home. B. Take acetaminophen as prescribed for pain. C. Expect a burning sensation in the injected areas for 1 to 2 days. D. Wear graduated compression stockings for a week after the procedure. E. Change the dressings once a day.

A. Increase the amount of time walking at home. B. Take acetaminophen as prescribed for pain. C. Expect a burning sensation in the injected areas for 1 to 2 days. D. Wear graduated compression stockings for a week after the procedure.

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

A. Increased abdominal and back pain

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

A. Keeping the legs in a neutral or dependent position

A client who is diagnosed with Raynaud syndrome reports cold and numbness in the fingers. Which finding should the nurse identify as an early sign of vasoconstriction? A. Pallor B. Cyanosis C. Gangrene D. Ulceration

A. Pallor

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

A. Participate in a regular walking program.

Which of the following is the most effective intervention for preventing progression of vascular disease? A. Risk factor modification B. Avoid trauma C. Wear sturdy shoes D. Use neutral soaps

A. Risk factor modification

Which of the following is the most effective intervention for preventing progression of vascular disease? A. Risk factor modification B. Wear sturdy shoes C. Avoid trauma D. Use neutral soaps

A. Risk factor modification

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

A. Teach the client how to apply an elastic sleeve

Client with a history of aching leg pain seeks medical attention for the development of a leg wound. Which assessment findings indicate to the nurse that the client is experiencing a venous ulcer? Select all that apply. A. Wound has an irregular border B. Thick, tough skin around the ankles C. Darkened skin around the lower extremities D. Wound is superficial E. Wound base is pale in color

A. Wound has an irregular border B. Thick, tough skin around the ankles C. Darkened skin around the lower extremities D. Wound is superficial

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: A. elevational pallor. B. elevational rubor. C. no rubor for 10 seconds after the maneuver. D. a 30-second filling time for the veins.

A. elevational pallor.

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

A. forcing blood into the deep venous system.

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: A. left calf circumference 1" (2.5 cm) larger than the right. B. a decrease in the left pedal pulse. C. pallor and coolness of the left foot. D. loss of hair on the lower portion of the left leg.

A. left calf circumference 1" (2.5 cm) larger than the right.

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? A. "As soon as you feel pain, we will go back and elevate your legs. B. ""Walk to the point of pain, rest until the pain subsides, then resume ambulation." C. "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room." D. "If you feel pain during the walk, keep walking until the end of the hallway is reached."

B. ""Walk to the point of pain, rest until the pain subsides, then resume ambulation."

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

B. Anterior surface of the foot near the ankle joint.

The nurse is caring for a client recovering from acute axillary lymphangitis. Which treatment will the nurse anticipate being prescribed for this client after antibiotic therapy has concluded? A. Arm sling B. Compression sleeve C. Physical therapy D. Aspirin therapy

B. Compression sleeve

Which aneurysm results in bleeding into the layers of the arterial wall? A. Anastomotic B. Dissecting C. False D. Saccular

B. Dissecting

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? A. Lower the patient's legs and massage the calf muscles to note any areas of tenderness. B. Dorsiflex the foot while the leg is elevated to check for calf pain. C. Elevate the patient's legs for 20 minutes and then lower them slowly while checking for areas of inadequate blood return. D. Extend the leg, plantar flex the foot, and check for the patency of the dorsalis pedis pulse.

B. Dorsiflex the foot while the leg is elevated to check for calf pain.

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? A. Enzymatic debridement B. Hyperbaric oxygen C. Vacuum-assisted closure device D. Surgical debridement

B. Hyperbaric oxygen

Which term refers to enlarged, red, and tender lymph nodes? A. Elephantiasis B. Lymphadenitis C. Lymphangitis D. Lymphedema

B. Lymphadenitis

Aortic dissection may be mistaken for which of the following disease processes? A. Stroke B. Myocardial infarction (MI) C. Pneumothorax D. Angina

B. Myocardial infarction (MI)

Which risk factor is related to venous stasis for deep vein thrombosis (DVT) and pulmonary embolism (PE)? A. Surgery B. Obesity C. Trauma D. Pacing wires

B. Obesity

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? A. Platelet count B. Prothrombin time (PT) C. Partial thromboplastin time (PTT) D. Bleeding time

B. Prothrombin time (PT)

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? A. History of increased aspirin use B. Recent pelvic surgery C. An active daily walking program D. A history of diabetes mellitus

B. Recent pelvic surgery

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

B. Ulcers in the edematous area

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

C. "Shoes made of synthetic material are best for my feet."

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? A. 0.25 B. 0.10 C. 0.50 D. 0.35

C. 0.50

The nurse is caring for a client recovering from surgery to treat aortoiliac disease. Which assessment findings indicate to the nurse that manual manipulation of the bowel occurred during the surgery? Select all that apply. A. Coffee-ground emesis B. Left lower quadrant pain C. Abdominal distention D. Liquid bowel movement E. Absence of bowel sounds

C. Abdominal distention E. Absence of bowel sounds

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

C. Attempt to palpate the dorsalis pedis and posterior tibial pulses.

Pentoxifylline (Trental) is a medication used for which of the following conditions? A. Elevated triglycerides B. Hypertension C. Claudication D. Thromboemboli

C. Claudication

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? A. Higher than normal blood pressure and falling hematocrit B. Slow heart rate and high blood pressure C. Constant, intense back pain and falling blood pressure D. Constant, intense headache and falling blood pressure

C. Constant, intense back pain and falling blood pressure

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

C. Episodes may be triggered by unusual sensitivity to cold.

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

C. Moderate to severe arterial insufficiency

A patient with impaired renal function is scheduled for a multidetector computer tomography (MDCT) scan. What preprocedure medication may the nurse administer to this patient? A. Epinephrine B. Dipyridamole (Persantine) C. Oral N-acetylcysteine D. Oral iodine

C. Oral N-acetylcysteine

The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm? A. Rectal bleeding B. Hypertensive crisis C. Severe pain D. Hematemesis

C. Severe pain

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? A. Wear antiembolic stockings daily to assist with blood return to the heart. B. Keep your feet elevated above your heart. C. Stop smoking. D. Do not cross your legs for more than 30 minutes at a time.

C. Stop smoking.

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 gaiter 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? A. Neither venous nor arterial insufficiency B. Trauma C. Venous insufficiency D. Arterial insufficiency

C. Venous insufficiency

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: A. elevate the affected leg as high as possible. B. place a heating pad around the affected calf. C. keep the affected leg level or slightly dependent. D. shave the affected leg in anticipation of surgery.

C. keep the affected leg level or slightly dependent.

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

D. "It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet."

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? A. "Administration of two anticoagulants decreases the risk of recurrent venous thrombosis." B. "Enoxaparin will dissolve the clot, and warfarin will prevent any more clots from occurring." C. "Because of the potential for a pulmonary embolism, it is important for you to take at least two anticoagulants." D. "The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect."

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

A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD? A. exercise electrocardiography B. electron beam C. computed tomography D. ankle-brachial index E. photoplethysmography

D. ankle-brachial index

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? A. "If you feel pain during the walk, keep walking until the end of the hallway is reached." B. "As soon as you feel pain, we will go back and elevate your legs." C. "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room." D. "Walk to the point of pain, rest until the pain subsides, then resume ambulation."

D. "Walk to the point of pain, rest until the pain subsides, then resume ambulation."

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

D. 1.5 to 2.5 times the baseline control

Beginning warfarin concomitantly with heparin can provide a stable INR by which day of heparin treatment? A. 2 B. 3 C. 4 D. 5

D. 5

Approximately what percentage of the arterial lumen must be obstructed before intermittent claudication is experienced? A. 20 B. 30 C. 40 D. 50

D. 50

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

D. 50

A patient is admitted to a special critical care unit for the treatment of an arterial thrombus. The nurse is aware that the preferred drug of choice for clot removal, unless contraindicated, would be: A. Streptokinase B. Reteplase. C. Urokinase. D. Alteplase.

D. Alteplase.

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

D. An incompetent venous valve.

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: A. Lack of exercise. B. Stress. C. Obesity. D. Cigarette smoking.

D. Cigarette smoking.

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

D. Demonstrate how to apply and remove elastic support stockings.

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? A. Avoid foods with iodine. B. Elevate the legs periodically for at least an hour. C. Refrain from sexual activity for a week. D. Elevate the legs periodically for at least 15 to 20 minutes.

D. Elevate the legs periodically for at least 15 to 20 minutes.

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? A. Metoprolol (Lopressor) B. Hydrocortisone (Solu-Cortef) C. Cimetidine (Tagamet) D. Epinephrine

D. Epinephrine

A client with lower extremity edema is diagnosed with lymphedema. For which medication will the nurse prepare teaching for this client? A. Amoxicillin B. Heparin C. Oxycodone D. Furosemide

D. Furosemide

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? A. Plasma protein fraction B. Thrombin C. Phytonadione (vitamin K) D. Protamine sulfate

D. Protamine sulfate

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? A. Thrombin B. Plasma protein fraction C. Phytonadione (vitamin K) D. Protamine sulfate

D. Protamine sulfate

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? A. Buerger's disease B. Peripheral vascular disease C. Arterial occlusive diseases D. Raynaud's disease

D. Raynaud's disease

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

D. Teach the client how to apply a graduated compression stocking.

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

D. The client can walk about 50 feet before getting pain in the right lower leg.

The most important factor regulating the caliber of blood vessels, which determines resistance to flow, is: A. Hormonal secretion. B. The influence of circulating chemicals. C. Independent arterial wall activity. D. The sympathetic nervous system.

D. The sympathetic nervous system.

Which of the following is the most common site for a dissecting aneurysm? A. Sacral area B. Cervical area C. Lumbar area D. Thoracic area

D. Thoracic area

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 A. lymphoscintigraphy. B. lymphangiography. C. air plethysmography. D. contrast phlebography.

D. contrast phlebography.