Exam 1: Aortic Disorders

Expanding Rupture

Interprofessional Care Surgical intervention may occur earlier in patients with a rapidly ___________ aneurysm or a high _________ risk

a

A client has sudden, severe pain in the back and chest, accompanied by shortness of breath. The client describes this pain as a "tearing" sensation. The healthcare provider suspects the client is experiencing a dissecting aortic aneurysm. The emergency supply cart is brought into the room because one complication of a dissecting aneurysm is a. cardiac tamponade b. stroke c. pulmonary edema d. myocardial infarction

d

A client had a repair of a thoracoabdominal aneurysm 2 days ago. Which findings should the nurse consider unexpected and report to the HCP immediately? a. abdominal pain at 5 out of 10 for the last 2 days b. HR of 100 after ambulating 200 feet c. urine output of 2,000 ml in 24 hours d. weakness and numbness in the lower extremities

c

A client is admitted to the ED with severe abdominal pain. A radiograph reveals a large abdominal aortic aneurysm. The primary goal at this time is to a. maintain circulation b. manage pain c. prepare the client for emergency surgery d. teach postoperative breathing exercises

c

A nurse in the emergency department is admitting a client who has a possible dissecting abdominal aortic aneurysm. Which of the following actions is the priority for the nurse to take? a. administer pain medication as prescribed b. provide a warm environment c. administer IV fluids as prescribed d. initiate a 12 lead ECG

c

A nurse is admitting a client who has a suspected occlusion of a graft of the abdominal aorta. Which of the following manifestations should the nurse expect? a. increase in urine output b. bounding pedal pulse c. increase in abdominal girth d. lower extremities have irregularly shaped cyanotic areas

a b d

A nurse is planning postoperative care for a client following a surgical placement of an endovascular stent graft to repair an aneurysm. Which of the following interventions should the nurse include in the plan of care? Select all that apply a. assess pedal pulses b. monitor for an increase in pain below the graft site c. maintain the client in high-fowler's position d. monitor the femoral site for bleeding e. report hourly urine output of 60 mL

a b e

A nurse is reviewing manifestations of a thoracic aortic aneurysm with a newly hired nurse. Which of the following findings should the nurse include in the discussion? Select all that apply a. cough b. shortness of breath c. upper chest pain d. diaphoresis e. altered swallowing

d

A nurse is teaching a client who has a new diagnosis of an aneurysm. The client asks the nurse to explain what causes an aneurysm to rupture. Which of the following statements should the nurse give? a. "this can occur when the wall of an artery becomes thin and flexible" b. "this can occur when there is turbulence in blood flow in the artery" c. "it is due to abdominal enlargement" d. "it is due to hypertension"

b

A patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, it will be most important to ask about a. back or lumbar pain. b. difficulty swallowing. c. abdominal tenderness. d. changes in bowel habits.

Renal

Nursing Management To monitor _______ perfusion status, monitor urinary output, fluid intake, daily weight, and BUN/Creatinine

b

A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. Which signs and symptoms would suggest that his aneurysm has ruptured? a. rapid onset shortness of breath and hemoptysis b. sudden, severe low back pain and bruising along his flank c. gradually increasing substernal chest pain and diaphoresis d. sudden, patchy blue mottling on feet and toes and rest pain

d

A patient was admitted for possible ruptured aortic aneurysm. No back pain was reported. Ten minutes later, the nurse notes sinus tachycardia 138 beats/min, blood pressure is palpable at 65 mm Hg, increasing waist circumference, and no urine output. How should the nurse interpret the findings? a. Tamponade will soon occur. b. The renal arteries are involved. c. Perfusion to the legs is impaired. d. Bleeding into the abdomen is likely.

Intraarterial

Aortic Dissection: Interventions Preoperatively, the patient with an aortic dissection will have continuous ECG and ____________ pressure monitoring

b

A patient who is postoperative following repair of an AAA has been receiving IV fluids at 125 ml/hr continuously for the past 12 hours. Urine output for the last 4 hours has been 60, 42, 28, and 20. What is the priority action that the nurse should take? a. monitor for a couple more hours b. contact the HCP and report the decrease in urine output c. send blood for electrolytes, BUN, and creatinine d. decrease the rate of infusion to prevent blood leakage at the suture line

a

A patient with a history of an abdominal aortic aneurysm is admitted to the emergency department (ED) with severe back pain and absent pedal pulses. Which action should the nurse take first? a. Obtain the blood pressure. b. Ask the patient about tobacco use. c. Draw blood for ordered laboratory testing. d. Assess for the presence of an abdominal bruit.

b

A patient with a small abdominal aortic aneurysm is not a good surgical candidate. What should the nurse teach the patient that is one of the best ways to prevent expansion of the lesion? a. avoid strenuous physical exertion b. control hypertension with prescribed therapy c. comply with prescribed anticoagulant therapy d. maintain a low-calcium diet to prevent calcification of the vessel

a

A patient with a type A dissection of the arch of the aorta has a decreased LOC and weak carotid pulses. What should the nurse anticipate that initial treatment of the patient will include? a. immediate surgery to replace the torn area with a graft b. administration of anticoagulants to prevent embolization c. administration of packed RBCs to replace blood loss d. administration of antihypertensives to maintain a mean arterial pressure of 70-80 mm/Hg

Resection

Aortic Dissection: Interventions Surgical treatment involves the ___________ of the aortic segment and replacement with a synthetic graft material

c

A surgical repair is planned for a patient who has a 5.5 cm abdominal aortic aneurysm. On physical assessment of the patient, what should the nurse expect to find? a. hoarseness and dysphagia b. severe back pain with flank ecchymosis c. presence of a bruit in the periumbilical area d. weakness in the lower extremities progressing to paraplegia

d

A thoracic aortic aneurysm is found when a patient has a routine chest x-ray. The nurse anticipates that additional diagnostic testing to determine the size and structure of the aneurysm will include which test? a. angiography b. ultrasonography c. echocardiography d. CT scan

Asymptomatic

Abdominal Aortic Aneurysm An abdominal aortic aneurysm is often ____________, and only found when a patient is examined for an unrelated problem

Toe

Abdominal Aortic Aneurysm An abdominal aortic aneurysm may spontaneously embolize, causing "blue ____ syndrome"

Thoracic

Abdominal Aortic Aneurysm Another complication of this aneurysm is a rupture into the _________ or abdominal cavity. This causes massive hemorrhage that is commonly fatal

Epigastric Claudication

Abdominal Aortic Aneurysm Clinical manifestations include back pain, __________ discomfort, altered bowel elimination, and intermittent _____________

Grey Turner's Sign

Abdominal Aortic Aneurysm Complications of this aneurysm include a rupture into the retroperitoneal space. Bleeding may be tamponaded by surrounding structures, and can present as back/flank ecchymosis, otherwise known as _______ _________ sign

Ascending Aorta/Aortic Arch

Aortic Aneurysm An aortic aneurysm in this area results in the following signs: -Agina -Transient ischemia attacks -Coughing and SOB -Hoarseness and/or dysphagia

Superior Vena Cava

Aortic Aneurysm An ascending aortic aneurysm can cause decreased venous return, distended neck veins, and edema of the face and arms if it presses on which structure?

Thoracic Aortic Aneurysm

Aortic Aneurysm This type of aortic aneurysm is often asymptomatic, but the most common manifestations include deep diffuse chest pain and pain that extends to the interscapular area

ECG

Aortic Aneurysm Diagnostic Studies This diagnostic test is used to rule out MI

Ultrasonography

Aortic Aneurysm Diagnostic Studies This diagnostic test is useful in screening for aneurysms generally, but also helps to monitor their size

X-Ray

Aortic Aneurysm Diagnostic Studies This diagnostic test may demonstrate a mediastinal silhouette and any abnormal widening of the thoracic aorta

CT Scan

Aortic Aneurysm Diagnostic Studies This is one of the most accurate tests to determine: -Anterior-to-posterior length -Cross-sectional diameter -Thrombus presence -Best type of surgical repair

Angiography

Aortic Aneurysm Diagnostic Studies This is the hallmark standard for diagnosing aortic aneurysms. It provides an anatomic mapping of the aortic system using contrast and can provide information about involvement of intestinal, renal, or distal vessels

MRI

Aortic Aneurysm Diagnostic Studies This test is used to diagnose and assess the location of the aneurysm as well as its severity

Occludes

Aortic Dissection A complication of an aortic dissection occurs when it __________ major branches of the aorta, cutting off the blood supply to the brain, abdominal organs, kidneys, spinal cord, and extremities

Track

Aortic Dissection A tear in the inner layer allows blood to ______ between the inner and middle layer

Lumen

Aortic Dissection An aortic dissection is the result of a false ______ through which blood flows

Degeneration

Aortic Dissection An aortic dissection occurs due to ___________ of the elastic fibers in the arterial wall

Pressure

Aortic Dissection As the heart contracts, each systolic pulsation increases the __________ on the damaged area

Neurologic

Aortic Dissection If the aortic arch is involved, there may be ___________ deficiencies present

MI

Aortic Dissection The pain associated with an aortic dissection mimics the pain of an _______

Anterior Intrascapular

Aortic Dissection The pain caused by an aortic dissection is described as sudden, severe pain in the _________ part of the chest, or _______________ pain radiating down the spine to the abdomen or legs

Ruptures

Aortic Dissection Complications Another complication occurs if the aorta _________. This results in exsanguination and death

Pulsus Paradoxus

Aortic Dissection Complications This is a complication described as a fall of the systolic blood pressure of more than 10 mm/Hg during the inspiratory phase

Cardiac Tamponade

Aortic Dissection Complications This is a severe, life-threatening complication of aortic dissection that occurs when blood escapes from the dissection into the pericardial sac. Manifestations include hypotension, muffled heart sounds, distended neck veins, and a narrowed pulse pressure

Thoracic Endovascular

Aortic Dissection: Interventions A __________ ____________ aortic repair is the standard procedure to treat acute and chronic aortic dissection with complications

Esmolol

Aortic Dissection: Interventions Drug therapy is aimed at reducing the blood pressure and myocardial work load. The most important is IV ________ in addition to calcium channel blockers, nitroprusside, and ACE inhibitors

Contractility

Aortic Dissection: Interventions One of the initial goals in treating aortic dissection is reducing the blood pressure and myocardial _____________ to diminish pulsatile forces within the aorta

Semi-Fowler's

Aortic Dissection: Interventions Preoperatively, it is very important that the patient maintain a ____________ position and that a quiet environment is maintained

Peripheral

Aortic Dissection: Interventions Preoperatively, the nurse must ensure that there is adequate observation of changes in the quality of ___________ pulses

Perfusion

Interprofessional Care If during an AAA resection, the cross-clamp must be placed above the renal arteries, be sure to check for adequate renal __________ after clamp removal and before closure of the incision

Risk Decreasing

Interprofessional Care If the aneurysm is small, conservative therapy is used such as _______ factor modification, __________ blood pressure, and diagnostic testing every 6-12 months

b

During preoperative preparation of the patient scheduled for an abdominal aortic aneurysm, why should the nurse establish baseline data for the patient? a. all physiologic processes will be altered postoperatively b. the cause of the aneurysm is a systemic vascular disease c. surgery will be canceled if any physiologic function is not normal d. BP and HR will be maintained well below baseline levels during the postoperative period

c

During the assessment of the patient with a type B aortic dissection, what should the nurse expect the patient to manifest? a. altered LOC with dizziness and weak carotid pulses b. a cardiac murmur characteristic of aortic valve insufficiency c. severe "ripping" back or abdominal pain with decreased urine output d. severe hypertension and orthopnea and dyspnea of pulmonary edema

a

During the initial postoperative assessment of a client who has just been transferred to the postanesthesia care unit after repair of an abdominal aortic aneurysm, the nurse obtains these data. Which finding has the most immediate implications for the client's care? a. Arterial line indicates a blood pressure of 190/112 mm Hg. b. Cardiac monitor shows frequent premature atrial contractions. c. There is no response to verbal stimulation. d. Urine output is 40 mL of amber urine.

b

During the patient's acute postoperative period following repair of an abdominal aortic aneurysm, the nurse should ensure that which goal is achieved? a. hypothermia is maintained to decrease oxygen needs b. BP and all peripheral pulses are evaluated at least every hour c. IV fluids are administered at a rate to maintain urine output of 100 ml/hr d. the patient's BP is kept lower than baseline to prevent leaking at the incision line

Bleeding

False Aneurysm A false aneurysm is also called a pseudoaneurysm that results in __________ contained by surrounding structures. It is most often caused by trauma or infection, or removal of a cannula

c

Following an ascending aortic aneurysm repair, what is an important finding that the nurse should report immediately to the HCP? a. shallow respirations and poor coughing b. decreased drainage from the chest tubes c. a change in the LOC and inability to speak d. lower extremity pulses that are decreased from the preoperative baseline

d

Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? a. Wrap both the legs in warm blankets. b. Notify the surgeon and anesthesiologist. c. Document that the pulses are absent and recheck in 30 minutes. d. Review the preoperative assessment form for data about the pulses.

a

In preparation for abdominal aortic aneurysm surgery, what should the nurse include in patient teaching? a. prepare the bowel on the night before surgery with laxatives or an enema b. use moisturizing soap to clean the skin 3 times the day before surgery c. eat a high-protein diet and a high-carbohydrate breakfast to help with healing postoperatively d. take the prescribed oral antibiotic the morning of surgery before going to the operating room

Intraabdominal Hypertension

Interprofessional Care This is a potentially lethal complication in emergency aneurysm repair. It is associated with abdominal compartment syndrome, which reduces blood flow to the viscera. This impairs end-organ perfusion. Treatment consists of percutaneous drainage with/without tPA infusions

Open Aneurysm Repair

Interprofessional Care This surgical intervention involves inserting a synthetic graft, and suturing the native aortic wall around the graft to act as a protective cover

Endovascular Graft

Interprofessional Care This surgical intervention is an alternative to conventional surgical repair. It involves placement of a sutureless graft into the aneurysm through a femoral artery catheter

AAA Resection

Interprofessional Care This surgical intervention requires cross-clamping of the aorta proximal and distal to the aneurysm

Flatus

Nursing Management It is important to assess for signs of bowel ischemia or any GI dysfunction. The return of ________ is a great indicator of returning bowel function

Antidysrhythmic Antihypertensive

Nursing Management Monitoring cardiovascular status includes continuous ECG, electrolyte, and ABG monitoring, as well as administering ____________ and _____________ medication

Rupture

Nursing Management Monitoring for signs of a ________ include these signs: -Diaphoresis, pallor, weakness -Tachycardia, hypotension -Abdominal, back, groin, or periumbilical pain -Changes in LOC -Pulsating abdominal mass

Peripheral

Nursing Management To assess _________ perfusion, assess the extremities for temperature, color, capillary refill, sensation, and movement

Patency

Nursing Management To maintain graft ________, it is important to maintain normal blood pressure, IV fluids, and blood components

Output Hypertension

Nursing Management To maintain graft patency, it is important to monitor urinary _________ and avoid severe ___________

d

Several hours after an open surgical repair of an abdominal aortic aneurysm, the patient develops a urinary output of 20 mL/hr for 2 hours. The nurse notifies the health care provider and anticipates orders for a. an additional antibiotic. b. a white blood cell (WBC) count. c. a decrease in IV infusion rate. d. a blood urea nitrogen (BUN) level.

c

The first priority of interprofessional care of a patient with a suspected acute aortic dissection is to a. reduce anxiety b. monitor for chest pain c. control blood pressure d. increase myocardial contractility

a

The nurse evaluates that treatment for the patient with an uncomplicated aortic dissection is successful when what happens? a. pain is relieved b. surgical repair is completed c. BP is increased to normal range d. renal output is maintained at 30 ml/hr

a

The nurse is admitting a 68-yr-old preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which medication? a. Vitamin K b. Cobalamin c. Heparin sodium d. Protamine sulfate

c

The nurse is assessing a client who had an abdominal aortic aneurysm repair 2 hours ago. Which finding warrants further evaluation? a. absent bowel sounds and mild abdominal distention b. a BUN of 26 and creatinine of 1.2 c. an arterial BP of 80/50 d. +1 pedal pulses in bilateral lower extremities

b

The patient had aortic aneurysm repair 6 hours ago. What priority nursing action will maintain graft patency? a. Assess output for renal dysfunction. b. Use IV fluids to maintain adequate BP. c. Use oral antihypertensives to maintain cardiac output. d. Maintain a low BP to prevent pressure on surgical site.

Fusiform

True Aneurysm This is a type of true aneurysm that is circumferential and relatively uniform in shape

Saccular

True Aneurysm This is a type of true aneurysm that is pouchlike with a narrow neck connecting the bulge to one side of the arterial wall

c

What are the priority nursing interventions after an abdominal aortic aneurysm repair? a. assessment of cranial nerves and mental status b. administration of IV heparin and monitoring of PT c. administration of IV fluids and monitoring of kidney function d. elevation of the legs and application of graduated compression stockings

d

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

b

When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important to communicate to the health care provider? a. Absence of flatus b. Loose, bloody stools c. Hypotonic bowel sounds d. Abdominal pain with palpation

d

Which nursing action in the care plan for a patient who had an open repair of an abdominal aortic aneurysm 3 days previously is appropriate for the nurse to delegate to experienced nursing assistive personnel (NAP)? a. Check the lower extremity strength and movement. b. Monitor the quality and presence of the pedal pulses. c. Teach the patient the signs of possible wound infection. d. Help the patient to use a pillow to splint while coughing.

b

Which nursing action will be included in the plan of care after endovascular repair of an abdominal aortic aneurysm? a. Record hourly chest tube drainage. b. Monitor fluid intake and urine output. c. Check the abdominal wound for redness or swelling. d. Teach the reason for a prolonged rehabilitation process.

d

Which observation should indicate to the nurse the presence of the complication of graft thrombosis after abdominal aortic aneurysm repair? a. cardiac dysrhythmias or chest pain b. absent bowel sounds, abdominal distention, or diarrhea c. increased temperature and increased white blood cell count d. decreased pulses are cool, painful extremities below the level of repair

a

Which person should the nurse identify as having the highest risk for abdominal aortic aneurysm? a. A 70-yr-old man with high cholesterol and hypertension b. A 40-yr-old woman with obesity and metabolic syndrome c. A 60-yr-old man with renal insufficiency who is physically inactive d. A 65-yr-old woman with hyperhomocysteinemia and substance abuse

a

Which surgical therapy for abdominal aortic aneurysm is most likely to have the postoperative complication of renal injury? a. open aneurysm repair (OAR) above the level of the renal arteries b. excising only the weakened area of the artery and suturing the artery closed c. bifurcated graft used in aneurysm repair when the abdominal aortic aneurysm extends into the iliac arteries d. endovascular graft procedure with an aortic graft inside the aneurysm via the femoral artery